Episode 210 — Time is Brain
Guest: Dr. Suzanne Goh • Date: June 27, 2024
Episode Overview
This week's guest, Dr. Suzanne Goh, MD, BCBA, cofounder and chief medical officer of Cortica, discussed autism's root causes and the importance of personalized, holistic care. We explored treatments like neuromodulation and the need for collaboration among professionals. Her new book, "Magnificent Minds: The NEW Whole Child Approach to Autism," aims to empower families and provide hope.
About Dr. Suzanne Goh
Suzanne Goh, MD, BCBA, is cofounder and chief medical officer of Cortica, the largest provider of comprehensive health services for autism in the United States. Cortica began in Goh’s one-room medical office in San Diego ten years ago and has grown to a staff of more than a thousand doctors and therapists who serve tens of thousands of autistic children and their families in the United States and abroad. A graduate of Harvard University, Oxford University, and Harvard Medical School, she is the former co-director of Columbia University's Developmental Neuropsychiatry Clinic for Autism, where she conducted research on the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. Goh is currently a faculty member of the Medical Academy of Pediatric Special Needs and is a frequent speaker for parent advocacy organizations. She lives in San Diego, California, with her husband and two children.
You’ll Discover
A Book To Get You On The Right Track (3:52)
The Approach You Want To Take (6:41)
Why A Root Cause Focus Matters So Much (10:04)
Why Specialists Aren’t Enough (13:38)
Characteristics Of The Right Team (18:49)
Why Time Is Brain (21:41)
Why The Importance of Nutrition Is Undeniable (28:59)
The Merits of Genetic Testing & Some Things To Let Go Of (35:44)
A Key Test To Perform (38:22)
Why The Brain Deserves Urgent Attention (41:12)
Emerging Neuromodulation Techniques (46:08)
Referenced in This Episode
Full Transcript
Dr. Suzanne Goh | 00:00
That's part of why I felt like the phrase time is brain. Was so important because, you know, there are so many options. It's important to know what not to do just as important as to know what to do, because it's, anything that you decide to do is going to take time and effort and resources. And if it's not the right match for your child given their unique biological and neurodevelopmental profile. Then you're placing really precious time and energy towards something that is not going.
And then you're not placing it somewhere else. That is a better match and is could then yield the progress that you're hoping for, you know.
So it's really important to navigate all of these options well.
Cass Arcuri | 00:46
Want to truly be the best parent you can be and help your child thrive after their autism diagnosis? This podcast is for all in parents like you who know more is possible for your child.
Len Arcuri | 00:57
With each episode, we reveal a secret that empowers you to be the parent your child needs now, saving you time, energy, and money, and helping you focus on what truly matters most, your.
Cass Arcuri | 01:07
Child. I'm Cass. And I'm Len. Welcome to Autism Parenting Secrets.
Len Arcuri | 01:24
Hello and welcome to Autism Parenting Secrets. I am thrilled to be joined by an incredibly distinguished guest whose latest book is now on my Mount Rushmore of books that every parent must have. The book is called Magnificent Minds and the author and my guest today is Dr. Suzanne Goh. Her credentials are extensive, so I'm actually going to read her bio. Suzanne Goh, MD, BCBA, is co-founder and chief medical officer of Cortica, the largest provider of comprehensive health services for autism in the United States. Kourtika began in her one-room medical office in San Diego 10 years ago and has grown to a staff of more than 1,000 doctors and therapists who serve tens of thousands of autistic children and their families in the United States and abroad. A graduate of Harvard University, Oxford University, and Harvard Medical School. She is former co-director of Columbia University's Developmental Neuropsychiatry Clinic for Autism. Where she conducted research on the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. Dr. Goh is currently a faculty member of the Medical Academy of Pediatric Special Needs and is a frequent speaker for parent advocacy organizations. She lives in San Diego, California with her husband and two children. Her latest book, Magnificent Minds, the new whole child approach to autism was released in April, 2024. And the secret this week is time is brain. Welcome, Dr. Goh.
Dr. Suzanne Goh | 03:02
Thank you for having me.
Len Arcuri | 03:03
I don't usually read the bios at the beginning, but yours was very worthy to read because, again, you have lots of extensive experience. This book that you've written, I know, is a culmination of decades and decades of work.
So I so appreciate the work you've done and the fact that you're continuing to pay it forward. Most recently with a very digestible book for parents like myself and my wife, Cass, and other people who are listening.
So with that background, talk to me a little bit about this particular book and what inspired you to put pen to paper at this point in time.
Dr. Suzanne Goh | 03:41
Well, thank you so much, Len. And, you know, Magnificent Minds has, for me, been something that I've wanted to write, you know, for many years now. A big part of the inspiration was for me as a physician working closely with families for many decades. I had always wanted a book.
