Autism in the Adult

Join Dr. Regan in an episode about the power of small talk as a social welcome mat and a way of testing the waters before creating longer social connections.  Neurodiverse Love Conference 2025 Use checkout code Theresa50 for $50 off _______ Autism in the Adult website Resources for professionals Video Visits Video Courses      

Join Dr. Regan for this episode of the Lifespan of a Household Series. The episode focuses on the experience of the autistic adult during the seasons of retirement and the empty nest.  Calendar example:      Autism in the Adult website Resources for professionals Video Visits Video Courses  

Join Dr. Regan for this episode of the Lifespan of a Household Series. The episode focuses on the experience of the autistic parent in a household with teens and young adults. Dr. Regan discusses the child's quest for identity and separation and the parent's changing role. She reviews coping strategies for the parent during this time of transition and uncertainty. Autism in the Adult website Resources for professionals Video Visits Video Courses  

Join Dr. Regan for the sixth episode of the Lifespan of a Household Series. The episode focuses on the experience of the autistic parent in a household with preteen children. Dr. Regan discusses the parent's shifting role across the child's developmental seasons, develops images to help parents relate to the shift, and provides practical input about succeeding in these changes in the parenting role.  The Holidays and Autism: Holding Fast and Letting Go Planning a Merry Holiday on the Autism Spectrum How to Talk So Kids Will Listen and Listen So Kids Will Talk   Autism in the Adult website Resources for professionals Video Visits Video Courses      

Join Dr. Regan for the fifth episode of the Lifespan of a Household series. Today's episode focuses on topics important to autistic individuals who are parenting young children.   Autism in the Adult website Resources for professionals Video Visits Video Courses    

Join Dr. Regan for the 4th episode in the Lifespan of a Household series. Today's episode focuses on topics important to the autistic individual who is preparing for parenting.    Autism in the Adult website Resources for professionals Video Visits Video Courses  

