Mental Health Resources
Health Resources for physicians to improve their client care
based on current research in neuropsychology.
ADHD v.s. ASD
Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are two neurodevelopmental conditions that affect how people think, learn, communicate, and interact with the world. While they share some overlapping characteristics, they are distinct diagnoses with different features, needs, and supports.
Understanding the similarities and differences between ASD and ADHD is important for accurate identification, appropriate support, and increasing appreciation for individuals with these conditions.
Shared Features & Overlap
-
Both ASD and ADHD may involve:
-
Difficulty with emotional regulation
-
Trouble focusing and following instructions
-
Executive functioning challenges (planning, organizing, remembering)
-
Sensory sensitivities
-
Co-occurrence: Many individuals may have both diagnoses
-
Assessment
We use comprehensive, multi-method approach to assess and differentiate Autism Spectrum Disorder (ASD) from Attention-Deficit/Hyperactivity Disorder (ADHD).
This process begins with a detailed clinical interview with the individual and caregivers to gather developmental history, medical background, academic functioning, and family dynamics. Standardized behavior rating scales are administered to parents, teachers, and in some cases, the individual, to measure patterns of attention, impulsivity, social behavior, communication, and emotional regulation across different environments. Direct behavioral observations are conducted to examine how the individual engages in social interactions, responds to structure, navigates transitions, and regulates attention and emotions in real time. Cognitive and academic testing is sometimes included to evaluate attention, memory, problem-solving, and learning style, which can help rule out learning disorders or intellectual disability.
Equally important, psychologists screen for mental health conditions such as anxiety, depression, trauma-related symptoms, and obsessive-compulsive tendencies, which can sometimes mimic or mask features of ASD or ADHD. For example, chronic anxiety may look like social withdrawal or difficulty focusing, while trauma can lead to impulsivity, emotional dysregulation, or sensory sensitivity. Structured interviews and emotional-behavioral checklists help to distinguish between neurodevelopmental and psychological concerns.
We synthesizes data from multiple sources—behavioral observations, rating scales, testing, and interviews—to determine whether the individual meets criteria for one or both conditions, or whether another diagnosis may be more appropriate. This nuanced approach ensures an accurate diagnosis and a tailored intervention plan.
Support and Intervention
-
Parent Management Training
Teaches caregivers how to reinforce positive behavior, set clear expectations, and manage challenges. -
Classroom Strategies
Includes structured routines, appropriate school accommodations, and behavior plans tailored to the students -
Stimulants (e.g., methylphenidate, amphetamine salts)
-
Most effective first-line pharmacological treatment
-
Improve attention, reduce hyperactivity and impulsivity
-
-
Non-Stimulants (e.g., atomoxetine, guanfacine)
-
Used when stimulants are not effective or well-tolerated
-
May be preferred for those with co-occurring anxiety
-
-
Regular monitoring of progress and side effects
Therapy and Intervention
-
Applied Behavior Analysis (ABA)
-
Structured intervention to teach communication, self-care, and social skills
-
Uses reinforcement and data-driven strategies
-
-
Cognitive-Behavioral Strategies-helps children and adolescents build self-awareness, organization, and emotion regulation.
-
Speech and Language Therapy-targets verbal and nonverbal communication challenges
-
Occupational Therapy-addresses sensory processing, fine motor skills, and activities of daily living
-
Social Skills Training-individual or group-based; helps children understand social rules, cues, and peer interactions
-
Executive function coaching-set concrete, achievable goals, develop strategies and tools for challenges in executive functioning
Collaborative Approach
-
Multidisciplinary team: psychologists, psychiatrist, educators, speech language pathologists, occupational therapist and families
-
Individualized Education Plans (IEPs) and community-based services enhance support
-
Academic Support by special education teacher
How to Create Safe Environments for Patients
The Neuroscience of Safety:
In the rush of busy clinics and the pressure of limited time, it’s easy to focus on diagnoses and treatment plans. But beneath every health concern, behavioral issue, or physical complaint is one fundamental need: the need to feel safe.
