Front Matter
Publication: Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies
Neurodiversity
From Phenomenology to Neurobiology and Enhancing Technologies
Neurodiversity
From Phenomenology to Neurobiology and Enhancing Technologies
Edited by
Lawrence K. Fung, M.D., Ph.D.
Director, Stanford Neurodiversity Project
Assistant Professor of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Palo Alto, California
Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.
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Library of Congress Cataloging-in-Publication Data
Names: Fung, Lawrence K., 1970- editor. | American Psychiatric Association, publisher.
Title: Neurodiversity : from phenomenology to neurobiology and enhancing technologies / edited by Lawrence K. Fung.
Description: First edition. | Washington, DC : American Psychiatric Association Publishing, [2021] | Includes bibliographical references and index.
Identifiers: LCCN 2021001921 (print) | LCCN 2021001922 (ebook) | ISBN 9781615373024 (paperback ; alk. paper) | ISBN 9781615373956 (ebook)
Subjects: MESH: Neurodevelopmental Disorders—genetics | Nervous System Physiological Phenomena—genetics | Biodiversity | Neurobiology—methods
Classification: LCC QP360 (print) | LCC QP360 (ebook) | NLM WS 350.7 | DDC 612.8—dc23
LC record available at https://lccn.loc.gov/2021001921
LC ebook record available at https://lccn.loc.gov/2021001922
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Dedicated to
Michele, who has been my companion in this journey of neurodiversity; Zachary, who has inspired me to devote my life to the field of neurodiversity; and Hannah, whose whipped coffee has gotten me through some challenging times.
Contents
Contributors
Foreword
Temple Grandin, Ph.D.
Preface
Acknowledgments
CHAPTER ONE
Neurodiversity: The New Diversity
Lawrence K. Fung, M.D., Ph.D.
Nancy Doyle, Ph.D.
CHAPTER TWO
Positive Psychology and Strengths-Based Approaches to Neurodiversity
Michael L. Wehmeyer, Ph.D.
CHAPTER THREE
Strengths-Based Model and Savantism
Matthew Doll, Ph.D.
Darold Treffert, M.D.
Thomas Fabricius, M.D.
Edward Jedlicka, Ph.D.
Vivian Hazell, LPC
Tara Geier, M.A., BCBA
Bryan Mischler, LCSW
Erin Whittington, B.A.
CHAPTER FOUR
Strengths-Based Model of Neurodiversity and Autism
Lawrence K. Fung, M.D., Ph.D.
CHAPTER FIVE
Strengths-Based Model of Neurodiversity and ADHD
Lawrence K. Fung, M.D., Ph.D.
CHAPTER SIX
Strengths-Based Model of Dyslexia
Nicole S. Ofiesh, Ph.D.
Henry B. Reiff, Ph.D.
CHAPTER SEVEN
Neurobiology of Neurodiversity
Lawrence K. Fung, M.D., Ph.D.
CHAPTER EIGHT
Neurodiversity in Higher Education: Support for Neurodiverse Individuals and Professionals
Nancy Doyle, Ph.D.
CHAPTER NINE
Specialized Employment Initiatives for Neurodiverse Individuals: A Model Program
Jose Velasco, M.S.
CHAPTER TEN
Technologies and Difference: Insights from Education Breakdown and Exclusion
Jutta Treviranus, Ph.D.
CHAPTER ELEVEN
Using Technology to Provide Transition Support for Neurodiverse Young Adults
Steven M. Keisman, M.A., M.S.
Index
Contributors
Matthew Doll, Ph.D.
Director of Behavioral Health, Outpatient Services, Treffert Center, Fond du Lac, Wisconsin
Nancy Doyle, Ph.D.
Research Fellow, Birkbeck College, University of London; CEO and founder, Genius Within, London, United Kingdom
Thomas Fabricius, M.D.
Research Director, Family Practice, Treffert Center, Fond du Lac, Wisconsin
Lawrence K. Fung, M.D., Ph.D.
Director, Stanford Neurodiversity Project, and Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
Tara Geier, M.A., BCBA
Behavior Analyst, Treffert Center, Fond du Lac, Wisconsin
Temple Grandin, Ph.D.
Professor, Department of Animal Sciences, Colorado State University, Fort Collins, Colorado
Vivian Hazell, LPC
Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin
Edward Jedlicka, Ph.D.
Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin
Steven M. Keisman, M.A., M.S.
Senior Vice President, Identifor, Mendham, New Jersey
Bryan Mischler, LCSW
Psychotherapist, Treffert Center, Fond du Lac, Wisconsin
Nicole S. Ofiesh, Ph.D.
Co-founder and Chief Innovation Officer, Potentia Institute, Half Moon Bay, California
Henry B. Reiff, Ph.D.
Professor of Education, McDaniel College, Westminster, Maryland
Darold Treffert, M.D.
Research Consultant, Treffert Center, Fond du Lac, Wisconsin
Jutta Treviranus, Ph.D.
Professor, Inclusive Design Research Centre, OCAD University, Toronto, Ontario, Canada
Jose Velasco, M.S.
Vice President, Product Management, SAP Labs, Austin, Texas
Michael L. Wehmeyer, Ph.D.
Chair, Department of Special Education; Ross and Marianna Beach Distinguished Professor in Special Education; and Director and Senior Scientist, Beach Center on Disability, University of Kansas, Lawrence, Kansas
Erin Whittington, B.A.
Senior Assistant II, Quest Lab Team Lead, Carmel Clay Public Library, Carmel, Indiana
Foreword
Temple Grandin, Ph.D.
In my work as a designer of livestock handling facilities, I have been working with neurodiverse individuals since the 1970s. Back in the 1970s, 1980s, and early 1990s, most people were not aware of the term neurodiversity. When I was designing equipment and working with major corporations, almost nobody knew I was an autistic person. They viewed me as different, but I was recognized for the quality of my work. I learned to sell my work instead of selling myself. I did this by showing potential clients a portfolio of design drawings and photos of completed projects. It is likely that approximately 20% of the people who constructed the equipment I designed would have been diagnosed as autistic, dyslexic, or ADHD or given some other label if they had been children today.
None of my colleagues was formally diagnosed, but when I look back on the different places where I worked, it has become obvious that many of these talented people were autistic or dyslexic or had sensory processing problems. Two of the autistic people I worked with had multiple patents. To maintain confidentiality, I have to be vague in describing the equipment they invented. Both of these people invented clever mechanical devices and were owners of equipment companies. One of them sells products all over the world, and both were poor students in high school. Another person headed into a successful career after he took a high school welding class. He then started selling his creations and built up his business with one satisfied client at a time. Throughout a long career, I worked with welders, inventors, and designer drafting people who would have been special education students today. The most clever ones quickly progressed to inventing and patenting major pieces of mechanical equipment. They then sold their inventions to large corporations.
We Need Neurodiverse People to Prevent Loss of Essential Skills
Today, the people I worked with are retiring, and they are not being replaced because high schools have removed skilled trades, art, drafting, and other hands-on classes. Vital skills are being lost because talented neurodiverse children are not having opportunities to develop their abilities. The children who should become the replacements are often deprived of the opportunity to be introduced to hands-on skills.
I did not realize how serious the problem was until I visited four state-of-the-art poultry or pork processing plants in 2017 and 2019. I had been brought in to consult on animal handling. After touring these plants from one end to the other, I learned that almost all of the specialized equipment was now imported from Europe. European schools have kept their skilled trades and have trained neurodiverse people who can build it. Other things the United States no longer builds are elevators, ski lifts, and conveyors for moving stuff in warehouses and factories. It is a part of engineering that I call the “clever engineering department.” The parts of the factory that are still built in the United States are the building, boilers, and refrigeration systems. The reason for this is neurodiverse thinking. The more mathematically inclined thinkers excel in traditional college engineering classes; refrigeration systems, boilers, and structural engineering of the building require this type of education. The visual thinkers, like me and many of the people I worked with, cannot do abstract math such as algebra. I had to drop a biomedical engineering class because I could not do the math. Boilers and refrigeration systems require abstract math, but designing and building a complex packaging machine requires a neurodiverse visual thinker.
In my own work with almost every meat company, I have observed the same pattern. The clever engineering people I worked with at many companies almost never touched boilers or refrigeration systems. The math-skilled engineer and the visual thinking equipment designer have skills that complement each other. Building a complete factory requires both kinds of skills. It is also likely that many of the more mathematically inclined engineers are on the autism spectrum. At autism meetings, grandfathers who were either NASA engineers or computer scientists have told me that they discovered they were autistic when a grandchild was diagnosed. Mathematical thinkers and visual thinkers have skills that complement each other. A common denominator for both kinds of diverse minds is that they are highly specialized; they are good at one skill and poor at another. People who are extremely good at either mathematics or visual thinking skills are often socially awkward.
