Dr. Sanam Hafiz: Unfolding Neuropsychology – From Holistic Profiling to Navigating Adulthood Challenges in Autism and Giftedness

Welcome to Why Not Me the World?
Podcast hosted by Tony Mantor, broadcasting from Music City, USA, Nashville, Tennessee.
Join us as our guests tell us their stories. Some
will make you laugh.
Some will make you cry.
Real life people who will inspire and show that you
are not alone in this world. Hopefully you gain more awareness, acceptance,
and a better understanding for autism around the world.
Hi, I'm Tony Mantor. Welcome to Why Not Me the World?
Today we welcome Sonam Happias, a renowned pioneer in neurocycle
logical assessments with expertise and trauma learning Problems ADHD, and autism.
As a trusted media expert, she has received multiple honors,
including faculty appointments, and is on the New York City
Panel of Medical Experts for the Court Systems. Since founding
Comprehend the Mind in two thousand and six, per organization
has experienced continuous growth. It's an honor to have her
with us today. Thanks for coming.
On, Thank you, Thanks for having me on.
Oh it's my pleasure.
So if you would give us a little background on
how you started and what led you to do the
work that you do today.
So I have a doctorate in psychology, and the doctorate
was very sort of scientific for a doctorate in psychology,
very evidence based cognitive vial therapy, with a huge emphasis
on assessments and evaluations. And then I turned out that
I just loved it. I loved the diagnostic part of neuropsychology,
and I ended up my first job out of graduate
school was as a neurodevelopmental psychologist in a hospital in Brooklyn.
I enjoyed that immensely, and I started like a small
private practice on the side, which evolved and became big
enough that at one point I had like one hundred
contractors evaluating for me. And now we have a small
center about five psychologists and a decent sized team that
does administrative and psychometric type tasks. So I spend my
time managing or directing the private center, seeing patients. I
see patients every day, and I do some forensic and
media work like we're doing right now.
So do you specialize in any one thing with your
psychology or do you expand and do other things as well?
So my specialization is assessments, is diagnostics, so you name it,
you know, whether it's ADHD, learning disabilities, autism, but also
to parse out by poor disorder from depression or to
diagnose schizophrenia. You know, the brainnus is a beautiful organ,
but it's very small, and so it's sometimes a lot
of things overlap. You could have something neurological but also
have something psychiatric going on.
Sure, because many times you will see an autistic person
that is also diagnosed with ADHD.
It's very common to have overlapping diagnoses.
Yes, So what's your process when a parent brings a
child to you not knowing what's going on? What are
the steps that they have to take to find out
whether it's autism, ADHD or whatever else it might be.
So it's a really well structured and it's complex, but
a simple process. We start with a very detailed initial
assessment that allows me to interview and if we're going
to talk about children, then I interview the parents, I
interview the child, I observe, I get the teachers involved,
and so we kind of develop a profile, a background.
You know, children are they don't exist in They're not
an island. They don't exist in isolation. They're nego. They're
part of a big ecosystem that involves you know, who
lives at home, they are family history, genetics, the teachers,
the school, the kind of services they get, and so
to do an evaluation without taking all of those factors
into account would be such a disservice, as you can understand, right,
And so I call my initial assessment a probe. I'm probing,
I'm digging. I'm asking, you know, questions as in, so,
who goes grocery shopping in your home? You know? And
you'd be amazed at what a lot of simplistic questions
can bring up about a family. I ask has anyone
been diagnosed? And a lot of times answers like no.
You know, back in the day, no one ever went
to a psychologists or a psychiatrist or you know, my
culture has been very sort of suspicious or mistrusting of
mental health, so we don't have a lot of that.
But I dig and I find out that they're often
family members, relatives, people they've never met with there was
a fair history or at least a narrative that there
was something going on with them mental health wise. So
I try to show families that, look, you may have
a grandparent that you've never met, but their DNA has
met you, right, their genes have somehow made it down
to you and into your child, and it really does
open up a lot of dialogue with families that have
never considered that. So that's one aspect of it. Then
I basically take all that data that I've gathered, a
lot of the quantitative data that I've gathered, and I
go back to my team and we design what we
call a testing battery. So in my center, because what
we primarily do is diagnostics, we have standardized measures that
test for everything from your IQ to your academic functioning,
to your neurological and psychiatric functioning. And we designed a
battery of tests, a set of tests based on what
the patient might have come looking for, but also what
that initial assessment evoked or brought up. And I say, well,
I also want to look at this, this, and this,
and so when we set out to test, we're looking
at all facets of a child's functioning or an individual's functioning.
