When a child receives an autism diagnosis, parents are typically handed a comprehensive evaluation report packed with list after list of recommendations. From speech and occupational therapy to behavioral interventions, the sheer volume of therapeutic tasks can feel completely overwhelming. It is easy to look at the massive array of challenges your child faces and see a vast, insurmountable ocean.
In a recent episode of the Autism: A New Perspective podcast, host Kat Lee and Dr. Sarah Wayland, an RDI® parent and consultant, dove deep into a critical topic that often gets lost in early intervention planning: distinguishing core autism features from co-occurring conditions.
Understanding this distinction isn’t just a matter of clinical accuracy—it is a vital step toward protecting your family from burnout and ensuring your child gets exactly what they need.
The Core of Autism vs. The Body We Have
In the world of Relationship Development Intervention (RDI®), the core targets are dynamic intelligence, cognitive flexibility, and resilience. However, parents frequently expect these protocols to automatically resolve physical or motor challenges, such as speech articulation or fine motor control.
As Dr. Wayland notes, we must learn to separate the core cognitive struggles of autism from separate neurological or physical conditions. “We have to work with the body we have,” Dr. Wayland explains. An autistic child can think beautifully, flexibly, and dynamically while still utilizing assistive tools like a communication device to navigate a separate motor challenge. When we fail to see the difference, we risk declaring that an intervention “isn’t working” simply because it didn’t cure a completely unrelated physical condition.
You Can’t Boil the Ocean
When facing a long list of symptoms—ranging from profound sleep disturbances to severe attention deficits—the sense of urgency can feel frantic. Parents often feel that if they do not fix everything immediately, the clock will run out on their child’s future.
Dr. Wayland offers a liberating piece of advice passed down from her own chiropractor when her oldest son was first diagnosed: Pick one thing to work on at a time. Trying to run a household while managing four different therapists a week leaves both parent and child utterly exhausted, robbing children of the vital time they need to just explore, be a goofball, and be a kid.
Prioritizing means identifying the immediate “fire” that needs to be put out. If a child is suffering from active medical issues, such as seizures or absolute exhaustion from lack of sleep, their nervous system cannot fully access or benefit from behavioral or educational therapies.
The Biological “Muddle”
Why do these issues get so easily tangled together? The confusion is entirely understandable given how frequently these conditions naturally overlap. Statistically, roughly 60% of individuals diagnosed with autism also present with ADHD, and rates of Obsessive-Compulsive Disorder (OCD) and sleep disorders are exceptionally high in neurodivergent populations.
Furthermore, research indicates that the co-occurrence is fundamentally biological in nature. For instance, post-mortem brain tissue studies have revealed that some autistic individuals possess a jumbled, non-layered visual cortex, which directly causes cortical visual impairment. Because the genetic variations governing early brain development impact multiple structures simultaneously, physical, sensory, and cognitive challenges frequently arrive in tandem.
The Advice: Stay Curious
To cut through the noise and design a targeted path forward, Dr. Wayland signs her book with a simple, foundational mantra: Stay curious.
When you observe a high-level symptom like a severe sleep disruption, do not simply write it off as “part of the autism”. Investigate what sits directly beneath it. Is the child struggling with the profound neurological transition of letting go of their waking body? Are they experiencing subclinical nocturnal seizures? Are they hyper-sensitive to minor ambient changes in bedroom temperature or noise?
Each distinct root cause demands an entirely different, systematic therapeutic approach. By slowing down, picking a singular focus, and maintaining a deep curiosity about your child’s internal experience, you can replace a state of perpetual family crisis with structured, meaningful growth.
Learn More and Get Connected
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Full Transcript
Kat Lee: Welcome back to Autism, A New Perspective, the podcast show where we help you understand what is going on in the mind of your child, and we encourage you that growth for your child is possible. I’m Kat Lee, and today I visit with Dr. Sarah Wayland. Sarah is both an RDI parent and consultant, and we discuss co-occurring conditions that your child may have that are not autism, and why it’s important for professionals and parents alike to understand.
Let’s listen in.
Dr. Sarah Wayland: What Dr. Gutstein is targeting with the protocol and Dr. Sheely is the core challenge of flexibility, right, and dynamic intelligence. And I have many parents and colleagues, frankly, who say things like, well, this isn’t helping with my child’s fine motor control, or, you know, my kid is still, oh, I don’t know, still has trouble speaking because of motor, you know, that’s a form of fine motor control also. And so they think that targeting the other stuff will help with that, which it can sometimes, but you also need to work with somebody who knows how to work with, you know, the articulators for speech or, you know, ability to write with, you know, a pencil or a pen or something like that, or type, whatever, you know.
