Dr. Liz Angoff on Best Practices for Talking with Kids About Diagnoses

Debbie:

Hey, Dr. Liz, welcome to the podcast.

Dr. Liz Angoff:

Hey Debbie, I’m super excited to be here.

Debbie:

Yay, I love it when my guests are excited to be here. That’s awesome. And as we were just talking before I hit record, I’ve been referring to your work for several years now because you have been, you know, kind of a hub for so much information that I know my community wants specifically centered around talking to our kids about their neurodivergence. And I know you do more than that, but I’m really just looking forward to sharing your work and your ideas around these important conversations. I know it’s not one conversation, but these conversations. But before we get into that, I always ask my guests to introduce themselves in their own words and connect that kind of to their why. I always love to know why you do what you do?

Dr. Liz Angoff:

Absolutely. So I’m an educational psychologist and I have this background in school psychology, school neuropsychology, and I am really passionate about helping kids understand their brains. Specifically, I do a lot of assessment work. So kids go through this entire assessment process, whether it’s either school or now that I’m in private practice with me, and then they’ve done all the work, but then we turn around and talk to their parents and their teachers and all the adults, and it just seems so important to talk to kids. In my why, when I first went into private practice, my very first case, the parents asked if I would explain the testing results to their child. And it was a big aha moment because after 10 years of practicing in the schools, nobody had ever asked me that before. And so I prepared a lot. put together a bunch of materials, all kinds of hands on, you know, visuals, then a metaphor, sat down with the kid and said, you know, I want to talk to you because We learned that you’re dyslexic and his head went down to the table. He started crying, ran out of the room. It was devastating. And I had no idea what had gone wrong. So I started talking to colleagues and the main advice I got was you started too young. We just need to wait till kids start to ask us. And at the same time I was asking, I was working with a lot of adults who had learning and developmental differences. And so I started asking them, what did you understand about your brain when you were young? And inevitably they said, I just assumed I was stupid. I was told I was lazy. just heartbreaking story after heartbreaking story about what that narrative was, but it was clear that they had started to create that narrative of really, really young. And so it wasn’t an option for me to wait. I realized that we have this opportunity to really start helping kids create this empowered and positive narrative around how their brain works from a very young age. And that we could avoid all of those years of thinking these negative and harmful thoughts. If we started the conversation, if we figured out if we crack the nut on how to have this conversation really early, continue it throughout their development so that the narrative is positive and helpful. So that’s

Debbie:

And how long ago was that?

Dr. Liz Angoff:

That was 12 years ago now. So I’ve been on this journey for a while.

Debbie:

Okay, that’s great. I love that you shared that story. And of course, my brain has gone in a whole other direction and just imagining being that child who, who gets that understanding from a very young age, like how much trauma it can prevent, how much self-esteem it can maintain or self-worth and all of those things. So this is such important stuff that we’re talking about. And just to clarify, even to talk about specific ages, you’re talking, I mean, you said very young at a very young age. Is it ever too young to have these conversations?

Dr. Liz Angoff:

I don’t think so. And the reason is because having these conversations with kids starts with talking about neurodiversity and the fact that all of our brains are wired differently and really celebrating just within your family how everybody’s brain works a little bit differently. And there’s a metaphor that I love to use: that our brains are under construction. That as we’re learning new things, we’re creating these new pathways. And some of those pathways are highways. And highways might be things that come naturally. Highways might be things that we’ve built over time with our hard work. But we can start to recognize that we all have different highways. And then our brains are also under construction. And we can start talking to kids very early. And I work with kids as young as three. And so having conversations about what your brain is building and really celebrating. See, you’re working hard to build that new skill or it seems like, oh, it seems like this is a tricky skill to build. We’re going to try a different way or let what if we did it this way instead and really normalizing those conversations from a really young age. It just helps kids to start to develop this narrative. Oh, I’m different. And that’s neat. That’s cool. That makes me unique. That gives me my, um, you know, special way of walking through the world. And that conversation we can have with anybody. And as kids get older, we might get more detailed about what we share with them. As we get more information as parents, because if you’ve been through the diagnostic process with your child, you know it’s a journey in trying to understand. But we can start talking to kids and celebrating their differences very, very young and normalizing neurodiversity is just part of what makes our world grow and evolve.

