On this Papers Podcast, Dr. Jiedi Lei discusses her JCPP paper ‘Understanding the connection between social camouflaging in autism and security behaviours in social anxiousness in autistic and non-autistic adolescents’ (https://doi.org/10.1111/jcpp.13884). Jiedi is the primary writer of the paper.
There may be an outline of the paper, methodology, key findings, and implications for apply.
Dialogue factors embody:
- The definition of ‘social camouflaging’ and ‘masking’, the way it usually manifests, and the way it pertains to social anxiousness in autistic adolescents.
- Security behaviours in social anxiousness in autistic and non-autistic adolescents.
- How members had been recruited and engaged utilizing cartoon-like stop-motion movies.
- Gender variations that emerged.
- Implications of the findings for CAMH professionals and the way the findings might inform evaluation and therapy of social anxiousness dysfunction for autistic adolescents.
On this collection, we communicate to authors of papers printed in one in every of ACAMH’s three journals. These are The Journal of Little one Psychology and Psychiatry (JCPP); The Little one and Adolescent Psychological Well being (CAMH) journal; and JCPP Advances.
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Dr. Jiedi Lei is a medical psychologist and autism researcher at present finishing a Analysis Fellowship on the College of Oxford, with a deal with Understanding Strengths-Based mostly Approaches in Supporting Autistic Kids and Younger Individuals (CYP). Jiedi’s analysis pursuits embody understanding mechanisms that preserve anxiousness issues corresponding to social anxiousness in autistic CYP, with an intention of translating analysis to tell and enhance medical therapy for anxiousness difficulties on this group. Jiedi is at present inspecting methods of assessing and incorporating character strengths to embody strength-based method when supporting autistic CYP and their households in psychological well being settings and past. Jiedi has been awarded NIHR Oxford Senior Analysis Fellowship for her translational analysis to enhance psychological well being for autistic CYP underneath the Oxford Well being BRC Psychological Well being in Improvement Theme.
Different sources
- Open Entry paper from Autism ‘Exploring the affiliation between social camouflaging and self- versus caregiver-report discrepancies in anxiousness and depressive signs in autistic and non-autistic socially anxious adolescents’, (March 2024), Jiedi Lei, Eleanor Leigh, Tony Charman, Ailsa Russell, and Matthew J Hollocks
- Instance stop-motion video from the mission
Transcript
[00:00:01.360] Jo Carlowe: Howdy, welcome to the Papers Podcast collection for the Affiliation for Little one and Adolescent Psychological Well being, or ACAMH for brief. I’m Jo Carlowe, a Freelance Journalist, with a specialism in psychology. On this collection, we communicate to authors of papers printed in one in every of ACAMH’s three journals. These are the Journal of Little one Psychology and Psychiatry, generally referred to as JCPP, the Little one and Adolescent Psychological Well being, referred to as CAMH, and JCPP Advances.
Right now, I’m interviewing Scientific Psychologist, Dr. Jiedi Lei, Paul Basis Scientific Analysis Fellow on the Division of Psychiatry on the College of Oxford. Jiedi is the primary writer of the paper, “Understanding the Relationship Between Social Camouflaging in Autism and Security Behaviours in Social Anxiousness in Autistic and Non-Autistic Adolescents,” lately printed within the JCPP. This paper would be the focus of as we speak’s podcast. In the event you’re a fan of our Papers Podcast collection, please subscribe in your most popular streaming platform, tell us how we did, with a score or evaluate, and do share with associates and colleagues.
Jiedi, welcome, thanks for becoming a member of me. Are you able to begin with an introduction about who you’re and what you do?
[00:01:17.992] Dr. Jiedi Lei: Thanks for having me. So, my identify’s Jiedi, I’m a Scientific Psychologist, and likewise Autism Researcher. So, my major focus is working with autistic youngsters and younger folks and supporting their households. And I’ve wrote this paper as a part of my medical psychology doctorate once I was finding out at King’s.
[00:01:37.640] Jo Carlowe: Thanks. So, we’re going to have a look at your JCPP paper as we speak, that is, “Understanding the Relationship Between Social Camouflaging in Autism and Security Behaviours in Social Anxiousness in Autistic and Non-Autistic Adolescents.” I’d like to begin with some definitions, so starting with ‘social camouflaging,’ together with masking, are you able to outline this for us and clarify the way it usually manifests, and the way it pertains to social anxiousness in autistic adolescents?
