Autism Assessments

Banu Balaji, the host and an occupational Therapist chats with Dr. Michaela Connolly , senior educational and child psychologist with over 30 years of experience working in disability services. For 15 years, she worked on a multidisciplinary team in a specialist autism service, providing psychological support to autistic children and adults.

Michaela currently works on an interdisciplinary team in a disability service for children and young people.Michaela is a chartered member of the Psychological Society of Ireland and the co-author of the book "Making Space for Autism: Strategies for Assessing and Modifying Environments to Meet the Needs of Autistic Individuals

In the Therapod Podcast, Dr Connolly highlights the shift in terminology from "disorder" to "autism assessment" or "autism identification," reflecting a more person-centered and neuro affirmative approach. Dr. Connolly explains that autism assessments involve a multidisciplinary team evaluating communication, social interaction, learning style, sensory processing, routines, and preferences. She emphasizes the importance of considering autistic individuals' perspectives and using a strengths-focused approach. The assessment process can involve various tools, including structured observations and interviews with parents and the individual themselves. Dr. Connolly also notes that some autistic individuals may mask their true communication style during assessments, and that assessments can take several hours to complete. She emphasizes the need for a comprehensive understanding of autism and the importance of considering co-occurring issues and difficulties.

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Transcript

 Welcome to Therapod. Therapod podcast is about breaking down what we've learned and what we practice as therapists into easy to understand and accessible information.  We know that parenting and caring for a child, especially one that has additional needs, can be challenging, if not overwhelming. We are here to break it down for you. 

We're a group of experienced clinicians, occupational therapists, speech and language therapists, psychologists, and pediatricians, and we will be chatting with parents, teachers, and other professionals working with children. We will also be reviewing books, toys, and equipment so you can make informed decisions. 

Our information is not clinical advice. These are useful insights and information. So please seek professional help if you need it.

Hi, this is Bhanu Balaji, Occupational Therapist and host for TheraPod podcast. Today we speak to Dr. Michaela Connolly, who is a senior educational and child psychologist with 30 years experience working in disability services, providing psychological support to children and adults.  For 15 of those years, Michaela worked on a multidisciplinary team in a specialist autism service, and she currently works on an interdisciplinary team in a disability service for children and young people.

Her work involves assessment, support, therapy, training, and the development and implementation of materials and programs to advance understanding and awareness of autism and ways to support Autistic people.  Mikaela is an occasional lecturer in UCD and a guest lecturer in UCC. She is Adjunct Module Author and Lecturer on the National Training Program for Special Educational Needs Assistance, Awith University, College Dublin, in collaboration with National Council for Special Education.

Mikaela has published research on supporting parents.  Autistic children and peer reviewed journals and has been a guest editor and peer viewer on internationally published journals. She's also co author with Sharon McCarthy and Kaylin McCarthy of the book, making space for autism strategies for assessing and modifying environments to meet the needs of autistic individuals.

She's passionate about working in a person centered, neuroaffirmative and strength focused way. And she's a chartered member of the Psychological Society of Ireland



 hi Michela, you're very welcome to TheraPod. I'm so excited to talk to you because I know you have loads of experience with, especially with autism because that's the kind of service that you work in, you've been working in for how many years now?

. Well, Bhanu, listen, it's very nice to be here, first of all. Um, so I worked in a specialist autism service for 15 years, and I'm now working in my current service for three years. And I would get to meet a lot of autistic children and young people. And I'd also do a little bit of private assessment because that's something I really enjoy doing.

 And I suppose  a big question for a lot of parents um,  out there would be,  The word assessment is a very overwhelming word. And the minute you hear that, the first thing they're thinking is, how long am I waiting? But even if they did get an appointment letter, there's,  Um, anxiety there of what's going to happen.

What happens in, uh, we'll call it ASD, even though I don't like the D side of ASD. An assessment, which is what they're called here in Ireland, aren't they? They're called an ASD assessment. They are, but actually it's interesting that you mention that because I suppose things are changing a lot. So we're becoming a lot more aware of autistic people's preferences, especially in relation to language by listening to autistic people.

And over the last five or six years, there's been huge changes in how we are looking at autism now. And  From listening to autistic people, it's emerging that language is very important to them. So where I work, we wouldn't really use ASD anymore. We just say autism because that D for disorder has huge significance and it's something you don't want to be kind of imparting to young people, especially in children, that there is something disordered about them. 

