Direction Therapy: Rethinking Care for Neurodiverse Young Adults with Dr. Andrew Rubin

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Hello, folks.
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Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country, sharing their thoughts and insights on the world of behavioral health care, broadcasting on WPVM 1037, The Voice of Asheville, independent commercial-free radio.
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I'm Todd Weatherly, your host, therapeutic consultant, and behavioral health expert.
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It is my pleasure to welcome to the show today a person I consider a friend, Dr.
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Andrew Rubin.
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Dr.
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Drew is a licensed clinical psychologist, founder of the International Society for Autism, ISA Research.org, and the founder and CEO of New Directions for Young Adults, a transitional independent living program for young adults on the autism spectrum, helping them get on the road to a healthy independent life.
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Dr.
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Rubin was appointed by the by Governor Rick Scott in 2013 to the Florida Department of Health Board of Psychology, retiring from the board as chairman in 2020.
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Dr.
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Rubin's background integrates expertise in CBT, developmental theory, and neuropsychology into an evidence-based treatment approach called direction therapy.
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Both empathic and based on scientific literature, direction therapy is a flexible model and clinical approach specific to certain diagnoses.
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Dr.
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Rubin has expertise working with multidisciplinary treatment settings and was formerly the lead psychologist at the Unicorn Child Development Clinic at the NSU Mailman-Segal Institute for Early Childhood Studies.
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In this position, he supervised postdoctorate fellows, doctor O-level practicum students, and student interns in the diagnosis and treatment of developmental disorders, as well as facilitating a lot of parenting programs.
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Prior to that, Dr.
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Rubin was on staff at Tulane University's Department of Psychiatry and Neurology and Louisiana State University's Health Science Center.
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In those roles, he provided treatment and performed education and neuropsychological evaluation.
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His clinical expertise expands child development, infant mental health, child and adult psychopathology assessment, and therapeutic interventions.
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Also actively engaged with Dr.
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Greg Chasen, author of the book Flawed, and the University of Chicago, producing research on hoarding and anxiety disorders with his population there, and co-founder of the Autism Research and Training Symposium, the third annual conference coming up here in January 2026.
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I'll have the pleasure of attending.
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Dr.
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Drew Rubin, uh, it's very good to see you.
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Welcome to the show.
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Well, thank you so much for having me.
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I'm genuinely excited to be here.
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Um, well, you and I, I have the distinct um privilege of gotten to hang out with you a lot, and I enjoy your company as much as anything else.
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But you're also one of the brightest guys I know.
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So um I'm super we could spend a lot of time.
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I mean, we could spend hours just kind of talking, and we have, about some of the stuff that's really exciting in the work that you're doing, the research that you're helping produce.
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But you and I were also a couple of things I'd like to try and get to, and I think one thing that's important for our listeners to hear is this uh the the the concept of some of the treatment that's going on out in the world today, some of the therapy and some of the work that's going on with especially young adults and even and children and adolescents that people think is right because all the evidence points to it being right, and this is what everybody's always done, isn't actually the right care.
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Talk a little bit about that, would you?
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Yeah, let me let me just make sure I understand the question.
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And by the way, thank you so much for all your kind words.
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It's uh, you know, I really appreciate that.
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And and you're a lot of fun to hang out with too, Todd.
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So I always look forward to that.
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I try not to be a bore, you know what I mean?
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So and I and uh you have such an amazing radio voice, by the way, too.
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You're very fortunate in that.
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Thank you, sir.
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Thank you.
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I got it from my dad, he gave it to me.
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And I am uh looking forward to having you also come and speak, by the way, at our um International Society for Autism conference in January.
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And uh I really appreciate you coming and look forward to it.
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Oh yeah, I've I can't wait.
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It's gonna be a good time.
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So um, but yeah, the the question is that you know, there's some forms of treatment that are inappropriate for people, but they're being regularly used out in the world.
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Like, talk about what the how you gained that insight, like what brought you to under to knowing that in the first place, and then how do we correct it?
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Like, what's your what's your idea here?
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Yeah, I you know, I I don't always I don't want to put folks off by saying right and wrong and using that really extreme terminology.
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Um, you know, there's lots of ways to think about and conceptualize um interventions, and you know, just to give you an example, just a really basic example, like maybe a behaviorally based, you know, therapist as opposed to someone who's a lot more psychodynamic, you know, just something like as black and white as that.
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We'll just use that as an example.
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And of course, there's lots of different therapeutic styles out there, and I'm not just targeting behaviorism or psychotherapy, I'm talking about in general, I'm gonna make some statements here, okay?
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Well, and I mean, I to speak to that a little bit, you know, you've got we try to find the right treatment for the right condition.
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And for people who are on the spectrum, if you send them to a program that's heavily reliant on like group work and lots of social interface, especially for some of them, it's not gonna work for them because it doesn't reach them.
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So, I mean, you're addressing something that's kind of pivotal in the treatment world, but I that well, I don't know.
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You know, the answer to that is it depends upon the person, of course.
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Yeah, you have such a range of, you know, there's that old saying when you're working, let's say, with one individual who's neurodiverse or on the autism spectrum, you've worked with that one person because there's such a diversity.
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Right.
