Neurodevelopment PT 1 ASD

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We've got a fantastic guest with us today. Her name is Hannah Salazar, and she is both a therapist AND a professional school counselor. She also tutors new therapists as they work to pass their NCMHCE licensure exam. So, if you need one-on-one tutoring, send Hannah an email at:

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... and I'm sure she'll get you up to speed for your exam.

Ever met a client whose childhood “quirks” suddenly became roadblocks at work, at home, or in relationships? We dig into the real-world nuances of neurodevelopmental disorders with therapist and school counselor Hannah Salazar. We unpack autism spectrum disorder through a brain-based lens—frontal networks, amygdala, cerebellum, and connectivity—so the social reciprocity gaps, nonverbal communication challenges, restricted interests, and stimming behaviors make sense instead of feeling mysterious or oppositional.

From there, we map the edges: what actually separates ASD from ADHD, social anxiety, language disorder, and intellectual developmental disorder, and how to avoid false positives when culture shapes eye contact, tone, and social rules. You’ll hear practical cues to look for when adult responsibilities outstrip old coping strategies, plus how to document onset, identify pervasiveness, and test hypotheses with empathy. We also touch on overlap with OCD and schizotypal personality disorder, highlighting distinctive patterns of sensory processing, developmental course, and social cognition that sharpen your diagnostic lens.

If you’re studying for the NCMHCE or refining your intake flow, this conversation offers concrete takeaways: translate criteria into behaviors, run a quick differential drill, and connect findings to supports—from visual structure and social scripts to academic testing and executive function scaffolds. Press play to sharpen judgment, reduce bias, and bring more clarity to clients who’ve waited years for a name that fits. If this helped your practice or your study plan, follow the show, share it with a colleague, and leave a quick review so more therapists can find it.

If you need to study for your national licensing exam, try the free samplers at: LicensureExams


This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Episode Transcript

Linton (00:08):
Hello, all you wonderful therapists out there, and
welcome to another episode ofour licensure exam podcast.
I'm your host, Dr.
Linton Hutchinson, and I'm herewith my co-host, Stacy Frost.
Hey, Stacy.
Toe.
Hey, Toe, Linton.
Yeah, well, tell us uh what oursurprise is today.

Stacy (00:26):
Let me guess.
You got some extra visabi onyour BOGO Public sushi there.

Linton (00:30):
No, that's not it.

Stacy (00:32):
All right, just kidding.
Okay.
That's not the surprise.
We've got a fantastic guestwith us today.
Her name is Hannah Salazar, andshe is both a therapist and a
professional school counselor.
She also tutors new therapistswho are working to pass their
NCMHCE licensure exam.
So if you need some one-on-onetutoring, send Hannah an email
at info at thoodneuron.com, andI'm sure she'll get you up to

(00:57):
speed for your exam.
Welcome, Hannah.

Hannah (01:00):
Hi guys, thanks so much for having me today.

Linton (01:04):
Really?
Oh, today's episode, we'regoing to talk about
neurodevelopmental disordersthat you may seem to know for
the exam.
We'll be talking about autismspectrum disorder, attention
deficit hyperactivity disorder,and specific learning disorder.

Stacy (01:24):
And you may not be very familiar with the ins and outs
of these disorders unless youspecialize in working with kids
because the neurodevelopmentaldisorders have an onset during
the early developmental period.
Although you might see an adultclient who has
neurodevelopmental issues thathave gone undiagnosed until they
wind up in your office.

Linton (01:42):
I see a lot more of that on, you know, when I go to the
publics and you look at thelittle magazine racks, there
seems to be more about adultADHD.
Have you noticed that?
Yeah.
So really, it's actually prettycommon for ADHD or autism
spectrum disorder to go reallyundiagnosed until adulthood,

(02:02):
where the increasedresponsibilities and demands of
adulthood seem to start toovertake the coping strategies
that that person developed whenthey were a child.
So it's good to have a solidworking knowledge of these
disorders.
And it's really essentialbecause as a therapist, you'll
be working with adults that areexhibiting these

(02:24):
characteristics.

Stacy (02:26):
So let's kick it off with autism spectrum disorder.
And Hannah, I know that you'vegot expertise in working with
kids on the spectrum.
So could you walk us throughthe DSM 5 TR criteria and some
key diagnostic features thattherapists will need to know
about autism spectrum disorder?
We can also just shorten it andcall it ASD.

Hannah (02:45):
Yeah.
So yeah, I actually startedworking with autism spectrum
disorder or ASD.
Oh my gosh, almost 10 years agonow.
It's insane.
So I started working way, likeway back in 2017.
But when we're talking aboutdiagnosing any disorder, it's
really, really important tounderstand what the disorder is

(03:06):
and the symptoms that come withit.
It's also important tounderstand what is going on in
the brain and why the disorderis manifested the way it is.
So when we even talk aboutautism spectrum disorder, we
really can't talk about itwithout explaining how it's a
complex brain disorder thataffects the frontal cortex, the
cerebellum, the temporal lobe,the amygdala, the mirror neuron

(03:29):
system, the connectivity betweenbrain systems, including
neurotransmitters, aka the wayyour brain talks to itself.
We could also talk about howneurotransmitters are, those
neurotransmitters are affected.
What by talking about theglutamate or like GABA?
But that's probably for anotherpodcast for another day.
That sounds quite fun.