[00:02:07.579] Dr. Jiedi Lei: Social camouflaging is, type of, an umbrella time period, and it’s used to explain a variety of behaviours used to cover autism traits, and typically it’s known as ‘masking.’ So, on this explicit paper we used the self-report questionnaire, referred to as the Camouflaging Autism Traits Questionnaire, to have a look at barely completely different points of social camouflaging behaviour. So, this included masking, which is round hiding points of someone’s autistic presentation, or presenting a non-autistic persona to different folks.
[00:02:40.160] Jo Carlowe: Hmmm hmm.
[00:02:41.160] Dr. Jiedi Lei: It additionally included compensation, in order that’s discovering methods round, type of, the social and communication difficulties you would possibly expertise that’s related to having autism. After which the final side of camouflaging was assimilation, and that is makes an attempt to attempt to mix right into a social state of affairs the place you would possibly really feel uncomfortable, so that you’re attempting to not let different folks see the discomfort that you just is likely to be in.
So, the way it pertains to social anxiousness, effectively, what we all know is that once we’re fascinated about what maintains social anxiousness in anyone is that, you realize, when you’re feeling fearful about the way you’re going to return throughout to different folks in a social state of affairs or how would possibly different folks understand you, what folks typically do is that they attempt to interact in behaviours that they consider will maintain themselves secure and away from damaging perceptions from different folks. So, these security behaviours can embody issues like avoidance, so attempting to keep away from eye contact, staying on the sting of the group, or they might be behaviours referred to as, type of, impression administration behaviours. So that is once you’re attempting to actively come throughout effectively, and attempting to forestall the issues that you just’re fearful about from occurring.
On this explicit paper, what we’re all for is camouflaging in some points appears similar to these impression administration behaviours, within the sense that, you realize, you’re attempting to handle the way you current your self in a social state of affairs, and also you’re attempting to return throughout effectively. Particularly, we’re all for how this would possibly current itself throughout adolescence, as a result of what we all know is that the adolescent mind, it’s actually attuned and really delicate to look evaluations. And so, throughout adolescence, once you’re making a call, you’re very a lot influenced by what friends would possibly suppose or react to your response, and that need to slot in and are available throughout effectively could be very robust throughout adolescence.
So, we’re actually all for how these, type of, social worries you would possibly expertise about not wanting to return throughout bizarre is likely to be actually related throughout this developmental section. And we additionally know that adolescence is likely one of the peak durations for folks to expertise social anxiousness, as effectively.
[00:04:41.360] Jo Carlowe: That’s actually useful. Simply sticking with security behaviours, within the paper, I believe you speak about how this relates each to – effectively, to social anxiousness, however in each autistic and non-autistic adolescents. Are you able to say one thing about that, and maybe in regards to the distinction between the 2 group?
[00:04:57.220] Dr. Jiedi Lei: Security behaviours is commonly referred to within the medical language used round social anxiousness. So, these discuss with various kinds of behaviours folks would possibly do to maintain them secure when they’re fearful about coming throughout badly in a social state of affairs. So, the motivation there actually is to return throughout effectively, or to not embarrass your self in a specific social state of affairs. So, examples of security behaviours can embody issues like avoidance, so attempting to not appeal to consideration, avoiding eye contact, staying on the sting of the teams. However they will additionally embody issues like impression administration. So these are issues like making an effort to get your phrases proper, perhaps rehearsing what you’re going to say in your thoughts, attempting to slot in and act regular.
And I believe it’s beneath this sort of impression administration behaviours that received me actually all for fascinated about how this would possibly look actually just like camouflaging behaviours. As a result of components of that camouflaging, when you’re fascinated about it purely from an autism literature, is that means to, type of, disguise any social communication variations, and likewise attempting to slot in and act regular in a social state of affairs.
So, on this explicit paper, I used to be fairly all for, you realize, we’ve these two units of behaviours, which, once you’re simply it from the outset, might need some similarities, however from the autism and social anxiousness literature, they stem from completely different, type of, mechanisms and motivations. Are we truly capable of distinguish the 2 once you’re autistic adolescents specifically, who’ve excessive ranges of social anxiousness?
[00:06:26.039] Jo Carlowe: Hmmm. You’ve already gone into among the particulars of the paper…
[00:06:29.170] Dr. Jiedi Lei: Yeah.