If you were to come to my office, we would
use the same exact paradigm, if you will on you.
Okay, that was my next question. What's the difference between
a five year old, a fifteen year old, twenty five
year old, or even a thirty five year old that
may come to you.
So you know, it's interesting, it differs, but it really
doesn't differ because people are people, and so a five
year old might have an in progress, like it's a
site under construction. Right when you're five, your cognitive functioning
is not set in stone. Yet you're still developing. You
might be getting services at this school level. You have
parents that control or determine a lot of what's happening
with you. A twenty five or thirty five year old
are in even if they're adults, they're in two developmental
milestones or developmental stages that are very different. So a
twenty five year old maybe someone who just gone out
of school, Maybe someone who's getting a job and lives
with a bunch of roommates. Maybe someone who's struggling and
has moved back in with his or her parents. They
may not have a lot of history about themselves, right.
So a lot of times they say, if you have
a parent around, especially if you have a mom around,
ask her ask for these things, you know, ask her
if she recalls having concerns about let's say, let's talk
about autism. I see a lot of adults very concerned
that they may be on the spectrum and really almost
sometimes even fighting for that diagnosis. And I say, well,
if you have a parent around, ask them when you spoke,
ask them when you walked, ask them how related you were,
if you made eye contact, if you toe walked, if
you flapped your hands, if you had tantrums. So a
lot of times the adults are twenty five and thirty
five year olds may not have a lot of historical
narrative about themselves because they've never asked anyone. But I
will say, do you recall getting pulled out for services?
Do you recall struggling when you were younger? And so
that does bring up a lot of stuff that doesn't
always point to autism. And so we cannot do psychiatric
testing or personality measures with a five year old, but
we can do that with a twenty five and a
thirty five year old.
When a parent comes to you with their child, you
see that they are really struggling, not knowing exactly what's
going on. Their child has meltdowns that happen from time
to time. They have all the markers that point towards
their child being autistic. How do you define those markers
so they can go to the local charity or the
local community so that they can search out and find
the help that they need to get them through this.
So when we do the assessment process, when they come
back to us for testing, we use, like I said,
a battery of tests, and at the end of that
assessment model is an appointment that's almost always with me
to discuss the results in findings. So what they get
after I give them the results and the diagnoses, they
get a report, a written, detailed, thirty forty fifty page
report that entails all of that data, that entails a
summary of the findings and what that means, diagnoses, and
very detailed recommendations, because a neuropsychological evaluation can look really fancy,
but if you don't tell people what to do with that,
it's useless, right, It's essentially doesn't mean anything, just fancy
words and tables on a report. So I am very
very detailed and very committed to having people pations of mine,
find resources and find ways to remediate or help themselves.
Of course, when someone brings us a five year old
the world my oyster, right, I can recommend a million things,
and hey, come back every year and a half, so
I can keep reassessing your kid, But what do I
do with a twenty five and a thirty five year
old that has missed a lot of time to make
some of those changes. But also life gets in the way,
Spouses gets get in the way, jobs get in the way,
you know, And so I insist, Look, if you don't
follow some of these things, things are not going to change.
But even if you implement three or four of the
recommendations out of the twenty that I'm making, when you
come see me back in you know, twenty twenty five,
you're going to see that you're a very different person
than you are now because the change isn't going to
happen overnight. But consistency is what matters. What you said
about are dound during this podcast is true for valuations
and treatment as well. Consistency and a commitment to doing
it day and day out is what's going to make
a big difference. And yes, a year and a half
two years later, people come back and they are like
they're born and new. But a lot of that we
just did the job of assessing them, diagnosing them and
giving them the direction. A lot of that is really
on them. They do the work.
Once you diagnose them, you find them to be autistic,
ADHD or whatever the case may be, do you help
them find other areas that can help them expand learn
and evolve so that they can keep moving forward with
their life.
So we explain them, you know what their diagnoses mean clinically,
what the implications are, why there's so much of an overlap.
They start to make those connections when we give them
the final report. We also give them resources. We give
them resources such as psychiatrists who are in their neighborhood
who take insurance. We give them psychologists or therapists and
their neighbors who take their insurance. With individuals who are
on the spectrum or have ADHD, we have resources in
the community in New York City, you know, entire agencies
and charities that are dedicated to working with those populations.