Safety isn't just a “nice to have” in healthcare—it’s a neurobiological prerequisite for healing, communication, and trust. As a physician, understanding the neuroscience of safety—particularly through the lens of Polyvagal Theory—can radically transform how you approach care.
What Is the Neuroscience of Safety?
At its core, the neuroscience of safety refers to how the brain and nervous system assess whether an environment is safe or dangerous. This process is mostly unconscious and is referred to as neuroception, a term coined by Dr. Stephen Porges, founder of Polyvagal Theory.
Unlike perception, neuroception happens without conscious awareness. Our nervous system constantly scans the environment, people, and even our own body signals to determine if we're safe.
-
If we feel safe, our ventral vagal system (the social engagement system) becomes active. This allows for connection, emotional regulation, learning, digestion, and healing.
-
If we sense danger, the sympathetic nervous system prepares us for fight or flight.
-
If danger feels overwhelming or inescapable, we may shut down through the dorsal vagal system—leading to withdrawal, freeze, or disconnection.
This sequence isn’t just theoretical—it plays out in every exam room, every day.
Why Safety Matters in Medicine
When patients don't feel safe—whether because of a rushed appointment, past trauma, cultural barriers, or uncertainty about what will happen next—their nervous system shifts into protection mode.
This can look like:
-
Difficulty remembering or expressing symptoms
-
Resistance or non-compliance with treatment or intervention
-
Physiological symptoms like rapid heartbeat, pain, or digestive issues
-
Avoiding follow-ups or cancelling appointments
Importantly, this isn’t about the patient being “difficult.” Their nervous system is doing its job—trying to protect them. But when the environment signals safety, patients can move back into regulation and openness.
The Polyvagal Roadmap to Creating Safety
Polyvagal Theory gives us a practical framework to promote healing by supporting patients’ nervous system states. Here are evidence-informed ways family physicians can create a neurobiologically safe environment:
1. Regulate Yourself First
Your nervous system co-regulates with your patient’s. If you are calm, grounded, and present—even in brief interactions—it gives the patient’s system permission to settle.
-
Take one grounding breath before entering the room
-
Drop your shoulders and relax your muscles
-
Give yourself time between patients
2. Start with Connection, Not Questions
Instead of jumping straight into “What brings you in today?”, take 5–10 seconds to connect as a person.
-
Offer a friendly tone: “Good to see you, how are things going for you today?”
-
Use your face to convey warmth
-
Make gentle eye contact (when culturally appropriate)
These micro-moments of connection activate the ventral vagal system, signaling “you’re safe here.”
3. Offer Predictability and Choice
Uncertainty triggers anxiety. When patients know what to expect and have a sense of control, it reduces threat.
-
Briefly explain what’s going to happen next
-
Ask for consent: “Would it be okay if I check your abdomen now?”
-
Offer options when possible: “Would you like to sit or lie down for this?”
4. Attend to the Environment
Small environmental cues have big neurobiological impacts.
-
Warm lighting, art, or natural elements help soften the space
-
Reduce harsh noises and interruptions
-
Ensure privacy and a respectful layout (e.g., avoid standing over the patient)
-
Even placing a chair beside the patient rather than in front of a computer screen can foster a sense of partnership rather than hierarchy.
5. Be Curious, Not Judgmental
When patients are dysregulated, reactive, or confused, avoid interpreting this as defiance. Instead, ask:
“I wonder what might be making this feel hard for you right now?” Curiosity invites regulation. It shifts the patient’s system from defense to reflection.
6. Affirm Their Strength
Many patients have been through adversity and trauma. Even small statements of respect and validation can deeply shift their experience.
-
“Thank you for trusting me with this.”
-
“That sounds really tough—and I appreciate you talking about it.”
-
“You’re doing a great job explaining something that’s hard to talk about.”
These are not just kind words—they’re neural anchors of safety.
Safety Is Medicine
Creating safety is not an “extra” part of care—it is care. It’s the foundation upon which healing is built. When patients feel safe, they’re more likely to engage, remember instructions, share critical details, and return for follow-ups. And when you feel grounded and supported, your clinical intuition and connection deepen too.