(03:50):
Just know like your basicneuroanatomy will help us to
truly understand how this canaffect a person and really
affect how they view and theysee the world.
So when you are diagnosing ASD,there are key features we
really want to pay attention to.
So mainly we're looking atchallenges with social

(04:10):
communication, socialinteractions.
We're looking for restrictedrepetitive behaviors or these
hyperfixation type of interests.
These are all going to reallycharacterize ASD.
Specifically, when we talkabout what the DSM5TR criteria
focuses on, it more focuses onthese persistent deficits.
So we're looking at all ofthese things all together.

(04:32):
So what does it all mean?
Well, typically we see thatthese social skills that are
very, very low.
For example, we may have asmall child who has an interest
in cars.
But instead of playing withcars like they should, where
they're racing them, wherethey're putting them against
each other and going vroom,vroom, vroom, vroom, we will see
that they're just lining uptheir cars the same way all the

(04:55):
time, this repetitive type ofplay, or they only prefer all
the cars to be red or blue orgreen, or they're gonna tell you
about every single car partthere is and every detail and
how this brand is different thanthis brand, and it'll be
extremely detailed.
But we'd also be looking at howthey're going to react to

(05:16):
changes in their daily routinesand schedules, if they're making
eye contact with others, ifthey communicate to others their
wants and needs effectively,all of these things are going to
paint that picture.

Linton (05:28):
That's interesting.
But Hannah, how do uh thosedeficits manifest in uh social
communication?

Hannah (05:34):
Well, one of the big ones is social emotional
reciprocity, which is the backand forth flow of social
interactions and sharing ofemotions and interests.
We typically see this andpeople with ASD kind of
manifests in an atypical way.
It might be hard for them to,it might be hard to gauge their

(05:55):
emotions or interests becausethey don't know how to openly
share what they're thinking orwhat they're feeling.
Many people will struggle witheven naming or recognizing their
emotions.
This is partly due becausesomeone who has ASD, they truly
think better in images orvisuals, and they have less
connection with words and lessconnection with how their body

(06:17):
will feel.
And that's a key factor, evenwhen we start talking about
treatment for ASD as well.
So some will have difficultyinitiating or responding to
social interactions, and somewill have trouble even keeping
up a conversation.
I often have seen this withchildren as, you know, young as
three or four, where you havethem come into your office and

(06:41):
they, you know, don't reallytalk at all.
Or if they do talk, it's onlyabout specific things that they
truly care about.
So they may even look like theyhave, you know, extreme social
anxiety.
They may engage in what weconsider stimming behaviors,
which are repetitive movementsto help calm that anxiety.
So things where they'reshaking, they have a bead

(07:04):
necklace and they're twirlingthe bead necklace over and over
and over and over again andthey're staring at it and
watching it.
Um, it could be, you know, handflapping, we talk about a lot
with younger people with ASD,especially younger toddlers and
children.
We can talk about jumping.
Some people do that as stimmingbehavior.
So it really is a very big,various amount of stimming

(07:26):
behaviors we can see with kids.
But sometimes the client willalso exhibit difficulty with
nonverbal communication, likewhat does it mean when someone
smiles at me?
Or why do I have to make eyecontact?
Or, you know, I didn'tunderstand that you were mad at
me.
They don't really pick up onany kind of nonverbal
communication, which is reallydifficult to communicate with

(07:46):
someone doesn't, given ourcommunication is always about 95
to 98% nonverbal.
So many children with ASD willjust avoid eye contact
altogether.
But we have to always talkabout cultural sensitivity and
being aware that some culturesteach their children not to make
eye contact with adults.
I experienced this forfirsthand as a child growing up

(08:07):
in an Asian culture wherechildren are taught from a young
age, it's very rude to makethat eye contact as a child with
an adult.
So we do have to be very awareof how cultural influences can
also influence how a childreacts in social situations.
Differential diagnosing issomething I always talk about,
but it's definitely warranted ifthis is one of the only

(08:28):
symptoms that we're seeing witha young one.
There's also the relationshipaspect.
So people who have autism havetrouble the understanding,
developing, maintainingrelationships.
They often have trouble evenchanging or adjusting their
behavior to match differentsocial settings.
So they may act one way here inschool, and then they may not

(08:50):
change that to go play oranything because they're really,
really rule-bound.
They often have difficultyadjusting or misinterpreting
other people's intentions andperspectives, kind of like what
I was talking about.
What do you mean?
Why do I have to smile?
Or what did I didn't knowyou're mad at me?
They will have trouble readingsocial cues and understanding
all of those verbal nonverbalcommunication dynamics.

Stacy (09:09):
Gotcha.
So, for example, a child withautism spectrum disorder might
have trouble with greetings,like saying hi or farewells,
saying goodbye, sharing theirtoys or even experiences with
our kids, responding when theirname is called.
And of course, like you'retalking about, you know,
relationships and making friendsat school.
And this doesn't necessarilymean they don't want to connect

(09:30):
with others, right?
But they don't quite understandthose unwritten rules of social
engagement.