[00:06:30.170] Jo Carlowe: …are you able to give us a, type of, overview of what you checked out, and why, simply to set the scene for us?
[00:06:34.790] Dr. Jiedi Lei: After all, yeah. So, on this paper, our major intention is to know how camouflaging behaviours and security behaviours is likely to be differentially associated to social anxiousness and autism traits in a pattern of autistic and non-autistic adolescents. And due to, you realize, the overlaps in impression administration behaviours and camouflaging behaviours we simply talked about, and we all know that there’s a excessive degree of social anxiousness signs amongst autistic youngsters and younger folks, what actually received me is in attempting to know, can we truly distinguish between these two units of behaviours, when it comes to why folks is likely to be doing them? Is it purely associated to hiding autism traits? Is it additionally associated to co-occurring ranges of social anxiousness? And the way distinctive is that this to autistic adolescents, or will we additionally understand this in non-autistic adolescents, as effectively? So, that was, type of, the primary intention of our explicit research.
[00:07:30.550] Jo Carlowe: And might you inform us a bit in regards to the methodology used for this research?
[00:07:34.110] Dr. Jiedi Lei: We determined to recruit a lot of autistic and non-autistic younger folks to finish some self-report questionnaires, issues like autism traits, social anxiousness signs, and likewise, security behaviours and camouflaging. So, general, we recruited 115 younger folks, largely coming from baby and adolescent psychological well being providers, and that included 61 autistic younger folks, and 54 non-autistic adolescents.
A essential design side of this research is as a result of we anticipated autistic younger folks to have larger ranges of social anxiousness, what we needed to know is, you realize, we needed to make sure that the relationships we’re seeing, it’s all the way down to variations in autism traits, and never as a result of the non-autistic adolescents even have, type of, decrease ranges of social anxiousness. So, what we tried to display screen for is we requested non-autistic younger folks to reply a couple of quick questions on their self-reported ranges of social anxiousness, to attempt to display screen for younger folks that skilled larger ranges of social anxiousness, in a approach that, type of, matched the 2 teams, when it comes to social anxiousness symptom severity.
We simply requested younger folks to finish these completely different questionnaires on-line, after which we took their self-report measures and inputted all of that knowledge into one, type of, mannequin that allowed us to concurrently have a look at all of those associations between all the completely different constructs, to attempt to perceive how behaviour is measured underneath the camouflaging questionnaire, and the protection behaviour questionnaire would possibly differentially relate to autism traits and social anxiousness throughout the 2 teams.
As a result of, you realize, a lot of the younger folks from our research got here from a medical pattern, we needed to additionally guarantee that the relationships we’re seeing should not resulting from different psychological well being signs, corresponding to, generalised anxiousness or despair. So we requested younger folks to additionally full these questionnaires, and we had been capable of management for these various kinds of symptom severities when these explicit relationships, as effectively.
[00:09:27.430] Jo Carlowe: I believe I observed that with the recruitment, you used a reasonably good, very accessible video, to draw members.
[00:09:34.519] Dr. Jiedi Lei: Yeah.
[00:09:35.519] Jo Carlowe: Simply describe that.
[00:09:36.709] Dr. Jiedi Lei: That is one thing I picked up truly throughout my PhD research, and I used to be speaking to somebody round how will we interact younger folks, particularly autistic younger folks, who typically have fairly concrete methods of understanding data, and is usually a little bit tougher to succeed in.
[00:09:53.800] Jo Carlowe: Hmmm hmm.
[00:09:54.800] Dr. Jiedi Lei: And simply interact them in a extra enjoyable approach, to inform them what the research is about? And I used to be speaking to somebody who used to supply some documentaries for the BBC truly, and…
[00:10:02.760] Jo Carlowe: Wow.
[00:10:03.760] Dr. Jiedi Lei: …he stated, “Have you ever ever thought of making a brief video?” And I assumed, wow, that’s actually fascinating, to supply some very easy, type of, cartoon-like, cease movement movies.
[00:10:13.029] Jo Carlowe: Hmmm.