Debbie:

Yes, I’m like applauding over here. I mean, that is, I so believe that and that’s, you know, so much of why I started Tilt, these years ago was just to normalize all of this, that there’s nothing wrong here. So I love the way that you framed that. And I actually want to even taking a step back. So you’re talking about normalizing these conversations. Everybody’s brains are wired differently. and that’s what makes us all cool. And having these conversations from an early age and a stage, even preparing for the assessment, I imagine, right? So we kind of jumped in talking about how to talk about their diagnosis, but how do we even start those conversations if we know that our child is gonna go in for an assessment? Do you have ideas around preparing them and what is this for?

Dr. Liz Angoff:

Yeah, so, I think it starts with our own understanding of what assessment is. so assessment is really an opportunity to understand how your child’s brain works and how it works best, what the environment is, where it’s really going to thrive and where the mismatch is between the environment and how your brain, how your child’s brain works. And that’s where these points of friction or the challenges come up because of this mismatch. So just understanding that that’s what’s happening with assessment. And too often we go in thinking we’re going to find out what’s wrong or we’re going to find out what the diagnosis is. A diagnosis is a shortcut to understanding what this mismatch is between the way your child’s brain works and the way the environment expects it to work. So just knowing that for ourselves. And then for our child, I really find it important to start with their words, their lived experience and something that they know is a challenge. So it could be as simple as, know how you’ve been telling me you don’t like your math homework lately? Well, I found somebody who might be able to help us figure that out. And while our questions might be much bigger than that, they may be so many questions. But if our child has something that they’ve been saying is hard for them, that it’s been tricky for them, or that we find we’re nagging them a lot about, you know, I’ve been nagging you a lot and we’re having trouble getting out of the house in the morning. You know, I need to know more about that and I found someone who can help us figure that out. So we’re starting with a problem that’s interesting for the child to solve and that they recognize as something that is tricky or not ideal. And that helps us explain why we’re engaging somebody to help us understand what’s going on. And it’s going to help me as a parent be a parent for you. And it’s going to help you understand your brain so you know what to ask me for so that things can go smoother for us.

Debbie:

Yeah, that’s great. I love that. I also love the way you defined the process and you use this word mismatch, which has been coming up in different conversations. recently had Dr. Amy Laurent on the show from Autism Level Up, and we were talking about a mismatch between the environment and someone’s energetic state or regulation. so, mismatch, it’s non-judgmental. It’s just information and it’s describing what’s actually going on instead of this is a problem, something’s wrong, there’s a normal way, there’s a right and a wrong way. So I just wanted to say I’m really loving that word mismatch.

Dr. Liz Angoff:

Yeah, me as well. I think it’s more accurate to what’s going on because we have these environmental norms, but that doesn’t mean that they’re right. It doesn’t mean that there’s one better way. We just have designed things to work for this range of what we call average, but that doesn’t make one way of being better than another way. In fact, it’s the folks on the tails that really make our worlds evolve and change and better. And so we want to make sure our environment is helping those brains to thrive. That’s what makes sense to me.

Debbie:

Yeah, absolutely. And we know that average doesn’t even exist, right? I think Todd Rose wrote that book, The End of Average. like, yes, that’s so true. So I’m just wondering, you said earlier about the parents kind of having a clear sense of what they’re wanting to get out of an assessment in the first place. some of what I talk about here, and I’m curious to know if this is also part of how you support parents or prepare them, is kind of doing our own work to uncover internalized ableism we might have, or just ideas that we might have about neurodivergence that we need to pay attention to before we go down this path.

Dr. Liz Angoff:

Yeah, it’s really interesting you asked that because I’ve been talking to practitioners a lot recently about how we introduce assessment and what our intake interview looks like with parents, recognizing that our culture is full of very deficit-based understandings of ADHD, of autism, of learning disabilities, mental health challenges. We use a medical model, which means we’re going from this framework of something is wrong and we need to fix it. But what we’re learning about brains is that it’s not a wrong and fix it question. It’s that mismatch that we were talking about. And so I think that as a parent, we get messages that there’s something wrong and you go into assessment because there’s a problem. There’s something that is really, really tricky about your experience and you want things to be easier for your child. That’s why we’re going in for the assessment. And so I think that it’s a real conversation it’s our responsibility as practitioners to really help parents to shift from there’s a problem we need to fix to my child’s brain might work differently and we’re here to discover what that is so that I can change the way that I approach things as a parent so that I can give advice to teachers and other people who work with my child to do things a little bit differently.

