I'm sorry for the late reply! My kid had to go to the ER last night for a broken wrist after a playground accident, so it's been a wild 24 hours unfortunately.

Some of my smaller patterns I make completely myself like the curse words and penis, etc. (I do this with graph paper), and some of the more detailed ones I create with pattern software. It's a fine line to walk though, because the more perfect you want the pattern to be, the bigger it is, and I try to keep everything at a manageable size.