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I would say in my field of psychology, my expertise would be in child development and in autism in general.
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And and that's combined my training and also, of course, my experience, and have now been working with young adults, which was a transition for me because early on I was a more of an early childhood expert.
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But in working with adults that also have developmental disorders, um, I just I, you know, I was really just passionate about it and just thought about it maybe at that time, which is you know almost 20 years ago now when we founded our first sort of treatment model, not even I don't even want to call it a program.
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It was really a theoretical idea that I had had and discussed with folks about working as a team, um, working with extreme communication between the professionals that were providing treatment, as you would on any type of an inpatient setting these days.
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That wasn't always even the case on an inpatient setting.
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My training at Rush Presbyterian St.
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Luke's Medical Center in Chicago really taught me how to sort of approach that type of thing as a team.
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And I've worked in a couple of different hospitals at that time around Chicago.
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Not everyone was doing that on the on the same floors.
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There was some some folks had extreme communication, some had no communication.
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This is like taking uh you know clinical expertise, if you will, and really um, you know, planned and specific communication to try to have the best outcome results for the client, so to speak, on a statistical level.
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Um I say statistical level because of course there's such a divergence, you're not gonna be, you know, and what how do you define success necessarily, right?
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What does that mean for every individual?
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And that's why, by the way, it's called direction therapy because young adults on the, you know, who have neuro neurodiversity, they go in different uh areas.
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It's not always success in college that will perhaps inhibit success in the world and independence.
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So that's why whatever that's why it's named direction therapy.
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Well, and you you presented about this when you spoke this year at the conference, um, talking about how you know we when we're dealing with these individuals, there's a lot more here going on than than what our categories for people in their diagnoses would suggest.
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It's like don't let this don't let this definition over here, we may have drug out of DSM, whatever, completely guide your work, look at the person.
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And and the gist of, you know, if I was to boil it down simply, the gist of direction therapy is like that person is giving you the direction that you need for their care as you as you bear witness to their process and everything else.
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Is that is that accurate?
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Would you think differently?
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Yeah.
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I mean, yeah, and simplified everyone has strengths and weaknesses, and it's about capitalizing on your strengths.
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Unfortunately, you know, what you know, fortunately and fortunately, in a way, because this is what I do every day for a living.
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And if I didn't have these folks who needed help, I probably wouldn't be working, you know, a new direction, so to speak.
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But you know, um there are some specific supports, obviously, uh given the diagnosis, and there's some specific evaluations, even the ADOS, you know, which is the simplest of things to diagnose someone and have a true understanding of what their abilities and disabilities are.
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But of course, you know, there's in intellect, of course, and it varies, so diverse, um, you know, with the populations that we deal with, and that that's a huge factor.
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But let me just take it back a little step further, more on an organic, humanistic level.
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You know, I started a lot of my training in early childhood um development, like we're talking folks that may have suffered um, you know, reactive attachment disorder.
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I had the I had the fortunate, uh fortunate ability to work with uh or or cross paths with a gentleman by the name of Charles Zena at the Tulane University when I was training there.
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And um he had something at that time, uh he I think it was called infant round.
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So, you know, we would go on and we would look at diversity and you know, even very young small children, right?
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So if you have you know, if you have difficulties for whatever reason is very early, early in your development or or even in utero, um, you know, that that that starts the ball rolling.
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Now, if you complicate that with maybe a genetic inherited disorder, not not disorder, so let me rephrase that a genetic inherited diagnosis, potentially, right?
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And that includes all diagnosis that have any kind of genetic component.
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Now you take those two factors, okay?
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And let's say you have both in unison, that would be important to treatment, so to speak.
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So even early childhood information about clients and things can tell you a lot about that client, maybe why they're in front of you today and what you might be able to do to help them moving forward, and assessing appropriately what that direction, what their what their likes and dislikes are, and what direction, maybe where they can be successful, so to speak, or not successful, you know.
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Which is like largely ignored in acute care, you know, like they're they don't look at any of that stuff when they're they're determining, you know, when we see cap folks that are in urgent situations or in hospitals and things like that.
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I mean, I just to get the doc to look at the history of meds that's been taken is is is something, you know.
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So I I think that you're receiving a lot of individuals into your care who've never had someone look at them through the lens that you're looking at them through.
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And you're also providing, you know, the University of Chicago with data about what you're seeing out there.
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What are you seeing?
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Um, well, I don't want to I don't want to speak to that data set yet because it's not complete and analyzed, but I'll I can talk a little bit about some of our early studies and what was impactful, you know, just in my mind, theoretically, you know, kind of led us in the direction we're in right now.
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And basically, you know, um, I told you, Todd, uh, you know, it was almost accidental that um we had included some of the assessments, the early childhood assessments that we typically had done uh during research at the Illinois Institute of Technology in our laboratories, which focus mostly on child development in a much older population.
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Um so basically by uh just throwing in a couple extra things because we were used to doing them and having them around type of thing, we actually found some stuff that was notable in the research that was very interesting.
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And basically, to sum it up, what it basically told me and told us sort of as a group when we discussed it, uh and I and this guy, I I want to talk a little bit about uh, you know, um Robert Schleser at the Illinois Institute of Technology.