Join Dr. Regan for this third episode in the "Lifespan of a Household" series. This episode highlights topics important to living in shared space, including the sensory environment, alone time, and control over objects. Also, check out links to resources on her website and a transcript of the episode below.  Autism in the Adult website Resources for professionals Video Visits Video Courses   Hi, everyone. Thanks for joining me for this third episode in our series on autism and the lifespan of a household. My name is Dr. Theresa Regan, and I'm your host. I'm a neuropsychologist, a certified autism specialist, and mom to a young adult on the spectrum. This series is the result of listener requests about living as a couple or as a family within a shared household. And as we've touched on, one of the challenges of tackling the topic is that households can take so many different forms. And I know that I can't do them all justice in just one series, but I wanted to touch on some important life seasons within a household. So our first episode was about dating, and the second covered the topic of physical intimacy and relationships. And today we're going to talk about sharing physical space with other people. So joining households, living in the same space. I'll also let you know that a lot of my website renovations have been completed. There are still some things I'm tweaking and trying to make work better, but lots of the pages are active and working. And I also now have the new service of video visits for people to consult me about the topic of autism or how that impacts you in your household. There are some geographic limitations and there are some specifics about payment and if you are interested in that type of service head on over to my website at adultandgeriatricautism.com and look under video visits. So there are many different instances where physical space might be shared in a type of household. So we may be talking about a traditional couple or a family household or even other situations like having roommates or renting a portion of someone else's home. And sharing living space can be complex for lots of reasons, but for the autistic, there may be a few specific challenges that we could cover in the episode today that would help people navigate those things. So in particular, we're going to cover the sensory environment, alone time, and having control over objects. So let's tackle the sensory environment first. First, because the autistic individual may have sensory sensitivities, living in the household with other people may be overwhelming because people bump into each other or reach over each other or they brush against each other to navigate the physical space. Noise can be another sensory input that's elevated in a household, and the noise could include voices, babies crying, arguments, even just surround noise like television or music. How things smell can be important to someone on the spectrum. The scent of food cooking or aftershave, candles, cigarettes, cleaning products, taste and texture can come into play if we're talking about shared groceries or family meals, does everyone have to eat the same thing? Let's not forget about visual inputs. So not only does this include lighting, but a very common issue that I hear about is concern for the visual space or having visual chaos. So for some on the spectrum, the sight of a visual messiness or overcrowdedness or chaos can be overwhelming. And this could include things like decorations, messy work areas, things on the floor, clothes, garbage, food, strewn about various surfaces. And this visual chaos can feel overwhelming. Now, before you start laughing because you've seen someone's space and you know that they're not concerned about visual chaos, that's true. Not everyone on the spectrum will have the same sensory processing feature. And neither will everyone who is neurotypical. So people in the household will have different preferences. Many people on the spectrum may have very little care for the visual cleanliness or organization of their space except for a few specific things. So maybe they have very significant care about where their favorite objects are placed or how things are lined up, but other things are strewn over the floor and there's not much care at all. The more people there are in the household, the more mix there will be of habits and preferences and clash with the habits and preferences of others. Another complicating factor is that as people age across life seasons, their sensory processing and preferences can also change. So you have not only complexity, but you have this multifaceted, always changing sensory sensory environment, and sensory preferences across multiple people within the same shared living space. So that is a moving, dynamic, complex kind of issue. Now, one of the best ways to start addressing this is what we've talked about in multiple other episodes, And that is self-awareness. So that's that ability to say, hey, I know what makes me tick. I know what my nervous system likes and doesn't like. I know what I need today. And I also observe and have talked to and am aware of other household members. I have awareness that what they need may not be the same thing I need. And this place is shared by people with different needs. So having awareness of what the needs are is a huge place to start. The next step is to add the right now element. So the self-awareness that we talked about, that's the always element. Like, I know what's generally, typically always true about our household from day to day. Now, look at the right now element. So in this specific moment, what do people need? What do people need this morning, today, this week, this holiday season? One way to accomplish this in a household is to have huddles. So a huddle is a very quick rundown. It's a triaging process. For those of you who maybe use that in a workplace or know what that means, triaging is the ability to quickly scan what's happening, what's most important, what needs to be done the quickest, and to prioritize how these things will be handled. So in a triaging process where people are able, they're already self-aware, they're are able to highlight how their system is doing and what the day will be or has been like given their schedule. A huddle could take place between two parents of three young kids, maybe in the morning and after work. This type of brief communication helps everyone get on the same page. So instead of this confrontation and argument where one person says, I told you to do this or why are you doing that? We start with, hey, this is really chaotic. what do you need right now? This is what I need. This is the schedule for the day. This type of communication also represents and reestablishes that the household is committed to partnership. I want you to do well. I want to know what's important to you and what you need. And here is what is a priority for me today. So rather than being impulsive and reactive to what's happening throughout the day, oh my gosh, something just happened to me. I react to it because I want it to stop. We can start off with awareness and a general game plan rather than kind of flipping around crisis mode, and often that means pushing against other people. The household itself will also need some adaptations to the sensory needs of the individual. So not only do we start with self-awareness and then have up-to-date huddles, like this is what's going on this morning, this is what's going on after work, we also have to look at the sensory needs in the whole household and how that can be adapted. So there will likely be some foods that are completely off the table, like there's just such a high smell, taste, or texture aversion that cannot be avoided or coped with that it's not worth the amount of drain on people in the household. So one person may love fish or collard greens or something with a strong smell or scent that's really overwhelming to someone else and there's just no way around it. It just gets into the house. So those foods are off the table. If you're going to have that food, go out to someone's house as a guest and eat it there or eat it at a restaurant. Some adaptations may not be all or nothing. They may have to do with getting equipment like sound-canceling headphones or earbuds for people, sometimes having a designated quiet time if the kids are old enough to understand stand and regulate this. Like 12 to 1 is quiet time. A weighted blanket may be a good sensory tool for calming, as might something like a rocking chair or a swing set. Another thing I want to point out that may be confusing to people about the sensory environment in household with neurodiversity is that the person who is sound sensitive may also make a lot of noise. And that seems to be because the noise they make is predictable and controlled by them, whereas the noise that comes at them can feel repeatedly startling and overwhelming and they don't have the control that they need. And another thing is that sometimes, you know, it's this hard to understand presentation because the person may be loud because they're overwhelmed and need quiet. So it can be, you can't always kind of look and say, well, you're being loud, you must not need quiet. Or you're running around and crashing and rolling, you must not need quiet time. So a lot of times those kinds of behaviors are a signal that the person does need some regulation help, and that can be achieved by a quieter space, time alone, a weighted blanket, and those kinds of things. In addition to having things about the environment that support sensory needs within the household, consider having separate time or alone time so that people don't have to do things together. I know sometimes as a family, we try to create this together time or a family evening or a forced family time. And sometimes that's great and there are great memories. And other times, you may become aware that the needs of the people in the household are such