You don’t need to be a trauma specialist to use these tools. Just a few intentional shifts, grounded in the science of the nervous system, can make your practice more humane—and more effective.
Understanding Immigrant Mental Health & Acculturation Challenges
Immigration is more than just a change in geography—it's a profound shift in identity, belonging, and daily life. For many immigrants, the journey is marked by hope and resilience, but also by loss, isolation, cultural adjustment, and pressure to succeed. These experiences can take a toll on mental health, often in quiet and unseen ways. As such they are at increased risk of underrecognized and undertreated mental health challenges. As frontline professionals, physicians play a crucial role in early detection, validation, and referral for support.
Key Mental Health & Acculturation Challenges
Based on current immigrant psychology research and Reiman’s work, immigrants often present with:
-
Acculturative Stress: Conflict between heritage and host cultures, fear of losing identity, or pressure to assimilate.
-
Cultural Bereavement: Grief over loss of homeland, traditions, language, and status.
-
Somatic Symptoms: Physical expressions of psychological distress due to stigma or lack of mental health vocabulary.
-
Intergenerational Tension: Gaps between children’s faster cultural adaptation and parents' traditional values.
-
Trauma & Displacement: Pre-migration violence, asylum journeys, or systemic discrimination post-arrival.
Immigrants may not use the language of “anxiety” or “depression,” but may report chronic fatigue, stomach pain, memory issues, or heart palpitations.
What You Can Do as a Physician
Screen Compassionately & Holistically
Use tools like the PHQ-9, GAD-7, or RHS-15 (Refugee Health Screener) alongside open-ended, culturally sensitive questions:
-
“How are you sleeping since your move?”
-
“Are there worries that keep you up at night?”
-
“What do you miss most from home?”
-
“Do you feel connected to your community here?”
Be aware that mental health stigma may cause patients to downplay symptoms or only present once distress is severe.
Recognize Cultural Idioms of Distress
In Reiman’s words, “Distress in immigrant communities often wears a cultural mask.”
-
Some cultures express emotional suffering as physical pain.
-
Others may interpret psychological distress as spiritual imbalance or moral weakness.
-
Working excessively or taking on multiple jobs to cope with anxiety or guilt and driven by pressure to “make it” or provide for family back home.
-
Distress may manifest as short temper, control, or impatience, especially in adults under pressure.
Acknowledge and validate these expressions without pathologizing them. Ask:
“In your culture, how would someone talk about feeling overwhelmed or sad?”
Principles for Culturally-Informed Care
Cultural Humility Over Cultural Competence
Rather than assuming knowledge of a cultural group, approach each patient as the expert of their own story. Build rapport through curiosity:
-
“What would you like me to understand about your background?”
-
“What helps you feel well or strong?”
Strengths-Based Framing
Highlight their resilience:
-
Surviving migration
-
Learning a new language
-
Supporting family across borders
“Dignity and agency are powerful therapeutic tools.”
Support Bicultural Identity Integration
Immigrants often feel torn between staying true to their roots and adapting to their new environment. Support a “both/and” narrative. Encourage retaining meaningful traditions while also embracing elements of the new culture that bring opportunity and joy. Validate identity confusion as normal in the acculturation process.
When & Where to Refer
Refer to mental health professionals who are trained in trauma-informed, culturally responsive care. Whenever possible, connect patients with:
-
Practitioners who speak their language or share cultural background
-
Community health centres with newcomer supports
-
Peer-led support groups or ethnocultural wellness networks
See yourself as bridges—not gatekeepers—between medical and psychological well-being.
For Collaborative Care Teams
When working with mental health professionals:
-
Share cultural context, observed symptoms, and patient concerns.
-
Coordinate care around the patient’s core values (e.g., family, religion, community ties).
-
Include interpreters where appropriate.
Takeaway for Physicians
“Immigrant patients are navigating invisible terrain—the loss of familiar ground, the weight of survival, and the pressure to succeed. Your empathy, patience, and clinical awareness can be a turning point.” — Joachim O. F. Reiman
Autism Spectrum Disorder (ASD) Traits in Females
Better Social Camouflaging
Females often "mask" autistic traits by mimicking peers and scripting social behavior (rehearsing conversations ahead of time). For example, copying facial expressions, tone of voice, or gestures and forcing eye contact. The social camouflaging is often due to social pressure to conform and "be nice" and/or fear of being rejected, teased, or misunderstood.