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Unfortunately, he's he's now passed, he passed a couple of years ago from from cancer, unfortunately.
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But, you know, um, this is definitely as a result of his influence.
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And when I talked about this with him, the notable thing for us was that some of these kids weren't, you know, and I'm gonna talk a little bit about like Jean Piaget and early childhood development, but some of the young adults that we were testing developmentally uh in the older population weren't transgressing to levels of development that they were typically supposed to be at, given a lot of the early research has been done on um on cognitive ability level from early childhood onward.
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Does that make sense?
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Yeah, absolutely.
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They weren't achieving that.
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And what so the finding was why weren't they achieving that?
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Yeah, I think more is the implication if they weren't achieving it, and you think about them like an early childhood and what their ability level is at a specific age, what would your expectation be cognitively about a young child's ability, let's say, to do some more sophisticated types of therapeutic work?
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Right.
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And if if those deficits led to them being unable to engage in that therapeutic work, you're gonna be spinning your wheels all the time, basically.
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And and unfortunately, spending your money in the wrong place.
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Right.
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If that makes sense, and on and in this country, there's a lot of I I would say inappropriate styles of therapy that are being utilized with this population, and that probably translates into lots of money for insurance companies and out of pocket for for clients.
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Well, you know, you you you've got a system that's that's designed around billable hours, it is not designed to be uh very sophisticated at all.
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You and I could walk out and we could go say, hey, you know, I'm having some problems, I'm gonna go see a therapist.
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I'm gonna pick one, you know, I'm gonna scatter sample five therapists and try to pick one out of that set, and I'm gonna go see that person.
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And maybe I've done a little research about what it is I might need in terms of therapeutic care, but I'm gonna land in some front of someone who's got maybe a basic set of skills, but they're not gonna be prepared to engage in looking at me the way that direction therapy does.
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Um, and I I might be sitting with someone who's just doing a lot of you know, relatively decent reflective listening and that sort of thing.
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I could do that until the like I could do that until I retire and never really make much gains depending on the condition that I'm struggling with.
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But I feel like I'm trying to do work.
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And what you're saying is is like, look, and you know, part of the job as a therapy is it's on a lot of what we do is like match the condition to the treatment, obviously, um, and find somebody who's capable of digging in with a person and getting them to a place where they can achieve outcomes as a especially for young adults who are, you know, this quote unquote failure to launch kind of thing.
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What is it where when did you make this jump over to young adults and like, hey, we need to bridge these things?
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Like, what was the what was the was it during your doctoral program?
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Where was the flash of insight?
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So I uh my first job out of uh graduate school as a as a working um clinician was at the Mailman Siegel Institute of Early Childhood Studies at Nova Southeastern University.
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And there's a program that was right across the street, still is there, called College Living Experience.
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A lot of people in our in our industry, I'm sure, have heard of this program.
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They have multiple uh programs similar to it around the country.
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And so I was sort of moonlighting as a psychologist there and uh working with some of these young adults and families.
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And, you know, at the time I I realized uh that when I was working there that I wasn't having the opportunity structurally, and also no one was dedicating any time to the information that I was gleaning that could have been really helpful to the clients, you know, on a very structural level, of course.
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And again, there's lots of variation, especially when you're dealing with um like uh multiple diagnoses, you know, comover diagnoses, some of them maybe involving psychosis or severe anxiety.
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And I would say that anxiety in general is one of the most underestimated, impactful things that affect young adults on the spectrum.
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A lot of people don't realize how much uh anxiety stymies growth in young adults on the spectrum.
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Um, so you know, there's a lot of there's a lot of comorbid conditions that have to be considered, I guess is what I'm trying to say.
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Well, and let's talk a little bit about anxiety.
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Um, and I know that we want to also talk a little bit about technology and you know how that's you know involved in the treatment world and and the great the wonderful things that we're seeing that are coming and not so wonderful things coming out of AI.
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But when the the young adults that you're working with who are on the spectrum, what is how does anxiety play this kind of critical role in their in in the problems that they face and then how they overcome them?
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Like what are you what is that you see in your clients as you work with them on a daily basis trying to forge an independent life?
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Well, you know, look, technology is affecting us all, and um in technology we see it affecting our profession, not just in the autism, just let's just talk about the psychological profession, profession, profession.
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Um I I I uh was honored to work with a team of psychologists from around the country.
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When I was on the board of psychology, I was the representative to discuss what the future of assessment would be for incoming psychologists.
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And that entailed working with integrated technologies and um AI type devices that will be able to, you know, better assess, you know, a more consistent, it's not just pen and paper type answers.
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These are given the scenarios, you know, how you would diagnose and things like that, things that are more observable and really updated testing for the EEEP testing, which is what folks around the country need for licensure in psychology.
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So being an early part of that, I saw technology coming in, they were planning for it, they understood the value of it.
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If we jump, you know, five to seven years, wherever we're at at this point in time, um, we see technology, we have we see uh technology doing helping us with our progress notes.
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Psychologists are using this today, very valuable tool.
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What does that translate into, by the way, for your time and you know how efficient you can be, of course, right?
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And that also translates into uh monetary gain for you if you can use that time in other way.