that separation time is so important that there's a place for that as well. So for example, one person could do homework in one household location and a second person in another. So rather than having both kids at the table doing homework so that it's convenient for for the parent to help or whatever, that just may be unrealistic for either of those individuals and their sensory needs. They may need space and quiet and time. One individual could work on a chore at a separate time or space than another individual doing their chore. So I worked with a family once that had two teen girls and one was neurotypical and one was autistic And they were very perplexed at the autistic individual who didn't have a diagnosis that all of a sudden she would melt down and push her sister and just be so, quote, unreasonable, end quote, that she'd have to wait outside until she could calm down and come back in. And what actually was happening is that because they were doing chores in the same room, which was the kitchen every night, but the chores were split. The shared space was too much. And sometimes the sister would do just silly, friendly, wonderful things that she thought would be no big deal, but were really overwhelming. At the end of the day, you know, the resilience for the one child was just really low and touch, especially unexpected touch, a hug from behind, tapping on the shoulder would just set things off. So allowing people to do their chores in separate areas. There could also be individual variants. Sometimes our kind of go-to within a household is that everyone is the same. It's most fair if everything is the same for every child all the time. And actually that just may not be realistic and it may not end with the best outcome. So sure, there are some things that are the same for every person in the household and there probably needs to be some individual variance as well. So this is your toothpaste flavor. This is your shampoo scent. And in the end, the target will be a balance of number one, no one does this. So maybe that's smoking or Cook's Curry or Blair's Music all the time. Number two, individual variations. So we make sacrifices for each other and we give each person breaks and some alone time. And number three, some of we all do this. Like we all have huddles. We all try to figure out how everyone can get their needs met. We all try to focus on compromise and having an awareness in the moment. So having a mix of this never happens, this always happens, and let's do some individual triaging. That's going to work really nicely. So what we covered so far was the sensory environment. And the second point we're going to talk about is alone time. So alone time is typically really important for the regulation of the nervous system for the autistic. So protecting someone's alone time likely needs to be a very high priority. You can see how this gets easily eaten up, particularly if there's kind of a traditional family unit where there are multiple people in the same household. Everyone comes together at dinnertime. They have multiple things that they need to get finished. They need to work together. There are errands to run. And there's a lot of times when other people need something from you. I want a snack, I need help with this, I need you to do X, Y, Z so I can have a break. This would be a good time for a huddle. So let's regroup. Let's get a game plan that we actually decide on rather than just reacting about. And let's not let life roll over us and us trying to keep up with the flow. You might want to designate where someone can get alone time. Maybe there's a tree house, a garage apartment, a basement area. Try to be creative and create space for this. So it may be in a corner of a room with a small tent-like structure and pillows inside. Maybe under a table with a blanket for small children. The adults need alone time too. Regrouping after After work, it can be really hard for both spouses to come home from work and then feel like they both need alone time and yet they have kids running around in the house or other demands on them. The huddle can help work together to figure out how each person can decompress. Maybe alone time is riding your bike after work, driving your kid to baseball practice, but needing to read a book in the car rather than getting out and visiting with parents or watching practice. Maybe there are things the family do all together, like eating meals or doing chores or playing games or watching movies, but there may be room for thinking about who needs alone time rather than together time, and not to have this picture that the family is doing the the best when everyone wants to be together all of the time. So really trying to protect and designate alone time and separation time for each family member based on what their nervous system needs. The third thing I want to talk about in a neurodiverse household has to do with having control over objects. So this may or may not be something that rings a bell with you or that you relate to. But for many people on the spectrum, they just have a real keen eye for objects and they may like to accumulate them or have collections of them. They may have a hard time throwing things away or sorting through things that they don't need. And so there can can be this real feeling of importance about where the objects are and are they safe and can I see them? And so that may have to be taken into account within a household as well. The person may say, yes, a place for everything and everything in its place. Again, that these objects are important and the symmetry of them is important and where they go is important. And I want people to put everything back where it should belong. One person may really focus on keeping items rather than parting with them to free up space and reduce clutter. letter and that can be a difference in how different people in the household want to work. So it could really stress someone to have too many objects in the house and it can really stress another person to part with an object. Take for example an autistic child who leaves their stuffed animal in the family car and wakes up in the middle of the night and realizes that that they don't have their stuffed animal and they're very worried that rabbit is not going to be okay in the car. So if I can't see where rabbit is, then I feel like they might not be okay. I really need parent to go out and get the stuffed animal from the car. Now for the autistic child, that may be a very strong, important nervous system need because they may actually really worry about this object if it's not in a known location. So understanding is one of the first steps, right? I understand why this child needs this and I respond according to how high the importance is for them. Compromise is another part of this. Like if I have self-awareness that that objects are really important to you, and you have self-awareness, that visual calm is really important to me, then can we compromise? Could a compromise be that we store things in a storage unit that are not out in the open, but you know that they're safe and protected, and you can can alternate objects whenever you want. So you could take some objects that are on display at home. You can go to the storage unit and change them out for other objects and bring those objects home. So some sort of compromise would be ideal. So understanding this actually is really important to them. And them understanding what's very important to you. So what doesn't work is these repeated conversations about, it's fine, it's just a stuffed animal, it's just a transformer collection, it's, you know, even for people who are retiring and downsizing, we hear this, that, you know, I just can't get rid of my collections, it would be like a death in the family to downsize. It can be that upsetting. So again, I think the part I want to point out here is that that neurologic. Strain is very real for them. That's really a very difficult thing to do. And reasoning with the person about why you don't need these boxes anymore or the cleanliness of the area or the safety of the area, that's really not going to be that compelling to them. What might work a little bit better is number one, seeing if they can give some of the objects to a trusted person so that it has a good home, rather than just throwing it out or giving it away to an unknown person. Another thing that could work is compromising about a space where things can go. As we said, it could be a rented space, it could be an outbuilding, a place in the basement, and how much can be visible at one time. And it also could be compromise about spaces that are protected. So you have your space in this man cave here or whatever, and you get to put your objects in this space. But every other place in the house that's a family area, we compromise about. And then I get my space. And so I get to make decisions totally in my space about visual calm and being uncluttered. So we have some compromise space and some individualized space. Living in a household is complex because everyone has a nervous system. Everyone's system is a little bit different than the other person's. And the best place to start is self-awareness. And knowing that there's going to be this fluidity from day to day and from life season to life season. The things that are calming or soothing or upsetting and frustrating are going to be different to a two-year-old than they are to an 18-year-old than they are to a 50-year-old, etc. So this dynamic and moving thing that is a household is going to have these elements. So self-awareness, compromise, huddling up, making some decisions about the space and how the space can support the needs of the individuals, and really knowing what is legitimately very difficult for each person. I'm so glad you joined me today to talk about living in a household, sharing space, joining households. Households, and I hope you'll continue to listen to this series on the Lifespan of House

