We often describe Autism as occurring along a spectrum, but as any clinician, parent, or autistic adult can tell you, that word barely scratches the surface. Why do some children talk early while others are late bloomers? Why do some folks mostly wrestle with social connection, while others face challenges in mood, learning, attention, or all of the above? 

A major new study from Princeton University and the Simons Foundation brings us a little closer to an answer. By following more than 5,000 children and analyzing hundreds of behavioral and developmental traits, researchers found evidence for at least four distinct clusters or subtypes of autism spectrum disorder (ASD). Each has its own unique blend of strengths, struggles, and even distinct underlying biology.

1. Social and Behavioral Challenges (37% of the study's sample)
These are the kids (and adults) whose most noticeable challenges are in social communication and repetitive behaviors. These are the features that people often associate with "classic" autism. Most people in this group reach developmental milestones like walking and talking on time. However, they are more likely to also have other concerns, like attention deficit disorders (ADD or ADHD), anxiety, or obsessive-compulsive disorder (OCD) alongside autism. The research suggests that, for this group, the biggest changes in brain development happen after birth, not before..

2. Mixed ASD with Developmental Delay (19% of the sample)
This group tends to reach milestones (e.g., first words, first steps) a little later than expected, and may again show more classic autistic traits. Kids and adults in this group tend to have fewer additional mental health diagnoses (as compared to the Social-Behavioral group). Also in contrast to the first group, their genetic profile points to differences that begin before birth, which may help explain the early and global impact on development. Finally, evidence suggests that these traits are more likely to be passed down through families.

3. Moderate Challenge (34% of the sample)
Individuals in this group show milder autistic traits, tend to reach milestones on time, and have the lowest rates of co-occurring mental health concerns. Their genetic and developmental profile sits somewhere between the first two groups. People in this category may be less likely to be identified early or may fly under the radar, but their support needs are just as valid.

4. Broadly Affected (10% of the sample)
This group faces more extreme and wide-ranging challenges. They may have significant developmental delays, social and communication difficulties, repetitive behaviors, and co-occuring mental health conditions like anxiety, depression, mood dysregulation, or behavioral difficulties. These traits do not appear to be inherited from parents, but rather may be the result of rare, non-inherited changes or mutations that shape the brain early in development.

Why This Research Changes the Game
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For years, the “spectrum” metaphor has helped us think more flexibly about autism. This new research goes further, showing how and when the brain develops differently for different individuals. This could have some real implications for...

• Personalized Care: If we know which subtype someone best fits, we may be better able to predict and support their unique combination of strengths and needs, not just for autism, but also for related challenges they may face like ADHD or mood issues.
• Early and More Precise Intervention: Understanding a child’s profile could help clinicians and families plan proactively, rather than taking a wait-and-see approach.
• Better Research, Policy, and Advocacy: Future studies (and, ideally, funding priorities) can move beyond “one-size-fits-all” thinking and focus on what works best for each subgroup. This could change how we approach diagnosis, treatment planning, and support across the lifespan.

How This Might Affect You or Your Family

If you or someone you love is on the autism spectrum, this research offers a reminder that your story is uniquely yours. There is no single right way to define autism, and no universal timeline. Support needs may change, and understanding which “road” you’re on can help you be more proactive, prepared, and, honestly, a little more compassionate with yourself (or those you love).
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What's Next?

This study is a big step, but there is so much more we have to learn. As the science gets better at connecting the dots between genetics, brain development, and lived experience, I hope we’ll see more precise diagnoses and more effective, individualized support for those with autism and their families.

If you, like me, are a clinician, keep an eye on this research as it develops. It may re-shape assessment and intervention in the years to come. For parents, educators, and self-advocates: keep asking questions, keep seeking information, and don't be afraid to ask your providers how new science might affect your options. And keep sharing your stories! They are the real foundation for understanding the spectrum in all its forms.

Like so many of you, my heart has ached in the days since the floods in Central Texas and the tragic losses at Camp Mystic. Even if you and your loved ones were not directly in harm's way, it's natural to feel grief, worry, or a sense of helplessness in the face of so much loss and destruction. 

If you are a parent, teacher, or just someone caring for kids or teens right now, I know that it can be hard to know what to say or do. The Grant Halliburton Foundation has put together a Trauma and Loss Resource Page with tips on how to talk with young people about loss, what to look for if they are having a hard time, and ways you can support their mental health as everyone begins to process what has happened. 

If you or someone you care about could use help finding a counselor or mental health support, you can call the Here For Texas Mental Health Navigation Line at 972-525-8181, Monday through Friday during the day. Their team really listens and can point you to resources close to home. You can also browse HereForTexas.com for local providers or just to get some helpful information.

Please share these resources with anyone who may be having a difficult time right now. Sometimes just knowing what's available can make things a little lighter. None of us are meant to go through times like this this alone.