And so that I can support my child in building skills they might need to navigate this world. But we’re balancing it from the environment, like how we’re going to change the environment and how adults can do things differently. And then how we’re going to support the child to learn what they need to learn to interact with the world. So I think that going into the assessment process, really listening to podcasts like yours and looking for neurodiversity affirming sources. And I think that’s a term that people have different levels of familiarity with, but really understanding what we mean by neurodiversity as opposed to a deficit understanding of a diagnosis can really help shift your lens. And then my hope is that the practitioner you’re working with is going to help that conversation in your initial interview to start really looking at that we’re trying to find that mismatch to turn the assessment process into a discovery process in that vein.

Debbie:

So I don’t even know if I can phrase this question properly, but as you’re sharing that, I’m like, yeah, this is what every parent needs and deserves when they are realizing there’s something going on with my child. They’re not thriving in certain environments. There’s a mismatch. I want more information. And it’s so hard to know what you don’t know. So if we don’t know that neurodivergent affirming assessors exist, right? If our only experience is with the more medical model pathologized language is all that we know, how do we, I don’t know if you have an answer, I’m just thinking like, how do we make sure that parents who are just at the beginning of this know that this exists? I, it just feels like we need like this giant public relations campaign or something to draw attention to the fact that there’s another way to do this that is strength based, that is, isn’t deficit based, that isn’t pathologizing, but is really about, as you said, it’s about a discovery process.

Dr. Liz Angoff:

I think that knowing the questions to ask your assessor is really important. I would love maybe out of this podcast, the next blog post that you see is a list of questions to ask your assessor because I think it’s really critical. And one of the main questions I would recommend that people ask in going into assessment is what happens at the end? What will you be telling me at the end? Because if the answer is, I’ll be telling you what your child diagnosis is and it stops there, then the focus is not aligned with what we’ve been talking about. If the answer you’re looking for is something more like, we’re gonna really figure out what the steps are to helping your child thrive. I’m gonna have specific recommendations for what teachers can do differently. I’ll have resources for you as a parent. I’m going to have a plan for what’s next. And that’s what you’re listening for because a diagnosis is just, like I said before, it’s a shortcut to understanding how your child’s brain works. But even within a diagnosis, there’s a ton of diversity. And so you’re listening for a practitioner who really understands that nuance. I think another thing that you can ask is what will you tell my child?

And if the practitioner is really thinking about the child’s experience in that assessment, because that’s going to tell you that they are listening for the child’s lived experience, which is a key component to neurodiversity affirming assessment, and that they really are not just looking for the deficits, but they’re really trying to bring out the strengths in the child. So that’s another question I think is really important. And then the third question might sound something like, what is your understanding? My concern or one of the questions I have is, does my child’s profile fit ADHD? I might ask, what is your understanding of ADHD? And if a practitioner parrots back the criteria from our DSM manual, then I know that they have that very traditional deficit-based understanding If they can give me a more holistic understanding of the strengths and challenges that come with an ADHD profile, then I know that they’re coming from that more affirming profile and that they’re really gonna help me understand my child’s strengths as well as the things that are challenging for them.

Debbie:

Mm-hmm. That’s great. Those are great questions. And I especially love the second one. What will you tell my child? I think that is such a great question. And also just making sure that they see our kids as creative, resourceful, and whole humans and not a problem to be fixed or a puzzle to solve or just a checklist to go through and tick things off boxes. So I really like that question. So, okay, what I’d love for you to do before we take our next break, would you introduce your framework for how to, know, we’ve got, let’s say we’ve gotten the assessment, and now we have information that we want to share with our child. And you have a framework for how to have that conversation. And I don’t know why I’m making that singular, because again, I know it’s conversations. But would you walk us through your framework?

Dr. Liz Angoff:

Absolutely. So you’re right, it is conversations. so I think that thinking about how we introduce the vocabulary for starting to talk about things, and to have a metaphor for continuing that conversation as specific things come up. Kids tend to be very concrete. And so having very real right now examples can be really, really helpful. But we talked earlier about really paying attention to the child’s lived experience and the things that they point out as tricky, frustrating, not ideal in some way or another. And we can start there. So you just did all of this work and you know how you were telling me that this was tricky? Well, we learned that we learned why and we learned some helpful information so it won’t be as tricky anymore. So for example, you know how you were telling me that math has been really frustrating this year? Well, all that work that you did with Dr. Liz helped me understand why it’s been so tricky. And I share what I learned. And that little question, I’ll actually highlight it because it’s really important. They were about to talk about something that is vulnerable and asking permission really just gives kids a little token to say, you’re in control of this conversation and you get to say no or stop it. And because this is about you and this is your information. So out of respect and value for what we’re talking about here, I’m gonna ask your permission first. It also gets kids really curious, like, ooh, what is she going to tell me? And so it can really open the door to talk about the conversation. 