Dr. Regan continues the series about the lifespan of a relationship and/or household. The first episode focused on dating relationships, and this second episode focuses on sexual intimacy in relationships with an autistic partner.    Dr. Regan's Resources: Empowered Parenting Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians      

Dr. Regan begins a new series about the lifespan of a relationship and/or household. This first episode focuses on dating relationships. The episode provides practical insights and strategies to help you make informed and intentional choices in your relationships, ensuring they are fulfilling and sustainable for both partners. Dr. Regan's Resources: Empowered Parenting Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians      

Join Dr. Regan for the final episode of the Powerful Self-Care Series. Rather than becoming the victim of an intense world, constantly in survival mode, learn strategies for self-care. This episode focuses on how to increase resilience in active and effective ways. Empowered Parenting   Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for this second episode of the Powerful Self-Care Series. Rather than becoming the victim of an intense world, constantly in survival mode, learn strategies to become effective with self-care. This episode focuses on how to reduce draining inputs in order to budget your resilience.  Explore Dr. Regan's new Learning and Equipping page and the specific course page for "Empowered Parenting."  Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for this first episode of a new self-care series. Rather than becoming the victim of an intense world, constantly in survival mode, learn strategies to become powerful at self-care. The first step is self-awareness which can begin by noticing your fight, flight, freeze, and physical reactions to events and experiences.  Explore Dr. Regan's new Learning and Equipping page and the specific course page for "Empowered Parenting."  Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for the third and final episode of the Communication Series. This episode highlights ways to communicate while talking about challenging topics.    Explore Dr. Regan's new Learning and Equipping page and the specific course page for "Empowered Parenting."    Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for the second episode in the Communication Series. This episode highlights ways to use communication to protect and grow relationships.    Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for the first episode of the new Communication Series. This first episode highlights moments of connection, such as talking in the car, going out on date night, and catching up with a friend. Tune in to hear what to avoid and what to focus on to enhance connection.    Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians      

In this third episode of the executive function series, Dr. Regan discusses sticking, releasing, and switching gears in everyday life.  Related resources: Podcast Episode: Autism and "Just Right" Podcast Episode: Gaining Momentum for Activities Amazon: Time Timer (I don't receive any income from your purchase)   Dr. Regan's Resources: Zur Institute courses for clinicians Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

The Holidays and Autism: Holding Fast and Letting Go Planning a Merry Holiday on the Autism Spectrum

In this second episode of the executive function series, Dr. Regan breaks down how speed, working memory, and sequencing impact daily life.  I Love Lucy chocolate factory TV clip Executive Function Book Series by Dawson and Guare: Smart But Scattered (children's version) Smart But Scattered (Teen version) Smart But Scattered (adult version)   Dr. Regan's Master Class for Clinicians (Sept, Oct, Nov, Dec 2023) Zur Institute: Master Class   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians          

Do you understand what Executive Function (EF) refers to and why it is important? If you have EF difficulties, have you been diagnosed with ADD? Do you wonder if you have a diagnosis of autism or if you should have a dual diagnosis of autism and ADD/ADHD? Dr. Regan breaks down the concepts and shares about the relationship between EF, ADD/ADHD, and autism.    Executive Function Book Series by Dawson and Guare: Smart But Scattered (children's version) Smart But Scattered (Teen version) Smart But Scattered (adult version)   Dr. Regan's Master Class for Clinicians: Zur Institute: Master Class   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians  