Something that I could recommend to them, families very early in their journey, or even families who've been on the journey for a long time, something that was really understandable. And that gave them what I thought of as the liquid gold, you know, the really essential, most important information that I want every family to have. From the very beginning, because I think it puts them in such a better place to do the most and do the best for their child, which I know is that's, all that parents want. And so I hope Magnificent Minds accomplishes that. I wanted it to feel empowering, optimistic, hopeful, because I truly believe the journey is all of those things. It's just that sometimes we get distracted by detours. And there are a lot of there's a lot of messaging out there and a lot of confusion that I think can make it harder for families. And so I wanted to try to give people. Parents, caregivers, other family members, something to set them off on the right track.
Len Arcuri | 05:04
Fantastic. Well, mission accomplished, because again, I think it does all those things that you mentioned. And that's super important because really so many of the influences a parent has early on after getting that diagnosis is are disempowering. It's people who want to kind of, you know, have you lower your expectations and kind of take your autonomy away of like really figuring out what's right for your child. And I know early on, because my wife Cass put me on a plane to go to a Dan conference where I started to, you know, hear different perspectives.
You know, a lot of times parents just don't know what their options are and they don't Have anyone encouraging them to look at things perhaps differently than what most of the influences around them are saying to them? Because it really is messages of disempowerment and the hope. Is very hard to find. There's a lot of well-intentioned people but they're whispering a lot of things that are anything but hopeful.
Dr. Suzanne Goh | 06:07
That's right. And I've, you know, I've over the years, I have learned so much. From the parents that I work with. But I've then seen the effects of what I call negativity bias. That comes from so many different places. Certainly, it comes from healthcare professionals who are well-meaning, but we too are often trained and taught from a lens of looking at the problems, looking at the negatives. And all of the language and so many of the practices that are part of our field, whether it's ABA or medical or even some of the developmental therapies, there's just so much that I have seen sets parents off on the wrong track. And so much of my career and really what has motivated me to do this work is to Bring... Professionals together and say we can and we must do better. And this is what it looks like. It looks like a whole child approach. And it's not a single, there is no silver bullet. There is no single pill. There is no single magic therapy. That is the solution. It's just not that way. There are a lot of things. And so I'm a huge proponent of a holistic approach, a comprehensive approach, and to help parents realize that doesn't mean it has to be overwhelming. You can still navigate it in the way that feels right to you, that's really doable, no matter what your resources are. And that's what I hope to lead parents to.
Len Arcuri | 07:45
That's wonderful. And it's true.
I mean, I'll raise my hand. I was definitely one of those parents. Desperately, I wanted it to be one thing, right? One quick fix. I wanted to be out of the autism game, if it seemed like a game to me. And it's easy to get into that frame of mind because... If it is more complicated than just one thing, that's hard to get your head around, especially since as the parent, you're not an expert in this and a lot of terms and interventions and things are being thrown around. It's easy to be overwhelmed really quickly. But I love what you just shared, though, because even though it is complex in the sense that it's not one thing and it's going to be multiple factors going on, Ultimately, what a parent can do about it to help their child can be very simple and doesn't have to be complicated or incredibly costly. But that's where, you know, what this looks like in terms of what a parent can do. The good news and the bad news is there's lots of options.
You know, that's a good news because you have not just a few options, but you have many to choose from. But it can be bad news in a sense that it can be overwhelming if you allow it to be, but it doesn't have to be, especially if you take a root cause approach to what's happening to your child, which I know sometimes when I mention that people get triggered because they'll just say, it's autism. What do you mean root cause? But as you've talked about in your book, and I've learned from some phenomenal people over the last 14 years, the label, it's just a label. There's some Something that's driving... How your child's feeling, how they're behaving. And with that root cause approach, So much becomes possible in terms of meeting your child where they are and helping them to thrive as best as they can.
Dr. Suzanne Goh | 09:45
That's right. And really, it all starts with... When we think about root, these root causes. They can That umbrella, that term for me captures so many different things.
So certainly a big... A big area that is referring to relates to medical or biological root causes. And that is, One area that unfortunately still is so neglected, you know, I'm meeting children all the time at varying ages who have had an autism diagnosis for years and have not had the appropriate medical investigations. And so even though our knowledge has really advanced, which is a wonderful thing, and medical research on autism has come such a long way. Is still somehow not translating. Into the clinics. There are still not enough physicians who understand it. There are not enough parents who are aware of what to ask for or how to get their child the best medical care. And so my hope is that By putting what I felt was the most important information about medical root causes into Magnificent Minds, that it would, in the hands of doctors or parents, it would just allow so many more children to get the appropriate treatment. Evaluations, testing, and then from their medical treatments.