[00:10:14.029] Dr. Jiedi Lei: That provides younger folks a few eventualities of what it’s prefer to have social anxiousness experiences that they may be capable to relate to. And thru that, type of, telling a narrative about someone who experiences social anxiousness and the troubles they’ve, hopefully, younger folks can watch that, relate to some points of the video, and suppose, okay, effectively, this might probably be one thing that I will help with, or one thing I’m all for studying extra about. So, that was, type of, the intention of conveying the research in a barely extra enjoyable strategy to…
[00:10:41.779] Jo Carlowe: Hmmm hmm.
[00:10:42.779] Dr. Jiedi Lei: …recruit and have interaction younger folks from extra numerous backgrounds, as effectively.
[00:10:46.040] Jo Carlowe: Implausible, and we are able to embody a hyperlink to that. Let’s return to the findings, what key findings from the paper would you want to focus on?
[00:10:55.820] Dr. Jiedi Lei: I believe this was the primary time that we checked out a pattern of autistic and non-autistic younger folks, to have a look at this potential overlap between camouflaging and security behaviours, in relation to each autism and social anxiousness. So, I believe it was fascinating that we discovered, you realize, masking behaviours. So these points of attempting to cover autism associated traits, and impression administration behaviours, each confirmed a really robust constructive relationship, suggesting that, you realize, the 2 are, a minimum of at face worth, younger folks reported them to be fairly related, they usually had been extra related to social anxiousness reasonably than autism traits.
This was significantly fascinating as a result of I believe, typically, we take into consideration camouflaging is one thing that’s particular to masking autism associated traits…
[00:11:41.029] Jo Carlowe: Hmmm.
[00:11:42.029] Dr. Jiedi Lei: …and impression administration could be very a lot spoken about in a social anxiousness upkeep context. However, truly, what this research is suggesting is that each points truly require you, if you’re doing them effectively, they require you to pay a lot of consideration to your self, throughout that social state of affairs, to essentially self-monitor what’s occurring, turning that focus of consideration inwards, to have the ability to know, you realize, that is how I believe I’m presenting myself, and that is how I wish to current myself.
And so, what this research is suggesting is that, you realize, if a youngster experiencing excessive ranges of social anxiousness, and they’re growing that focus inwards, to deal with how they is likely to be coming throughout, then that very same mechanism probably operates for camouflaging. And, inadvertently, if you’re attempting to cover some points of your self throughout a social state of affairs, you would possibly truly be inadvertently reinforcing that sample of social anxiousness as effectively, ‘trigger you’re not specializing in how different individuals are truly, type of, responding to you within the second. However you’re too fearful about, you realize, I simply don’t wish to accidently do something that may embarrass myself.
I assume it’s additionally fascinating that that is the primary time we recruited a lot of younger folks largely from a toddler and adolescent psychological well being setting. So we all know these are younger people who find themselves struggling in some points of their psychological well being and looking for help. And so, it additionally allowed us to have a take into consideration, you realize, is that camouflaging actually particular to only autism traits? Or are younger individuals who probably have psychological well being difficulties, are they partaking in some points of attempting to cover these difficulties away from their friends, in that exact age group, as effectively?
[00:13:10.210] Jo Carlowe: Have been there any gender variations that emerged within the research?
[00:13:13.570] Dr. Jiedi Lei: Yeah, so it is a actually fashionable query. As a result of our pattern dimension was nonetheless fairly small, so it was probably not doable to make very conclusive selections round gender variations. However we did discover that – you realize, we requested younger folks truly to report gender identification, reasonably than organic intercourse. So when gender identification, what we did discover is that this relationship between security behaviours and social anxiousness was stronger in younger individuals who self-identified as male, in comparison with those that are self-identified as feminine. So, maybe that relationship, you realize, between self – security behaviours and social anxiousness reasonably than autism traits is extra important in those that self-identify as male.
[00:13:53.870] Jo Carlowe: I used to be within the thought out of your paper that points of camouflaging, corresponding to masking and compensation, might be conceptualised as coping methods in social conditions that aren’t distinctive to autism. Was that discovering surprising?
[00:14:07.610] Dr. Jiedi Lei: I believe, to some extent, what we all know is that, you realize – so, impression administration behaviours, typically, it’s a really human trait, as a result of all of us enter a social state of affairs wanting to place our greatest foot ahead and desirous to current the perfect model of ourselves. However I believe, you realize, the strain of feeling like you must conform to the social norm you’re in may not be the identical for everyone. So, typically that might be influenced by your individual beliefs round the way you would possibly come throughout or how different folks would possibly understand you, however a lot of occasions, these inside components actually work together with the exterior or wider societal beliefs, as effectively.