Because for some people.  Autism isn't a disorder as such.  It's very much a difference for many people. It's an identity. And I think that's becoming more and more  mainstream now. But still, yeah, when when you're strictly adhering to clinical guidelines, disorder still comes up in terminology. And people like me try to.

Walk a line between all that  we try and keep that clinical rigor, but we also really try and listen to autistic people and Adopt what we call or what the autistic people who call that neurodiversity paradigm  in other words Neuro meaning brain, diversity meaning different, that all brains are different.

Autistic people have one kind of a nervous system. It is different and for some people that can of course lead to a lot of difficulties. It can lead to disability, it can really impact on their well being, but for many people  They can manage that given the right environment and the right supports.  So in short, I would be using autism as the, you know, or an autism assessment.

And I would also sometimes be using the term autism identification,  because for some people that's what it is. It's they want to have their identity validated. So they might come to a professional for what they call a professional.  validation. And then there are many autistic people who self identify and who know themselves that they are autistic and they decide, well, this is who I am.

And they, they're able to identify themselves.  And that's a lovely explanation, because I would have been quite stuck with what to say, what to call it, and I really do not like the D part, even the S part of the whole,  but I know that ICD 10 and the DSM 5, that is what is said, but that doesn't mean we should all say it.

Yeah.  Yeah. You're walking a fine line because you want to be rigorous with people. If people are coming to me for an assessment or an identification, I want them to know that I did a good job. And they're often coming because they, they really want to know for themselves, is this what's going on for me?

Um, I autistic. And just even when I'm using the term autistic person, that is a term that The majority of autistic people prefer, but I also know some people would like to be called person with autism. So that's still a thing. So it's something we do. We ask people, what's your preferred, you know, way of describing yourself?

So I'm just going with the majority term. I think that's important. But yeah,  it's it's a kind of bearing in mind that those are the guidelines that we use, as you mentioned,  the DSM five, which is the diagnostical. Diagnostic Statistical Manual, the fifth edition, and that was is published by the American Psychiatric Association.

And then you mentioned the ICD, which is the  International Classification for Diseases, I think, unfortunately,  which is World Health Organization. So one of those two are commonly used to make sure somebody meets what we call the criteria for autism are for a number of other. differences and difficulties as well. 

And tell me, assessment, generally it is younger children that are, um, put forward for assessments. Am I right? I know that there, there might be people waiting when they're older, like young persons, you know, late teens and even young adults, but the pressure in Ireland is around the younger, um, cohort. Is that right? 

It, it actually varies because I think the pressure  is dependent on, um, things that have happened, changes that have happened in maybe legislation and in different areas. So  there, the assessment of need act, which came in to force that was from, was it 2005? You can remind me.  It's a long time ago, but I suppose.

That covered children born from that time. So each year, more children are included in that. And actually now young adults, because, um, we've got to that stage, young adults, every year, more people are going to be included under that act. So the assessment of need act meant that there was a time frame around somebody getting an assessment. 

And because of the numbers and the limited resources, it means that  I would say the majority of people don't get that assessment within the legal time frame. And we have always had waiting lists for autism assessments, and now we have even more. And many people wonder if that's because, you know, everyone's thinking about it now, so everybody's getting it.

I, I think it's because autistic people have always been around and we're getting better. at noticing and identifying them.  And so the pressure for young people is there for children is there. But we would see a lot of teenagers where I work and I work in the public sector. And I would know a lot of adults now who are questioning themselves.

And a lot, naturally, of the young people we would see parents might feel themselves  that they are neurodivergent as well. Maybe autistic, maybe ADHD.  So I think there's pressure from all ages really, because there's a question that we ask, we see so many young people, but where are all the autistic adults?

They're there. Yes, they are. Yeah.  Yeah,  and they have managed somehow, but they do feel that I suppose they get they they are worried and they worry for their child, they worry for the resources that they may or may not be able to get in school and the support, they may not be able to get in school and that's why I think maybe a lot of people come forth.

But I think we should also remember that before this even the AON the assessment of needs came through when the.  Um, the changes in the system came through, there was already a massive waitlist. Yes. Yeah, there was. Yeah. And that was building. Yeah. With more awareness. Yes, there was. Yeah. Yeah. Um, so let's talk assessment specifically.

