Autism, ADHD & Advanced Maternal Age: The Truth from a Developmental Pediatrician

In this powerful and informative episode of Musings of a Geriatric Mama, Kedna Amey sits down with developmental and behavioral pediatrician Dr. Nidsy Mejia Roque to discuss one of the most frequently asked questions surrounding motherhood later in life:

Is there really a connection between advanced maternal age and autism?

Together, they unpack what research actually shows, while addressing the cultural myths, stigma, and fear that often surround conversations about neurodiversity, autism spectrum disorder (ASD), ADHD, and developmental delays.

Dr. Roque shares her evidence-based perspective as a specialist who works closely with children and families navigating developmental diagnoses. She explains how autism and ADHD are diagnosed, what red flags parents should look for, and why early intervention can make a meaningful difference in a child's development.

Most importantly, this episode provides reassurance to women who are choosing motherhood later in life — whether in their 30s, 40s, or beyond — reminding listeners that risk does not equal certainty and that motherhood journeys are deeply personal.

Listeners will walk away feeling more informed, empowered, and supported as they learn how to move from fear toward clarity and confidence.

If you are a high-achieving woman navigating identity, ambition, and motherhood, this episode offers both medical insight and emotional encouragement.

You are not alone in this journey.

Key Takeaways

• Research shows increased risk does not mean certainty
 • Both maternal and paternal age can influence developmental risk factors
 • Early intervention improves long-term outcomes
 • Autism and ADHD exist on a spectrum and present uniquely in each child
 • Parents should not blame themselves for developmental diagnoses
 • Cultural awareness can help reduce stigma around neurodiversity
 • Advocacy plays an important role in accessing support services
 • Children with developmental differences can live fulfilling, independent lives
 • Balance in parenting approaches is essential for long-term development
 • Faith, knowledge, and support can coexist in the motherhood journey

Chapters

00:00 Introduction to Advanced Maternal Age and Developmental Health
05:15 Dr. Nidsy Mejia Roque's Journey to Developmental Pediatrics
08:54 Understanding Developmental and Behavioral Pediatrics
11:34 Common Conditions in Developmental Pediatrics
13:27 Defining ADHD: Medical Perspectives
16:24 Understanding Autism Spectrum Disorder
19:50 Red Flags for Autism Spectrum Disorder
23:26 The Importance of Early Intervention
25:09 Cultural Perspectives on Neurodiversity
28:56 Breaking Myths and Fears Surrounding Diagnoses
30:19 Understanding Advanced Maternal Age and Developmental Risks
36:56 Navigating the Diagnosis: Resources and Support for Families
42:17 The Journey of Children with Autism into Adulthood
46:19 Empowerment Over Fear: Making Informed Choices in Motherhood
50:49 Finding Balance in Parenting: Discipline and Flexibility
54:28 The Impact of Generational Perspectives on Parenting
58:57 _musings of a geriatric mama YouTube Video outro.mp4

Find Dr Roque: https://www.instagram.com/dr.nidsymejia/

Feeling Overwhelmed? In a Season of transition? On the brink of burnout? Stay connected with a community of like-minded ambiti

Let's stay connected!  https://linktr.ee/K.AmeyInspires?utm_source=linktree_profile_share&ltsid=0eb50dac-1e79-445d-9c1e-8a5dd2e34847

Transcript

SPEAKER_00 0:00

Welcome back to Musings of a Geriatric Mama. I'm your host, Kedna Ame, and I'm so glad that you are here. This episode is really important to me. This episode is an episode that I have been waiting to film. I've been waiting to have a conversation with a specialist that can help debunk some of the myths when it comes to advanced maternal age and the connection to autism. So this conversation that I had with Dr. Mejia Roque was one that was insightful, inspiring, and really just one that was reassuring in a very special way. So to all those amazing mamas, mother figures, father figures, caregivers that are guiding an amazing, awesome little one or adult on the spectrum, just know that you are doing amazing. And you are doing impactful, purposeful work. And that person, whether they're nonverbal or verbal, that little one loves and appreciates you so much. So I hope that you get plenty of insights, and I hope that you remember that you're not alone in this journey. It gets tough sometimes, but you are loved, you are seen, and you are heard. Thank you. And thank you for tuning in. Welcome to Musings of a Geriatric Model, where we discuss all things millennial and motherhood. This is not your average show where we romanticize anything about, but rather a place where we can keep it real while guiding you through a restorative living and welcome to my body. Here you'll find impactful insights by other people. Navigating life with possible. You may laugh or cry and even possibly feed yourself. So do a giggler too and hold on to your feet. It's going to be a fucking cry. I'm your host. My guest, Dr. Nidzi Mehia Roque, is a developmental and behavioral pediatrician dedicated to helping children reach their fullest potential while empowering families to navigate every stage of their child's growth with confidence and care. In her practice, Dr. Roke supports children with needs related to attention, such as ADHD, communication, speech and language delays, learning, including dyslexia, social development in the case of autism and behavior. Her mission is to provide compassion, evidence-based care that blends modern medicine with holistic wellness, supporting both the child and the family as a whole. Born and raised in Santo Domingo, Dominican Republic, Dr. Roquet earned her medical degree with honors from the Instituto Tecnology de Santo Domingo before completing her residency in general pediatrics at Brookdale Hospital and Medical Center in Brooklyn, New York. She later pursued fellowship training in developmental and behavioral pediatrics at Cohen Children's Medical Center, where she discovered her passion for guiding children with developmental differences and supporting the families who love them. Dr. Roke's approach is integrative and balanced. She looks beyond symptoms to consider nutrition, health, environment, and lifestyle. She believes that both natural strategies and modern medicine have an important role to play in a child's development. Her work reflects a deep commitment to helping families build understanding, resilience, and hope as they raise children who think, learn, grow in wonderfully unique ways. I know this episode is going to educate, encourage, and equip so many of us. Welcome, Dr. Roke. Thank you for having me. I'm really excited. I am excited too because you are such an integral member of the healthcare team. And I love the fact that in your bio you mentioned that these children just they think uniquely. And how do we meet them in their unique world instead of us trying to make them fit into our world, if that makes sense? So I'm so excited that you're here. And I can't wait for your knowledge and wisdom because I think that it's going to impact so many families in such a wonderful well, in such a wonderful way. So thank you again, Dr. Roke, for being here. Thank you for inviting me. Absolutely. Okay, so before we deep dive a little bit further into this conversation, basically about advanced maternal age, or as I call it on my show, just to make fun of how society has put us in a box when we decide to have children later in life, geriatric motherhood, but now we really know that medically and properly it's known as advanced maternal age. So before we get into the topic of if there's any correlations to advanced maternal age and a child's development, I would love to know a little bit more about your journey. So can you share a little bit about your pathway to medicine and what led you to special specialize in developmental pediatrics?