So there's so much more we could, I'm happy to talk more about the medical side, but root causes applies to what I think of as more sort of like the neurodevelopmental root causes of behavior, So things like sensory processing differences, motor differences, or dyspraxia, differences in cognitive processing. If we can look there rather than just describing behaviors, then again, we can get to a much better way of supporting a way of approaching, it just opens up the toolbox so much. And that's really That's one thing I'm super passionate about and what I spend a lot of my time at Cortica teaching our team of therapists how to do.
Len Arcuri | 11:55
Yep. No, I appreciate that. And I'm sure your team is dynamite with everyone who has this very different way of, you know, looking at things. But what's your guess, though, when you think about your colleagues, you know, who might like you wrote this book, which for you seems pretty obvious after, you know, you focusing on this for so long. But is the issue, is the reason why other, let's say the pediatricians or other practitioners, is it that people just lack a curiosity?
Like you kind of have an idea of what you think something's about. And, you know, is it just that, cause a lot of things that are in your book, by the way, are, they've been known for a long time.
I mean, and now I think maybe science has caught up and has demonstrated a lot. It was maybe guessed that before, but this information has been out there for a while and it's shocking that so few people really understand what autism is, what it isn't, and these root causes behind those behaviors and physical symptoms.
Dr. Suzanne Goh | 12:57
Yes. I mean, I You know, I do think it's shocking. And I think there are actually a lot of reasons why. More people aren't aware. I sometimes, you know, I look at So Magnificent Minds has close to 400 different books and research articles referenced.
You know, these are the things that in the course of my career, I found so important and, Really? As you say it. These are things that we know. And it's really when you put them all together, it then leads you to what I call a whole child approach to autism. But there aren't enough people, I think, putting it all together. There's so much of a tendency today in research and in clinical care for people, for practitioners like myself to specialize, to hyper specialize. And autism is not something that you can. Do justice for... If you're hyper-specialized, it requires making connections and it requires a holistic view... I think that when I look at my physician colleagues or my, you know, colleagues in ABA or in the developmental therapies, What I see is certainly a desire to do the right thing and to offer the best possible care to patients and clients. But there's a lot to know and they're pressed for time. The current, you know, healthcare system does not reimburse appropriately for the kind of care that neurodevelopment and especially autism needs. And so You know, insurance companies aren't paying for collaboration time. And we know different providers have to talk to each other. And so we're just as providers, we're in a bind. And there isn't a lot of time, you know, if you're a general pediatrician, there's so much that you have to do. Often they're seeing 40 or 50 patients a day. When they see their patient with autism, It's their stuff too. They don't. Quite know what to do and they don't have the time to investigate it. I was in a position where When parents came to me and would ask me about things that I didn't know about, which is extremely common for the longest time, I had to say, let me read about it and I'll get back to you. But again, you know, insurance, The current healthcare system does not support providers to have that type of time.
So I think The desire to do good is there, but there's so many barriers. You know, there's a lot going against us. I will say, you know, sometimes I look at the elements, those building blocks of what now is, you know, a whole child approach that we use at Cortica and that I'm advocating for and hoping that all families can create. And I think so many of those building blocks are what I call neurology 101. There is no question that the brain functions this way, that development happens in this way that child development you know, We can build and can support children no matter their diagnosis. It's because we understand the fundamentals of neurology. And it's just about Really taking the time to connect the dots and bring it all together and deliver it.
You know, so much of the best knowledge is in research studies and academic institutions within the research lab. But there the researchers are busy.
You know, they're trying to push forward the frontiers of science. So they're not then figuring out how it translates directly into the clinic. And so that's what I see as my job is to understand the best of the research that's there. I used to be a researcher, you know, in a lot of different academic institutions. I so value what they're putting out there. And I know as a researcher how hard it is to have the time. To then translate it into the direct care of children.
So that's what My goal is, and that's what our team at Cortica is trying to do.
Len Arcuri | 16:57
That's great. Yeah. And it's amazing how you have so much under one roof because again, it is the correct term is holistic, right? There's so many facets of what might be happening with a person on the spectrum. And so therefore going to see a specialist that sounds like the right thing to do, right? Go see who's the expert. Oftentimes then you have someone who's going to be very limited to what they can actually do. And even what you were alluding to, talking about the curiosity of practitioners, it's not even only curiosity, but as you said, they're limited on time, how much time they can spend.
And then on top of that, even if they want to be able to help answer some of your questions that you might have, if it's kind of outside the scope of the standard of care, then you have kind of legal issues, right? In terms of like what somebody's you know, what they're qualified to opine on what they're not.