What happened  in an assessment? Well, that depends where you go.  Um, I suppose it is going to vary, but I can tell you maybe roughly what we would do or what might be considered best practice. And they're very helpful and neuroaffirmative guidelines that psychologists can use and anyone can look them up.

So from the psychological side. On their website, they have autism guidelines, and they're very comprehensive, and they would describe what the best practice would be. They are guidelines, so nobody's going to say, it has to be this way or it has to be that way, but we all try to adhere to what would be considered best practice. 

For a psychologist, it would be,  doing a team assessment. So there's more than one person looking at the little person or the young person or the adult. Well, adults might be different, but for children, certainly up to 18.  It's best practice to have a kind of team approach.  There are no strict guidelines of what, about what kind of tools you would use, even though some people think there are certain gold standard tools. 

It's not as straightforward as that. Um, but people might hear of tools such as the ADIR, which is a parent interview, or the DISCO, D I S C O, which is another parent interview. Many people would have heard of the ADAS, which is a structured observational tool for autism. Um, and then there would be naturalistic observations.

So best practice simply put would be probably a psychologist and one other clinician. It might be a speech language therapist. It might be an occupational therapist. Sometimes we'd, um, be lucky enough to have social workers involved as well. And it would be seeing a child or young person.  Maybe at home or in a school setting and also really getting a good detailed background from parents as well so that you are looking at the child's development from when they were very small and trying to get as much information as you can on how they are doing across a variety of settings. 

And the key areas that you'd be focusing on are a person's communication, their social, um, interaction style. You'd be looking at how they're learning, maybe. You're not doing a learning assessment, but just getting a sense of What way does this child like to learn? You might look at sensory preferences or sensitivities that a young person would have.

Examples of that would be sensitivity to noise or a preference for moving someone who really likes to move a lot. And you would be looking at a preference for routine. A lot of people really like to move a lot. like to have routine and predictability, they might find change and transition difficult. So they're the kind of areas that we'd really try and get a detailed picture of.

And  more and more, I suppose, in my work, we try to ask young people themselves about their experiences, if we can.  So in previously, We might have been more focused on doing a structured observation or, you know, getting them to do a series of tasks. More and more, we're kind of asking, what are the things  that you're finding tricky or what are the things you're really good at?

And getting a sense, you know, from them of what their lives are like and their strengths and their challenges. And that's, that's really working well too. Yeah. And it's also looking at their interaction with yourself, isn't it?  Yeah.  Absolutely. So you're trying to get a sense of what is, is this young person or this child or young person, um, presenting with an autistic communication style or an, you know, their style of interaction.

Now, what can happen though for some young people is with non-autistic people and with other people they might have learned how to put on a mask almost. Or not, they might not even do that consciously, but they might really be trying to communicate in a non autistic way because they've learned  that's what you're supposed to do almost.

And so  knowing whether somebody, their true interaction style, whether you're saying that are their true, um,  preference for communication. You mightn't really see that in an assessment  because, you know, so sometimes we give permission for young people, maybe not to make eye contact, or to be as comfortable as possible, to be able to leave at any time if they need to. 

Um, and that's easy for me to say because I've been doing this a long time and that's, that's, I know, you know,  pretty good at kind of judging.  somebody's communication and interaction style. It mightn't be as easy if you're new to autism or new to the area. And that's why in the best practice, you really should know a lot about autism before you're engaging in doing assessments.

And that's very relevant because sometimes you could be in an assessment where they might be just nervous or anxious and then present in a way that seems.  Um, I suppose. Yes. So you, some people do mask and that's why it's important to get information from different sources and from people who know the young person well.  to see if that's what's happening.  And that's why assessments can take a long time. They can take a few hours from start to finish. 

And they're time consuming and they're very laborious as well because there's a lot of information we want to get and we need to  put it into context and also write it down in a way that makes sense to everybody.  Yeah, and I suppose we are becoming better at Being more strengths focused as well and not so much framing autism as a deficit, but more as a difference.

So I think that's important in an assessment, that when a parent reads, or a young person, because often young people do,  Whether they're meant to or not, they get their hands on reports, but that they recognize themselves in it and that it is strengths focused. So you're using a neuroaffirmative approach and not that somebody has failed this test of being, you know, typical, but more that they're  wonderfully different.