So, we all know that, you realize, for some teams that is likely to be extra vulnerable to being perceived with social stigma, or maybe have extra damaging bias perceptions from different folks. They may even be partaking in impression administration behaviours for barely completely different causes, as effectively. I believe once you have a look at these two points of behaviours, camouflaging and security behaviours, particularly impression administration behaviours, once you simply have a look at the questions, at face worth, there may be fairly a little bit of overlap when it comes to the observable behaviours they is likely to be measuring. However I believe it’s – so, you realize, from that side, I don’t suppose it’s too stunning that we discovered the findings within the explicit paper, beca – and younger individuals are decoding them in a really related approach.
However, yeah, what’s fascinating is these identical behaviours truly measured in a single context may additionally be sustaining inadvertently psychological well being difficulties in a barely completely different context. And so, it was extra fascinating to consider the broader affect of a few of these behaviours, which could transcend hiding one explicit side of your self, however may additionally affect upkeep and growth of psychological well being difficulties specifically.
[00:15:53.290] Jo Carlowe: We’ll have a look at the implications of that in a second, however I simply puzzled if there was anything within the paper that you just wish to spotlight?
[00:15:58.699] Dr. Jiedi Lei: One factor that actually struck me is, you realize, once you’re purely one questionnaire, taken at face worth, and also you is likely to be utilizing that in isolation, or decoding the outcomes from that in isolation, it may not all the time provide the full image. So, you realize, the questionnaire camouflaging typically is framed within the context of autism, and autism traits, however, truly, once you have a look at it along with psychological well being difficulties, that very same questionnaire would possibly faucet into behaviours that serve a barely completely different perform.
And so, I believe it’s fairly necessary for Researchers, when utilizing both the camouflaging or measuring psychological well being difficulties to consider how does that very same questionnaire function underneath completely different situations, as effectively, and what different measures are you attempting to seize inside that exact research?
[00:16:42.680] Jo Carlowe: So, what are the implications of your findings for CAMH professionals? So, for instance, how would possibly your findings inform evaluation and therapy of social anxiousness dysfunction for autistic adolescents?
[00:16:56.339] Dr. Jiedi Lei: I believe that, holding in thoughts among the limitations of utilizing these questionnaires in isolation, I believe it’s actually necessary for Clinicians to maintain that open thoughts that, you realize, decoding any single evaluation measure will not be going to provide the full image. And I believe, as a Clinician, you’re educated in doing very cautious assessments and really cautious formulations of what’s occurring with that younger individual. So I believe it is rather a lot sustaining that perspective, and to work along with that younger individual to essentially perceive, from their perspective, how are they making sense of those behaviours? Behaviours that once you’re simply reporting on paper would possibly look actually related, however they may have barely completely different, from the younger individual’s perspective, barely completely different motivations…
[00:17:36.590] Jo Carlowe: Hmmm hmm.
[00:17:37.590] Dr. Jiedi Lei: …behind that. So, I believe it’s useful for Clinicians to carry in thoughts that the identical behaviour which could look actually related, some younger folks would possibly suppose, I’m doing that to cover autism associated difficulties. However, truly, serving to the younger individual to scaffold that considering a bit bit extra and clarify, you realize, perhaps by means of psychoeducation, a few of that behaviour we all know can even preserve social anxiousness.
So, can we assist that younger individual to know, actually weigh up, you realize, the professionals and cons of that behaviour, in several settings, in order that they’re higher capable of decide round what types of behaviour experiments they may wish to do in social anxiousness therapy, and what they’re keen to, type of, change or adapt or drop in a social state of affairs, as effectively.
[00:18:16.910] Jo Carlowe: Any ideas in regards to the sorts of interventions or remedies which are helpful and from what you’ve found from the analysis?
[00:18:22.610] Dr. Jiedi Lei: Yeah, so what we all know is that, you realize, this explicit mannequin, and fascinated about security behaviours, typically, refers lots to the Clark and Wells social anxiousness mannequin, and that’s what informs, type of, the cognitive remedy in adults with social anxiousness. So, a whole lot of these is establishing, type of, behavioural experiments with the person, to consider what would possibly occur if you happen to had been to drop the protection behaviours that you’re now extra conscious of in a social state of affairs, and may we try it out? Does your worst, type of, predictions that individuals will discover you embarrassing and make these damaging remarks, does that actually come true, once you’re not doing among the security behaviours?