So it does get complicated that it's not like the practitioner is a bad person because they're not willing to answer all your questions. A lot of times they're really limited to what they can weigh in on.
So, you know, going back to the idea of, you know, I as the parent was looking for that one fix, that one thing to do. I was looking for that one expert to tell me what to do. And that person doesn't exist.
Dr. Suzanne Goh | 18:16
That's right. That's.
Len Arcuri | 18:17
Right. But it sounds like you've assembled a team where collectively given enough people with the right perspectives, that could be phenomenal for a parent to get, you know, the perspectives of a number of people who are looking at it in a useful way and can again, meet your child or yourself where you are, because that's the maddening thing about that. It's all so individualistic that there is no step-by-step process.
Dr. Suzanne Goh | 18:46
That's right. So it does take a team. No single person has the answer. And Really, once you have the team and you have a team that has the right mindset, understands all of those, elements that I dedicated the first part of Magnificent Minds to. Understands the importance of a holistic approach, understands different types of intelligence, understands the neurodiversity movement and what neurodiversity affirming intervention means, understands a strengths-based approach. Once all of that is understood and is the foundation whether you're a parent or a professional, Then you have the right people together then they can work together effectively and collaborate effectively. It's almost like that is the shared language That is the starting point. And so a big part of the inspiration behind Magnificent Wines was to make sure that parents coming in and joining our team, because we see parents as partners to us. We aren't the authority. They are bringing their knowledge and expertise in so many ways. We are partners to them. And for us to effectively partner together, we all need a common shared language. And for me, that's the language of neurodiversity, of a strengths-based approach, of understanding multiple intelligences, realizing that IQ is not the definitive answer. And when I still hear a lot of professionals say, well, what was the child's IQ? As though that is somehow gonna tell them what a child is capable of or their trajectory. And that's false. And so that is what we have to come in together knowing.
And then we can embark on what is in part two of Magnificent Mind, which I call the whole child path. Because from there, once you've got the right mindset and the right principles in place, then you can really move and move fairly quickly to figure out of all the different therapies that are available, medical or developmental or behavioral therapies. What should what which are the ones that are going to help a child the most? And how do you then move really efficiently and effectively through all of them?
Len Arcuri | 20:56
No, it makes perfect sense. And a key part of that is, you know, what are the critical few things that you can do and to do them well? Because again, I think my wife and I made all the same mistakes in terms of like throwing the kitchen sink, trying too many things that we didn't fully understand.
So yeah. That's the secret for sure. A lot of the coaching we do with parents is to help them discern what are those few things, because otherwise it can be so easy to just get caught up in just a sea of doing and losing perspective on where's your child now and what's the most useful thing to do for them now is something that most parents don't pause to reflect on.
Dr. Suzanne Goh | 21:40
Yes. And that's part of why I felt like the phrase time is brain. Was so important because, you know, there are so many options. It's important to know what not to do just as important as to know what to do, because anything that you decide to do is going to take time and effort and resources. And if it's not, the right match for your child given their unique biological and neurodevelopmental profile, then you're placing really precious time and energy towards something that is not going.
And then you're not placing it somewhere else. That is a better match and is could then yield the progress that you're hoping for, you know.
So it's really important to navigate all of these options well.
Len Arcuri | 22:26
Yeah, there's a sequencing. There's the, going back to root cause, there's, you know, things that you might be able to do to address symptoms that are going on, but otherwise, there's a whole different set of actions that you could take that might really help you to get at what's at the root of what's going on, which is, you know, where you're more likely to see lasting permanent change if you're addressing the root cause. Because otherwise, I think the whole model, if you will. It's all symptom driven. It's a diagnosis based on symptoms for purposes of getting insurance coverage to treat those symptoms. There's very little about getting to the root cause, which is why an organization like the Medical Academy of Pediatric Special Needs are, you know, integrative functional type organizations. Professionals, practitioners, you know, who have this whole systems approach and are dedicated to focusing on with kids with special needs or including those on the spectrum.
So that's why we talked about that organization a lot on this podcast. We've had episodes with their executive director, Honey Manassella, and their leader, Dr. Nguyen-Schwander.
So again, that's That is all part of that first step, I think, again, that many parents miss, including us, which is you have to form that team. Who is that main medical practitioner that's advising you, not who's in charge, but who's partnering with you?
And then who are those other people that you want to have on the team now? To benefit from their collective perspective. And again, it seems like what you've created is under one roof, a lot of those disciplines, which are so essential to have that perspective on the team.
Dr. Suzanne Goh | 24:09
Yes, that was my goal was to have this single integrated team working very closely together. That could cover what I felt were the most important components of optimal autism care. And it doesn't mean that there won't be others.