SPEAKER_02 5:57

Yeah, of course. So I decided really early on that I wanted to be in medicine. I remember being in like fifth grade, maybe, and already knowing that like I wanted to be a doctor. And I remember uh we had this arts and crafts class in that we were learning to do cross stitch. And my project that year was uh I did this like beautiful cross stitch of this like bear with a white coat and a stethoscope, and there was a doctor, and I was like, I'm gonna have this in my office when I grow up. That's amazing. That ended up not happening, it disappeared somehow. But yeah, I decided really early on. I had different ambitions that early on, too. I was like, I'm gonna be a pediatric neurosurgeon. Oh wow. Um, but somehow, you know, things just evolved and I ended up in a neurology adjacent area, right? Absolutely, but not necessarily a neurosurgeon. I like I learned early on that like the surgery life was not for me. It's intense. When I was in residency, residency is where we become general pediatricians. Okay, so that's a three-year training program. And during those three years, we rotate through different specialties of pediatrics as part of like our required rotations. And you know, towards the end of maybe of my second year in residency, there was nothing that I liked enough to um do a subspecialty. And I was like, I'll be a general pediatrician because I really like it, I really like the longitudinal relationship with families, like seeing someone since they're a baby and then seeing them growing up, yeah. Yeah, I was like fascinated by that. Yeah. Until I did my rotation in developmental pediatrics, and I was like, I was in love. Like the the combination of the longitudinal relationship, right? Like diagnosing someone from the time they're a little baby, seeing them develop, seeing them overcome all those challenges. That was something really that really like caught me. So um, I ended up applying for it like a month before the deadline to apply for sub-specialty training because I found out really late that I that that's what I was actually liked, and um, yeah, that's um how I ended up. I feel that it was just like meant to be for me for sure. There when I applied, there were only two programs in New York. Wow, and I only applied to those two, and I was like, let's see what happens. And I ended up in what I think is the best program, not biased, not biased at all. But yeah, um, like everything was just like so meant to be, and I'm so happy.

SPEAKER_00 8:31

You know, that's really special because when someone or a provider is passionate about what they're doing, I feel that the outcomes are even better. So thank you for just your heart and your passion. And I think a lot of people may not fully know what a developmental pediatrician does. So would you mind guiding guiding us into your practice and what exactly do you help families with?

SPEAKER_02 8:57

Yeah, of course. So developmental and behavioral pediatrics is a subspecialty of pediatrics. So after we're general pediatricians, we do an additional three years of training exclusively in development and behavior. Oh wow, three years. Wow.

SPEAKER_01 9:12

Yes, three years.

SPEAKER_02 9:13

Yes, and during those three years, we're very exposed to like everything from like Down syndrome, general developmental delays, like speech delays, motor delays, autism, ADHD, dyslexia, etc. And I see it just like I say in my website, I see it it's a very good combination of like the medical aspect of development with the social part, with the environmental part of it. Whether it's like we have overlap with other disciplines, like pediatric psychologists, for example, can also diagnose um autism and ADHD. But then they're with all my respect to them, I love working with them. I'm not putting them down. But I feel that like the coming from the background of medicine gives us such a wide perspective, of course, like being able to include nutrition, sleep quality, yes, those things into the context of the diagnosis.

SPEAKER_00 10:03

Absolutely. And what you just said something that made me think about how multidimensional some of these conditions are. It's not just not just one thing, it's not just that this a child presents with X, Y, and Z symptoms, and you therefore give X, Y, and Z treatment. But okay, what does nutrition look like for that child? How do we help them with sleep? What happens when sleep is affected? How it could affect it's like a ripple effect. And what I realize, you take a holistic approach to addressing all these different things that can, once they are addressed properly, can actually help the child thrive even better. So I can't wait for us to talk a little bit more about some of the conditions that you see in your practice. And what are some of those conditions that you see in your practice?

SPEAKER_02 10:50

I see a lot of autism, a lot of ADHD, a lot of learning disabilities, including dyslexia.

SPEAKER_00 10:56

Okay.

SPEAKER_02 10:57

I see a lot of um what I what I right now I call nondescript behavioral problems. I have kids that have like some behavioral problems that don't really meet criteria for anything specific, or they come to me with like a diagnosis of like a positional defiant disorder, which is a diagnosis that I don't don't love particularly. I feel that it's very it can be a little stigmatizing, maybe because of where I trained and how I how it was seen there. But it's very mixed, honestly. What I see, like I can get someone referred to me because like, listen, I'm just having trouble potty training my kid. What am I supposed to do? Sure. So yeah, it's very it's very broad, but I I would say the bread and butter of my practice is ADHD and autism.

SPEAKER_00 11:40

Okay, and how young are you seeing some of these children come in with the ADHD?

SPEAKER_02 11:46

With the ADHD for a formal diagnosis, yeah, because sometimes I see them already on and I'm like, oh, I think you're at it that way.

SPEAKER_00 11:54

Yeah, I see, I see, okay, okay, okay.

SPEAKER_02 11:57

I would say four-ish. Four-ish. Usually, yeah, those things are usually start becoming concerned when kids are start pre-K. Okay. And then can become uh particularly the hyperactive type of um hyperactive impulsive type of ADHD, you know, they tend to present more as like maybe they're aggressive in the classroom in pre-K and the teacher can't really control them, things like that. So usually, you know, in the pre-K age for um for ADHD, if for if it's um hyperactive impulsive, if it's inattentive, it presents a little later when demands like when they can't compensate anymore, like their capacity and their demands, and like you know, start like falling off track and uh, you know, like doing poorly in school and things like that. And for autism, that's all over the place for me, honestly. Like I see kids, it depends on the parent and if they have more kids. Usually for experienced parents, I I've had parents bring me kids like 12-13 months. I see wow. When they have like four kids already, and they're like, I'm you know, they're not developing the way their siblings did.