Have you ever struggled over whether to accept an invitation or opportunity? Should I say yes, or no? Join Dr. Regan as she discusses the importance of identifying goals and asking "what might that look like" before making a final decision.    Previous podcast episodes mentioned: Attention Deficit Disorder and Autism: Similarities and Differences Dr. Regan's Master Class for Clinicians: Zur Institute: Master Class   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript: 1 00:00:07,670 --> 00:00:08,520 Hi there. 2 00:00:08,529 --> 00:00:13,520 This is Doctor Regan joining you for an episode of Autism in the Adult podcast. 3 00:00:13,760 --> 00:00:15,029 I'm your host. 4 00:00:15,039 --> 00:00:18,739 I'm also a neuropsychologist, author and speaker, 5 00:00:19,000 --> 00:00:24,719 a certified autism specialist and the parent of a teen on the autism spectrum. 6 00:00:25,850 --> 00:00:29,040 You are joining me today for an episode entitled, 7 00:00:29,049 --> 00:00:30,620 "what might that look like?" 8 00:00:30,909 --> 00:00:35,240 One of the things that clients and families often ask me is, 9 00:00:35,250 --> 00:00:39,909 "should we plan on this" or "should I say yes to this?" 10 00:00:40,189 --> 00:00:40,669 Now, 11 00:00:40,680 --> 00:00:48,659 this could mean being the best man at a family wedding or taking a family vacation to a cabin in the woods. 12 00:00:49,419 --> 00:00:53,509 It could mean accepting a full time job in an office setting. 13 00:00:54,299 --> 00:00:55,029 Now, 14 00:00:55,529 --> 00:00:58,509 my response is rarely yes or no, 15 00:00:58,520 --> 00:01:01,270 but rather "what might that look like?" 16 00:01:02,590 --> 00:01:05,519 So before we jump into the topic for today, 17 00:01:05,529 --> 00:01:09,559 we are coming up to the third anniversary of this podcast, 18 00:01:09,879 --> 00:01:19,639 the first episode launched on August 7th 2020 it highlighted similarities and differences between autism and ADD or ADHD. 19 00:01:20,050 --> 00:01:20,379 Now, 20 00:01:20,389 --> 00:01:33,279 this premiere episode is one of the most popular of the podcast and I plan to expand this topic into a series after today's episode which will further define executive function, 21 00:01:33,550 --> 00:01:41,050 its presentation in autism and ADD, and resources for harnessing the power of executive function. 22 00:01:42,199 --> 00:01:43,089 Secondly, 23 00:01:43,099 --> 00:01:46,930 I want to inform clinicians about an upcoming master class. 24 00:01:46,940 --> 00:01:52,069 I'm offering through Zur Institute about autism across the lifespan. 25 00:01:53,190 --> 00:02:04,459 I received so many emails and messages through my website about people seeking autism informed clinicians to provide them with diagnostic input information, 26 00:02:04,470 --> 00:02:08,919 education and solutions for roadblocks they may have encountered. 27 00:02:09,649 --> 00:02:17,270 So the bottom line is that more clinicians are needed to serve individuals who are searching for this specialization. 28 00:02:17,600 --> 00:02:28,779 And my response has been to offer multiple courses through Zur Institute. It's a continuing education site for clinicians. 29 00:02:29,330 --> 00:02:36,809 My goal is to equip clinicians across various regions to assist individuals in their communities. 30 00:02:36,860 --> 00:02:39,320 When this type of service is needed, 31 00:02:39,979 --> 00:02:51,729 the master class offering will focus on advanced topics and it starts in September space is limited and I'll have the link in the show notes. 32 00:02:52,360 --> 00:02:55,449 So let's jump into our topic for today. 33 00:02:56,380 --> 00:03:10,369 The autistic individual may have opportunities to accept or decline invitations and the invitation may be to enter an advanced academic program rather than the basic program. 34 00:03:10,789 --> 00:03:13,770 Perhaps the invitation is to travel. 35 00:03:14,429 --> 00:03:24,199 The invitation may be to lead a group such as being the best man at a family wedding or presenting research to professionals. 36 00:03:25,720 --> 00:03:33,619 My experience is that there's value in viewing the invitation not so much as a yes or no question. 37 00:03:33,889 --> 00:03:35,369 Do I accept this? 38 00:03:35,380 --> 00:03:36,580 Do I say no. 39 00:03:36,759 --> 00:03:38,880 But by asking ourselves, 40 00:03:38,889 --> 00:03:40,410 what might that look like? 41 00:03:41,149 --> 00:03:41,710 A yes, 42 00:03:41,720 --> 00:03:47,160 no view would be to see the invitation as a formed and complete package. 43 00:03:47,289 --> 00:03:51,080 So if I say yes to being the best man, 44 00:03:51,089 --> 00:03:53,080 I will plan the bachelor party, 45 00:03:53,089 --> 00:03:54,240 make a speech, 46 00:03:54,380 --> 00:03:55,020 toast, 47 00:03:55,029 --> 00:03:56,509 the couple at the reception, 48 00:03:56,520 --> 00:04:00,869 et cetera saying no to the invitation means I'll, 49 00:04:00,880 --> 00:04:03,440 I won't participate in these activities. 50 00:04:03,990 --> 00:04:05,360 But instead of a yes, 51 00:04:05,369 --> 00:04:06,589 no mindset, 52 00:04:07,100 --> 00:04:11,199 we can often talk through alternatives by asking, 53 00:04:11,210 --> 00:04:12,919 what might that look like? 54 00:04:13,300 --> 00:04:14,990 What might it look like to say? 55 00:04:15,000 --> 00:04:15,729 Yes, 56 00:04:16,170 --> 00:04:19,630 in a way that works for me and for the people around me. 57 00:04:22,149 --> 00:04:26,200 The first point to think about is what is the ultimate goal? 58 00:04:26,209 --> 00:04:28,320 What is the desired outcome? 59 00:04:29,779 --> 00:04:36,600 The goal for a vacation with family members may be to have relaxing experiences, 60 00:04:36,660 --> 00:04:43,480 to see natural landscapes that you've never seen and to connect with other family in a meaningful way. 61 00:04:44,829 --> 00:04:50,709 The goal for presenting your research to professionals may be to advance your career, 62 00:04:50,720 --> 00:04:57,040 make professional connections with others and highlight your role in the work that's been done. 63 00:04:58,730 --> 00:05:09,549 Identifying what a good outcome would look like is empowering because it helps us identify a handful of core foundational objectives. 64 00:05:10,029 --> 00:05:12,640 And when we work toward those objectives, 65 00:05:12,649 --> 00:05:17,220 we can release some of the trappings that may be part of the activity, 66 00:05:17,230 --> 00:05:23,959 but they're really not core to what we're going after for the individual, 67 00:05:23,970 --> 00:05:26,440 considering a full-time office job, 68 00:05:26,470 --> 00:05:31,089 he may decide that the foundational goals would be to have work stability. 69 00:05:31,510 --> 00:05:34,140 If he's currently doing consulting work, 70 00:05:34,149 --> 00:05:35,200 for example, 71 00:05:35,290 --> 00:05:35,769 he would, 72 00:05:35,779 --> 00:05:45,109 he may want more of a predictable salary and to have his name associated with a company that has a respected reputation in his field. 73 00:05:46,239 --> 00:05:53,489 So the first step you can focus on is determining what would be a good outcome. 74 00:05:54,480 --> 00:06:02,549 What would it look like in this situation to really dive in and also to feel like things went well. 75 00:06:04,519 --> 00:06:10,970 The first step you should focus on is determining what a good outcome would look like in this situation. 76 00:06:11,589 --> 00:06:15,779 What would a good outcome for participating in the wedding look like? 77 00:06:16,140 --> 00:06:21,519 What about going on a family vacation or accepting an office job? 78 00:06:22,910 --> 00:06:32,970 The second part after we've identified what the core features we're going after are those core foundational goals? 79 00:06:33,179 --> 00:06:35,000 We can ask ourselves, 80 00:06:35,010 --> 00:06:36,459 what might it look like? 81 00:06:36,470 --> 00:06:41,559 What might the situation look like that would allow for those outcomes? 82 00:06:42,480 --> 00:06:44,950 So let's go back to the examples. 83 00:06:45,410 --> 00:06:49,690 The gentleman invited to be best man at an out of town family wedding. 84 00:06:49,700 --> 00:06:51,200 Let's call him Joe. 85 00:06:51,790 --> 00:06:54,510 He may realize his instinct is to say, 86 00:06:54,519 --> 00:06:55,160 no, 87 00:06:55,679 --> 00:06:58,809 he knows that he gets overwhelmed in crowds. 88 00:06:58,820 --> 00:07:09,809 He dislikes being the center of attention and he relies on routine and specific favorite activities to remain grounded in daily life. 89 00:07:10,170 --> 00:07:24,489 He feels pulled in different directions because he wants to support his family member and he knows that it's really an honor to be asked to connect with the couple in this way at the ceremony. 90 00:07:25,890 --> 00:07:28,390 So Joe and his family may want to discuss, 91 00:07:28,399 --> 00:07:31,570 what would it look like for you to be best man? 92 00:07:31,809 --> 00:07:36,630 What might it look like for Joe to be best man in a relational, 93 00:07:36,640 --> 00:07:38,899 satisfying and meaningful way? 94 00:07:38,940 --> 00:07:44,929 But in a way that also offers him the freedom and the space to take care of his needs. 