Different Kinds of Thinking
Howard Gardner’s multiple intelligences (Gardner 1983; Gardner and Hatch 1989) are featured in this book. There are nine types of intelligences. They cover a wide range of skills that include thinking styles, interpersonal skills, and athletic skills. A theme throughout this book is to develop a person’s area of strength. This is called strengths-based learning. It is a concept I fully support. My mother always helped me to develop my ability in art. Art and visual skills were a foundation of my design career.
Since the publication of Gardner’s book in 1983, many studies now support my observation that there are visual thinkers and math pattern thinkers. In my book Thinking in Pictures (Grandin 1996), I discussed how I see everything in photorealistic pictures, but there are other autistic people who think in patterns. Scientific studies show that some people are object visualizers similar to me, whereas others are visual-spatial and mathematical (Kozhevnikov et al. 2002, 2005; Mazard et al. 2004). The object visualizers often go into fine arts or industrial design, and the visual-spatial processors enter engineering or computer science. Psychology is a field that is populated mainly by verbal thinkers who think mostly in words (Perez-Fabello et al. 2018).
The first step in helping neurodiverse minds to be successful is to recognize that different people think differently. Educators and parents need to work to develop a person’s unique skills and recognize that verbal language is only one way of thinking.
References
Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983
Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989
Grandin T: Thinking in Pictures: And Other Reports From My Life With Autism. New York, Vintage Books, 1996
Kozhevnikov M, Hegarty M, Mayer RE: Revising the visualizer-verbalizer dimension: evidence for two types of visualizers. Cogn Instruct 20:47–77, 2002
Kozhevnikov M, Kosslyn S, Shephard J: Spatial versus object visualizers: a new characterization of visual cognitive style. Mem Cognit 33(4):710–720, 2005
Mazard A, Tzourio-Mazoyer N, Crivello F, et al: A PET meta-analysis of object and spatial mental imagery. Eur J Cogn Psychol 16(5):673–695, 2004
Perez-Fabello MJ, Campos A, Felisbeeti FM: Object-spatial imagery in fine arts, psychology and engineering. Think Skills Creat 27:131–138, 2018
Preface
This book was completed at the strangest era of our time, as the world faces both the coronavirus pandemic and the Black Lives Matter movement. Although more people are now acknowledging that diversity is one of the most precious aspects of humanity, diversity remains a very confusing concept in practice. Most people treasure moral values of equality and justice, yet racial and gender disparities in health care, education, employment, and other opportunities continue to impact affected groups negatively and profoundly. Although initiatives for diversity and inclusion have been implemented in many large organizations, the total societal impact has not been quite enough. Cultural change to embrace diversity in our society continues to be slow, and most of the change that has occurred has been focused toward the visible diversities of skin color and sex.
What about the invisible diversities? We can only expect that it is even more challenging to achieve cultural changes that embrace invisible differences. This is why we write this book. In particular, we are focusing on neurodiversity, a concept that regards differences in behavior and brain function as part of the normal variation of the human population. When we talk about neurodiverse conditions, we include conditions such as autism, ADHD, and dyslexia. Like racial disparities, inequalities in health care, education, employment, and other opportunities are significant issues facing neurodiverse individuals.
Many neurodiverse individuals face significant mental health issues. Co-occurring conditions such as depression and anxiety are common in this population. Psychiatrists, psychologists, and other mental health providers have used the medical model to identify symptoms, with the ultimate goal of removing them. It is rare for providers to assess the strengths of their patients and to incorporate that information into their interventions. It is even more uncommon for providers to use strengths-based approaches to enhance patients’ abilities to help them overcome their challenges.