SPEAKER_00 13:01

Right.

SPEAKER_02 13:01

For first-hand parents, it tends to be a little bit later because they just don't know what to expect. They don't know what's normal and what's not.

SPEAKER_00 13:07

Yeah. Oh, I can't wait to for us to kind of deep dive into there. So now that we kind of were able to decipher two of the main um conditions that you see or um or that you diagnose children with, can we talk a little bit more about because ADHD is such a hot topic, you know, whether in adults or in children, especially now in adults. Like everyone says, like, I have ADHD, whether it's used loosely, I would love to know your medical evidence-based definition of ADHD and how we can really use the term appropriately in society.

SPEAKER_02 13:46

You're asking for the definition, like medically DSM 5 definition that we use for diagnosis. Okay. So it's essentially, and the way I like to simplify it for parents, is like it's essentially a combination of um a few um challenges, right? It can be um hyperactive and impulsive behaviors or difficulty paying attention or a combination of both. Um, and then one of the key aspects is it has to be present in more than one context. Okay, it can just be a kid that is like hyper at home and an angel everywhere else. That's usually more like a family dynamic issue, right? Of like what's happening at home there. But um though one of the key things is that it has to present at the developmental age, so like someone under 18. And contrary to what a lot of people think, we don't really need there's no real like minimum age for for the diagnosis of um ADHD. Um, so we can we can technically diagnose a five-year-old as opposed to like some people still think that like, oh, they need to be seven, they need to be eight. Like it needs to occur within the developmental age, which is considered under 18. Understood. Even if the person is diagnosed later on, we can rely on collateral information from parents, right? Yeah, siblings saying that like they've always been like that, like they were always like forgetting everything, even when you were a little kid, you forgot everything. Okay, so it doesn't necessarily have to be happening in that, like everything combined in that exact moment. Yeah, perfect. Um, and uh yeah, in two or more contexts, um, it's like critical for kids. And the other part that's critical for kids is that it has to be beyond what is expected for their developmental age, for the developmental level, right? Yeah, which is why I say sometimes I can see a three-year-old that it's a little hyper, and I'm like, ah, you may be heading that way, right? But is it really inappropriate their behavior for a three-year-old? Three-year-old, right? Right, yeah, so we cannot pathologize everything.

SPEAKER_00 15:43

Say like hyper ADHD. Right, yes, yes. I think that's so important, and that's why it's imperative for us to have a specialist that really understand, and we're not just generalizing children's behavior based on what we see, but we really have the experts in alignment that can give us the wisdom to really help our children or really identify something that may or may not actually be a quote unquote problem. I love that you were able to do that. So thank you for clarifying for our audience because I think it's so important. And then how about autism? How is autism diagnosed or formally defined, I should say?

SPEAKER_02 16:24

So, same thing. I like to explain to parents it's like difficulties in two main areas in life. One of them is the social communication, and the other one is restrictive and repetitive behaviors. So, social communication, not just communication. There's still this misconception out there that if a kid can talk, they're not on the spectrum because they have language, right? It's the social aspect of it, not the actual communication part.

SPEAKER_00 16:50

That's good to know.

SPEAKER_02 16:51

Then they're repetitive and restrictive behaviors, it's not just repetitive movements, right? It's also repetitive behaviors, like I need to drink from this cup. If you don't drink in this cup, and not just in isolation, right? A kid that does that a few times when they're three, whatever. It's the pattern of like, we need to take this route to school. If you don't take this route to school, I'm gonna have a meltdown. I need to uh um I need to eat this snack from this specific package from this specific brand, otherwise, I'm not gonna eat it, even though it's the same snack, it's just a different brand.

SPEAKER_00 17:26

Understood.

SPEAKER_02 17:26

Like, for example, I have a I had a patient a while ago that he really liked this particular snack, and the company changed the packaging. Wow, and uh he never touched it again after that. It was like absolutely not. And the mom was like, but look at it, I opened it, it's the same thing, and he was like, No, yeah, I'm not eating it, it's not the same. So difficulties in social communication and repetitive and restrictive behaviors that also present in the developmental age.

SPEAKER_00 17:51

Understood.

SPEAKER_02 17:52

Kids under 18. And you know, the way it presents, it's very wide, mostly I would say related to the age where concerns start because the social expectations of all the three-year-old are not the social expectations of a 16-year-old, right? Understood, yeah. The concerns that are brought up to me that make me think, ah, maybe like this particular patient, maybe on the spectrum, have more to do with when they come to me and what the social expectations were for them at that particular time.

SPEAKER_00 18:24

Understood. So as you as you said, it's a spectrum, it's a wide array of um presentations. So we can't just say, well, this is just textbook X, Y, and Z. Every child or person um that is on the spectrum is unique, and how they they uh their requirements and and how they go throughout life is unique. So there's not just one particular thing, but there is an understanding of a collective of evidence that would say, okay, then this person could or couldn't be on this spectrum.

SPEAKER_02 18:57

Correct. And sometimes, you know, sometimes I'm on the fence about someone and I'm like, uh, and you know, sometimes I'm on the fence and end up deciding if whether or not to give the diagnosis, depending on like what are they gonna get out of it? Right, like is it gonna change their services at school? Yes. Is it gonna like open up uh specific therapies for them? Yes, is it gonna bring them self-awareness? That for example, in the case of like I recently had a teenager who asked the mom, like, I want to get evaluated, like I think I'm on the spectrum. Yeah. And that, you know, it turned out to be like I ended up diagnosing her, and it turned out to be that that was a concern when she was very little, but then she outgrew some of those behaviors, and then you know, like life got busy, whatever, and mom just it just fell through the cracks because she outgrew them, she didn't have major challenges, yeah. So then mom was like, Well, it kind of makes sense. Like that was something we were worried about when she was very little.

SPEAKER_00 19:52

Yeah, yeah. Um, so as we're talking about parents being aware of what to look for, are there any things that are red flags that if a new parent or a parent that's just unsure, are there any red flags when it comes to ASD, which is for listeners who may not know, ASD is also known as autism spectrum disorder. Are there any red red flags that parents or people should look for?