So we provide medical care, developmental therapies like occupational therapy, speech therapy, physical therapy, music therapy, ABA, behavior therapy, and mental health support. So counseling for individuals, couples, families. Amen. That is... A very comprehensive team, it doesn't mean there won't be others who will be very helpful. Certainly, we you know, the school system, teachers, educators, And there are other professionals in the community who can be a huge help. In fact, I've seen some of the most wonderful work done by, for example, personal trainers and coaches and, you know, amazing community resources.
So there's no doubt. There's no wall that separates what a child may need from, you know, what child wouldn't.
You know, there's for a given child, Piecing together and bringing together the right people to be part of their team is very individual and changes over time. So it's incredibly dynamic. And I think that is something I do see parents come in and say, well, eight years ago, we did A, B, C, D, E, F, G, H, and the laundry list. And so when I suggest something, they'll say no, we tried it eight years ago. It's not a single intervention or single point in time. It really is ongoing, step by step. From make new decisions and you change things. And so it's, you know, continuously evolving, which I think can make it challenging. But really it's true for all people, certainly for all children. None of us stays static. And for children, the changes are even more rapid. And so that is not unique to autism. I think it's part of child development and learning that you continually evolve and continually change. But I do see how that can contribute to you know, a sense of being overwhelmed and a sense of confusion for a lot of caregivers.
Len Arcuri | 26:32
Yeah, it's not as simple as we'd like it to be. But I think The concept you just shared, though, is an important one because, you know, so often you may try something, try an intervention or whatever it might be. It doesn't work.
And then you move on and you check it off the list. But that's, you know, the thing is, yes, it may not have been a fit at that point in time, but that doesn't say it wouldn't be a great fit down the road. And maybe a lot of it gets back to what you started with, you know, if you focus on the foundational items, neurology 101, and you have those in place first, then you're Other interventions will likely have more of an impact, but if you're missing some fundamentals, you know, it's really hard for anything to really have the effect that you'll want it to have. And that's where it does come down to things like nutrition, like eating nourishing foods, having everyone in the family, including perhaps a child on the spectrum in an environment that's not as toxic with environmental stressors. And I know there's a whole bunch of them we could talk about, but my guess is as part of what you've seen, that's part of the neurology 101, right? In terms of getting certain things in place that will benefit any brain, not necessarily just a person on the spectrum.
Dr. Suzanne Goh | 27:47
Yes. And that's something that is, for me, I think is so clear now, is that these principles around optimizing brain and body health are very similar for all people. And that is... One of the things I talk mentioned in the book is that, you know, just 10 years ago, if you were to ask a doctor, does nutrition matter for autism? 99.9% of doctors would have said no. And just imagine how wrong we were back then. Nothing could be more important for brain health, whether for autism or ADHD or OCD or anxiety or depression or anything else. Then what we eat, then nutrition, exercise, how we move our bodies, the social relationships we have. These are, again, I could call that health 101. And so We have to recognize how important these are and then take one step further and look at the research and say, okay, what do we then know about it? Nutrition for autism. And there's a tremendous amount that we do know. One of the most important being that it's not a single diet. I know a lot of families are interested in elimination diets.
You know, they sort of approach it as, okay, what is the one or what are the one or two or three things that I can remove? That will be, you know, the answer. And it just, it's not that simple. But there are professionals, you know, we at Cortica have a very in-depth nutrition and feeding program.
So we're thinking about nutrition, what a particular child needs. Or should be eating to help with their overall health and with their development and brain function. And there's a lot of evaluation and testing that can inform that.
And then we're thinking about How? How to eat because that is often a limiting factor. Many children have sensory, they have hypersensitivities to certain textures or tastes. And there's a tendency to prefer routine and sameness as part of autism. And so it can mean more difficulty or reluctance to try new foods. But there are ways to shape all of that and to help. Autistic children have nutrient dense diets that truly do meet their nutritional needs. But again, it's a stepwise approach. It takes some time, but it's absolutely achievable.
Len Arcuri | 30:20
And I wish what you said was true about the fact that practitioners get it now because there's so many clients we've had who say that their doctor even still now is saying, that the diet doesn't really matter. So it's something that's much better understood now, but still there may be a lot of practitioners out there who, again, this hasn't hit their radar yet about how important nourishment is, which, you know, there's a, as you mentioned, there's a lot of factors that go into it, but simply put, stop eating things that are toxic and then start eating more things that fuel the brain and help the body with whatever it might uniquely be needing.
So yeah, incredibly important avenue. And again, I wish it was as simple as, okay, just let's eliminate gluten. And, you know, It doesn't mean that might not be helpful, just like maybe going to an all organic diet could absolutely be helpful, but it's likely that's not going to truly meet your child where they are in terms of what do they need to, you know, for their body to be the best that it can be.