And yes, many people do need a bit of support because. Autistic people live in an unautistic world, so they do need support in many areas, but that's only because they're really not catered for.  much of the time.  Um, typically, like sometimes I suppose there are co occurring issues and difficulties and disabilities that an autistic person can have.

So I think some people,  you know, would offer extra assessment pieces. So you might look at,  there could be an intellectual disability for the young person or child, or there could be other things going on and And sometimes when I'm seeing a young person, we have a question about whether is there something like ADHD happening here as well?

And so we might just suggest to parents if they ever had any concerns about that and and if that would be a good idea to follow up with their local maybe child and adolescent mental health service. But we are not going to be assessing for that. But if we see areas of need, we would be trying to kind of signify those are things that might help. 

Um, and as I think like with all developmental type of assessment, there is a lot of questioning though, that  the assessor does. I think that is something that can be quite, um, difficult for parents to firstly to remember a lot of developmental milestones, but also difficult to process for them because it's quite intrusive. 

It's important. Yeah, it is. And I suppose you don't want it to be too intrusive either. So for professionals, I'd be kind of saying just take the information you really need, because some of these forms that I would be working with, you could be asking so many questions.

Not all of them are relevant at all. So, yeah,  but I would say to parents, who  have concerns or think their child might be autistic. Keeping notes can be really helpful.  Um, what are you seeing that's different? And I don't want to be giving people another job because there is a huge amount of form filling.

There's a huge amount of frustration when you're on this road. Um, And look at neuroaffirmative information.  Follow maybe autistic adults on social media because they give out such great advice. They give great content if you're looking at autism.  And, you know, I noticed maybe what's different or what you see in your child.

And often people say to me, I hate comparing them to their sister or to other people, but that's what we naturally do as people. We do compare. So just maybe notice your comparisons. And that can help you to remember. when somebody is asking you. And of course, if you've more than one child, it's a nightmare to try and remember who did what and when.

And, you know, what is significant and what would they be looking for? Um, What are the features  that, that they're going to be asking me about? It's really helpful I think as well for parents to have information before coming for an assessment or an identification. So if the service you're going to or the provider you're going to has any information for you, that would be great.

You know, of course you'd like to know what's going to happen.  100%, 100%. And things that can look like autism?  Well,  different things. There are what we call differentials and you could look for differentials. So sometimes people would talk about things like language disorders might look like autism or sensory processing. 

Things might look like autism, um, some mental health issues can look like autism. Maybe ADHD can look like autism. There can be an overlap there. But we, I wouldn't be ruling out autism by saying it's something else, because you can always be autistic like anybody else. and have ADHD or have an intellectual disability.

So it's almost not like ruling it out,  um, just because it's something else. You know, if, if you've concerned, if you've an idea that something  looks like autism, then, you know, it's worth checking it out.  Um, what would be some things that a parent might need to notice to kind of  think that is there autism there or not, you know,  and so for some people, it's. 

It's easy to see  the things  mean they might be autistic. So some of the things that we would often find that are common for autistic people are differences in their communication, for example, so people who might prefer. other people to be very clear in their communication or delays in communication. So children who  maybe are different, they're behind in their non autistic peers, maybe in the development of their language.

Something that is we would also consider  worth investigating is when somebody maybe has a setback or a regression in the development of either social or communication or play skills that they seem to be coming along.  typically up to a certain age, and often that's between 12 and maybe three years of age.

But there was a setback and that area maybe stopped developing.  Other things that are quite common are stimming, like flapping hands and making unusual little movements, or they might seem unusual. They're not unusual to autistic people. And Maybe repeating speech. So  a lot of autistic people learn speech in a certain way.

And we call that echolalia. So they can learn by repeating chunks. It's a lovely, natural, different way of learning how to communicate. And it's, it's called  gestalt processing. So they just process things differently. Um, sensitivity to noise is a really common one. So that. Being really sensitive to noise, easier to spot in younger children, but older children maybe learn how to mask it. 

Often people look at everyone else around them and go, well, they're not reacting to the noise, so I must learn to kind of suck it up almost. So sensory sensitivities would be very common  in autistic people.  And I suppose, yeah, people who might be quite happy in their own company are who love to be with other people, but it really drains their battery for older  children and young people.

We'd see coming out of school and being absolutely exhausted. just really running on empty from working so hard all day long and everything, including social interaction. And sometimes this unfortunately can lead to what we call autistic burnout.  So young people who come out of school maybe for a time or really need to rest and recover from their school experience or other experiences in life when they've just been really overwhelmed for too long  and really depleted of their energy.