SPEAKER_02 20:18

In the case of a small child, usually like very early on, like around 18 months, things like a significant language delay, particularly in a kid that is not trying to compensate for it either. Right? A kid who has obviously there's exceptions, it's not like nothing in medicine is like 100%.

SPEAKER_01 20:38

Right.

SPEAKER_02 20:38

Um, but uh in a lot of cases, kids that have an isolated speech delay and are otherwise developing, typically in the social aspect, try to overcome for that lack of expressive language. They like like do really good pointing and like have like what we call three uh point gaze, which is like pointing at something, pointing at the caregiver, and pointing back at the thing. It's like look at the thing that I'm showing you. It's very common for kids, young kids um on the spectrum, not to do that of like just like pointing and not trying to overcome just like pointing, and then like parents having to figure out like what are you pointing at? Like, what is it that you want, right?

SPEAKER_01 21:14

Right.

SPEAKER_02 21:16

So those things with like not really trying to engage, maybe, or really trying to engage very intensely, but having difficulties understanding like personal space, which is something we tend to learn very early on, right? Like touching people's faces, sensory-seeking behaviors, like licking you, sniffing you, rubbing things on their face, things like that. And then for older kids, um maybe toddlers or like just school age children already, something that I see that it's missed a lot is kids that have social motivation, which is again, it's another still another big misconception in for autism, right? That like, oh, someone with autism has no social motivation, they don't want to make friends. That's not true. They can't have a lot of social motivation and just have difficulties understanding how to. Make friends, how to interact with how to interplay with these other kids. Understood. So that's that's something that I see very often missed by parents too, because of that misconception. A kid that has a social motivation, but then is maybe rejected by peers because maybe they're intense and they the other kids are like, You're always in my space, right? Like or a kid that may be like very, very bossy when they're playing with other kids and like doesn't really understand, you know. Sometimes we play what I want to play, sometimes we play what you want to play. Right. Right? Things like that. And you know, in addition to the very classical things that I would say most parents know, like the repetitive modern behaviors with like the flapping, the spinning, the rocking, other repetitive jumping, as well as the rigid behaviors. It's normal for a kid to have some resistance to changes in in uh to transitions in routines and like changes in activity, right? Particularly if they're going from a preferred activity to a non-preferred activity. It's pretty normal for a kid to have a few minutes of like maybe whining, oh, but I want to keep painting, things like that, right? But to the extreme of like, it's gonna be like a 20-minute ordeal to like get them to put the collars on and we have to go take a bath, right? Like, and I'm gonna make this huge production of like going on the floor, kicking, hitting, biting, and everything. Like, that's a little bit more to the extreme of significant travel transitioning from one activity to the next.

SPEAKER_00 23:26

And there is this there is this theory of early intervention. What is your take on early intervention, Dr. Roke?

SPEAKER_02 23:34

My take is the more intense you go in the beginning, especially when the kid is diagnosed early, the better for them in the future. Yes. I've seen a lot of kids who maybe because of fear or stigma or whatever, um, are always like kind of like stuck in like maybe a classroom that they could have outgrown if they received the services that they needed early on. And I see a lot of kids whose parents, like despite fear, right, do enroll their kids in like an autism-specific classroom, right? When they're three, four, and it's very intense. And then later on, they're like, they can be in a general education classroom now.

SPEAKER_00 24:13

Right.

SPEAKER_02 24:13

Right. But like the earlier and the more intense, the better.

SPEAKER_00 24:17

I love that. And I think more people need to hear that. So I'll repeat that. The earlier and the more intense, the better. The more tools and coping mechanisms and skills that these children can acquire to continue to thrive. We're not saying that we want these children to fit into society's mold, but be able to be as independent as possible in order to be who they were meant to be. That's how I see it. Um, and we're giving them the tools early enough to do it. And I want to talk about, you know, stigma because I really believe I'm in South Florida. Culturally, we have so many beautiful cultures and backgrounds and countries that are represented here. Autism and ADHD, those are things culturally that a lot of people that may come from the islands or um, you know, Southern and you know, different Southern South America, Central America, different countries that we didn't grow up listening to that. I'm of Haitian descent. So it, you know, talking about these things, it was more like, well, yeah, you know, you have a cousin, she's quiet, she's never gotten married, da-da-da-da-da. And then as we get more, and you're like, okay, okay. And then as you, as, you know, I've grown and as I've gotten to the medical field myself, I'm realizing, oh, this isn't isn't just she's quiet, this is actually or potentially likely, you know, ASD. So it's just empowering families with information from diverse cultural backgrounds that it's not a taboo if your child or your cousin or your family member is neurodiverse, you know? And I think the more that we have these conversations, Dr. Roke, the more people will feel comfortable enough with the right information because there is some misinformation that is circulating for some time. And that's why I felt like it was so imperative to have an expert like yourself to really debunk some of these myths. And we're gonna go into it a little bit more about if there is actually a significant correlation between a lot of these um conditions that we're seeing in an advanced maternal age. We're gonna be going there very soon. But I wanted to just have a moment to just talk about some of those cultural things and how we really could just overcome them and with the right information and how do how do we empower our culturally diverse communities? Yeah, yeah.

SPEAKER_02 26:42

One of the biggest uh cultural beliefs, and I'll like I'm from the Caribbean too, right? So, like one of the biggest cultural beliefs that I still see sadly is then um, oh, he's just lazy or uh, mom, you're just calling him too much or her, right? Things like that. And it's just I think it comes more from grandparents, honestly. I see it less and less from parents themselves, which is very refreshing, yeah, and reassuring. Sometimes I see parents that are like, I don't know if I want to share this diagnosis with their grandparents because they're gonna start telling me a million things, right? Yeah, that's true. That's your child's medical history. You can share it or not share it with whoever you want. Yeah, right. Like, um, you're not obligated to share that with anyone, yeah. Uh, which brings me to another point of like a lot of fear that I see from parents is that oh, but then that diagnosis is gonna chase them. Yes, what happens when they apply for a job? That's protected medical information first and foremost. You don't have to share that, and they don't have to share that with anyone. Employers don't have don't need access to like anyone's medical records, right? Except in like particular situations, the kid wanted to be a cop in the future, military, things like that. Sure. And still that would be a choice, right? You need to give consent, and the person needs to give consent for them to be able to access those records. Another one is like, oh, but what if they what if they're forced in an institution? What I tell parents when they bring that up is listen, you're gonna have to fight hard to get them services.