95 00:07:45,790 --> 00:07:46,920 So at this point, 96 00:07:46,929 --> 00:07:57,320 there is a commitment to the core goals and there is flexibility with the trappings that might otherwise go along with a wedding ceremony. 97 00:07:59,109 --> 00:08:00,369 In the case of the wedding, 98 00:08:00,380 --> 00:08:02,769 Joe may have a separate hotel room, 99 00:08:02,779 --> 00:08:07,369 so he has a quiet alone space to regroup as needed. 100 00:08:08,350 --> 00:08:20,239 Joe may know that he is grounded and centered when he gets pressure inputs in his muscles and joints and he gets these inputs at home with a weighted blanket, 101 00:08:20,260 --> 00:08:22,339 rock climbing and bike riding. 102 00:08:23,239 --> 00:08:36,650 He's decided to choose a hotel that has a swimming pool and an elliptical machine so that he can get these pressure inputs in ways that will still feel grounding to him. 103 00:08:38,489 --> 00:08:48,789 Joe also plans to use small noise canceling earbuds as needed just to shield himself from some of the noise in crowded areas. 104 00:08:48,968 --> 00:08:50,289 They're barely visible, 105 00:08:50,299 --> 00:08:55,698 they help him a lot and it'll be a step toward really increasing his comfort. 106 00:08:56,940 --> 00:09:00,880 Joe and his family agree that he won't attend the bachelor party, 107 00:09:01,150 --> 00:09:09,630 but still he'll have a time that evening where he and the groom have a private drink together to celebrate the union. 108 00:09:11,020 --> 00:09:18,960 Joe also decides to record a video of him toasting the couple rather than making a live toast. 109 00:09:19,409 --> 00:09:26,979 These things in combination with others really help him or regulate himself to have a relation, 110 00:09:27,010 --> 00:09:33,950 meaningful contribution at the ceremony and to also protect what his nervous system needs. 111 00:09:34,820 --> 00:09:38,260 The main points are that Joe and his family are thinking, 112 00:09:38,450 --> 00:09:39,950 what might this look like? 113 00:09:39,960 --> 00:09:47,789 What do we want to work toward and how can we best get there with a mindset toward getting everyone's needs met. 114 00:09:49,020 --> 00:09:50,140 Similarly, 115 00:09:50,150 --> 00:09:53,250 the researcher invited to present her work. 116 00:09:53,260 --> 00:09:54,030 Let's call her, 117 00:09:54,039 --> 00:10:03,669 Susan may avoid the invitation because handling unexpected situations during a presentation is very stressful to her. 118 00:10:04,080 --> 00:10:10,799 She also really shies away from being the center of attention and speaking in front of others. 119 00:10:11,409 --> 00:10:19,219 If she does present her goals would be to take credit for her work and to connect with like minded professionals. 120 00:10:20,369 --> 00:10:26,169 Perhaps her focus on what might this look like leads to the following plan, 121 00:10:27,190 --> 00:10:35,840 Susan and her mentor decide to present the information together with specific slides identified for each of them. 122 00:10:36,559 --> 00:11:02,320 So this plan allows Susan to have an experienced partner to guide her through unexpected glitches and it also ensures that Susan can count on presenting specific material but also have expected breaks while her mentor is speaking during the question and answer section at the end of the presentation, 123 00:11:02,539 --> 00:11:13,679 Susan will take the lead on questions she feels comfortable with and her mentor may cue and structure her thoughts by adding prompts like saying Susan, 124 00:11:13,690 --> 00:11:19,400 this may be a good time to discuss your findings in the area of XY or Z. 125 00:11:21,340 --> 00:11:37,650 So what might that look like process allowed Susan to work toward her desired goals without taking an all or nothing approach to all of the trappings that may typically accompany a professional presentation. 126 00:11:38,219 --> 00:11:47,140 So the first thing we talked about was figuring out what's foundational in the goals and then figuring out how to get there, 127 00:11:47,150 --> 00:11:52,770 what might it look like to accommodate these goals and to let some other things go. 128 00:11:54,070 --> 00:11:57,070 The third thing to think about is when to say no. 129 00:11:57,840 --> 00:11:59,729 So having said all this, 130 00:11:59,739 --> 00:12:12,960 there will be times when what might this look like when that process leads to the conclusion that really this is probably unlikely to help achieve our best, 131 00:12:12,969 --> 00:12:14,179 our best outcome, 132 00:12:14,190 --> 00:12:15,369 our best goals. 133 00:12:16,030 --> 00:12:17,479 Um So saying, 134 00:12:17,489 --> 00:12:20,460 no may be the best decision in that case, 135 00:12:21,900 --> 00:12:27,979 although there would be benefits to finding a compromise that meets the needs of multiple people. 136 00:12:27,989 --> 00:12:45,590 The process may be unrealistic in a particular situation and that may be because the individual's needs at that time are so high in this season of struggle or it may be because features of the situation just can't be adjusted. 137 00:12:47,289 --> 00:12:53,179 Let's take the consultants situation who's considering a full-time office job. 138 00:12:53,390 --> 00:13:15,960 Let's call him a the best answer for him may be no if he is in an unusual season of struggle and maybe he's having difficulty consistently getting his consulting work done and to then switch to a setting that would be more challenging for him may really not be good timing, 139 00:13:16,719 --> 00:13:22,520 his needs as an individual may be so far from what the job can offer him. 140 00:13:22,770 --> 00:13:25,729 That the best answer in this season is no. 141 00:13:27,179 --> 00:13:28,309 Alternatively, 142 00:13:28,320 --> 00:13:32,619 the answer may be no if he's doing well in his consulting work. 143 00:13:32,830 --> 00:13:42,119 But there are core features of the job that would prevent him from having the flexibility that he would really need to thrive. 144 00:13:42,809 --> 00:13:47,280 He may realize that he would need a hybrid work model, 145 00:13:47,289 --> 00:13:50,280 combining office work and remote work. 146 00:13:51,070 --> 00:13:57,289 He may have the self awareness that working on new business proposals keeps his interest level up, 147 00:13:57,650 --> 00:14:06,549 but he needs help maintaining interest in projects that feel like old hat that the work can get boring very quickly. 148 00:14:06,640 --> 00:14:21,630 And the consulting job allows him to pick and choose the types of projects that he does and for things not to get stale if the office job offers him stability in one sense, 149 00:14:21,729 --> 00:14:26,719 but a lack of flexibility to kind of meet in the middle. 150 00:14:27,530 --> 00:14:30,950 He may need to say no to that invitation. 151 00:14:31,330 --> 00:14:33,929 Uh Based on what he knows about himself, 152 00:14:38,130 --> 00:14:42,099 an individual invited to come along for a family vacation. 153 00:14:42,239 --> 00:14:44,090 Let's call her MEREDITH. 154 00:14:44,460 --> 00:14:49,940 She may realize that no is the answer that makes the most sense in her season. 155 00:14:50,799 --> 00:14:53,890 After thinking through what might this look like, 156 00:14:53,900 --> 00:15:02,969 she can't envision any way that realistically meets her needs and achieves the goal of connecting with family on this trip. 157 00:15:04,080 --> 00:15:05,250 For example, 158 00:15:05,260 --> 00:15:14,809 she may have a really severe fear of flying and taking multiple planes is the only way to participate in the vacation as planned. 159 00:15:16,049 --> 00:15:23,179 MEREDITH may realize that her core goal is to connect with two family members in particular. 160 00:15:23,880 --> 00:15:26,580 So her next thought process might be, 161 00:15:27,229 --> 00:15:30,859 I'm going to have to say no to the invitation of the trip. 162 00:15:30,929 --> 00:15:34,429 But how else could I connect with those family members? 163 00:15:34,500 --> 00:15:37,849 Even I'm if I'm going to turn down this invitation, 164 00:15:39,489 --> 00:15:55,979 this process of evaluating invitations and opportunities by asking what might that look like can help us identify what our core goals and needs are while adjusting or releasing things that really aren't foundational. 165 00:15:57,039 --> 00:15:59,809 The decisions often don't need to be all or nothing. 166 00:15:59,820 --> 00:16:03,750 Although after thinking through what might this look like? 167 00:16:03,940 --> 00:16:08,150 We might see that some opportunities just aren't a good fit. 168 00:16:10,030 --> 00:16:22,359 I hope you have invitations that help you grow toward your goals and that your decision making process can also reflect your values and your needs at all seasons of your life. 169 00:16:22,460 --> 00:16:24,500 Thank you for joining me today. 170 00:16:24,750 --> 00:16:36,599 The next episode will launch our new series on Executive Function and clinicians ... check out the link to the master class opportunity with Zur Institute coming up in the fall.  171 00:16:36,690 --> 00:16:41,710 I hope you can join me next time for our episode on Executive Function.    