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So technology is impacting us as therapists, but think about the technology and the assessment if you had sort of an ongoing ability to track people's progress on multiple domains on a daily level, how you would change your treatment modality based on how that's going.
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So you could actually have a model like that real-time run recommendations for clients and make sure that staff on the ground are aware that they need to do certain things.
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Like it's the possibilities are limitless.
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It's amazing.
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Well, you know, you you've got an AI that's been cued to observe, you know, when a person becomes symptomatic, when they engage in certain kinds of behaviors, what kind of support they would need.
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And if you think about it from a staffing standpoint, not that you can eliminate humans from treatment, you can't, but like from a staffing standpoint, if you've got something that's observing at that level and providing your team with like, hey, this person's the one that needs support.
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I mean, you and I know from a program from a program management side, your humans being able to be in the right place at the right time is one of the biggest things you manage.
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Like if you've got if you've got a mechanism that could drive that efficiently, because it's sitting there all the time, observing and cued to say, hey, by the way, somebody was experiencing they were up at five in the morning and they were ruminating.
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This is the person that needs support this morning.
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You could really have a major impact on treatment on the treatment world in general.
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I mean, is that what you're doing?
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What what if you had something that help you early recognize psychosis in a client, make sure that they get psychiatric care um sooner than they later would, so they avoid that trip to the hospital.
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And we see amazing statistics when when we see previous admissions to hospitalizations for folks that have diagnoses that have like psychosis involved, and there are multiple.
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We see a real much lower incidence of hospitalizations post-treatment because we're just more aware because we have more contact and touch points, um, especially in really important situations.
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And again, we're talking about such a spectrum of diagnoses.
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There's a lot of spectrum young adults that don't require any medications, right?
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Right.
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So, you know, and they have maybe other diagnoses that are called morbid potential.
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So adjusting to the variables at hand is basically what we're talking about and the efficiency of it.
00:21:43.920 --> 00:21:44.400
Yeah.
00:21:44.400 --> 00:21:45.039
Yeah.
00:21:45.039 --> 00:21:47.279
I, you know, I was just talking to uh Dr.
00:21:47.279 --> 00:21:55.359
John Stevens, his medical director at Lakewood Center down in Florida, and you know, we were talking about like how do we kind of get ahead of some of this problem?
00:21:55.359 --> 00:22:12.480
And he was talking about how um what we're seeing, and even with psychosis, and uh like first break, a lot of the the technology and therapeutic work and technology and intervention first break is that first break is a lot of times mood, it's mood centered.
00:22:12.480 --> 00:22:32.880
Like if you can help this person and they don't treat it with antipsychotic, they train it with a with a um a benzo, you know, uh PRN benzo, so that that person can kind of regulate and calm down and everything else, and avoid having to go on an antipsychotic and avoid some of the kind of big scries that happen as a result of a psychotic break.
00:22:32.880 --> 00:22:41.279
Is like if you could find a mechanism that caught people at that place, you'd see a lot fewer of these psychotic breaks and a lot fewer hospitalizations and everything else.
00:22:41.279 --> 00:22:44.720
Like, I mean, it's it's pretty exciting what you're talking about.
00:22:44.799 --> 00:22:54.079
But you know, back to say I can't, I I don't just officially want to say I'm a psychologist, not an MD doctor, so I like reserve the right to officially comment on those things.
00:22:54.079 --> 00:22:59.680
But I can just tell you that, you know, integrating psychiatry with the psychological aspects of what you're doing.
00:22:59.680 --> 00:23:15.759
If you need reminders, for example, or um, you know, just practic, just practical things, you know, help helping make sure folks are taking their medications because maybe their anxiety is causing them to not want to take their medications, you know, making sure it happens and being able to report it efficiently.
00:23:15.759 --> 00:23:26.480
Simple things, you know, working as a team to understand those variables and adjust, um and adjust over the course of treatment is very, very important to be flexible in that model with the communication.
00:23:26.480 --> 00:23:28.000
That's just basically all it is.
00:23:28.000 --> 00:23:30.160
How could you not be more efficient?
00:23:31.200 --> 00:23:31.519
Right.
00:23:31.519 --> 00:23:41.119
Well, and you're you're talking you talked earlier a little bit about kind of immersing people in a skinarian environment, you know.
00:23:41.119 --> 00:23:50.079
I mean that technology has some real advantages in an environment like that because you're talking about cues, right?
00:23:50.079 --> 00:24:07.519
Um so if you if you had like carte blanche, you know, you got access to all the money and technology and everything that you need that that is currently available and you were gonna you were gonna whistle and bell your current program, what would you do?
00:24:07.920 --> 00:24:12.880
I I think it's you know it's not it's I don't know how to how to answer that.
00:24:12.880 --> 00:24:17.759
I think it's more of a um it's more of a theoretical model for everything.
00:24:17.759 --> 00:24:20.000
It's not just me and my program.
00:24:20.000 --> 00:24:53.759
It's just if you're thinking about as a model for efficiency, even in a hospital, wherever you are, outpatient, whatever, um, just having efficient information, if you have people who are skilled, you know, and they know how to best direct therapy, you want them to be able to get as get as much information as possible to be able to help the client and then direct therapeutic interventions in a way that has shown through training to be the best uh way to approach clients, you know, given the diagnoses, right?
