An Autistic Nurse Practitioner Speaks on Neurodivergence
Hear directly from a nurse practitioner on how to better understand and treat patients with an autism spectrum disorder.
Growing up, Meriah Ward, DNP, FNP-BC, PMHNP-BC — now a nurse practitioner (NP) based in North Carolina — came to the unusual conclusion that they didn’t mind being in trouble at school. Or, more accurately, they found that the punishment that teachers doled out for bad behavior could result in a surprising opportunity to focus.
“Growing up, I felt very out of place,” Ward explained to host Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FAANP, FNAP, FAAN, on the latest episode of NP Pulse: The Voice of the Nurse Practitioner® entitled “Neurodivergence: An Autistic NP’s Lived Experience.” Ward recalls they would “often get in trouble for speaking during class,” and “got into conflict with other students because there was a big social gap — and we know that’s a huge component, as one of the diagnostic criteria for autism. When I struggled with those social connections, I would get very frustrated, and I would find myself arguing with other students...and I would get put in in-school suspension (ISS).” In ISS, Ward was able to “finish all my work within the first day of my suspension, and then I would spend the rest of the time just reading books, and it was the best time that I ever had in school.”
Reflecting on why that was, Ward notes that “I think it was because I was able to sit in a quiet area by myself. I wasn’t intruded upon by other students, and so I was able to get all my work done and read all of these books while being in school, and I felt good — it didn’t feel bad.” Ward clarifies: “When I recall that [time], do I really love how I got into ISS? Of course not. But being able to be by myself and learn on my own was so invigorating.” They didn’t know it at the time, but what they were experiencing would come into sharper focus after they went through a diagnostic screening for autism in their thirties.
“I only got diagnosed because I had gotten pregnant with my daughter, and I just didn’t feel connected to my body, to her, and I was really worried something was wrong with me,” they tell Thomas. “I had her, and then spent a year trying to find a good fit to get diagnosed.” Ward connected with a psychologist (“she was wonderful”) and went through the assessment process, which Ward recalls “was about two whole days’ worth of diagnostic procedures.” At first, Ward suspected they might have PTSD or autism, and then learned that they in fact had both. Later, Ward was able to combine this new knowledge with their training as an NP, and created a presentation entitled “Neurodivergence in Clinical Practice: Perspectives from an Autistic NP,” which they recently gave to other NPs at the 2024 AANP National Conference.
Accessibility and Knowledge
More and more children are receiving an autism spectrum disorder (ASD) diagnosis, with the Centers for Disease Control and Prevention (CDC) stating that in 2023, approximately 1 in 36 children received an ASD diagnosis by the age of 8. Of course, this doesn’t mean that more people have ASD than in previous years — rather, ASD is just better understood than in the past, and awareness of ASD is leading to diagnoses that may have been previously misunderstood or misdiagnosed. Says Ward: “Accessibility and knowledge into the community has grown the diagnosis. So maybe we always were 1 in 36, right? But the accessibility for being diagnosed has grown rapidly.”
After receiving their diagnosis, Ward felt compelled to share with other NPs what their experience has been like as both a patient and a provider. They recall an instance when they were being singled out at their job for excellent charting, and the CEO wanted other providers to follow suit. But Ward had to be clear that “This is neurodivergence...this is me being autistic.” Ward explains that their diagnosis helped explain their focus and diligence with charting in particular: “Getting that diagnosis helped me fit in. It sounds very wild, especially when we’re thinking about neurodivergent experiences. We tend to stand out, but it helped me fit in by learning my diagnosis because then I can work around my other colleagues and be like, ‘Look, like I know that they’re telling you that you should perform like I’m performing — here’s the reality. I’m performing this way because I’m autistic and this is my interest, and this is what I’m passionate about.’”
Treating Neurodivergent Patients
How can an NP make neurodivergent patients feel at ease and understood? “The first thing is: always do chart reviews,” says Ward. “Introduce yourself, and then say, ‘I noticed that you had a diagnosis on your chart that maybe leads me to think that you’re neurodivergent...are there any accommodations you need for today’s visit?’” Ward also says to “really make sure we’re getting consent to touch...touch is such a big thing for autistic people. Most autistic people are not very touchy, and they really need that consent to want to be touched.” Ward notes that “Oftentimes, I think that we assume that patients want to be touched because they’re in the office, but the reality is that they don’t necessarily want to be touched. So, ask before you do things — really get that consent and make sure that they understand.”
Access Resources and Continuing Education Related to Neurodivergence
NPs interested in learning even more about mental health are invited to join AANP’s Psych and Mental Health Community, where members may engage in discussions, share documents and exchange knowledge with fellow NPs. Finally, AANP has members-only resources like the Practice Brief: "Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder” available online in the Psychiatry and Mental Health clinical resources area.