More Internalizing Behaviors
Females are more likely to experience anxiety, depression, and emotional withdrawal rather than the externalizing behaviors (e.g., aggression, hyperactivity) seen in males.
Special Interests Seem More “Socially Acceptable”
Females may develop intense interests in areas like animals, celebrities, books, or fashion, which are seen as typical, but the depth and rigidity of these interests is often overlooked.
Desire for Social Connection
Autistic females may strongly desire friendships and can form close but intense or one-sided relationships. They may appear socially active but struggle deeply with understanding social dynamics.
Late or Missed Diagnosed
Many females are diagnosed in adolescence or adulthood due to subtler symptoms and effective masking strategies. They are often first misdiagnosed with anxiety, depression, ADHD, or eating disorders.
Language and Communication Differences
Females may have better early language development and use more complex vocabulary, which can hide comprehension or pragmatic communication issues (e.g., knowing what to say vs. when/how to say it).
Play Patterns May Seem Typical
Autistic girls often engage in pretend play, but it can be highly scripted, repetitive, or solitary (e.g., reenacting the same story over and over).
Greater Sensory Sensitivities
Females may report more intense sensory sensitivities, especially to
-
clothing textures (e.g., dislikes certain clothing fabrics, tags, or seams; avoids hugs or touching others),
-
sounds (e.g., covers ears with loud noises, easily overwhelmed in busy or noisy environments)
-
food textures (e.g., picky eater; craves bland, predictable, or texture-specific foods)
How It Shows Up in Behavior
Sensory sensitivities in females may lead to:
-
Meltdowns or shutdowns after sensory overload
-
Avoidance of social or public situations
-
Being labeled “dramatic” or “overreactive”
-
Fatigue, headaches, or anxiety after school or social events
Because females often try to mask their reactions, they may hold in their distress at school/work and release it at home—leading to confusion about the source of their struggles.
Academic Compensation
Many autistic females excel in school due to perfectionism and rote learning, but experience burnout, anxiety, or breakdowns outside school settings.
More Co-Occurring Conditions
-
Females are more likely to have co-occurring mental health conditions, such as:
-
Generalized anxiety
-
OCD
-
Eating disorders (particularly ARFID and anorexia)
-
PTSD from social trauma or bullying
-
Evaluation for ASD in females
Our assessment process follows the guideline according to National Institutes of Health and Canadian Paediatric Society.
Our assessment are multimodal (ie, encompassing self-report, direct observation and informant report) and include both current and historical information. Previous records are also reviewed such as report cards and developmental evaluations. Information is obtained by asking semi-structured, open-ended questions, and may be integrated with information from a standardized questionnaire completed before or during the interview. The collection of developmental, multi-perspective information is especially helpful for overcoming challenges to diagnostic accuracy posed by camouflaging and the co-occurrence of mental health problems.
Assessment and subsequent diagnostic formulation are broad, rather than simply focusing on core, diagnostic features of autism. It covers both characteristics of the individual (eg, cognitive capacity, values, hopes) and of their environment (eg, life events including any traumatic experiences, physical environment, social environment). This method of assessment supports formulation of the patient’s person-environment fit, which will in turn suggest ways of enhancing wellbeing and functioning. Our autism assessment includes comprehensive screening for a range of mental health and additional neurodevelopmental difficulties; and formulation of these in relation to any autistic traits.
We use standardised quantitative measures are used (e.g., the Autism Diagnostic Observation Schedule, Second Edition; Social Responsive Scale). As clinicians, we do make diagnostic decisions based only on quantitative diagnostic algorithms. Rather, we consider qualitative information collected via the measure, and how this relates to other information from the assessment and to autism diagnostic criteria. Camouflaging is assessed, via discussion with the person being assessed and/or use of standardized measures, such as the Camouflaging of Autistic Traits Questionnaire (CAT-Q).