00:24:53.759 --> 00:25:20.240
That's the most responsible thing, especially when you're dealing with depression, potential suicidal ideation, um, you know, what your appropriate follow-up should be, touch points should be, how when it's time to hospitalize folks, you know, that's those are professional decisions that are left for the professionals, but augment having this AI technology available to help the clinicians make decisions more real time and on behalf of the client is what we're talking about.
00:25:20.240 --> 00:25:22.640
And that can be on in on any level.
00:25:23.039 --> 00:25:25.039
Yeah, and how would you bring it home?
00:25:25.039 --> 00:25:41.279
Like, like in terms of like you've done a lot of training with parents and you know, you you know, we're talking about we're talking about care in professional care settings, but then this person's gotta go home or they go back into independent life or whatever.
00:25:41.279 --> 00:25:54.000
Like what would you if you were talking to a family right now and they were looking at making this transition with their loved one or whatever, like how would you orient them towards some of these methods and strategies and stuff like that?
00:25:54.000 --> 00:25:55.359
Like, what would you what would you say?
00:25:55.359 --> 00:25:56.319
Hey, do these things?
00:25:56.319 --> 00:25:57.599
What would your advice be?
00:25:57.920 --> 00:25:59.519
Yeah, I'll I'll give you I'll give you some of that.
00:25:59.519 --> 00:26:05.759
And I know I'm uh if for a lot of the folks that are listening probably today, they'll they'll maybe be able to rate relate with us.
00:26:05.759 --> 00:26:16.319
I I had uh a visual disability and and had attention deficit disorder when I was a kid and still have have a lot of ADHD, okay, myself.
00:26:16.319 --> 00:26:31.359
Technology helps me in that setting reminders, um, having people remind me of things, doing all kinds of utilities, whatever I can do to help myself stay on track, stay oriented, is extremely helpful and makes me more of an efficient person.
00:26:31.359 --> 00:26:31.759
Right.
00:26:31.759 --> 00:26:35.200
So if you think about just that's a basic thing, right?
00:26:35.200 --> 00:26:55.119
If you think about actually what's available to us right now in AI and how you could better not only be efficient, but also keep yourself more efficient in a structure that maybe is best for you, whatever that is, um, then I think people will be be able to achieve things they never thought they could achieve before.
00:26:55.119 --> 00:27:01.359
You know, but the I hate I hate the big the biggest problem is wasted talent.
00:27:01.359 --> 00:27:11.519
Um I see so many young adults that are so bright and so capable in in and and sometimes not the most capable or the brightest, but but capable.
00:27:11.519 --> 00:27:18.319
And um, you know, it's a tough world out there, but they can be successful oftentimes in areas that are best suited to them.
00:27:18.319 --> 00:27:20.880
Um, I think sometimes understanding what that is.
00:27:20.880 --> 00:27:24.640
We through our nonprofit, we started a vocational training program.
00:27:24.640 --> 00:27:27.279
We knew that was going to be important in Deerfield Beach, Florida.
00:27:27.279 --> 00:27:30.160
It's called under the International Society for Autism.
00:27:30.160 --> 00:27:38.000
I think we have about 39 or 40 internships right now where folks can go and work for periods of time and get experiences.
00:27:38.000 --> 00:27:46.720
And that's part of the process that we wanted to provide to the community as a way for people to figure out what's best for them and what they're best suited for.
00:27:46.720 --> 00:27:49.839
We became partners with Florida Department of Rehabilitation.
00:27:49.839 --> 00:27:57.279
So we do vocational and we get more funding through uh vocational rehab through the state of Florida, which is great when kids are getting jobs and keeping them.
00:27:57.279 --> 00:28:05.359
Yeah, and that that organization has been in existence now, I think it's about 12 or 13 years, and it's been really impactful in that in that area.
00:28:06.000 --> 00:28:07.039
Yeah, that's well.
00:28:07.039 --> 00:28:14.880
I mean, I was talking to a uh a guest recently and coined a term, he said experiential deprivation.
00:28:14.880 --> 00:28:20.160
And it's like people are not having enough of the right kinds of experiences.
00:28:20.160 --> 00:28:24.079
Any experiences or any experiences, right?
00:28:24.079 --> 00:28:28.960
Um, and they and and as a result, they like to look at the world.
00:28:28.960 --> 00:28:45.680
Um, and this is a the program is a program, the um uh in the New Summit area, but they're over in Costa Rica, and and part of the benefit that they have is that the kids go over there or the young adults go over there and they drop them into an environment where they don't know anything.
00:28:45.680 --> 00:28:55.039
It's like it's okay to not know anything because you're in a completely new environment, whereas in their environment they didn't know anything, but they were anxious about it.
00:28:55.039 --> 00:28:58.799
They were afraid somebody was gonna judge them because you're supposed to know things, right?
00:28:58.799 --> 00:29:03.200
You know, and I I don't wanna I don't wanna be seen as a person who doesn't know something.
00:29:03.200 --> 00:29:06.000
And it kept them from doing anything.
00:29:06.000 --> 00:29:08.640
Exactly.