We refer them to a state agency. If they're under
the age of eighteen, there's a state agency called OPWDD.
It is basically stands for Office of Persons with Developmental Disabilities.
It is funded by New York State. It's a federal agency.
It's a state agency that gets federal funding and they
can get set up for services and help basically throughout life,
they get something called a Medicaid waiver and it allows
them to access those services. Now let me bring you
back to that twenty five year old. Now, let's say
a twenty five year old. When they turned eighteen or twenty,
they graduated from their school's special education program. They went
to an adults with disabilities program. But they also graduated
from there. You can't stay there indefinitely, right, And maybe
they train them to do some sort of a job,
and so they have a job, you know, something simplistic.
Perhaps you know, they get mail from the office, and
they feel a sense of you know, community and a
sense of contribution to their life. But mom says, listen,
I'm getting older and I'm worried that my son may
have a job, but he can get taken. And these
are real stories. By the way, my twenty five year
old autistic son goes online and has gotten scammed and
we've had to get the police involved. Or my son
ignored the jury duty notice three times till we got
a warrant or something. These are things that happen to
people because you don't wear a sign on your chest
that says I'm autistic, and a lot of autistic folks
look very neurotypical. You can't tell.
That's so very true.
I've said right along that the reason why some charities
have a difficult time raising money is because it's a
mental issue that can't be seen. With that said, what
can we do to help people and help change that dynamic.
So one of the things that I've been a huge
advocate for is how do we keep them safe? Right?
Safety is a big deal. And I recall this one
patient I was seeing since he was maybe fourteen years old.
The last time I saw him, he was maybe seventeen
or eighteen, no the time before last, and I said
to his dad, I said, look, your son is autistic,
but he does not look autistic. I mean, I don't
know what even what that is, right, A lot of
people don't. And I said, if something happens, and he
had suddenly grown to be very tall and very big,
if something were to happen in public, if he reacts,
if he bolts, he just looks like a big black guy,
And I worry about him because what does that mean.
The next time dad comes back and he goes doctor
Hafi's I gotta tell you he had a seizure. He
passed out in a McDonald's. When he woke up, there
were cops looking at him ems and he bolted and
he was a big guy. And I had asked him
to have him like make and this is like ten
years ago. I had asked dad to maybe make a
bracelet and make him wear it that said Hi, my
name is seen. So I am autestic. And when the
cops saw that, he told everyone stop, stop, stop, You're
going to freak him out. He's aut testing. And the
dad was like, had I not done that? I am
really shook by what could have happened to my son
that day.
Well, that is just such a great idea and such
a great story for people to hear.
So it's important for parents, aging parents sometimes to make
to take stock of their child's situation and say what
happens to them when I'm gone. So I then also
guide them towards what we call surrogate court. It's a
court that allows you to bring a case to the judge,
to the court and say this child has profound about
mental disabilities. They cannot make decisions for themselves. They may
be intelligent on paper, but they have autism or a
defining disability that will not allow them to make that decision.
So I need to be able to assign another adult
to either take full guardianship, which the courts are not
crazy about, or specifically financial and medical guardianship or conservativeship.
So there are ways to address, but you have to
address everything. You can just be like, Okay, we'll put
them on medication. That'll be the end it. You got
to teach them skills, you've got to get them into
job training. But you also got to take care of
the legal end of things. That's what I try to
do with that end goal in mind.
So you diagnose. Once you have your diagnosis complete, do
you follow through with them or do you direct them
to other people that can help that may be closer
to them where they live. How do you get that
network together so they have that safety net in place
to help them through any particular crisis just in case
something doesn't go as planned.
Yeah, so we do both. We do follow up with them,
We do an evaluation in another year and a half.
But we're not a treatment facility, so we connect them
to a lot of treatment providers, psychiatrist, therapists, like I said, charities, institutions, agencies.
Then they then provide the services we recommend in our reports.
Yeah, that makes sense. So now it's the big unknown.
When a parent brings their child between four and eight,
or eight to ten, or even as much as twelve
years old, it's the big unknown. They don't know what's
going on. They're confused. They see all these things that
it could be, They hear all the stories, they hear everything.
They just really totally overwhelmed.