SPEAKER_01 28:20

Nobody's gonna chase you, nobody's gonna chase you to give them those services. Yeah, come to the therapy. No, no, rather they're probably deterring you from. The insurance is not gonna come and say, like, please take care of it.

SPEAKER_02 28:36

Please, please, please go to therapy. You're gonna have to fight tooth and nail for all those things. Yeah, so believe me, nobody's gonna come and grab your kid and say, like, you're going to an institution that costs money, and that's the last thing insurance wanna spend.

SPEAKER_00 28:50

Yeah, yeah.

SPEAKER_02 28:51

So um, yeah, that's uh those are I would say like the three main outside of like medical myths and yeah, yeah, the three cultural um misconceptions that uh people bring um after a new diagnosis.

SPEAKER_00 29:06

I just I want to pause there because I want to honor what you just did because for so many families, you've definitely broken some chains for them. You've definitely been able to give them a little bit of more freedom in their journey because the fear can be so overwhelming for families. Because more than anything, it's like there's a level of uncertainty. You know, you have your child, and of course, you're thinking a million things already, probably asking questions about whether I'm gonna be a grandma when your kids do.

SPEAKER_02 29:40

Yeah. You know, so those are the things right.

SPEAKER_00 29:43

You, you know, there's so many questions when there is a new diagnosis, but thank you for that because I think a lot of families do need to hear that you're just gonna be an advocate for your child, you're gonna have to fight for these things, but you don't have to be limited. Your fear doesn't have to limit what you're what you're able to do or how you advocate or show up for your child, you know? So thank you for that. I think that is so empowering. And I hope that someone can feel a sense of relief and hope that it's day by day, you know, day by day. And your fear doesn't have to hinder the progress of your child and that there are resources out there. You may have to fight a little tooth and nail for them, but you're your child's biggest advocate, and the resources are there. So I love that. So here is a little bit the meat and potatoes of what we wanted to talk about. There's been conversation about advanced maternal age being connected with certain developmental diagnoses, such as autism. From your medical perspective, what does the research really show?

SPEAKER_02 30:47

So there's like quite a like a good amount of research on it. And in summary, yes, there is some increased risk with advanced maternal age, um, in terms of like risk for neurodevelopmental disabilities in general, not just autism. What for some reason in our society that in the autism world blames mom for everything seem to ignore is that that research also points to the fact that like it's also advanced paternal age.

SPEAKER_00 31:13

Correct.

SPEAKER_02 31:14

Thank you. It's not just mom. Moms are not making babies for themselves, it's not the Holy Spirit. Yeah. So um, it's also patern advanced paternal age, and they are both independent risk factors um for some increased uh in the risk for autism as well as other uh you know developmental disabilities. So there it is.

SPEAKER_00 31:35

There is increased risk, but it doesn't mean indefinitely that if you decide to have a child in your 30s, 40s, or 50s, that's why I wanted to I wanted to ask the question because society tends to, yes, as you mentioned, put everything on the mother, you know? And we already as women have so much to overcome. And now we have one more thing that we're getting in quotations blamed for. But the more that we empower ourselves with the knowledge to understand that there's multiple factors that can impact this, the more we're we'll able to continue our motherhood journey with just a little bit more relief, you know, and unless less fear. Because I think what happens when we hear the these statistics or we understand some of these factors, it increases fear of wanting to even embark on this journey later on. So, how should moms who are having children later in life process this information without the fear, but with awareness rather?

SPEAKER_02 32:39

Right. Something very important, um, and that you touched a little bit on is that nothing in medicine is absolute. There's no 100% in medicine ever. I remember when I was in medical school, um, a professor that used to tell us in medicine, two plus two is not always four. It's not there's no absolutes. And I always tell parents to be very, very suspicious of anyone who speaks, any medical provider or wellness provider or or whatever it is that speaks to them in absolutes. This is definitely gonna happen. Your kid is not gonna talk, or your kid is definitely gonna have these problems if you if you plan motherhood uh after 35. Yeah, yeah, that part. There's no absolute, we know things that convert and increase risk, but like you said, it doesn't mean that is what's going to happen. Yeah, and there's also other risks that come with um having a child when you're not ready. Maybe not having a stable partner, yeah, maybe feeling unhappy because you had other dreams in your life that they had to put up because oh my god, I need to have a baby before I'm 30, right? Yeah, maybe you had career aspirations that you put off and then you end up putting that resentment in your child, which actually happened, which is one of the main reasons I decided to wait a little bit, right? I was in medical school for six years, then residency for three years, then special to the last three years. Oh my right? When I finished residency, my family, one intention, but whatever, started like, Oh, no, yeah, we're not a baby, we'll have a baby, have a baby. And I was like, listen, I just started having some freedom in my life and my schedule. That's no, I want to have a baby when I really want it, and I when I'm like really looking forward to staying home with that baby. Yes, not when I'm like stay home with the baby and I'm resenting it. Yeah, because maybe my friends were going out, yeah, and they were going on a boat, and I'm like baby, right?

SPEAKER_01 34:37

Go on the boat. I want to be like, oh my god, let me stay here with my baby.

SPEAKER_02 34:42

Yeah. So there's other risks that you uh we have to consider when like um about having a baby when we're just not ready, emotionally, socially, in terms of like a social network, financially. That is so powerful.

SPEAKER_00 34:54

And I love how I love how you I love how you flip that in this in the sense that there's a risk of when you're not ready or you know, doing something beforehand and being intentional with your choices, and there's nothing wrong with that. That is the power in in this community that we're building, Dr. Roquet, in empowering women to remember that their choice is their choice.

unknown 35:21

Yeah.

SPEAKER_00 35:21

And that whenever it happens, whether it's through whether it was teen pregnancy or whether it was geriatric or advanced maternal age pregnancy.

SPEAKER_02 35:29

In between, yeah.

