Houser speaks from experience, both as a family physician and as a person who discovered her own autism at age 37. She also received diagnoses of attention deficit/ hyperactivity disorder (ADHD), dyslexia, dyscalculia (difficulty with mathematics), and dyspraxia (difficulty with motor coordination and movement). Such neuro-logically based differences in thinking, learning, and communicating affect at least one in five people, and that number is likely higher because health care providers often miss autism in high-masking autistic people, Houser says.
Realizing that she is autistic helped Houser make sense of lifelong experiences—including in medical school—and inspired the creation of a new model of health care delivery. In November 2021 Houser launched All Brains Belong, a nonprofit medical practice in Montpelier, Vermont, that provides patients with health care, education, and social connections.
I sat down with Houser to reflect on her experience and learn about this unique practice and the community it serves.
Vermont Medicine: How did you discover you have autism? What was that experience like, and how did it change the way you practice medicine?
Mel Houser: Like many autistic people, I grew up masking—camouflaging my natural ways of thinking and interacting to fit into neurotypical expectations. It wasn’t until I became a parent navigating my own child’s development that I started learning more about the modern neuroscience of autism, and learning from the writings of autistic adults to better understand the vast ways autism presents. Ultimately, I received my autism diagnosis in the context of autistic burnout,* while living through early COVID, being on call 24/7 caring for sick patients in the hospital, seeing clinic patients, and homeschooling my 3-year-old. I lost the ability to mask.
Understanding that I’m autistic helped me make sense of my lifelong experiences, but more importantly, it allowed me to stop trying to fit into a mold that wasn’t made for me. I embraced my natural communication style, which is direct, clear, and deeply collaborative. It also made me more attuned to the unspoken barriers my patients face—things like sensory overload in medical environments, difficulty with ambiguous communication, or the impact of executive function challenges on managing health care.
As a result, I redesigned the way I practice medicine. At All Brains Belong, we remove unnecessary barriers and create an environment where people can access care in ways that work for their brains.
*Autistic adults described the primary characteristics of autistic burnout as chronic exhaustion, loss of masking skills, and reduced tolerance to stimulus, resulting from life stressors adding to the cumulative load they experienced and barriers creating an inability to obtain relief from the load.
VM: You were a strong student and commencement speaker for your medical class. What was it like to be a medical school student with autism, ADHD, dyslexia, dyscalculia, and dyspraxia? What do you want medical students to know?
MH: Medical training is challenging for anyone, but for someone with multiple neurodivergences—and who didn’t know that at the time—during my training, I regularly felt deficient. The expectation that everyone learns, communicates, and processes information in the same way leads to unnecessary shame.
I experienced a lot of trial and error in figuring out how to work with my brain rather than against it. For example, dyscalculia made medication calculations difficult, so I developed structured systems and quadruple-checking processes to ensure accuracy. ADHD meant I needed to build myself external scaffolding to manage executive function demands. I spent a lot of time before beginning a new rotation trying to find out from classmates exactly what to expect, otherwise I was super stressed out. Autistic brains are often very strong pattern-matchers, which has obvious benefits in medicine.
The medical education I received at UVM Larner College of Medicine was excellent. In particular, the value system embedded in UVM’s medical culture of patient-centeredness, of prioritizing the doctor-patient relationship, of understanding perspectives that are different from my own, of understanding community-needs assessment as a tool of public health, of connecting basic science to clinical applications, and of recognizing that everything is connected to everything—all of this is central to what I do today.
My training in family medicine, both as a medical student and a resident, is what uniquely prepared me for the work I do. My mentors imparted a broad scope of knowledge and skills that equipped me to be able to identify a niche of unmet community needs and adapt the delivery of health care to meet those needs. Understanding how to support the health of individuals and the health of communities is a core part of family medicine training.
To current and future medical students who see themselves in my story: There is no one “right” way to be a doctor. Your brain is not broken, and you don’t have to “fix” yourself to succeed. What matters is finding strategies that work for you—and advocating for environments that work for everyone. The world needs doctors who think differently.
“We all have different brains that experience the world differently, and different brains have different needs. When people feel heard and understood, they are more engaged in their care and have better long-term health.” — Mel Houser, M.D.’12
VM: How is All Brains Belong different from traditional family medicine practices?
MH: Our patients range from age 4 to 95. The majority are adults and children who have been historically excluded from traditional health care settings—particularly neurodivergent people with complex chronic conditions and those who have experienced medical trauma.* We have patients who have been suffering for decades.