00:29:08.640 --> 00:29:17.920
And and it's like, you know, what you're talking about is you're you're creating this this little environment where they get that opportunity to have it's like it's okay that you don't know anything.
00:29:17.920 --> 00:29:19.119
We don't expect you to.
00:29:19.119 --> 00:29:24.640
This is a chance for you to learn, um, and and have people around them that are helping manage their anxiety.
00:29:24.640 --> 00:29:27.279
And it just makes me so excited that you're doing that sort of thing.
00:29:27.279 --> 00:29:39.680
It's um it's what's gonna probably save a lot of young adults and and hopefully, you know, propel these individuals with a lot of potential into being innovative in this technology area.
00:29:39.680 --> 00:29:47.359
I mean, the the folks who are on the spectrum, there are a lot of those folks who they gravitate towards technology.
00:29:47.359 --> 00:29:51.759
They gravitate towards using these kind of mechanisms and things.
00:29:51.759 --> 00:29:53.200
I wonder what's going to arise.
00:29:53.200 --> 00:29:54.240
Are you seeing any of that?
00:29:54.240 --> 00:29:59.599
Like in the people that you meet with now, somebody who like you and I, we are brothers in arms.
00:29:59.599 --> 00:30:01.839
I too have ADHD.
00:30:01.839 --> 00:30:05.920
I I self-diagnosed and was given Ritalin.
00:30:05.920 --> 00:30:10.799
I went went from like not being able to read a full page into being able to read an entire book.
00:30:10.799 --> 00:30:13.759
Like I was like, holy cow, what what happened?
00:30:13.759 --> 00:30:15.680
Um do you have anybody?
00:30:15.680 --> 00:30:26.559
Do you see anybody like turn their treatment into something that's like becomes this superpower for them that they like give me an example?
00:30:26.720 --> 00:30:35.519
But but before I do, I just want to tell you, like, as you were telling me the story about, you know, you know, just like people isolating and the anxiety and how it can stifle them.
00:30:35.519 --> 00:30:44.799
I was thinking to myself, you know, even in that area, uh, why people isolate in their apartments vary so much, even under the anxiety diagnosis.
00:30:44.799 --> 00:30:50.480
Uh sometimes it's paranoia due to psychosis, for example.
00:30:50.480 --> 00:30:58.720
Sometimes it's their inability that they're not open socially because they've they've been beaten down, so to speak, or then they feel they have an inability.
00:30:58.720 --> 00:31:15.279
Sometimes these days, young adults are really connected through the internet, social media, and um video gaming, unfortunately, which kind of stifles in some ways other areas of growth potentially when you're sometimes super bright and have all this potential.
00:31:15.279 --> 00:31:27.519
I guess it depends upon what your aspirations are, I guess, and what you're trying to what you're trying to do in your life, I guess, and you know what's gonna make you happy and healthy as an individual, I guess, ultimately.
00:32:23.920 --> 00:32:24.480
Okay, good.
00:32:24.480 --> 00:32:25.839
Good, good, good.
00:32:25.839 --> 00:32:33.519
Um I edit I usually do I do clips and I I I edit, so I can I can just carve that out.
00:32:33.519 --> 00:32:34.400
So that's not a problem.
00:32:34.640 --> 00:32:36.640
Anything you can do to help me look better.
00:32:38.480 --> 00:32:41.519
Well AI a little, you know, a little makeup on you and everything else.
00:32:41.519 --> 00:32:45.119
Um just kidding.
00:32:45.119 --> 00:32:55.599
Um the thing I was asking was um, do you have like a like a uh a case example or something, one of these success stories that you can share?
00:32:55.599 --> 00:32:58.799
Because I think that you know a lot of people are looking for hope.
00:32:58.799 --> 00:33:01.839
You know, they're looking for like, wow, this actually can happen.
00:33:01.920 --> 00:33:16.799
Like people can well I you know, I guess I I sit with families a lot, so I I see things sometimes again and again, but other folks may sometimes not understand that things are happening to them, may sometimes be very common.
00:33:16.799 --> 00:33:19.279
And I'll give you an example.
00:33:19.279 --> 00:33:31.839
I guess in academics, for example, how many times have you heard of someone who has uh fairly either average to above average IQ and can't get through college, for example, right?
00:33:31.839 --> 00:33:37.759
And sometimes the reasons why they really can't get through, it's not because of their intellect or their ability.
00:33:37.759 --> 00:33:42.240
It could potentially just be the structure of what's going on academically.
00:33:42.240 --> 00:33:57.359
So from a clinical standpoint and also from an academic standpoint, if those two were working together, they could better employ a strategy to make sure the academics is structured in a way that someone can maybe reach a higher potential.
00:33:57.359 --> 00:34:11.760
And we have seen a lot of young adults go through school and then graduate school academically, that when they first came to us, there was talk of we should go a different direction, maybe go trade school or something, because school has never been a strong point.
00:34:11.760 --> 00:34:16.320
A lot of, a lot of folks I I hear that from.
00:34:16.320 --> 00:34:22.480
So that's just an example of a kind of a typical scenario that we see again and again.
00:34:23.119 --> 00:34:40.480
Yeah, I, you know, a close friend of mine, very intelligent, very talented, and everything else, just he would you know struggle to to be in an academic environment and and you know went turned to woodworker and was just this brilliant woodworker, you know.