And then it sounds like, well, I learned that your brain is under construction. The way that it works is there’s all these cells called neurons that are connecting to each other and they build these little roads. And we learned that a lot of your roads you can think of as highways. And your highways are things that come easily to you or the things that you’ve been working so hard to build that are so much easier now. And so I’m wondering if you can think of any or, you know, can you tell me some that you know of? So for my child right now, it might be bike riding and he is really excited about rollerblading. so those might be some highways. And then I can share some things we learned from the assessment. So from the assessment, we learned that you are super creative, would you agree? And that you know a lot of words. There’s something called vocabulary that you’re really strong in. And I’m excited to hear that because I know how much you love stories and how much we read together. There’s also some things that are under construction. So just like we see construction outside when they’re building a new road, your brain is always building new roads. So we also learned that there’s some things that are under construction. And for this, highways, I like to share a lot of highways construction. I might share one or two things that we learned that are really relevant to the child.

So it turns out the reason that math has been so hard is because this year, now that you’re in third grade, math has a lot of steps to it. And one of the things we learned is that your brain is still building the roads to holding lots of steps in your mind at once. And so I think you might be frustrated because there’s so many steps to math this year. Do you agree? So now we’ve taken the child’s lived experience and we’re explaining this complex concept called working memory, but in the child’s words. So now we know your highways, we know your construction zones, and I can say, you know, it turns out that you are not alone. There are lots of people in the world that I learned about that have highways just like yours, who are creative and passionate with big vocabularies, who love stories, and who have the same construction zones as you, who struggle to remember lots of steps, which can make math really frustrating. And we call these brains ADHD brains. Or in this example, we call these brains ADHD brains. And ADHD means that your brain is built in a way that makes you creative and passionate, but it can make it really hard to remember lots of steps.

So we’re defining the diagnosis using the child’s words, using their lived experience and helping them to understand what it means for them right now. We don’t have to go into the diagnostic criteria. We don’t have to talk about what it’s going to mean when they’re 13. We can talk about what it means right now when you’re eight years old in the third grade and this is your lived experience. And now we can introduce them to other people that are in the world. Simone Biles and Trevor Noah has been coming up a lot and you know all these these people who have a similar brain to to our children and who have been really successful in the world because of not in spite of the way that their brain works differently

Debbie:

Hmm. That’s great. I love that. Thank you so much for going through that with us. It does sound very affirming and exciting, almost like we’ve got this information. It’s kind of cool. And, yeah, anyway, so I just appreciate you talking us through that. Okay, so in the example that you just shared, that was an eight-year-old child, which is a pretty common age, I think, for these types of more involved neuropsychs, know, child’s in early elementary and you’re starting to really recognize, you know, this environment or what’s happening in schools is particularly tricky. And I also know that sometimes these assessments happen when a child is a little older and at a time when maybe in middle school where there might be more awareness of and stigma around certain labels that might be present in a school system. For example, I have a friend who has shared that the word autism is used as really an insult, right? Or it’s used as a put down at her child’s school. so getting information like that could be really hard for an adolescent or a teenager to kind of integrate. So I’m just wondering what thoughts you have for sharing information with kids who might be really resistant to hearing certain labels. What do you advise parents to do?

Dr. Liz Angoff:

I think that the idea that the child is in charge of their own information is a really important thing to go in with. this, you know, it can come up with my teenagers because I come in with a really positive view and excitement around discovering how their brain works. But they’re not always with me on the same page. so meeting the child where they’re at, I think is really, really critical and validating and recognizing that while we know that there is nothing wrong with having this kind of brain. It is a difference and it’s going to be really helpful for them in understanding where they’re going with their life and their career and kind of what the right environment is going to be. There are real world obstacles that are out there that we also need to help support them with. So I think understanding and holding space for that is really, really important with my teenagers, it becomes even more critical that I’m really using their language and their lived experience. And so, you know, I had one child who was autistic, but very much did not want anything to do with that label, but was saying just how isolated and alone he felt. And so we were talking about what we’ve learned about how his brain works that might help us understand why it’s been hard for him to find his people. And that we understand that his brain works in this different way that we call autism, but this is something that he can kind of hold and process and figure out what he wants to do with that. In the meantime, we wanna help you with the loneliness problem that we want to help make sure that you’re connected. And it doesn’t mean you have to go out and join a bunch of autism pride groups that might not be where you’re at. But I do want to help you to, I do want to help you to find some places where other kids have similar interests to you, that are places where you might be able to connect with folks in the way that you want to connect with them. And we did learn that your brain, connects with people in different ways. And so we’re gonna use that information to help you find community. But I’m not trying to force that identity on a child. I’m working with where they are at and letting them know that it’s their choice about what they wanna do with the diagnostic information. But we wanna help them with the things that are challenging for them.