Linton (09:35):
Oh man, Stacy, that sounds just like my entire
childhood.
I guess it didn't help that Iwrote backwards and upside down.
But it made perfect sense tome, but my teachers were always
on my case about something.
And and the fact that I had astutter didn't help at all.
Kids really didn't want to bemy friend.

(09:56):
So I was always picked last forwhatever game was was going on.
And as far as adults, sure, Ididn't want to respond or
interact with anybody.

Hannah (10:06):
Oh, well, I'm sure you made that up in your later
years.

Linton (10:10):
Yeah, I guess so.

Hannah (10:13):
It's also, I think it that brings up a great point
because it's really importantfor us to view autism spectrum
as the name implies, that autismis on a spectrum.
So no two cases are the same.
So, like I was saying before,and early in my career, I was
working at Ford Autism Center,and one of my colleagues told me
something I don't think I willever forget.

(10:33):
They said, if you meet oneperson with autism, you've met
one person with autism.
Oh, that's cool.
Right.
Yeah.
And that stuck with me becauseif you think about it that way
and you think about how broad,how big the spectrum is, and we
can have, you know, all thesedifferent kinds of
characteristics on it.
But if you think about that, itreally helps to view each case

(10:55):
with that mindset of yes, you'veseen autism cases before, but
you haven't seen this one.
Right.
And so we have to keep it'sit's really important to
internalize that and reallyimportant to approach each case
and each case that you comeacross with an open mind, as
well as understanding how eachperson's lived in experiences
are just unique to them.

(11:15):
Some people will have, I've youknow, definitely seen people
with very mild challenges, sojust kind of very shy, very
introverted, a little bit ofthat social anxiety, what we
would consider, oh, you're justa little awkward with people,
versus sometimes we see peoplewhere they're nonverbal, right?
We have people that use iPadsfor communication.

(11:35):
You know, you have substantialsupports built into their lives
all the time.
They're in, you know, they havethose IEPs, they are in special
education classes.
So we have to consider all ofthe different manifestations of
this disorder.
Most people, I would say,however, that they are some are
kind of in between.

(11:56):
They pretty much struggle tovarying degrees with social
interaction, communication, butthey will also exhibit these
restrictive repetitive behaviorsor interest.
So not only do we need to knowthe DSM 5 TR criteria for the
exam, but you'll also be testedon your knowledge of the
differential diagnoses, which iswhere you have two or more

(12:19):
conditions that share similarsigns or symptoms.
I will always harp on this withpeople like Tutor because
differential diagnosing is so soimportant when we decide to
make a diagnosis for somebody.
We need to always make surethat we're aware of which
diagnoses are differentials foreach other.
So some of the differentialsfor ASD include other

(12:40):
neurodevelopmental disorders.
We have ADHD, intellectualdevelopmental disorder, language
disorder, select amusism, andsocial communication disorder.
There's also a couple otherones, but those are those are
the main ones.
One thing I emphasize whentalking about autism with
counselors, when we're goingthrough tutoring or just you

(13:02):
know conversing about it, iswhat can you suspect causes
these particular disorders to bedifferentials for each other?
I always like people to reallythink about that question.
Because when we're talkingabout differentials, we're
talking about those symptomsthat are similar, but but why?
Why do these disorders sharesuch similar symptoms?

(13:23):
The answer is because they allaffect the same brain regions.
So to truly understand theseneural developmental disorders,
we can look at the basicneuroanatomy and kind of see
what areas are going to beaffected.
This is actually a pretty greatway of studying and kind of
looking at it because once youunderstand the areas that are

(13:44):
affected, you can understand whythese are all differentials for
each other.

Linton (13:49):
Wow.
I can see why people uh whyyou're in high demand as a tutor
for people studying for thisexam, Hannah.

Stacy (13:57):
Yes, it's not just enough to know it, but it's like why?
Let's go a little bit deeperwith it.
Wow.
Yeah.
Yeah.
So you mentioned some of thedifferentials of the
neurodevelopmental ones.
So there's also a few others,obsessive-compulsive disorder,
some of the anxiety disorders.
Like you mentioned a lot ofsocial anxiety issues.
So social anxiety disorder andagoraphobia, and a few

(14:19):
personality disorders, which Ithought was really interesting.

Linton (14:22):
Personality disorders.
That's a really interestingone, uh, Stacy.

Stacy (14:25):
I know that's one of your favorite ones to study, one of
your favorite areas.
It is.
So, yes, especially schizotypalpersonality disorder.
And this disorder has someoverlap with ASD in terms of
unusual preoccupations, oddthinking or speaking, that lack
of close friends orrelationship, and maybe some odd

(14:46):
or eccentric, what we mightcall eccentric behavior.
And there's differences inonset, cognition, sensory
issues, emotional skills, andinsight that can help you
distinguish between these twodisorders.

Linton (15:00):
Definitely sounds like some IT people that I know.
Got it.
It's in there.

Stacy (15:08):
It's in there.