Because the biggest fear and unknown is that most people
when first introduced to autism, they just have no clue
as to what it is and what it's about.
So that's a huge debate. And you know, when I
started working autism was it had very clean, clear demarcations.
You know, if you were not fully autistic, like textbook autistic,
we could look for features of aspergers or people who
were maybe pdd ns. We used to call them pervasive
developmental disorder not otherwise specified. There were a couple other
types of autism called ret syndrome or childhood disintegrative disorder.
When the DSM five kind of redid autism, we got
rid of all of those terminologies. We just made it
one big spectrum of autism over the pandemic and I
can tell you because I've been in practice in the
center doing assessments for almost eighteen years now. Over the pandemic,
people had a lot more time on their hands, and
a lot of people were taking to social media, and
obviously it's not a bad thing that there's so much
awareness of stuff, but there were articles being written that
could not quite capture everything about what autism is, and
the idea of neurodivergence really gained popularity. We went back
to work, and we only took maybe about three months off.
When we went back to work, you know, the idea
of autism sort of exploded. Everyone wanted to come in
and be evaluated and assessed for autism. Everyone was neurodivergent,
and there were some people who wouldn't take no for
an answer. So it kind of became frustrating because, you know,
I have actually said these exact words, But if you
knew you were autistic, why'd you bother coming to see us?
You know, we're people with licenses and doctorates and two
or three decades of experiences. I've got other people in
my team who've been practicing for much longer than me,
so I would tell them, look, we are not just
giving you expert opinion with clinical discretion. We're also using
standardized tests to tell you whether you're autistic, and if
you're not, what else might be going on that could
mimic or look like autism. And a lot of times
people are very grateful for it. And there are a
lot of times that it's primarily to do with autism,
where people are so married to the idea that all
their difficulties stem from autism that they're unwilling to accept
what else it might be.
Yeah, that's very interesting. So tell me what have you
found that mimics autism where people think they might be autistic,
but in reality they're not.
Yeah, I mean, look some people, and let's talk about
adults for a minute, they might just have certain personality trait.
A lot of times I find that that's not always
the only thing. They usually have a parent who also
might have been on the spectrum or looked like they
were on the spectrum. People who are you know, back
in the day, we would call quirky or or peculiar,
and yeah, in younger children for the longest time, remember
the diagnosis I said, pddnos. So if there was a
child who let's say wasn't speaking yet, or speech was
a big part of the problem, and they were having
temper tantrums, and someone suspected autism, but we didn't have
enough information about it. We might just give them pddnos.
So to this day, you know, now we have better
tools and better understanding of autism, and if there are
some other things going on, you know, very often I've
put in reports and I've explained to the families that
your child may have had a diagnosis of autism, but
your child also is intellectually defession. So it's hard for
us to parse out the low cognitive functioning, the low
intelligence from autistic features. And so this is why we
need to see him again in a year and a
half so we can. You know, it's sort of like
the oil and water. It separates and you get to
see the different things with older people or not children,
but let's say teenagers or adults. We notice a tremendous
amount of overlap in people who might have pretty severe ADHD,
maybe some social emo immaturity, and a lot of times
anxiety or OCD. So a lot of rigidity around things
can look like autism rush if you combine it with
neurological neurodivergence like ADHD.
Wow, that's pretty interesting. So is there anything else that
can mimic autism within adults?
Sometimes people who have severe social anxiety and can't make
eye contact can appure autistic to the naked eye. Sometimes
people with you know, even mood disorder PTSD and bipolar
disorder can a pure artistic if there's enough of a
neurological spin to the way they present outwardly. And we
do these tests, these very sensitive, standardized tests like IQ testing,
and there's a measure for autism called the ADOS. It's
the Autism Diagnostic Observation Schedule. We also give them self
reporting scales and then we observe them through several sessions
and it's a team effort and it's not always black
and white, but we're able to tell them, hey, this
test comes up. Yes, you rated yourself pretty high as autistic.
But when we did the ADOS, which is a clinician
administered test, you were able to have a lot of
reciprocal conversation. Not only did you make eye contact, you
were able to integrate nonverbal communication with verbal communication. For instance,
you're sitting there, you're nodding. I can see your eye
blinking exactly when I see something. You're holding your chin
as I'm talking, I'm using my hands, I'm gesturing an emphasis,
even though the majority of people who are all of
the people who are listening to me are not going
to be able to see this. But this is the
integration of nonverbal communication into verbal communication. Autistic individuals have
a very difficult time with that. They can learn eye
contact to some degree, even though it looked tilted and
awkward or forced, they cannot learn how to do this,
and they cannot learn how to do this at the
same level date I'm doing it right now. So those
are the things that you can't always put into words
or really explain to a lot of people who really
believe that they check off all the criteria on paper,
but not when I see them.