We either provide a definitive (categorical) diagnosis of ASD. In ambiguous cases (e.g., milder presentation, under the age of 2), a provisional diagnosis can be made, but the child must be monitored carefully, and referred for further, in-depth evaluation. Verbal feedback to the client (where age appropriate) and/or parents is always provided, with discussion of assessment findings, prognosis, and recommended supportive resources. Clients and/or parents given time to process the information being given and to ask questions during the feedback.
After a client has been diagnosed with ASD, we discuss treatment and intervention planning recommendations. We consider overall levels of functioning in several domains, including strengths, skills, challenges, and needs, to help develop effective, individualized treatment for home, work or school.
How to Support Females with ASD
-
Offer predictable routines and low-sensory downtime
-
Use sensory tools (noise-canceling headphones, fidget items, sunglasses, weighted blankets)
-
Allow sensory-friendly clothing choices
-
Provide quiet corners at home or school
-
Be patient and trust their experience, even if it seems minor
Females with ASD are often deeply affected by their sensory environment, even if they don’t always express it outwardly. Recognizing and supporting their sensory needs helps them feel safer, more regulated, and empowered to be themselves. We have create a sensory profile checklist for clients that we can share with you.
A Primary Care Toolkit for Managing Anxiety
Anxiety is one of the most common reasons patients visit primary care. But when time is tight and access to mental health services is limited, as a physician you may need tools you can use right in the exam room. Here’s a compact toolkit to help you identify, support, and manage anxiety—even if your patient doesn’t meet full diagnostic criteria.
Screen Briefly but Effectively
Use tools you can administer and score quickly:
-
GAD-7 (Generalized Anxiety Disorder-7): Simple and validated for primary care.
-
PHQ-4: Combines 2-item anxiety and depression screen.
-
Ask functional questions:
“How is this worry affecting your sleep, work, or relationships?”
Pro Tip: A GAD-7 score of 5–9 = mild, 10–14 = moderate, 15+ = severe. Use functional impairment to guide treatment decisions.
Use Supportive, Stigma-Free Language
Normalize anxiety as a common part of life that can become unmanageable.
Try:
-
“Lots of people deal with anxiety, especially when life is overwhelming.”
-
“Even without a diagnosis, your stress deserves support.”
-
“You’re not overreacting—your nervous system is doing its job a little too well.”
A 3-Step Flow in the Exam Room
-
Name it: “Sounds like anxiety is showing up here.”
-
Normalize it: “Lots of people feel this way—let’s look at what helps.”
-
Next step it: “We can try this tool today and follow up in 4 weeks.”
Use the B.O.L.D Framework for Brief Interventions
In a 10–15 minute visit, use the BOLD approach:
Breathe – Box breathing (inhale–hold–exhale–hold: 4 seconds each). Do it together for 1 min.
Observe – Help patient observe and label thoughts: “It’s just a worry, not a fact.”
Limit – Identify a small, manageable behavioral goal to improve anxiety (e.g., 5-min walk ).
Discuss – Normalize anxiety and offer follow-up or community resources.
Recommend Low-Barrier Self-Management Resources
Here are free, evidence-based tools you can suggest in 1 sentence:
-
Anxiety Canada: www.anxietycanada.com – CBT tools & mindfulness app (MindShift)
-
BounceBack Ontario: Free coaching + videos for adults & teens
-
MoodGym: www.moodgym.com.au – Interactive CBT modules
-
CMHA & ConnexOntario: Directories for local counseling and support
Know When to Refer
Refer to mental health services if:
-
No improvement after 2–3 medication trials
-
Symptoms are affecting safety (e.g., panic attacks while driving) or functioning (e.g., trouble going to work, not being able to manage household tasks)
-
Co-occurring depression, substance use, PTSD, or trauma history
-
Youth presenting with somatic symptoms (e.g., stomach aches, headaches)
If community resources are full, consider:
-
Psychiatry consult letters (OHIP-billable)
-
Integrated mental health teams or OHT referrals
-
Short-term local therapy networks (e.g., family health teams)
-
A private mental health or psychology clinic