Dr. Suzanne Goh | 31:27
That's right. That's right. And I wish that physicians and other practitioners... Instead of saying something like, you know, that intervention won't help or diet doesn't matter. If they would say. I don't know. Because really that's what the case is. They don't know, they don't have the answer. But I think it really is... Responsibility that all of us have. If we don't have the answer, then we look, we can guide a family to the people who do. And fortunately there are, you know, there are practitioners who now specialize and have a wealth of information and knowledge and can really help.
Len Arcuri | 32:06
Yeah, no, humility is key. There's lots of practice dynamite practitioners out there. But that's where for a parent, it might be that you need to do a little looking to find that person who's going to be a great fit for you. And again, early on, I know I didn't feel like I had the permission to do that. I kind of felt like I needed to find someone who was close by, you know, so I immediately limited to who was, you know, within five, 10 minutes driving distance and never really thought about what my requirements were for the right practitioner. And I just never really given it some thought.
So you know, once My wife and I did that. It became easier to see who was a fit and led us to a dynamite practitioner who made all the difference for us. And we did an episode with him. His practice was called the Whole Child Center, by the way, Dr. Larry Rosen in Orodell, New Jersey. And again, we were living in New York City and we would drive out of New York City an hour and 20 minutes to get to this other practice because it was worth it for that person's perspective. And so that's where having the right person on the team who meets your requirements is a step I think a lot of people miss.
Dr. Suzanne Goh | 33:18
Absolutely. And we're lucky now with virtual, with telehealth services now being so much more widely available. And really for autism, so much can be done. Virtually. And so I just think that's really exciting and it really makes access to great care so much more feasible for so many families.
Len Arcuri | 33:39
No doubt. No doubt. We kind of touched on root cause and I'm obsessed with root cause. And I'm not going to ask you what's the root cause of autism because that's kind of a silly question. But there are a lot of root causes to look at that might be just getting in the way of good health. For a child, right? And I know enough from your book and from other presentations you've done and others, right? It seems like Right now, it's this interplay of some genetic susceptibility, perhaps, coupled with the exposure to toxins of all kinds, environmental triggers. It's like that interplay between the two. And that gets to kind of like the total load theory, right? Where, you know, everyone has a cup and some children are born with a cup that's already pretty filled. And the more that they have in terms of exposures of all kinds, the more they're going to have to deal with. They kind of hit a tipping point. - I.
Dr. Suzanne Goh | 34:34
Think first as a starting point, it's so important to be thinking in this way, which is, We all have genes, we have our genetic makeup. That is unique to each of us.
And then... Each of us is within an environment and that environment influences gene expression. Which is called epigenetics. And Mark Hyman has a wonderful analogy. He says, you know, our genes are like the keys on the keyboard. And epigenetics is how you play those keys.
So it just tells us, you know, that there's so much that matters beyond our genes. And Having the framework then of recognizing just how important both genes are and the environment, Then, We know where we should be looking. What do we want to understand more deeply? And so in the past, when I would recommend genetic testing and there's a genetic testing has come such a long way.
So there are many different ways we can look at genes and understand a person's genetic makeup. And in the past, sometimes parents would say to me, We can't change genes.
You know, I don't want to do the genetic testing. I'll just feel guilty that I pass something on to my child. But so I think first, and you had mentioned this very at the start of our conversation today.
You know, the, Caregivers are sometimes carrying things around that unintentionally then maybe get in the way. Of taking those steps that ultimately could help the child. And so this is one of them where maybe a sense of guilt or blame is unfortunately influencing decisions or actions in ways that don't end up helping the child or the family. And so I feel very strongly, whether it comes to genetics or understanding your child's biochemistry, or anything else about their medical history or family history, that it's important to get rid of a sense of guilt or blame, No parent ever would have passed on something harmful to their child if they had known about it or had control over it.
So if we could let that go, then I think we can move forward quickly and take the steps needed and get the information. That we can then translate into really meaningful and helpful actions.
So I think genetic testing is absolutely essential. Fortunately, more and more insurance companies will cover it. And the tests are better. But, you know, families often don't know that the tests are changing. They're getting better and better every year. And so genetic testing itself isn't even something that you do only one time and never again. The recommendation now is that you repeat it every five years because you might find new things or the things that you do find There are new steps that can be taken.
So it's important to continue to revisit that. A big part of understanding that Sort of the root medical causes is looking at biochemistry, which is That term is interchangeable with metabolism. And so that refers to all of these complex biochemical processes, thousands and thousands that are happening in the body. And many of these are influenced by nutrition and by our intake of different vitamins, minerals and other supplements.