What other information could you give us for any parent
that may be thinking their child might be autistic.
If you are a parent, for instance, and you're listening
to this and you're wondering about your child, look for
things like eye contact. Look for a child having a
really difficult time. And I don't mean a child who
is having a temper tantrum because they didn't get what
they wanted I mean a child who likes to sleep
on a specific pillow, or likes to eat very specific foods,
or doesn't like loud unanticipated noises, or has issues with textures,
or really either struggles to make friends or has no
interest in socializing, or they don't understand or display inflection,
their language, doesn't have the intonation the music of language,
They don't understand sarcasm, they don't get jokes. Those are
the things to look for if you're an adult. The
funny or the ironic thing is that if you're an
adult and you may be on the spectrum, you don't
necessarily recognize that you may be on the spectrum. Having
an awareness hyper awareness of yourself. There's sort of the
inward navel gazing is not something autistic people can do
very well. That is a defining feature. So when people
come and really go to back for their diagnosis, I go,
you are truly autistic. You probably couldn't do that.
Yes, I can understand where knowing yourself and understanding yourself
might really make a big difference. Unfortunately, they think they
can outgrow autism, and that's just not the case.
It is not something that goes away, doesn't change and
when people sort of deny that they may not be autistic,
they're actually shutting off the things that you can fix.
You can't cure autism. What you can do is treat
the things that sometimes come along with autism. So even
if that is true, let's say you're an Asperger's type person,
the way to correct that is to go into cognitive
behavior therapy with someone who knows autistic people who can
teach you social strategies, work with you on eye contact.
We're not trying to change who they are. We're trying
to make them feel more at home or more easy
to get along with, or go to an interview and
get the job that they want and not feel left out.
Medication for anxiety can be helpful. Medication for ADHD can
be helpful. The key is first to get a full assessment,
to you understand where you really belong on that spectrum.
And you know, when people tell me they've had a diagnosis,
I am very curious where they got that diagnosis, who
diagnos them, what tools did they use to give them
that diagnosis, because the majority of people I know don't
own an ados, have never been trained on an ados,
and don't have the faintest idea what the ADOS is,
and it's a very critical tool. Everyone on my team
has a doctorate and is licensed and primarily does assessments.
I still have everyone trained on the AIDOS every two
years because there's so much research and critical thinking about
autism that comes out every couple of years.
That's great. I think that's good for everybody to know.
Now there's one last thing I wanted to mention. I've
heard that it's tough to diagnose the difference between autistic
people and some of those people that might be gifted.
Gifted individuals tend to have a tremendous overlap with autism.
I actually have a table that I use from the
Davison Institute and the CDC, and it's basically the overlap
or the similarities between people who are gifted and the
people who are autestic. Sometimes a gifted person can in
fact be autistic. There is no rule that makes autism
mutually exclusive. You can have both. But sometimes what looks
like autism is really giftedness. Being gifted is a bit
of a blessing and a curse. I have yet to
meet someone who got told that they were gifted who
went oh, oh, look at me. I'm gifted. They feel
like it is a burden. The brain never slows down,
the brain never shuts down, the brain never takes a break.
The brain is firing on all cylinders all the time,
and it's exhausting.
Yeah, I can just imagine. How do people find.
You comprehend the mind? And my Instagram is just my name,
doctor Sunam Hafiz.
Well, this has really been great conversation and great information,
so I really appreciate you coming on.
Yeah, it's great work. Thank you. As a mental health provider,
I thank you.
It's been my pleasure. Thanks again.
Thanks for taking the time out of your busy schedule
to listen to our show today. We hope that you
enjoyed it as much as we enjoyed bringing it to you.
If you know anyone that would like to tell us
their story, send them to tonymantor dot com. Contact then
they can give us their information so one day they
may be a guest on our show. One more thing
we ask tell everyone everywhere.
About why not me?
The world, the conversations we're having, and the inspiration our
guests give to everyone everywhere that you are not alone
in this world.