But we’re not going to necessarily address those, you know. And so then I hear families saying, oh, but then, so, you know, RDI isn’t helping. And it’s like, well, your child is actually thinking very flexibly and dynamically, working with the body they have, right.
And when I speak about this, I always have this slide I put up, it says, we have to work with the body we have. And our kids have to learn how to work with their own body the way it is to, as part of their dynamic intelligence, right, as part of their problem solving. Okay, I can’t speak with my mouth.
I’m going to type this on my, you know, assistive communication device, or I’m going to sign, or I’m going to do something else that will allow me to communicate with other people that, you know, and that, but that’s not autism. That’s, that’s like learning how to communicate and solve problems dynamically with the body you have.
Kat Lee: I was thinking when you were talking, just one of the things my son has struggled with is sleep. And we always said, 10 years with the sleep pattern of an infant. And but we did learn strategies of bed, you know, ritualistic bedtime, like, get hit that right window, the atmosphere of the room, you know, environment and those type of things.
When it really changed for us, and I know this is our story might not be everybody’s was when we started RDI, we actually saw a child develop over time, right, enjoy sleep. The joy going back to sleep instead of being literally heartbreaking for him. I mean, he would want to sleep so badly.
And we we think it’s because we were focused on that neurology of the brain. It doesn’t mean he doesn’t still rise early or things like that, as as many people do. But it really changed.
So both were equally important. Both were even changing his environment with just a sleep machine, you know, just having a little background noise, because he was so sensitive to noise. And those things really helped.
But RDI also contributed, we, we knew, you know, how sometimes you wonder what’s helping what it was, because we didn’t know, except RDI at that moment. Yeah, I think that’s overwhelming for parents sometimes, like the, the fact that it feels like we have to do so many things.
Dr. Sarah Wayland: It is so true. And I have a mantra, which is you can’t boil the ocean. And I think so often, all the things that our kids are dealing with feels like an ocean.
And, you know, I remember actually, when my older son was first diagnosed, I was getting chiropractic treatment, and my chiropractor had a daughter who was deaf. And she said, I remember, you know, I came in, and she said, How are you doing? And I told her, Well, my son was just diagnosed.
Actually, he didn’t have autism diagnosis at that moment. And, and, and she said, I know what you’re going to do. She says, you’re going to try to do everything they recommend in that report.
And then you’re going to go strong for a few months, and you’re going to burn out. Don’t do it. She said, don’t do it.
She said, pick one thing, and work on that. And when you start feeling like you’ve kind of getting things together, you can add in another thing. And then you can add in another thing.
And that’s, that’s what we did. And I am so grateful to her to this day, for that incredibly wise advice, because she’s right, I would have burned out. And I see this in families all the time, which is one reason why in RDI, one of the things we talk about is being in crisis, it’s a sign of crisis, that people are doing so many different things.
But you feel like the clock is ticking. And if you don’t deal with this right now, then, you know, who knows what’s going to happen in the future. And unfortunately, that could be true.
Right. And so like sleep is such a great example. I think most neurodivergent people struggle with sleep.
It’s just such a huge issue. And, and, you know, I mean, both our kids struggled with sleep. And I remember telling my younger son when he was nine years old, and he was still waking up two or three times a night, and coming in for comfort.
And I finally just looked at him. And I was like, sweetheart, I mean, I’ve been at that point doing that for 13 years, waking up two or three times a night for 13 years. And I was exhausted.
And I said to him, I said, sweetheart, I know you’re struggling to sleep. But if I don’t get sleep, I’m not going to be the kind of mom I need to be for you. And we’ve got to figure something different out.
And so we, we worked out a situation where we made like a little pallet next to my bed. And he just, you know, came and when he needed to know we were there, he would just come into our room and sleep on the pallet. And I just hold his hand off the edge of the bed, but I didn’t have to get up and go into his room and help him, you know, settle back down.
And that was, you know, and he realized like he knew he could see the nights he was having a bad night, then I was also having a bad day the next day. And he knew, and he knew that I was doing the best I could. But, you know, we had to address all the things at once, you know, and I think so many of our families are struggling with this, right?