Debbie:

Yeah. Now I appreciate you saying that because I do hear from families sometimes about feeling frustrated that their child doesn’t see the gifts in it, right? Or that they may not want to embrace the identity where the parent might be like, you have all these superpowers and like going in with that language. And so just that reminder to really respect. However, the child wants to own or not own or disclose or not disclose the information or the identity. I appreciate you sharing that.

Dr. Liz Angoff:

I’ll add just real quick that sometimes I find a lot of success with teenagers with just throwing the definition of the diagnosis under the bus that we there’s a you know a bunch of you know, old fogies who sat in a room and decided what all these things mean, but we’ve learned a lot about brains since then. And our understanding has evolved. And so I’m going to share with you a few things right now that are more of our evolved understanding of what autism means, of what ADHD means, of what your diagnosis means, so that you understand that what people in general think about this might not be aligned with what the science is saying.

Debbie:

Yeah, that’s great. Thank you. Okay, so the way that I first probably learned about you is what I want to share with listeners now is that, well, first of all, you have so many resources for having these conversations. And I mean, I don’t know how long you’ve been keeping this like spreadsheet, but you have a spreadsheet where you share like novels with characters, you know, different age groups who have different neurodivergence and it’s so helpful. So can you tell listeners about that resource as well as some of the other resources that you have available to help them navigate these conversations?

Dr. Liz Angoff:

Yeah, so if you go to explainingbrains.com, there’s a button right on the first page that says Tools for Parents. And there you’re going to pull up a page that says Empowering Your Neurodivergent Child. And there are articles and resources, videos, books that I hope are very well organized for you. They are living documents and I’m editing them all the time with new resources that I find. And they’re tools that ultimately I developed for myself to use as part of my assessment process. And they’re things that I’m using with kids all the time. So they are tried and true. They work with kids. They’ve been really, really helpful. And they’re designed because we as a field of psychologists, we’re not trained to talk to kids directly. It’s not part of our training yet. And so these resources are available so that you as parents have those tools to start these conversations and not have to wait for the field to catch up to understand that it’s so important that we’re starting to craft these narratives with kids from a really early age.

Debbie:

So great. Yeah, I’m just like, I’m so excited for and happy for the parents who are at the beginning stages of their journey now because the world is a different place than it was, you know, when I was parenting a three, four-year-old neurodivergent kid and had no idea where to turn. I would have loved these resources. So I just thank you. I want to thank you for the work that you do and for connecting with this why and then sharing it with the rest of us. So thank you for that. So you mentioned you’re exploring Brains website. Are there any other places that you would like listeners to connect with you?

Dr. Liz Angoff:

Yeah, so it’s explaining brains. That is just fine. Yeah, explainingbrains.com. And I also post a lot of the language that I use with kids on Instagram, which is also at explainingbrains.com. And I have a new book coming out called Our Brains. And it is designed to help parents and kids have a conversation together about their different brains. And it’s a facilitated conversation for parents to explain a diagnosis to kids. So that is in the works. It’ll be coming out soon. The information will be on explainingbrains.com. So keep an eye out for that as well.

Debbie:

That’s exciting. Awesome. Okay. We’ll keep an eye out for that. And listeners, as always, I will have links in the show notes for explaining brains. I said it right. Yes. Okay. Sorry. I’m going to say that again because I don’t want to screw it up. So listeners, as always, I will have links in the show notes page for explaining brains, for Liz’s books, for all the other resources we talked about. It’s just so valuable. so many of you I hear from you are like, I need to know the best books, the best movies, the best media to share. there’s so many great representations, but it can be hard to find them. So thanks for doing that work for us. And thank you for coming by the show and sharing everything you shared with us today.

Dr. Liz Angoff:

This has been a blast. Thank you, Debbie.