Ways to Help Others Impacted by the Floods
Many folks have asked how they can help, even from a distance. If you're wanting to do something concrete, here are a few trusted groups who are right there on the ground:

• American Red Cross – South and Central Texas: The Red Cross has opened shelters in affected areas and is accepting donations online. Select "Your Local Red Cross" or Disaster Relief as a donation option. Donations can also be made by phone at 1-800-HELP NOW (1-800-435-7669).
• Kerr County Flood Relief Fund: The Community Foundation of the Texas Hill Country established this fund to support vetted organizations providing rescue, relief, and recovery efforts.
• Kerrville Pets Alive! and Austin Pets Alive!: These animal shelters are caring for displaced pets and working with volunteer search and rescue groups to find lost animals along the riverbank. They are also providing support for families who have lost pets, including help with recovery and cremation costs.
• World Central Kitchen: WCK is providing meals for rescue workers and displaced families. Donations help keep these efforts going.

In moments like these, I'm reminded of how powerful it is when people come together. It is so important to remember the shared humanity that unites neighbors and communities. 

As we show up for our friends and neighbors, remember that small things matter. Give what you can with what you have. And give yourself permission to rest and let others show up for you, too.

I am holding space in my heart for everyone who is carrying sorrow right now, and for all the helpers (seen and unseen) who are quietly supporting others along the way.

Have you ever felt like you are just going through the motions? You may be keeping up with work, family, and your day-to-day life, but you still feel disconnected and emotionally drained. In a recent episode of the ZOE Science and Nutrition podcast explores what is often known as "high-functioning depression." In this episode, Dr. Judith Joseph, a Harvard psychiatrist and researcher explains that when people appear to be doing well from the outside, friends, family, and even physicians may miss that they are quietly struggling on the inside. High-functioning depression can be especially common among high achievers who are used to pushing through and staying productive no matter how they feel.

ZOE Science & Nutrition, Signs you may have high-functioning depression - and 5 ways to fix it Dr. Judith Joseph and Dr. Sarah Berry. 

It’s one thing to know mental health matters. It's another thing entirely to give yourself permission to act on that.

This year's theme is “Turning Awareness into Action,”  In my practice, I often hear clients say they know what they “should” do: eat well, get in movement and sunshine each day, prioritize quality (and quantity!) sleep, connect with friends and community.
The hard part is doing those things when life feels overwhelming, or exhausting, or like you’re holding things together with duct tape and coffee.

So this month, I’m not offering a pep talk about radical self-care or overhauling your life.
Instead, I want to offer a gentle nudge towards improving your mental health.

Start by checking in with yourself.
Before you can take meaningful action, you need to know how you’re really doing. Even a few minutes of reflection or journaling can help you notice what’s happening beneath the surface.

Try asking yourself:

• What's been giving me energy lately?
• What's been quietly draining me?
• What do I need more of right now? What could I use less of?
• Where in my life do I feel most like me?
• What feels in sync with what matters to me the most? And what doesn't?

Then, take one small step.
Not a ten-step plan. Not a life overhaul. Just one gentle shift.

• Reach out to a friend you've been missing.
• Say "no" to one thing this week so you can say "yes" to rest.
• Schedule that therapy session you've been putting off.
• Trade 10-minutes of doomscrolling for something calming or nourishing.
• Step outside and breathe for 5-minutes without doing anything else.

Those everyday actions add up.

And maybe, have that conversation.
You know, the one you've been rehearsing in your head, or avoiding entirely. Maybe it's about a boundary you need to set. Maybe it's being vulnerable enough to ask for help.

Whether it's a conversation with a loved one or with a therapist, saying the hard thing out loud can be a powerful way to take action for your mental health.

This month, let yourself remember:
​You are allowed to care for yourself. You don't need permission to tend to your mental and emotional well-being. It's part of being human. When you do, you're better able to show up in your life, in your relationships, and in your work as the version of yourself that feels whole and steady and real. 

Research reveals that our brains often interpret imagining an action as equivalent to performing that action physically. In her insightful article for Psyche, Anna Urbanek explores how to harness this connection between mental imagery and real-world performance. By mentally simulating future scenarios (an intervention often used in EMDR!), individuals can enhance their focus, confidence, and preparedness. Urbanek emphasizes the value of visualizing not just success but also potential obstacles, allowing for strategic planning and emotional regulation. Whether you're gearing up for a presentation, an exam, or a social encounter, engaging your imagination can be a powerful tool for achieving your goals. Read the full article here for practical strategies on mastering this mental technique.

As winter settles in, there is an accompanying rise in the prevalence of Seasonal Affective Disorder (SAD), a form of depression that occurs typically during the late fall and winter months. When daylight hours shorten in the winter, disruptions to our internal clocks occur, impacting the production of mood-regulating neurotransmitters like serotonin. Substantial research and clinical experience point to bright light therapy as an effective non-invasive treatment for seasonal depression.