Do you want to live with more intention to achieve your goals? In this 6th episode in a series on Intentional Living, Dr. Regan discusses ways to grow in areas of interest by expanding skills and using free or low cost methods of networking and introducing products or services to others.  Previous podcast episodes mentioned: Shifting Autistic Characteristics Across the Lifespan Autism in Women Coursera (online courses)   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the transcript: 1 00:00:06,019 --> 00:00:06,829 Hello, 2 00:00:06,840 --> 00:00:16,920 this is Doctor Regan joining you for the sixth episode of Our Living With Intention series on the Autism in the Adult podcast. 3 00:00:17,290 --> 00:00:20,159 I am the mom of a teen on the spectrum. 4 00:00:20,459 --> 00:00:26,180 I have a doctorate in the field of brain behavior relationships called neuropsychology. 5 00:00:26,440 --> 00:00:28,549 I'm also an author and speaker, 6 00:00:28,559 --> 00:00:36,279 a certified autism specialist and the founder and director of an autism diagnostic clinic in Central Illinois, 7 00:00:36,290 --> 00:00:38,000 serving adolescents, 8 00:00:38,009 --> 00:00:40,060 adults and aging adults. 9 00:00:42,180 --> 00:00:45,069 Before we jump into our topic for today, 10 00:00:45,090 --> 00:00:48,250 let's take a throwback to past episodes. 11 00:00:48,619 --> 00:00:51,790 Looking back to two years ago at this time, 12 00:00:51,869 --> 00:00:54,779 I published an episode about autism in women. 13 00:00:55,299 --> 00:00:59,330 It's been one of the most listened to episodes of the podcast. 14 00:00:59,779 --> 00:01:02,270 And one year ago at this time, 15 00:01:02,279 --> 00:01:13,699 we were in the midst of a series about how autism characteristics may shift somewhat across the lifespan during puberty across life, 16 00:01:13,709 --> 00:01:17,879 seasons in women and throughout the aging years, 17 00:01:19,120 --> 00:01:23,569 I'll go ahead and link these episodes in the show notes in case you miss them. 18 00:01:24,989 --> 00:01:25,199 Now, 19 00:01:25,209 --> 00:01:30,139 let's talk about our current episode in The Living With Intention series. 20 00:01:32,319 --> 00:01:37,309 I've named the series Living With Intention because sometimes as humans, 21 00:01:37,319 --> 00:01:53,690 we just kind of get swept up in the demands of daily life or we get stuck in some areas and it can help to pause and consider where we would like to be in various areas of our lives. 22 00:01:54,370 --> 00:02:02,739 And then to think about how to take small achievable steps on a path toward our intention. 23 00:02:03,839 --> 00:02:04,629 And so far, 24 00:02:04,639 --> 00:02:13,050 we've spoken about three areas of life that someone may have goals for such as improving regulation, 25 00:02:13,539 --> 00:02:15,539 that means feeling centered, 26 00:02:15,550 --> 00:02:18,619 calm and psychologically present. 27 00:02:19,720 --> 00:02:27,210 We talked about communicating and connecting and also about addressing issues of household culture. 28 00:02:28,750 --> 00:02:29,449 Today, 29 00:02:29,460 --> 00:02:32,679 we will look at the area of interests. 30 00:02:32,690 --> 00:02:44,070 Many people that I work with share that they're so captivated by a certain topic or activity that they would love to expand this in their life. 31 00:02:44,100 --> 00:02:45,500 For example, 32 00:02:45,509 --> 00:02:47,470 if someone is an artist, 33 00:02:47,710 --> 00:02:52,380 they may share that they think they would like to sell designs on Etsy, 34 00:02:54,000 --> 00:03:01,710 another person may share that they are immersed in sewing and this is so interesting and calming to them. 35 00:03:02,210 --> 00:03:09,970 They've developed quite a skill in this area and they're wondering if they could expand by doing some things in their community. 36 00:03:11,270 --> 00:03:21,240 Another may have an amazing brain for sports statistics and wish that they could get into sports casting as a niche in life. 37 00:03:23,399 --> 00:03:23,929 Again, 38 00:03:23,940 --> 00:03:29,149 it's important to emphasize that these are goals that the individual presents with. 39 00:03:29,360 --> 00:03:33,800 This is not an episode about what someone's goals should be, 40 00:03:33,949 --> 00:03:37,210 but rather to address the thought of gosh, 41 00:03:37,220 --> 00:03:48,089 I love this stuff and I would love to do more or use it in a way that reaches a wider area or a wider audience. 42 00:03:49,759 --> 00:03:58,970 So how does one start a path toward getting more involved in the area of an intense interest? 43 00:04:00,710 --> 00:04:07,130 So how to get started as we talked about in the second episode on this series, 44 00:04:07,399 --> 00:04:14,979 it is recommended that we take small defined achievable steps in the direction we would like to go. 45 00:04:15,850 --> 00:04:22,579 So one such step may be to gain some additional skills in the area of interest. 46 00:04:22,869 --> 00:04:23,880 For example, 47 00:04:23,890 --> 00:04:29,679 if someone produces a product and they would like to offer the product on the internet, 48 00:04:29,920 --> 00:04:39,200 they may wish to get training in things like basic marketing strategies using social media for sales and creating a website. 49 00:04:40,209 --> 00:04:44,359 Someone who creates a myriad of characters and stories, 50 00:04:44,549 --> 00:04:59,209 this individual may want to write fiction books in order to bridge the gap from having great ideas and wonderful creativity to bringing together some stories into a book. 51 00:04:59,239 --> 00:05:03,730 The individual may wish to take a formal course in creative writing. 52 00:05:06,600 --> 00:05:07,010 Now, 53 00:05:07,019 --> 00:05:12,209 I know taking a course can feel daunting but a wonderful place to learn. 54 00:05:12,220 --> 00:05:20,209 Some of these skills is on the internet and there are Myriads of free online courses in various areas. 55 00:05:21,209 --> 00:05:21,739 In fact, 56 00:05:21,750 --> 00:05:28,390 there are so many options that I just can't even list the top opportunities in the show note links. 57 00:05:28,399 --> 00:05:29,690 There are so many, 58 00:05:30,160 --> 00:05:34,279 but I'll share a few things about learning from the internet. 59 00:05:35,190 --> 00:05:37,279 Have you ever heard of a MOOC? 60 00:05:38,040 --> 00:05:41,059 That's M - O - O - C. 61 00:05:41,480 --> 00:05:46,750 It's a massive open online course - MOOC. 62 00:05:47,040 --> 00:05:54,359 And this is a free web-based distance learning program that's designed for huge numbers of people. 63 00:05:54,369 --> 00:05:59,869 Thus the word massive ... of geographically dispersed students. 64 00:06:00,049 --> 00:06:08,380 So open means that these are accessible to multiple levels of people very often, 65 00:06:08,390 --> 00:06:11,929 these are free and they're online. 66 00:06:11,940 --> 00:06:13,820 So this is all web based. 67 00:06:15,440 --> 00:06:21,950 I myself have been a student in several MOC courses to learn things that I can't learn locally. 68 00:06:22,079 --> 00:06:23,089 For example, 69 00:06:23,100 --> 00:06:28,390 I got to take a Behavioral Genetics course through the University of Minnesota. 70 00:06:28,609 --> 00:06:33,429 I took a neuroanatomy course through the University of Illinois Chicago. 71 00:06:34,790 --> 00:06:39,619 And what happens is that you earn a participation certificate from the course, 72 00:06:39,630 --> 00:06:41,079 which is free, 73 00:06:41,910 --> 00:06:50,410 but the benefits are both the information you learn and also having this on your resume as an area of self study. 74 00:06:50,839 --> 00:07:00,309 So the MOOC platforms also have developed paid versions of courses where you earn some type of verified credit or certificate. 75 00:07:00,739 --> 00:07:16,459 And they also have programs that are kind of compilation certificates... like, take seven writing courses and get this advanced writing certificate or a grouping of computer courses for an IT specialization certificate. 76 00:07:18,709 --> 00:07:25,670 The particular site for MOOC courses that I used was Coursera.org and I'll put that in the show notes. 77 00:07:25,899 --> 00:07:29,600 But there are so many sites to choose from. 78 00:07:30,920 --> 00:07:38,549 I encourage you to use an internet search engine for free online courses in the area of your interest. 79 00:07:41,500 --> 00:07:57,809 Another opportunity for learning more skills in your area of interest would be youtube tutorials and also programs like Adobe that offer video instruction to become more expert in their program offerings. 80 00:07:58,720 --> 00:07:59,809 In this context, 81 00:07:59,820 --> 00:08:03,690 you could learn things like video and audio editing, 82 00:08:03,700 --> 00:08:04,609 photography 83 00:08:04,619 --> 00:08:05,399 editing, 84 00:08:05,459 --> 00:08:08,390 how to use website design software... 