So there are different things. But I think. You know,  going with your gut as a parent and very often people are reassured by other people and told, Oh, no, you know, it isn't that or they'll grow out of it or he's just a boy, but I would really go with your gut if your child seems very sensitive, very sensitive around other people and finds it really hard to regulate their emotions and is you.

Fair minded and kind and has great focus on particular interests.  Really likes to know what's happening and if you find you're doing a huge amount of preparation for change or you know that you really are helping by scaffolding them.  All these together, but I suppose you need to meet a certain threshold because we are all different and it needs to impact on your functioning in everyday life really.

Um, to, to kind of meet the criteria. But I think anyone who feels they are autistic and feels that would explain things for them, you know, that's that's a good idea to get validated really.  And some, you know, and there's sometimes terms thrown like high functioning, low functioning or level one, two or three. 

Are they still in existence? The use of those words or  what's happening now with them? And definitely wouldn't be using high and low functioning. And autistic people explain this really well. It's not like a spectrum, like a line with high at one end and low at the other. It's much more like, you know, There's just different, different things going on for somebody and.

Even, you know, people who would say, Oh, they call me high functioning because I can speak, would say that there are days when I cannot function at all. And I don't, I'm not able to speak. I go non speaking because of stress. So it really doesn't make sense. And so it's just autism.  Would have been called low functioning before very often referred to non speaking people  and what we know about non speaking people is that  they have loads of strengths and ability as well.

So I think we don't say that so much anymore. Um.  The level one, two and three, uh, came out with that DSM five, the latest edition of that.  I think it's more relevant maybe in America where they look at insurance and the insurance entitlements might be linked to those.

That's what I think. We really don't use it where I work. I would never use that. I don't think it makes sense. Yeah, and, and my understanding of the levels is, um, it's the level of support somebody needs. So if they were on a lower level that they need more support, uh, you could easily have someone who has been supported in a lovely way by home and school and,  um, in their neurodiverse life. 

Presentation. Yeah. Um, and still be autistic and have  that and still function well enough. Yeah, yeah. Absolutely. Yeah. So it just, yeah, it doesn't make sense And, um, in an Irish perspective anyway, so we, we don't tend to use it that, and we would really just go with, well, what are the little person's needs?

Um, and how would they best be met? Be met, yeah. Girls and autism.  Girls have, I suppose, autism was traditionally conceptualized. more as a  really a white male middle class, you know, uh, thing. So it's not just that a whole load of girls were missed out, but a whole load of people from different, you know, ethnic minorities are different backgrounds would have been missed out as well, I think, traditionally.

But girls are considered to have a more subtle presentation.  Um, and so. Yeah, that there are these different tropes about it. I've met many girls who are clearly autistic and they're, you know, that's fine. And then maybe I've met boys who are masking as well. So I do think historically, girls have been definitely underrepresented.

But I do think that's changing. We're getting better at.   And more and more girls are coming forward now. 

Um, I wonder, was, were they just masking earlier because they had to? Um, and of course, then you see in later life as they get older, that's when the mental health kind of presentations  start to, uh, be very prevalent.  apparent, you know, the being more anxious and moving difficulties. And of course, then we have the hormones as well playing at us.

So, yeah, definitely. And I think, you know, we would have a number of young people still referred, many of them girls, from CAMHS. They've been to their child and adolescent mental health service first because of distress, because of burnout and resulting in mental health challenges. So sometimes they go to a service like that and the clinicians there would say, we think this might be autism as well, you know, so they'd be, they'd come through that route.

  And that's very common. And that's not, you know, for any parents listening, that is very common.  You might not ever, you know, and it's in the diagnostic criteria in the DSM 5, you might not notice somebody's autistic until demands exceed  their ability to cope.

And that can often happen.  after transition,  you know, to secondary school. So a lot of people have a lot of guilt around that, that I never thought I never knew I could. You you couldn't have known, you know, that sometimes it's not till later that  somebody who may have been masking or had been managing really well.

Suddenly, life changes a lot, doesn't it? When hormones kick in and secondary school and all that social stuff gets very complicated. But you can also see that younger, like some kids, some children would meet  criteria for an assessment. Straight away. And then with some children, you have to say, actually, we need to wait and see for another few years, how this is because it is hard to say it is,  as you say, not just a spectrum, but it's actually so different for the different people that Yeah.