I assume what this paper is highlighting is that among the camouflaging behaviours may additionally have an analogous impact, when it comes to sustaining social anxiousness. So, if you happen to’re working with an autistic younger individual and fascinated about structuring these behavioural experiments round what’s a security behaviour, what must you check for? Possibly a part of that, clarifying younger individual’s predictions, you would possibly wish to contact on, “Do you suppose any side of this is likely to be associated to having autism?” Or, “Is any side of the protection behaviour you’re attempting to, type of, disguise your autism traits? And might we take into consideration that, along with fascinated about the social anxiousness side of the social state of affairs, as effectively?”
So, I believe it’s serving to Clinicians to suppose a bit bit extra broadly, and produce autism into the dialog once you’re structuring these behaviour experiments, and take into consideration, what’s the perform of that behaviour in a specific context?
[00:19:49.460] Jo Carlowe: Very useful, thanks. Jiedi, are you planning any follow-up analysis, or is there anything within the pipeline that you just wish to share with us?
[00:19:56.780] Dr. Jiedi Lei: Yeah, so I believe one factor we’re additionally all for is whether or not camouflaging behaviours is likely to be associated to, type of, hiding or compensating for variations for different, type of, co-occurring psychological well being difficulties, not only for autism traits. So, we’re significantly all for, you realize, typically when you will have younger folks coming into CAMHS, you ask the younger individual and their guardian and caregivers to present parallel rankings on the younger individual’s, type of, psychological well being signs. And what we’re all for is in whether or not, if younger folks probably is likely to be partaking in camouflaging or hiding points of their psychological well being difficulties past autism traits, whether or not that is likely to be related to how mother and father and caregivers would possibly understand the younger individual’s psychological well being, and the way the younger individual’s score these signs themselves.
So, one of many research within the pipeline is to have a look at these caregiver and younger individual discrepancy rankings on psychological well being signs, and have a look at how that is likely to be related to younger individual’s reported camouflaging behaviours, when accounting for autism traits.
[00:20:56.950] Jo Carlowe: That’ll be actually fascinating. Are you on the recruitment stage? The place are you?
[00:21:01.900] Dr. Jiedi Lei: So, that paper is definitely underneath evaluate, so, fingers crossed that it might need a easy journey and are available out quickly.
[00:21:07.510] Jo Carlowe: Proper, good luck. Lastly, what’s your take residence message for our listeners?
[00:21:12.760] Dr. Jiedi Lei: Yeah, I believe the message right here is simply to focus on that behaviours are actually multifaceted constructs. So, two individuals who have a really related behavioural profile might need very completely different underlying motivations and, you realize, as to why they’re behaving in that approach, or, a minimum of, a really completely different understanding of why they suppose they’re behaving in that approach. So, I believe once you’re working with a youngster, specifically, particularly autistic younger folks, to only actually, actually unravel, you realize, serving to them perceive why they’re doing a specific behaviour, and what are they hoping to alter by means of that intervention, as effectively.
I believe in the case of this camouflaging paper, as a result of, you realize, all the pieces was carried out on-line and younger folks solely gave these self-report rankings, we weren’t actually capable of have these one-on-one conversations, or by means of a extra of a qualitative side, as to why younger folks is likely to be answering questions in a specific approach.
So, I believe, you realize, for Clinicians attempting to translate this into their apply, it’d be actually useful to have extra of these conversations and assist younger folks, whether or not, you realize, that’s from social anxiousness side or from autism side, to essentially absolutely perceive motivations that younger individual might need when it comes to doing a specific behaviour, and have, you realize, very clear predictions of what the younger individual believes would possibly occur. Whether or not resulting from their social anxiousness, or resulting from having autism in a social state of affairs, earlier than you go about manipulating any of those behaviours by means of intervention.
[00:22:38.200] Jo Carlowe: Sensible, Jiedi, thanks ever a lot. For extra particulars on Dr. Jiedi Lei, please go to the ACAMH web site, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t overlook to observe us in your most popular streaming platform, tell us if you happen to benefit from the podcast, with a score or evaluate, and do share with associates and colleagues.