That, that you feel like, you know, sleep, like that’s one of the most foundational things for a body, right? And so when a kid isn’t getting good sleep, and then you aren’t getting good sleep, like I like to say, ain’t mama happy, ain’t nobody happy.
Kat Lee: That was absolutely true. I think it’s a great example of how overwhelming it is. And I think it’s also a great example, a long-term mentor of mine just told me once, you know, it’s just hard for you to know which fires to put out.
And I think it’s an interesting way to put it, we, you know, might have said that in my workplace in the past, or something like that, or, you know, we’ve got this, and this, and this. But with our kids, there can be so many, and there are fires. I think it was good.
Like you, that sense of urgency, like it has to be, but everything can’t have to be. And because if it is, nothing is completely put out. I think that’s a really, really important point.
But so important to understanding that this over here, I’m just putting it here metaphorically, is what’s going on with neurodiversity. And this is what’s going over with your child having a receptive language issue, or they don’t understand anything anybody is saying. And or that this that they can’t be understood, they speak, but nobody can understand because like you talked about with articulation, and, and while they may occur at the same time, which I would add is really, really challenging.
You know, it, they may not be completely related, we know, because it’s just true of the body and the mind, things are interrelated, they affect each other. So we’re not saying that there can be profound issues, and they can all be influenced. I mean, if I have, if I’m a child, and I haven’t slept, how much do I really want to work on my articulation work?
Yes, yeah, right. I mean, I’m exhausted. How much speech can I really handle?
But But at the same time, we have to tease that out. I, I love that you have written on this topic.
Dr. Sarah Wayland: Yeah, and and Kat that, you know, choosing which thing to work on, I think is very challenging. Because like you said, if you’re exhausted, like you have nothing left to access a therapy, except that it might be that the therapy helps you be less exhausted. Right?
It’s there’s such a chicken and egg problem here. And, and so you really just have to do the best you can. One of the things that you just you pick, you pick something, anything, but you know, I had my older son, poor guy, I said, I listened to my chiropractor, I didn’t actually listen to her.
So at one point, he was literally doing four different therapies. He had speech therapy, occupational therapy, physical therapy, and he was working with an executive functioning coach, right? That’s four different therapists he worked with every week.
And one of them he was working with twice a week. And so he was exhausted, he didn’t have time to just be a kid, you know, to just be a goofball and explore things he wanted to explore on his own. And that’s really important time for our kids, too.
You know, but the other pieces, like some stuff is just so clearly a huge deal that you just have to address it. You know, like my younger son has seizures. And, and, you know, we had to address that, like nothing else was going to happen, if he kept having seizures.
So we had that was our, that was our one thing we picked for him, once we realized what was going on. So, you know, that’s, that’s, I think that that piece of it is, like, how do I prioritize which thing to fix? And how do I not completely exhaust my child, right?
Like these, these are all things that parents are trying to navigate, it’s very hard.
Kat Lee: And many times, many, many, many times, such as myself with no background, right, any of these areas, or problems, so you’re also learning. So as a parent in a professional, and when I say a professional, you’re amazing. And as a parent, you’re equally amazing more, but you’re just, you know, not sure my kids would agree, but okay.
I wonder why you think it is these things get muddled together as one, like autism, language issue, what, why? I know you don’t know, no, you don’t, you can’t look into a ball and go, here’s why. But I want to know what you think, because it’s so important.
And it’s so important, without judgment, that we help people start to really think about this. Because we want kids to, one of my big concerns is that kids may not get what they need. Like, you know, they may not be working on flexibility and resilience and adapt, or they may not be getting what they need, with something that’s co-occurring.
Dr. Sarah Wayland: So I can answer that question at different levels. So one level is just looking at how often they co-occur. And I think professionals struggle with this too, right?
So, you know, if you have a kid who has a repetitive movement disorder, right, like restless legs syndrome, or something like that, well, is that autism? You know, is that a, what, a repetitive behavior? Or is that a neurological thing that’s separate from that?
I don’t know that we always know the answer to that. And, you know, in that chapter, everything I listed in there are things that are more common for autistic people. And so when people get to know what autism looks like, well, they realize sleep problems, huge deal for almost every kid, you know, that is diagnosed with this.