It's not as apparent and you don't want to stick a label on them straight away.  Yeah. And I mean, I, I, and I think that might be, we might be moving forward with that as well, because I absolutely people say we, we don't want to label somebody, but we're getting better kind of saying, well, maybe it's, we could look at it as an identity.

And then. If somebody knows they're autistic, they can access all the resources and know that they are not the only one. There are millions of people in the world like you and that it's an identity and it's who you are. And it might explain all the things that are going on. So I know some people can be very hesitant and say, I don't want to label them.

I don't want to put it on them. But actually, we try and reframe that a little bit and saying you're opening up a whole other world to them. You know, and if it feels OK to them to identify as autistic, it can be really helpful.  And absolutely, it's a risk you take,  you know, with your young person. What if they really don't want to hear this?

So all that we would. Manage very individually.  Amazing. Um, that is very thorough and um, lots of insights into this world. It is a world, isn't it? It is. It is a world and I suppose like I'm I think I'm neurotypical. I don't know. I, I  We won't even go there.  But it's not a world where I live in, um, like a neurodiverse person does, but it does open up a whole world to them about the possibilities of  meeting other people who are like them  and have the world support them in a way that,  um, they can function without worrying, without being judged, I suppose.

Yeah, yeah, it's getting better. It certainly is getting better things. There is more awareness, but there is still a lot of things. lack of awareness and even where there is awareness, things aren't changing fast enough. But I think  it is really helpful to know,  to, to know if you are autistic because it can really explain your experiences and you can feel less alone.

And I know that's easy for me to say, because I'm so immersed in it. I see so many. amazing young people, so I can be positive about it. But I think it's a it can be a very lonely struggle when you're a parent starting off trying to figure all this out. Yeah. And the fear. And, you know, when you hear maybe you didn't think it, maybe somebody else said to you, I think you're a little person might be autistic or you might need to get a multidisciplinary assessment or something.

And the fear and uncertainty that you can experience because of that. Um, and I suppose. Everybody's journey is different. Some people are, you know, will be independent. They will absolutely live lives.  comfortably, they will be able to do all the things that you dreamed they would be able to do. Other people, it is trickier and they might have a different life. 

But  even autistic people who have a different life, who need a huge amount of support, would say, this is my life. And,  you know, this, this is my life. This is how I live it, but it, it is my life. You know,  um, I remember going to see Dr. Temple Grandin speak years ago. She was in Cork. ?

Yeah. Um, one mom asked a question that her tea, she said, my teenage daughter really finds it very hard to connect and make friends and socialize with her peer group, but she's fantastic with adults. And Dr. Grandin was like, she skipped all those steps.  What we want in the end is to be socializing with adults.

She's gotten there. Why are we worried? And that, that day was like in my mind. Yeah. You know, that's true. Sometimes we can get stuck on those little, little details and we forget what the end goal is. Yeah, and we'd often say that as well to young people, is that you're going to grow up and you can be friends with people of any age, you know, but it is quite tough when you're going through school and your peer group are really difficult.

And a lot of autistic people get on really well, like you say, with adults or with younger children, their own peers are really tricky. And I think, you know, just touching on that as well as  if we have more awareness, of autistic people, maybe we can go halfway in supporting them with their communication.

Maybe we don't always have to be putting the onus on them to be communicating in a non autistic way or to be socially interacting in a non autistic way. Maybe we can honor and validate their communication and their interaction. Um,  It's a two way thing, but that's really only starting  to kind of happen. 

Um, 100%. And I do think that younger, young people have more awareness.  that I would have had when I was that age at all. And they are much more accepting of a lot of differences. I'm not saying it's 100 percent perfect, but  they're they're used to it. They're aware of it. They absolutely are. So it I would be hopeful because young people are great. 

I'd be very hopeful that where possible, that's going to be a lot easier for people.  And on that hopeful note, um, we'll say bye. But also that, you know, I hope to have more chats with you. Oh,  that'd be lovely. Always a pleasure, Michaela. Ah, thanks a million for having me. Thank you. Yeah. Thank you, Benham. And before we finish, it's always good to hold in mind that if there's something that has resonated with you and that it's staying with you, or maybe leading to a big feeling that you want to talk about, contact your GP, who's your first port of call.

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