So there's a lot. It's incredibly dynamic. There's a lot we can do to shift and to optimize a person's biochemistry and metabolism. So for me, those are the big, those are really big buckets. I'll say if there's a third, it relates to, the electrochemistry of the brain. And so understanding, And we get a lot of information about the brain's electrical function through a test called an EEG or an electroencephalogram. That, in my view, is an essential test for almost all autistic children. And it tells us about the brain's electrical patterns of firing. It tells us whether a child is having seizures. We know about 15% of autistic children have seizures. And about 50% have different electrical patterns of firing. And so even understanding that can be really helpful as we proceed with making decisions about medical care.
So it's really I would say it really comes down to knowing what to look for in a person's genetics and metabolism and their neurology. And then understanding that environment and so many other things can influence it. And that's a really powerful combination.
Len Arcuri | 39:06
It is. And again, we could talk for hours about all the potential environmental stressors that are out there, some controversial, some not controversial. But the reality is, yeah, what's happening with your child is unique. And so with that curiosity of understanding what might have been something that got in their way or is getting in their way. And that's why if you did clean up the diet and have less chemicals, pesticides on the food, that is likely a very good thing. And one area I know that I focus on personally is the impact of EMFs in electromagnetic fields where just we see, my wife Cass and I see time and time again with the parents that we coach, How much that is a huge stressor for their child. And when parents take simple actions to minimize exposure, everything improves for the child.
So, you know, that's where it can be daunting with all the things to look around to worry about. But it's so empowering because oftentimes there's so much that you can do not to create a perfect bubble, but to basically reduce those exposures. And, and so from that standpoint, it's very empowering, you know, of what a parent can do and what they can see visible signs that what they're doing is helping.
Dr. Suzanne Goh | 40:23
Yes. And I think of each of these areas as an opportunity and I think that shift in mindset too can be very helpful.
Len Arcuri | 40:37
Yeah, no doubt. No doubt. You mentioned about time is brain. Can we just focus on that concept a little bit? Because I think it's a very intriguing concept. And I think in there, time is brain. There's an urgency, right?
Like you were saying, you don't want to waste time, energy and money now, right? You want to be able to kind of focus on what? Where your child's at or where they are. But this urgency can be something that isn't helpful for a parent because that could even cause more stress. Can you expand on that concept as you feel like in a helpful way that can help a parent who's trying to navigate better?
Dr. Suzanne Goh | 41:15
Sure. I like the phrase time is brain because it does bring attention and awareness I think a type of attention that the developing brain deserves. And that it hasn't received in the past.
So the phrase time is brain actually came about for the treatment of stroke which of course is a condition primarily in older adults. And we, For a long time, stroke, which is a condition where there's lack of blood flow or lack of oxygen to certain parts of the brain, That wasn't treated as an emergency. And it took Years and it took a shift in mindset and this phrase time is brain helped that for doctors and for non-medical people to realize. If you act more quickly, you can actually safe brain tissue and brain function. And that has been a huge success.
So there are incredible opportunities protocols now for managing stroke. They've reduced the time from the onset of symptoms to the delivery of the most effective treatments. And so outcomes for stroke have improved dramatically. And I want that sort of attention for neurodevelopment. And That is really, you know, if we can do that, it means that from the time a child begins to show early signs of autism or other neurodevelopmental diagnoses, it's that those signs are taken very seriously. They're understood. And, lead to a quick cascade of actions that get the child the appropriate medical testing and treatment and support. Where the phrase time is brain can have negative effects that I don't want is if it leads a parent to feel stressed. Or to enter a crisis mode in which they're having trouble taking action.
So there are certain types of crises or emergencies that are great because they lead us to take the right actions. And there are others that are not great if they lead to paralysis. And so really, My hope is that it's the former. And that's why in Magnificent Minds, there's strategies for helping to manage a parent's own stress.
So that they can take action in the most effective ways.
Len Arcuri | 43:44
Yeah, no, and that's really useful too because that's the issue here is that there's a balance of having an urgency mentality of wanting to respond and to help in the most powerful way possible, but it quickly can create you know, anxiety and stress that does get in the way of decision-making. And not only that gets in the way of decision-making, If a parent is in fight or flight, they're exuding an energy that is not very welcoming for the child. And so, you know, that gets to a lot of especially the coaching that we focus on with parents is to help them change their energy because that the child feeds off of that so much, which is why, yes, urgency mentality, time is brain motivate time. Do your best imperfectly. That's great. But if it's my goodness, time is brain and this idea that there's a window that unless your child changes by a certain age, then forget it. You've lost your chance. That just tends to, it just really, it causes such a weight loss. For parents. And that's where if you can strike that balance, that's the sweet spot you're going for.