ADHD, something, the co-occurring rate is something like 60% of people with autism also have ADHD. Those numbers are fuzzy and hard to get a good read on. But it’s, that’s a lot of autistic people who also have ADHD.
So is difficulty paying attention autism? Or is it ADHD? Can we separate those things out?
I don’t, I think it’s very difficult to do that. You know, we look at obsessive compulsive disorder, right? That’s way more common in people with autism.
I could just go on and on rattling these things off of all the different conditions that are much, much more common when you’re autistic. That’s one thing. And so I think professionals and parents think, oh, well, you know, 60%, like that’s more than half of people with autism have ADHD.
But when you’ve met an autistic person who doesn’t, it’s really different. It has a very different feel to it. And so anyway, that’s one piece.
There’s another piece, which I think is biological in nature. So if you look at, there were some studies done a number of years ago where they had autistic, the brains of autistic people. And after they died, they donated their brains to science.
And so the doctors wanted to look at different brain structures to see what was different. And one of the ones that really struck me was they were looking at the visual cortex. And normally the way the visual cortex develops is you have these layers, right?
You have layers and each layer processes things very differently. Well, when they looked at some of the autistic people, it didn’t have those layers. It was all jumbled up.
There were no distinct layers. So there’s a neurological thing going on here that makes it hard for that person to see. So these were people who had visual processing problems.
Cortical visual impairment is actually much more common in autistic people than non-autistic people. And so if the genes governing how the brain develops and has these structures is doing something different for that brain, it’s doing it. It’s not just doing it in vision.
It could be doing it in some other realms too, which is why I think some of these things co-occur so often. So I think there are biological reasons. And I actually think the co-occurrence is biological in nature.
And so I think people confuse them. And at the same time, it’s completely reasonable that it’s confused because it does co-occur so often.
Kat Lee: I know this is a big ask to give you a big ask, but what would be your advice to both professionals and parents? Because we’re talking about some really heavy things. Even the discussion’s big.
Dr. Sarah Wayland: It is. So one of the things I always sign when people ask me to sign my book is I say, stay curious. So when you see that your kid is having trouble with something, whatever it is, get curious about what might be underneath that.
Let’s take sleep. Is the problem with sleep that they have trouble with transitions, that transition from being awake to letting go of your body and letting it drift off into sleep? That is the biggest transition we go through on a regular basis.
And for some kids, that is what is so hard about sleep, is transitioning in and out of sleep. But for other kids, it might be that they’re having seizures when they’re sleeping, or they might be very sensitive to temperature. There are all these different things that could be leading to one particular outcome, difficulty sleeping.
And so you just have to get curious and try to figure out, how am I going to help this kid? The way you’re going to help a kid who has trouble with transitions is to make it extremely predictable, and just help them understand this happens this, now this, now that, now the other. And so they know exactly what to expect, and explain to them that that feeling of losing control of your body is actually completely normal.
And it’s not something to be, you know, you don’t need to fight against it or whatever. It’s just part of what we need to do when we sleep. So helping your child understand what those different phases of sleep are, that’s how you address that.
But let’s say they have anxiety, and it’s not about a transition, it’s just anxiety in general. Well, they may just be like very, very nervous. Okay, how are we going to calm your nervous system down?
Okay, we’re going to have strategies for that. But you know, if they’re having seizures at night, then we need to get those seizures under control. It’s going to be a very different approach, depending on what’s underneath that high level symptom.
So we just need to be curious about what’s going on for that person. And just keep in mind, when you think you’ve solved it, they grow and change, and then it’s a whole new thing. So you think you figured it out.
And then, oh, well, I guess I didn’t figure it out for a 10 year old as opposed to a nine year old. So, you know, thanks.
Kat Lee: No.
Dr. Sarah Wayland: Right.
Kat Lee: I think the message is hard, but a positive one that if we can really understand these differences, and we can start, that’s the first step. So you know what you’re doing and why you’re doing it. That is a huge relief.
Yeah, it’s when you know you’re doing and you’re not knowing what your goals are, or why you’re doing it. You just know you have all these things going on, right? And I think it’s a huge relief for us to talk about this topic, and to tell both parents and professionals that once we start doing that, we really can address the vulnerabilities in a more systematic way.
And I think that’s our message today.
And thanks for joining us for Autism, A New Perspective, the podcast show where we help you understand what is going on in the mind of your child. And we encourage you that growth for your child is possible.
I’m Kat Lee. See you next time.
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