SPEAKER_00 35:30

Or in between, your choice and your journey is your own. And you should be celebrated and empowered to feel to feel okay with your choices, to be assured that no matter what, you're still going to be the woman you were purposed and destined to be. Motherhood doesn't change that. And I that is why I want to have conversations, especially with women that are high-achieving, goal-oriented women that make intentional decisions, you know, to impact their future family whenever that does occur, you know, because a lot of us may be first generation college. We we're the first ones in our family to have an advanced degree, let alone a doctorate. Um, and we've seen some of the generational impact of growing up and maybe not having everything that we would want to provide for our child in the future. So making intentional decisions shouldn't be stigmatized, but all women should be empowered to journey through life as uniquely as their journey takes them and brings them, you know? And it's a beautiful thing. I'm so happy that you said that. Oh my goodness. Yes, yes, yes, yes, yes. We're debunking myths, we're empowering women, and I love I love it here. I love it here. Okay, just to talk a little bit more about empowering families, once they do have a diagnosis, kind of just getting back into what we were discussing prior, whether it is ADHD or it is autism. Once the a child is diagnosed, what resources or support systems do you recommend for parents?

SPEAKER_02 37:12

It depends on the kid's age. Okay. And when they come to me with that, uh with those concerns when I first make the initial diagnosis. If it's a child under the age of three, I usually refer them to um what in Florida is called early steps. It's essentially a uh program from the Department of Health, and every state has it. Um, it's just like the name can change depending on the state. For example, New York City is uh early intervention, and in that way they can receive free services at home in the child's natural environment, right? Yeah. Um, and that's a very big help. When the child is already of school age, then I usually first refer them to the special education services through their school district. Okay. If the child is going to public school. In the case of parents who don't want to have their child in public school for uh whatever reason, I always also refer them to private um therapies, you know, like depending on what the child needs up. Speech therapy, maybe focused on social uh communication part, occupational therapy, which is very common for kids on the spectrum to have high motor delays as well. Um, ABA, which can be hit or miss depending on like some parents have had bad experiences with it. In the autism community itself is very split on like whether or not ABA is a good or a bad thing, with um, you know, some people who received ABA as kids when it was initially creative, right? Now becoming adults and speaking up and saying, feel like an animal ABA, right? And other people saying, like, it was great for me. Like I love it, it helped me a lot.

SPEAKER_00 38:40

And what is ABA therapy, Dr. Roke, if we can, just in case someone in the audience doesn't know.

SPEAKER_02 38:45

So ABA is applied behavioral analysis, and it is essentially one of the main therapies used for autism. Um, not just for autism, actually. Um, it can be used for a lot of things because it's a lot of like behavior shaping, behavior redirecting. The reason um there's a lot of split about it is because when it was initially created, it was very rigid.

SPEAKER_00 39:03

Yeah.

SPEAKER_02 39:04

And it was very, and I say was because that's not how most people practice nowadays. Obviously, there's always people who say suck in the past, yeah, and don't evolve with uh their knowledge uh with the current times. But it used to be very, from my understanding, it used to be very um kind of like you kind of train a dog with like I'm gonna if you do this, I'm gonna give you this cookie. Yeah, I'm gonna give you this treat. Do this, I'm gonna give you this treat. So, which is why a lot of adults with autism now say, I felt like a dog, I feel like they were training a puppy. Yeah, but maybe other people who had providers with a more flexible approach, right, are the ones who are now saying, um, it was great for me. Like it helped me a lot, right? And um, you know, like with anything in life, you can find um therapists that are very committed and are very flexible and evolve their knowledge with time. Um, and you can find others that like maybe are just more stuck on um a compliance-based system of like you have to do what I say you have to do.

SPEAKER_00 40:05

Wow, yeah.

SPEAKER_02 40:06

Um, as opposed to like how do I where do I meet you in the middle here? So I like meet your needs and also teach you something that's gonna be helpful for you in the future. Absolutely.

SPEAKER_00 40:17

I think that's the best approach.

SPEAKER_01 40:19

Correct, yeah, yeah, yeah, yeah.

SPEAKER_00 40:21

Yes, okay, perfect. So there are resources out there for families, and therapy seems to be one of the first line treatments or interventions for older kids.

SPEAKER_02 40:33

Um like sometimes I diagnose like a 15, 16-year-old, right? 17 years old. For those kids, I refer them more to like um programs for developing more independence when they graduate from school. Yeah. Like we want to be able to transition someone from a very a system that does a lot of hand holding. Okay. Like a system that just like throws you on the deep end of the pool when maybe you're not ready, even less than a kid who was developing typically, right? If those kids graduate high school and they're not ready for independent life yet, imagine someone that was like just like struggling with certain things all along. Yeah. Uh, so they may need a little bit more hand holding. So there's programs in the state. Again, my experience is in Florida and New York, and both states have programs for that, like Access VR in New York. Um, there's a similar program here in Florida that focuses on vocational training and um community rehab, right? Like teaching uh these kids how to be functional adults. Yeah. Like uh, what do you what do you like? What do you want to work with in the future? What do you want to do as a career? Yeah in teaching them, you know, like how to hold an employment. Yeah. Like that. That may sound to us maybe sound like super obvious, but for a kid that was very protected, maybe their entire life, because they grew up with a disability, sometimes it's not so obvious to them, those things.

SPEAKER_00 41:51

No, I think that that's very important for us to talk about because I think a lot of families that are in the beginning phases of this journey with their child, it's the prognosis. Like people want to know, well, what happens when they are adults? You know, so have you seen some of your you know, patients or or seen the progress of familiar patients or heard of just how some of these children do when they actually do become adults?

SPEAKER_02 42:17

Yes, of course. Um, I have patients on the spectrum who are in college right now, some of them who maybe like are still staying with their parents and just like commuting to school every day, and some of them who were like, No, I want to dorm in school. And their parents felt confident enough in their abilities, they were like, Okay, so you guys dorm in school. Right? I love that big girl. Yeah, so yes, I've seen I've seen both ends of the of the spectrum, right? Like right, like people who like maybe didn't make as much progress or people who made amazing progress, right? But I always tell parents when that question comes to me inevitably of like, what do you think is gonna happen to my kid? Right. I know I always tell parents, I wish I had a crystal ball to tell you what a 10-year-old um so-and-so is gonna look like, yeah. Um, but I don't. What I can tell you now is what the challenges are now and what we can work on so they can make progress and overcome those challenges. Yeah. And hopefully in like five years, they look like a completely different person.