00:34:40.480 --> 00:34:43.199
It just it was something that made him come alive.
00:34:43.199 --> 00:35:07.760
Um so I was it was not long ago, it was um I was in a presentation, it was for the Therapeutic Consulting Association, their annual training, and they had folks who um came out and uh clinician gave a presentation on on working with people on the uh neurodiversity um or neurodiverse spectrum, if you will.
00:35:07.760 --> 00:35:20.559
And and there's a lot of programming, and this might go back to our initial time, but there's a lot of programming that was designed to, hey, let's help you fit into the world.
00:35:20.559 --> 00:35:29.280
And they were saying it's like it at least on a tr on that initial treatment level, it's like that's not a really good strategy.
00:35:29.280 --> 00:35:43.280
Um helping them figure out how to be who they are and find places in the world where they do belong and what they do and what they gravitate toward matches up is a far better approach.
00:35:43.280 --> 00:35:47.519
And it's almost like they were they were talking a little bit about direction therapy.
00:35:47.519 --> 00:35:56.320
But what is your thought about the way the world works with autism versus the way that New Directions does?
00:35:57.920 --> 00:36:05.760
Um, I mean, definitely New Directions, you know, we call it a coordinated multidisciplinary treatment model.
00:36:05.760 --> 00:36:23.599
Um, and that just means that everybody is in the loop and is uh working together in a very coordinated fashion uh to employ the variables that will, you know, in our clinical judgment, be most supportive for the clients that we're dealing with.
00:36:24.559 --> 00:36:25.199
Right.
00:36:26.239 --> 00:36:26.719
Right.
00:36:26.719 --> 00:36:35.519
So for also for me, efficiency of information for our therapists, um that's very valuable.
00:36:35.519 --> 00:36:49.840
Like it's it's important to know, for example, let's say just a real practical example, if someone's isolated and isolating and not showing up for social events, so having more of a real-time during the weekly meetings of have people gone out this week?
00:36:49.840 --> 00:36:51.920
And how were they when they were out?
00:36:51.920 --> 00:36:53.360
And what was their mood like?
00:36:53.360 --> 00:36:56.239
And did they report any symptoms of this, that, or the other thing?
00:36:56.239 --> 00:37:02.239
And you know, that's important information for the psychologist, for the psychiatrist, for the treatment model itself.
00:37:02.480 --> 00:37:03.039
Right.
00:37:03.039 --> 00:37:12.239
And like out in the world, though, like you're engaged, you see what's out there, you see what community behavioral health looks like.
00:37:12.239 --> 00:37:15.840
Like, what advice would you give other programs?
00:37:17.760 --> 00:37:18.079
Wow.
00:37:18.079 --> 00:37:23.679
Well, I've I've worked in the psychiatric ward at Tulane University, you know, so I've been in the thick of it.
00:37:23.679 --> 00:37:26.239
And proud to say I had the opportunity to do that with Dr.
00:37:26.239 --> 00:37:27.679
Tendler, and I'm still working with Dr.
00:37:27.679 --> 00:37:28.480
Tendler today.
00:37:28.480 --> 00:37:28.880
Dr.
00:37:28.880 --> 00:37:32.480
Tendler was in his MD training, training at Tulane University.
00:37:32.480 --> 00:37:35.519
And let me tell you, Todd, that guy is incredible.
00:37:35.519 --> 00:37:37.519
I'm so proud to work with him over the years.
00:37:37.519 --> 00:37:41.599
He's our, yeah, he's just a really great psychiatrist, to put it frankly.
00:37:41.599 --> 00:37:52.320
And um also, you know, he's a researcher himself, and he's brought to my attention a lot of new technologies like Prism, for example, transcranial magnetic stimulation.
00:37:52.320 --> 00:38:03.760
Um, you know, we've always used biofeedback, but those are technologies that are super effective for a lot of the young adults we work with, especially because of the comorbid diagnoses, such as anxiety, for example.
00:38:03.760 --> 00:38:06.079
And I'm talking statistically, right?
00:38:06.079 --> 00:38:12.639
You know, it's like half of every half of our population is gonna have a diagnosable anxiety disorder.
00:38:12.639 --> 00:38:14.639
Approximately, not more.
00:38:14.639 --> 00:38:16.079
Correct.
00:38:16.320 --> 00:38:16.800
Yeah.
00:38:16.800 --> 00:38:32.719
You know, I was it was just a Houston Methodist, and they've they've it's it's about to land on the scene, but they're doing rapid TMS, uh, which is 10-minute sessions 10 times a day on the hour.
00:38:32.719 --> 00:38:35.119
That's wow.
00:38:35.119 --> 00:38:37.280
Like, wow, right, exactly.
00:38:37.280 --> 00:38:42.880
But the results that they're seeing from this are are pretty groundbreaking from what I see.
00:38:42.880 --> 00:38:43.280
Dr.
00:38:43.280 --> 00:38:48.000
Alec Madon Madon out in Houston Methodists and part of their assessment clinic out there.
00:38:48.000 --> 00:38:49.280
I got to talk to him.