Dr. Suzanne Goh | 44:58
Absolutely. And it's important to know that there is no window of time that closes. The brain is plastic. The brain is capable of change throughout life. And really, I've seen some of the most dramatic transformative changes happen in adolescents and young adults. In older adults, it's possible. It continues to be possible.
So the idea of a critical window that somehow closes, I think, is not at all helpful or.
Len Arcuri | 45:28
Accurate. Great. Absolutely.
So I guess if you think about And I know you've been at this for decades, but is there anything, let's say in the last year or two? That is a real like significant aha for you. Is there something new that's emerged that maybe something that you didn't fully appreciate as much or something new that's been revealed in the research? Is there anything that jumps out at you?
Dr. Suzanne Goh | 45:52
I think that You know, one of the most exciting areas and recent areas of innovation is in the use of technology. So and there are a few different ways that this is emerging.
So one is in the field area called neuromodulation, which is the application of different electrical or magnetic stimulus to the nervous system to alter its function. And, What's really fascinating is that This kind of technology in the past, when it had emerged, it really was, there was sort of a societal bias against its use because it really reminded people of some of the most extreme types of electrotherapy, like electroconvulsive therapy.
So people have some negative image and associations with the use of electricity. In that way. But electrical stimulation in the nervous system has been used for really centuries and extremely effectively in certain ways.
Like, for example, there's a device called the vagus nerve stimulator, which is an implanted device that stimulates the major nerve of the parasympathetic nervous system called the vagus nerve. Extremely effective treatment for seizures that often can't be controlled by other means, by medication, by can be very well controlled with this type of electrical stimulation.
And then there are, of course, lots of ways that electro stimulation has been used in the peripheral nervous system to help with peripheral nerves and with muscle conditions. So extremely effective. It's just been a little bit more recently that is application to the brain. And to cranial nerves has really flourished. And this, one of the reasons this is so promising is because these approaches are effective and very well tolerated.
So tend to have far fewer side effects. Then a chemical interventions, which are essentially medications.
So neuromodulation, I think, is such an exciting area.
Len Arcuri | 48:02
And would two examples of that be like TDMS as an example or and would neurofeedback be an example of that from your standpoint?
Dr. Suzanne Goh | 48:12
Yes, I would consider both of those to fall within the category of neuromodulation. Neurofeedback is a little bit different because it's not direct. It's not electrical or magnetic stimulation directly to the brain, but it's measuring that information, the electrical information from the brain, and then providing the brain with sensory stimulus, either in a visual or tactile or auditory form.
So, yeah. Yeah.
Len Arcuri | 48:34
Yeah. Awesome. That's definitely helpful. And I think that is an exciting area that that's been just rapidly evolving. And while those could be good options, it goes back to what we were talking about before, right? Where those could be useful, but if some of the foundational stuff isn't in place, those are likely to have less of an impact.
So that's where, you know, you go back to what neurology one-on-one, what can help the brain and minimizing toxic exposure is, giving the body and the brain what it needs as some preliminary steps are so important to get in place.
Dr. Suzanne Goh | 49:10
That's right. You know, for some children, the place to start is neuromodulation, but for others, it's not. And if you were to start at the beginning, you might not see its effects because some of these other components that were more important for that child have not been addressed yet.
So it really is about picking the right approach for the right child at the right time.
Len Arcuri | 49:32
Yeah. Yeah. Everything that we've talked about keeps pointing back to the personalization, the fact that what's happening with your child is so individualistic. And again, the best moves to take, and there are best moves to take, but that's unlikely to be some standard step-by-step. And it's unlikely that you're going to get it from one person's perspective, which is why a team surrounding you is a very powerful move. And wonderful that, you know, your organization that you've provided a lot of that under one roof.
So, So fantastic. But the great place to start is with your book. I thought it was really incredible how you've worked in so many key concepts there.
So again, I recommend any parents. It's a foundational book. Definitely should be not only purchased, but read. And again, it goes on my top list of really useful books for somebody to digest that, again, will help you see things differently. Very differently.
So I thank you for putting that out. And if people want to find out more about you and your organization, where should they go? They.
Dr. Suzanne Goh | 50:38
Can come to Cordica's website. It's corticacare.com. My website, drsuzangoe.com.
Len Arcuri | 50:45
Wonderful. Well, thank you so much for sharing your perspectives.
So many powerful concepts. And I know we've only scratched the surface, but you'll find much more in the book.
So thank you so much, Dr. Goh.
Dr. Suzanne Goh | 50:57
Thank you.
Cass Arcuri | 50:59
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