SPEAKER_00 43:18

Yeah.

SPEAKER_02 43:18

Right. Um, that's all I can uh tell them in the moment.

SPEAKER_00 43:22

Yeah. And um, I think that's what a lot of families um can remember is that you just have to take it day by day and enjoy your child in the moment. Children develop and grow up so quickly, like it's a blink of an eye. And I think I didn't understand that before I became a mom, like, yeah, yeah, whatever people grow up. But like to really see the difference or feel like I just held my baby and now he's bossing me around and telling me what to do, it's like incredible. So hold on. Listeners, hold on to those special moments. You know, don't take it for granted, even though this is a journey that is challenging in and of itself. That's your sweet baby, you know, like every moment matters. Every moment matters. So you kind of went over this a little bit, but how do you continue to encourage parents to move away from stigma toward empowerment when navigating the diagnosis?

SPEAKER_02 44:27

One of the few things I always tell parents is, is this normal behavior for their age, right? Like uh when they bring a problem to me, like so-and-so and so in this, you know, like if a teenager, for example, is rebelling, I always tell parents, like, don't make everything big up big um about the diagnosis. Don't make everything about it, right? If your teenager with autism is rebelling, probably because they're a teenager.

SPEAKER_01 44:50

It's less likely that they're doing it because they're on the spectrum.

SPEAKER_02 44:53

It's probably because they're 14 and that's natural for a 14-year-old to do. Same thing with like a three, four, or five-year-old, right? Like, there's things that kids do kid things.

SPEAKER_03 45:02

Yeah.

SPEAKER_02 45:02

So I always tell parents, like, do you think this is a kid thing, or is this an autism thing? Like a kid thing.

SPEAKER_00 45:09

Yeah, yeah. For sure.

SPEAKER_02 45:10

Like, let's not make everything um pathologic. So remove from the the snake mouth, like, my kid is the only one doing those things.

SPEAKER_01 45:19

No, they're not.

SPEAKER_00 45:20

Yeah.

SPEAKER_01 45:20

No, they're not.

SPEAKER_00 45:21

I love that. Yeah, I love that. I love that. I I I I have to just go back to the fact that just in your practice, in and of itself, there's a lot of integration of hope. And a lot of the things that you do are practical but holistic. It's not just book-based, it's individualized interventions, individualized care, which a lot of providers don't necessarily always provide. So I have to continue to give you your flowers throughout this show, Dr.

SPEAKER_03 45:48

Rope.

SPEAKER_00 45:49

Honestly, it's just amazing just how practical and conversational and how approachable your practice is when it comes to caring for these families. So I just have to continue to thank you and tell you that. And as we speak to our community of women in their mid-30s, 40s, or even beyond, what message do you want to share with them for this community of women who are considering motherhood but maybe worried about developmental risk?

SPEAKER_02 46:19

I would emphasize again, the there's no absolutes in medicine, right? Um, it doesn't mean the fact that you're waiting doesn't mean that's what is going to happen in terms of like your child's outcomes. Those things could happen at any age, right? It can happen, it could have happened as a teen mom, it could have happened in your 20s, it could have happened like, and there's no way for us to know or for you to like, huh? This happened because of X and Y. We don't know yet. We don't have that information. We wish we did so we could provide better guidance to parents. But the reality is that, like, why blame yourself for something that you just don't know if it was gonna be that way or not, uh with a different choice in your life, right? So just you know, choose based on where you are in life and whether you're prepared or not. Because again, for example, like having a baby with a partner that maybe is not stable in your life, just for the sake of like I need to have this baby before I'm 30, yeah, can do a lot of damage to your child as well, right? Yes, like maybe the relationship they get to see growing up, maybe um having like parents that are like on and off together, yeah. So yeah, just like think of all those things. It's not just uh oh my god, the fear of autism. There's so many things that could be so much worse, yeah for a family and for a child.

SPEAKER_00 47:36

Yes, I'm happy you said that. That is thank you. Yes, there there are so many things because life is so complex and we don't have a crystal ball and we can't predict things. But for me, especially, and for this audience, because they know there's a lot of faith that we speak about in in this um community, is just having the faith over fear. That's kind of my thing, you know. Just continuing to trust in the women that you are, and for me, the God that I serve, and continuing to take life day by day, moment by moment. So I love that. And I know we talked about so many different things that for some people can be hard to hear, but I think the approach we took was very empowering versus stigmatizing. So that's why I wanted to have this conversation. Thank you. So we've actually come to a really fun part of the show where we talk about our millennial nostalgia break, and you know, we have a little fun, we make it a little lighthearted, and we talk a little bit about the generation of millennials right now that are having children and becoming parents, because I think that all the influences we had growing up in the 90s and 2000s is really is making us who we are as parents today, and I think that we are really fun. Tell me about a favorite millennial memory, whether it was fashion concerts, boy bands, or early college days.

SPEAKER_02 48:57

Oh, boy bands. So uh boy bands and Britney Spears. Yay! Um as you mentioned um in my intro, I grew up in the Dominican Republic. Okay, I didn't speak English as a kid, okay, but I was obsessed with the Backstreet Boys and Britney Sears. And uh I remember I used to sing, sing all their songs growing up, but I didn't know any English.

SPEAKER_01 49:25

So now thinking back, I'm like, what was I saying? What was I saying? What did I think I was saying? So yeah, that's a very fun uh thing to think about of like me growing up, like singing all these songs and like not really knowing.

SPEAKER_00 49:38

Not really. It was uh well now you know it was just a lot of love and a lot of fun. Oh, I love that. I'm actually team in sync. That's why I was like, Are you team Baxtery Boys? So I really loved InSync growing up. Um and Baxtery Boys, I appreciated them, but my preference was was in sync. But all the boy bands, the music was just so, I don't know, just it was freeing, it was fun, you know, and listening to that music now just makes me think of a simpler time, you know, less stress, more fun. And sometimes it's important. That's why I created this portion of the show for us to remember those things because it brings a smile to our face and it just makes things lighter. So I love that. I love that, I love that. We are coming to a close in our show, and this portion is always a reflective moment. So I just want to get your perspective and expertise when it comes to the way mothers understand their children, you know. So if you could give one empowering piece of advice to a woman navigating motherhood later in her life, what would it be?