00:38:49.280 --> 00:38:59.519
They're gonna be one of three centers that is gonna start doing this, and one of them's gonna be at MUSC in South Carolina, not not too far up the road from you.
00:38:59.519 --> 00:39:07.119
Um the other one's gonna be at Stanford, but like, you know, the some of the some of the I would I think you're right.
00:39:07.119 --> 00:39:16.239
It would be great to see in the private pay world, people can pay for things, and what you see as a result of that is innovation.
00:39:16.239 --> 00:39:28.960
You see some of the best techniques in the world happening in centers like yourself, like yours, and around other places where they're doing they're they're really being creative about what they're doing with people and how to have the best outcomes.
00:39:28.960 --> 00:39:33.039
Um, how do we like how do you get that to the public?
00:39:33.039 --> 00:39:34.639
Like, how do we get it to the public?
00:39:34.880 --> 00:39:35.920
I mean, it's out there now.
00:39:35.920 --> 00:39:45.360
I mean, when TMS, for example, first came on the scene, so to speak, I don't know, approximately, you know, I guess in 2016, 17 or wherever, whenever that was FDA approved.
00:39:45.360 --> 00:39:59.199
Think about uh just as an example, like folks that have had like severe panic disorder, maybe that won't take medication because it's part of their anxiety and taking the medication so they're resistant to medication, so it's you know, it feeds itself.
00:39:59.199 --> 00:40:20.400
And if they could go to something that's non-medication based that can be as effective at reducing chronic anxiety symptoms of anxiety, just that breakthrough for that period of length of time, that short breakthrough, that they are able to sort of uh just better adjust and integrate in a way that behaviorally they can be more functional in the world.
00:40:20.400 --> 00:40:25.679
Um, that's a new technology that's super impactful for a very specific diagnosis.
00:40:25.679 --> 00:40:33.199
That's just a great and thank you for that example, because I just want to point it out that that's just one technology that's available.
00:40:33.199 --> 00:40:40.880
And now we have so many, like Prism, for example, which I think is is interesting, you know, and um, and others that are coming out.
00:40:40.880 --> 00:40:44.320
And I think I don't know as much about the technology side.
00:40:44.320 --> 00:40:51.920
I know that there's a lot of sort of AI, uh, there's AI therapists, people are getting married to AIs a year now and all kinds of things.
00:40:51.920 --> 00:41:00.960
You know, there's likely some benefit actually from a humanistic standpoint, statistically, to having that available whereas they weren't before.
00:41:00.960 --> 00:41:08.559
If years from now, they'll probably do some studies that say for people that interacted with their AIs, they may have like a longer lifespan, for example.
00:41:08.559 --> 00:41:10.239
I would predict they would.
00:41:10.239 --> 00:41:13.360
So that's that would be pretty impactful if you think about that.
00:41:13.360 --> 00:41:18.000
Well, we could we could actually lengthen folks' you know, lifespans on average.
00:41:18.000 --> 00:41:19.519
That's pretty crazy to think about.
00:41:19.840 --> 00:41:24.800
Well, just having a connection, especially if your person has a tendency to isolate.
00:41:24.800 --> 00:41:28.880
I mean, you've got this mechanism that's here that feels like a relationship.
00:41:30.000 --> 00:41:31.519
I always recommend that movie her.
00:41:31.519 --> 00:41:32.159
Did you see that?
00:41:32.559 --> 00:41:34.719
Yeah, I totally, yeah, absolutely.
00:41:34.719 --> 00:41:36.079
I mean, it's pretty great.
00:41:36.079 --> 00:41:48.880
I I I think it's hilarious that the the the AI um, you know, turn to you know, uh Alan Watts is this, you know, the Alan Watts AI as the like, you know, I'm gonna stop hanging out with humans.
00:41:48.880 --> 00:41:51.119
I'm gonna go hang out with this Alan Watts guy.
00:41:51.119 --> 00:42:03.360
So um, man, I tell you, I I can't wait to one come to the conference, but I'm also just I I was excited when I saw you this year.
00:42:03.360 --> 00:42:13.920
I'm excited right now for the research that you're involved in, the partners that you have, the work that you're doing with young adults, the way that you're pioneering the field.
00:42:13.920 --> 00:42:14.639
Uh, Dr.
00:42:14.639 --> 00:42:19.679
Drew, my friend, I am uh, and it's a pleasure and an honor to have you on the show today.
00:42:19.679 --> 00:42:22.719
Uh, I think we need to do it again because we got more to talk about.
00:42:22.719 --> 00:42:24.960
But um my pleasure, my honor.
00:42:25.039 --> 00:42:26.400
Thank you for the kind words.
00:42:26.639 --> 00:42:29.280
I love I will look forward to being with you in January.
00:42:29.280 --> 00:42:34.719
Uh, until then, this has been Head Inside Mental Health on WPBN 1037, the voice of Ashville.
00:42:34.719 --> 00:42:35.039
Dr.
00:42:35.039 --> 00:42:36.400
Drew Rubin joins us.
00:42:36.400 --> 00:42:37.679
Thank you, Drew, very much.
00:42:37.679 --> 00:42:38.239
Thank you.
00:42:38.400 --> 00:42:39.119
Thank you again.
00:42:39.599 --> 00:42:40.320
See you soon.