This book is an introduction to the strengths-based model of neurodiversity (SBMN), designed to integrate and build upon existing theories of positive psychology (Seligman and Csikszentmihalyi 2000), positive psychiatry (Jeste et al. 2015), multiple intelligences (Gardner 1983; Gardner and Hatch 1989), and developmental psychology (Chickering and Reisser 1993) and to apply them to devise strengths-based assessments and interventions for neurodiverse individuals. Nancy Doyle and I describe, in Chapter 1, what neurodiversity means and how we define this concept in the context of leveraging the strengths of individuals with various neurodiverse conditions. In Chapter 2, Michael Wehmeyer describes what positive psychology is, how strengths-based approaches converge with social and person-environment fit models, and how they are practiced in assessing character strengths and self-determination. In Chapter 3, Matthew Doll, Darold Treffert, and their colleagues provide accounts of how their six-pronged, core-component approaches to assessment, diagnosis, organized treatment, and support are applied to the strengths-based curriculum at Treffert Center in Wisconsin. In Chapter 4, I describe the strengths of people on the autism spectrum and discuss how the SBMN is applied in assessments and treatments of autistic people. Similarly, in Chapter 5, I use the SBMN as the framework to describe the assessments and treatments of individuals with ADHD. In Chapter 6, Nicole Ofiesh and Henry Reiff formulate the strengths of dyslexic individuals using the MIND framework. (MIND is an acronym for four strengths: Material reasoning, Interconnected reasoning, Narrative reasoning, and Dynamic reasoning.)
In Chapter 7, I reveal the neurobiology of neurodiversity using a systems approach. Rather than describing the neurobiology of neurodiverse conditions, I dissect the cognitive constructs behind various domains of intelligences, including mathematical, reading, visual-spatial, musical, inter- and intrapersonal abilities, and creativity. Then I describe the neural correlates of the constructs in the general population and selected groups, including people who are autistic, those who are dyslexic, and people with ADHD. In Chapter 8, Nancy Doyle discusses the disparities for neurodiverse individuals in higher education and explores what active ingredients may be needed to level the playing field for neurodiverse students.
In the United States, about 80% of autistic adults are unemployed or underemployed. In Chapter 9, Jose Velasco provides a detailed case example of SAP SE’s Autism at Work program, a specialized employment program that has changed the lives of many autistic adults. These individuals in turn have contributed significantly to that company through remarkable innovations and productivity.
The book concludes with two chapters related to technology and neurodiversity. In Chapter 10, Jutta Treviranus discusses how the technology mindset is biased against diversity and how this impacts neurodiverse individuals. In Chapter 11, Steven Keisman details obstacles facing neurodiverse individuals as they find and sustain employment and explains how artificial intelligence may be used to help them identify their strengths and potential career options.
The field of neurodiversity is in its infancy. Much still needs to be investigated to further advance our understanding of its strengths; how those strengths can be uncovered accurately, efficiently and practically; and what interventions can be designed to improve the lives of neurodiverse individuals. I hope this book provides some first answers as we begin to promote neurodiversity as a necessary societal value, incorporate strengths-based approaches into our clinical practice, and advance the understanding of the phenomenology, neurobiology, and clinical research of neurodiversity.
Lawrence K. Fung, M.D., Ph.D.
References
Chickering AW, Reisser L: Education and Identity, 2nd Edition. San Francisco, CA, Jossey-Bass, 1993
Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983
Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989
Jeste DV, Palmer BW, Rettew DC, Boardman S: Positive psychiatry: its time has come. J Clin Psychiatry 76(6):675–683, 2015
Seligman ME, Csikszentmihalyi M: Positive psychology: an introduction. Am Psychol 55(1):5–14, 2000
Acknowledgments
This book would not be a reality without the support and encouragement of Dr. Laura Roberts. She is a champion of neurodiversity. Her trust in our team has allowed us to embark on the Stanford Neurodiversity Project (SNP), which secures our base to pursue works of passion such as this book. I would like to thank the SNP’s first (anonymous) donor, who believes in the importance of neurodiversity and empowers us to expand our work from a pilot to a full project. Without her support, we could not have written this book. I also want to thank my team in the SNP, especially Mark Gavartin, Vicky Lam, Christy Matta, Isabelle Morris, and Marci Schwartz. Discussions with this team have both challenged and refined my thinking about neurodiversity every day. I thank John McDuffie at American Psychiatric Association Publishing, who has shown tremendous support for this work. Finally, I thank all of the patients and research participants with whom I have interacted throughout the years. They give me the privilege to understand their strengths and challenges. They will continue to be my constant inspiration for how I can do better with neurodiversity advocacy, education, research, and clinical service.
Lawrence K. Fung, M.D., Ph.D.
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Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies
Pages: i - xix
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Published in print: 24 May 2021
Published online: 5 December 2024
© American Psychiatric Association Publishing
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