SPEAKER_02 50:50

It would be having balance in terms of discipline and um flexibility and emotional awareness. I feel that like I don't know what at what point in time we got so extreme in everything. With like either the extreme some parents that believe in extreme bad discipline with like corporal punishment, right? Which we know is not the way. And some parents the the extreme of like being too permissive, like maybe letting their kids be the boss, like everything, right? So something I always um remind parents, not just like autism, right? Even neurotypical kids of it's like it's not always going to be a democracy. Yes, when it comes to your child, right? Sometimes you're the boss, you're you're not here to be their friend. Um, you know, you can have some balance and like acknowledge their emotions and and all that. You don't have to be a dictator, yeah. But you can be in between where, like, you know, depending on the situation, what's going on, you can you get to decide what the best approach is, as opposed to like being the parent who like sadly I see not infrequently. It's like maybe being the parent that like lets their kid walk all over them. And then, like, you know, that that's a kid that's uh the rest of the world is not gonna put up with that. Like you're doing you're doing your kid a disservice when you're uh in the two extremes of like being a dictator and your kid thinks it's like things are all or nothing, and that maybe they displace that behavior onto other kids. So of like now I'm the boss and I'm a bossy kid, or being the other extreme of like uh you know, like maybe having no boundaries and things like that. So that's my biggest uh thing for parents as of recently because I feel that we see like those extremes and particularly in social media, right? Um, and the message that parents receive nowadays is can be very uh conflicting in like how they're supposed to raise their job, they're supposed to have like um gentle parenting, gentle parenting, but then also but and then like coming out how am I supposed to do all that, yeah?

SPEAKER_01 52:54

Like it's like uh you don't need to be an extreme, yeah.

SPEAKER_00 52:57

No, I think that's perfect. I think I think balance and harmony is something in life that all of us are still trying to just find what really works. But what I always what I always say is that you have to do what works best for your family, correct. And of course, for me, it's kind of rewriting some generational and cultural things, you know, where there might have been more rigidity, but understanding that rigidity to an extent has made me who I am, correct. So being able to, you know, I'm not gonna knock the old school, but so what I I have this sense of like excitement, if that makes sense, because millennials actually have both perspectives. We have grown up with likely the more rigid understanding of parenthood and raising children, but then now we understand that necessarily we may not want to completely implement some of the things that how we were parented. So now we could be that middle ground that is able to see both sides of the generations. We have our parents that are the baby boomers, and then we have our, you know, we're witnessing Gen Z and how they're just more free, carefree, and now we're in the middle, like, okay, okay. Um, but we have this unique perspective that I think will merge generations and create a very dynamic generation to come. I think our kids are really going to be world changers, and that's just what I believe. Dr. Roket, I cannot thank you enough for your time, the wealth of knowledge, your your spirit. I can't thank you enough for just, you know, your patience. And to be honest, the love that I can feel that you have for for what you do and who you serve. I know, I can tell. We've we've personally have been, you know, affected in a positive way from your practice and and how you guide parents and families through more challenging things, but just it's a breath of fresh air. You're you're a breath of fresh air. So I was so glad when I was able to have you here because I mean, of course, we can go more in depth, but I do believe that this has been life-changing and will be life-changing for a lot of families that listen. So, where can our community connect with you? Whether it's social media, website, resources, where can where can we stay connected with you?

SPEAKER_02 55:31

I have to admit, I haven't been very active on social media. I have to be better there. But I do have an Instagram, Dr. Mihia Roker. I'm sorry, Dr. Nitsamihia. Uh, my first name and ideas why, and then M-E-J-I-A, you know, like contacting me for a consult if uh Yeah, your practice. What's your practice? We need to hear about your practice for more like specific, less general advice, right? So my practice is located in Coconut Creek right now in Florida, uh, and that's South Florida. And my website is behavioralpediatrician.com. And yeah, it's a cash-based practice. I don't work with insurances, and I think that's one of the main things that allows me to provide the care that I want to provide. I feel that I would say most doctors uh want to do good for their patients, right? Nobody goes to school knowing they're gonna be spending 10-12 years in school.

SPEAKER_03 56:20

Yeah.

SPEAKER_02 56:20

Um because they don't want to help or because they want to harden. Yeah. But the current system that we have not just here, not just um in the US, like I feel like in in a lot of countries, values volume a lot. And uh, you know, we are when we're in training, we are very um, I feel like very early on in our training, we get that chip put in our brains of like this is just how it is, and you just have to apply with it. But very early on in my training, I was like, but that's not what I want to do, and I don't wanna I don't wanna be burned out and I wanna keep loving what I do, right? That the reason one of the main reasons I went private practice just by myself in cash base was because I was like, I really love what I do and I want to keep loving it. And that if I work for someone else that is telling me how I'm supposed to take care of my patient, when that goes against what I think my patient needs, I'm gonna end up hating it. That's just the truth. Yes, it's true. Yes, um, so far, at least uh for the near future, um, it's um a cash-based practice, which allows me to spend like a lot of time with patients. Like my intake visits are like never less than one hour just for the intake part of like tell me what's going on. Yeah, from the beginning, right? Yeah, um, and um yeah, that's all about it. Like my website and uh calling and uh Instagram when I do get better at it.

SPEAKER_00 57:52

I know that's social media these days is a is it's a job in and of itself, you know, promoting the business and growing. But I think that just taking such a holistic and human approach to medicine is going to bless your practice more than than you know, because you're really making impact and not based on um, and then you can come back and we can talk about healthcare today. We could have a whole conversation about healthcare. But what I do love is that you've made an intentional decision to make the difference that the world needs. So I just want to continue to thank you for that. For my listeners, please make sure that you connect with Dr. Roket, because as you can see and as you've heard, it's just going to create so much generational impact in both family. So as always, thank you for tuning in and using the geriatric mama. Don't forget to subscribe, share this episode with another mama that needs encouragement. And join me next time for another interesting.