The traditional health care system is built on assumptions that don’t work for many people. There are so many “defaults”: You must pick up the phone to make an appointment; you must fill out the 20-page packet, etc. Whenever there is a default, anyone whose brain works differently is “other.” We are demonstrating that a different way is possible. We use universal design principles and offer a menu of multiple options for how patients can choose to access various aspects of their care to co-create a customized experience.
We’ve intentionally kept our practice small so that we can provide deep, meaningful care instead of rushing through visits. We have a small but growing staff of two clinicians, a patient care coordinator, an education program coordinator, and a part-time coordinator for our Kid Connections program.
Our entire model of health care delivery is based on community connection. Patients come here to meet other patients. We address social isolation. We also provide employment support. It’s the idea of thinking about all the ways we can wrap around someone to support them.
Another key difference is that our model is constantly adapting to meet the needs of our community. We believe that solutions should come from those closest to the problem, and we regularly seek out and incorporate feedback from our patient community. We also compensate them for sharing their time and lived expertise.
*Medical trauma is a nervous system response to interactions with the medical system. Symptoms can include intrusive thoughts, avoidance, anxiety, anger, headaches, insomnia, and fatigue. According to Houser, medical trauma can result from big events or everyday experiences such as being restrained as a child, exposure to fluorescent lights, or communication in which a patient feels invalidated.
VM: Tell me more about the community connection and how it improves health outcomes.
MH: Health care is more than just doctor visits. At All Brains Belong, we’ve built a community of shared lived experience. Patients don’t just receive medical care; they gain access to a network of people who understand and support each other.
Social isolation causes the equivalent harm to health as smoking 15 cigarettes per day, according to a study published in the scholarly journal American Psychologist, September 2017. Feeling a sense of belonging reduces isolation, improves self-advocacy, and ultimately leads to better health outcomes. In our medical practice, 92 percent of our patients report improved health through this model, and this is a patient population that is mostly chronically ill and medically complex.
VM: You provide free education and training materials to medical providers, employers, and community members. What topics do you cover? How can our readers tap into your resources?
MH: We train health care practices about how to adapt their environments to address common barriers to health care access, including improving communication, reducing sensory barriers, and accommodating executive function differences. We also provide training on medical problems that autistic and ADHD people more commonly experience, that are usually not included in medical education.
Webinars for both professionals and the public help foster a new model of community-driven health care, one that’s designed and shaped largely by patients themselves. For an example, a recent webinar focused on the health care system’s role in driving and perpetuating the stigmatized narrative of autism, and what we can do instead.
We host a weekly community education program called Brain Club, which is a community conversation where we apply brain science to “everyday life.” Each week we have a presenter or panel about a different topic.
We released a free set of tools called “Everything is Connected to Everything: Improving the Healthcare of Autistic and ADHD Adults.” Since its launch in 2023, it has been accessed by more than 20,000 people from around the world. The purpose of the resource is to support primary care clinicians and patients in communicating about and working through the common medical problems faced by this population, including hypermobility, postural orthostatic tachycardia syndrome [POTS, a condition that causes dizziness, fast heart rate, or fatigue when someone transitions from lying down to standing up], mast cell disease, migraine, myalgic encephalomyelitis [also known as chronic fatigue syndrome, a condition causing extreme exhaustion and pain after physical or mental exercise], and post-infectious chronic illness like Long COVID.
We have trained more than 2,500 employers on creating neuroinclusive workplaces. Employers seek us out because they want to better understand how to create better office environments, and how to improve employee engagement and retention. These trainings are interactive and tailored to each organization’s needs. We offer one-time workshops as well as ongoing consultation and community-of-practice support.
VM: Is there anything else you want medical students and alumni to know?
MH: If I can drill down one thing that is absolutely the most important, it’s that patients are perceiving that their doctors don’t believe them, and this perception has significant implications for mistrust and poor health outcomes among patients who feel unsafe seeking health care. If we can do one thing to improve health care experiences and relationships, it’s to explicitly tell patients that we believe them.
“I want to emphasize that neuroinclusive health care benefits everyone. The changes we’ve made to support neurodivergent patients—clear communication, flexible scheduling, sensory-friendly environments—aren’t just helpful for autistic or ADHD patients. They create better care experiences for all.” — Mel Houser, M.D.’12
Also, if you read something here that resonates and you’d like to get involved with this movement, there are a lot of ways to plug in. VM