Light therapy, also known as phototherapy, involves exposure to a bright light that mimics natural sunlight. The science behind this therapy is rooted in its ability to regulate circadian rhythms and influence neurotransmitter levels. Research has shown that just 20 to 30 minutes of daily exposure to bright light (10,000 lux) can lead to notable improvements in mood, energy levels, and sleep patterns. This makes light therapy a valuable option for those seeking relief from the winter blues.
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A large number of light boxes are available on the market, but it can be difficult to know which of those meet the specifications researched for effective treatment of seasonal depression. Light boxes aren't regulated by the Food and Drug Administration (FDA) for SAD treatment, so it's important to understand your options. The Yale School of Medicine provides helpful information and links to specific light boxes that have been demonstrated to be effective.

Dallas is currently in the midst of another triple digit heatwave that, despite the no-doubt immanent arrival of pumpkin-spice season, shows no signs of letting up soon. While there are regular reminders in the news to guard against heat stroke and the physical effects of heat, it is also important to know that extreme heat can negatively impact our mental health as well.
 
A recent meta-analysis published in The Lancet found positive associations between temperature and suicide rates, hospital admissions for mental illness, and community mental health outcomes. Aggression, domestic violence, and substance use can also increase during periods of extreme heat.
 
Certain groups are more vulnerable to the mental health impacts of extreme heat. People with pre-existing mental health conditions, dementia, or those taking certain medications (more on that below) might be at higher risk. Socioeconomic factors, such as poverty and substance use disorders, also substantially contribute to vulnerability.

​Certain classes of medication used to manage physical health conditions can make it harder for your body to handle extreme heat. These include medications to treat heart conditions, blood pressure, diuretics, anticholinergics (such as those prescribed for Parkinson’s and overactive bladder), antihistamines, and decongestants.
 
Similarly, some medications used to manage mental health conditions can impact the body's ability to stay hydrated, regulate temperature, and respond to heat. These include central nervous system stimulants prescribed for ADD/ADHD, medications to treat depression and anxiety (SSRIs, SNRIs, and tricyclic antidepressants), as well as some medications prescribed for schizophrenia and bipolar disorders. These medications can be life-saving and have profound benefits for quality of life, so it is important for healthcare providers and patients to work together to manage medications effectively, especially during heatwaves or other extreme weather events.
 
As we collectively navigate the extreme heat of the next several weeks, you can prioritize your physical and mental health by staying well-hydrated, taking precautions against becoming overheated, and checking on vulnerable family members, friends, and neighbors.
 
If you'd like to learn more about the Lancet study, Dr. Robert Bright, a psychiatrist with the Mayo Clinic, talks more about that research and the effects of heat on mental health here.

Research has shown physical movement to be a powerful tool in alleviating symptoms of depression and anxiety, as well as enhancing our overall sense of well-being. As we enter the sunshine and blue skies of Hot Texan Summer (TM), it is helpful to remember the beneficial effects of movement on our mental health and the importance of incorporating physical activity into our daily lives.

Over the years, a growing body of research has shed light on the positive impact of physical activity on individuals experiencing depression and anxiety. These studies highlight several key findings:
 
Release of Mood-Boosting Chemicals. Engaging in regular physical activity triggers the release of endorphins, neurotransmitters that act as natural painkillers and mood elevators. Endorphins induce feelings of happiness and well-being, counteracting negative emotions. This chemical boost can significantly improve mood and reduce symptoms of anxiety.
 
Neurogenesis and Neuroplasticity. Movement has been shown to promote neurogenesis (the formation of new neurons) and enhance neuroplasticity (the brain's ability to reorganize and adapt). These processes play a vital role in improving cognitive function, memory, and learning abilities. By stimulating the growth and connectivity of brain cells, physical activity helps create a healthier neural network that supports mental well-being. Studies indicate that regular exercise may even significantly reduce the risk of developing dementia.
 
Stress Reduction and Anxiety Management. Movement acts as a natural stress reliever by reducing the levels of stress hormones such as cortisol and promoting relaxation. Regular activity can also help manage anxiety symptoms, which often coexist with depression. Engaging in activities like walking, jogging, yoga, or swimming can provide a much-needed respite from daily stressors, promote a sense of calm and mental clarity, and improve sleep.
 
Social Interaction and Support. Participating in group activities or team sports provides an opportunity for social interaction and support. Engaging in activity with others can foster a sense of belonging and community, creating a supportive environment that combats loneliness and enhances our sense of well-being.
 
Physical activity can be a powerful a complementary tool alongside professional treatment for depression and anxiety. A recent meta-analysis published in JAMA Psychiatry, found that relatively small doses of even moderate physical activity (2 hours per week) were associated with substantially lower risks of depression. (Dr. Roger Seheult examines this and another recent study exploring depressive symptoms and sedentary behavior in adolescence in the video linked below.)