85 00:08:08,799 --> 00:08:19,959 Podcast platforms like Podbean and others also provide podcasts about how to become and succeed as a podcaster in your area of interest. 86 00:08:20,200 --> 00:08:27,609 And they also offer blog posts and articles about all the things their sites offer to support your goals. 87 00:08:27,619 --> 00:08:52,500 So there's a lot of free learning opportunities in the form of videos, in the form of programs that offer their own education about their products and also podcasts that just talk about how to develop your niche in addition to increasing skills in your area. 88 00:08:52,780 --> 00:09:09,849 Another way to take a step toward your goal of expanding your interest would be to start doing some things on a volunteer basis or to provide giveaways or free products as promotions to highlight your work or skills. 89 00:09:10,549 --> 00:09:11,380 So again, 90 00:09:11,390 --> 00:09:14,409 this doesn't need to be the end goal, 91 00:09:14,489 --> 00:09:14,799 you know, 92 00:09:14,809 --> 00:09:18,950 to be volunteering as the ultimate end, 93 00:09:19,299 --> 00:09:28,400 but it can be one step to help you become more comfortable in this area to gain experience and also to get your offerings out there. 94 00:09:30,989 --> 00:09:40,159 Someone who bakes may wish to donate cookies to the local elementary school open house with a nicely crafted sign about their business, 95 00:09:40,169 --> 00:09:42,229 including their contact information. 96 00:09:42,630 --> 00:09:51,179 They could even put a QR code on the sign so parents can scan the sign and save their contact information in their website location. 97 00:09:52,320 --> 00:10:03,489 The individual who loves sports statistics and wants to become a sportscaster may wish to volunteer time to local sports teams as the sports announcer during the games. 98 00:10:04,450 --> 00:10:07,229 This helps the person create contacts, 99 00:10:07,510 --> 00:10:13,479 get used to the tasks involved in doing the work and lets other people see their skills. 100 00:10:15,929 --> 00:10:24,049 There are other ways to use free venues to increase your credentials and get your work out there. 101 00:10:27,109 --> 00:10:30,419 Looking for free opportunities to get involved, 102 00:10:30,440 --> 00:10:32,510 advance your skills and get your work out. 103 00:10:32,520 --> 00:10:38,219 There is a really good way to step toward that intention of expansion. 104 00:10:38,539 --> 00:10:39,739 So for example, 105 00:10:39,750 --> 00:10:45,809 someone who's trying to develop creative writing skills may wish to enter their stories into contests. 106 00:10:46,270 --> 00:10:48,960 And once you have a body of work developed, 107 00:10:49,119 --> 00:11:02,169 you might find it fairly straightforward to enter appropriate work in various contests for review and as your work earns mentions or comments or awards, 108 00:11:02,280 --> 00:11:06,270 these can be highlighted in your credentials on your website. 109 00:11:09,760 --> 00:11:21,210 Someone who loves making characters and writing may also want to write fan fiction on the internet as a way of using a resource to get their work out there. 110 00:11:23,190 --> 00:11:25,659 For an individual who loves, 111 00:11:25,669 --> 00:11:26,229 loves, 112 00:11:26,239 --> 00:11:35,909 loves running and decides they may wish to do some personal training for other long distance runners locally or in their community, 113 00:11:36,080 --> 00:11:42,500 this person may wish to enter races and keep track of these credentials to market their services. 114 00:11:43,030 --> 00:11:47,200 Some races or events may be free and others may have a fee. 115 00:11:47,250 --> 00:11:48,000 But in the end, 116 00:11:48,010 --> 00:11:52,440 this could be a way of meeting people with similar interests, 117 00:11:52,460 --> 00:12:02,169 getting your name out there as someone who's actively pursuing running and training and getting some race placements to add to your credentials. 118 00:12:05,869 --> 00:12:12,099 The important things about these approaches are that they're small steps, 119 00:12:12,640 --> 00:12:14,979 they're toward your desired outcome. 120 00:12:14,989 --> 00:12:22,760 Whatever you've decided your intention is this is where I'd like to be in this area of my life. 121 00:12:23,669 --> 00:12:30,200 And these small steps help you get a feel for what your goal may feel like in the end. 122 00:12:31,190 --> 00:12:32,320 For example, 123 00:12:32,330 --> 00:12:46,000 someone who thinks that they might want to become a teacher will gain a lot of information about teaching by volunteering to teach a course at the community center every Saturday for four weeks. 124 00:12:46,400 --> 00:12:53,440 So they get a taste of what it feels like to instruct a small group of adults or Children. 125 00:12:54,250 --> 00:13:03,460 They get a taste for some of the paperwork or the communication demands in between the actual classes and instruction. 126 00:13:04,229 --> 00:13:10,000 Some people who love a particular topic and they think they might want to teach, 127 00:13:10,030 --> 00:13:19,200 end up realizing after some of these volunteer opportunities that the actual process of teaching is not something they love. 128 00:13:22,530 --> 00:13:28,270 Another important thing about this approach is that for some of the options. 129 00:13:28,609 --> 00:13:35,520 There's really not a high demand for in-person contact or being in crowded classrooms. 130 00:13:36,059 --> 00:13:52,239 Some individuals may feel that expanding their interests into well formed skills or offerings is most daunting because they really can't imagine themselves opening a whole storefront or running a restaurant full of people. 131 00:13:52,640 --> 00:13:58,770 But this approach can harness all of the online opportunities for learning, 132 00:13:58,780 --> 00:13:59,909 for creating, 133 00:13:59,919 --> 00:14:05,880 for selling through the internet while engaging in certain community events that you choose. 134 00:14:06,159 --> 00:14:16,099 You get to decide how much uh event based activity do I want to do in the community or how much do I want to travel? 135 00:14:16,229 --> 00:14:23,330 How much customer interaction do I want versus time to regroup in my own space? 136 00:14:26,590 --> 00:14:31,000 I'm a firm believer that your community needs your gifts, 137 00:14:31,010 --> 00:14:32,159 your knowledge, 138 00:14:32,169 --> 00:14:40,070 your passion and whatever area you find that in and finding ways to take steps to your passion, 139 00:14:40,080 --> 00:14:42,229 not only blesses you, 140 00:14:42,440 --> 00:14:49,280 but those around you and having ways of expressing that also is something that fills you up. 141 00:14:49,619 --> 00:14:50,969 I love creating. 142 00:14:50,979 --> 00:14:51,929 I love writing, 143 00:14:51,940 --> 00:14:52,909 I love running. 144 00:14:52,919 --> 00:14:54,690 I love sports statistics. 145 00:14:54,960 --> 00:15:06,270 We like to have some balanced way of allowing you to learn and grow in this area to feed that passion and to serve your community. 146 00:15:09,030 --> 00:15:16,119 Thank you so much for joining me for the sixth episode of the Living With Intention series. 147 00:15:16,349 --> 00:15:27,099 And I invite you to check out the show notes for links to opportunities mentioned in this episode and for links to other offerings on my website. 148 00:15:27,349 --> 00:15:31,880 And I hope that you join me for the next podcast episode.  

Do you want to live with more intention to achieve your goals? In this 5th episode in a series on Intentional Living, Dr. Regan identifies ways to improve household interactions by attending to the needs of the group and establishing traditions and structured activities.    Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript here: 1 00:00:06,139 --> 00:00:06,480 Hi, 2 00:00:06,489 --> 00:00:07,110 everyone. 3 00:00:07,119 --> 00:00:12,170 This is Doctor Regan joining you for an episode of Autism in the Adult podcast. 4 00:00:12,489 --> 00:00:14,970 I'm the mom of a teen on the spectrum. 5 00:00:14,979 --> 00:00:17,500 I have a doctorate in neuropsychology. 6 00:00:17,700 --> 00:00:20,790 It's the field of brain behavior relationships. 7 00:00:20,909 --> 00:00:25,649 And I'm the director of an autism diagnostic clinic for adolescents, 8 00:00:25,659 --> 00:00:29,149 adults and aging adults in Central Illinois. 9 00:00:30,010 --> 00:00:30,459 Today, 10 00:00:30,469 --> 00:00:38,180 you're joining me for the fifth episode in a series about living with intention making goals, 11 00:00:38,189 --> 00:00:43,500 shifting in areas of life to get you closer to where you would like to be. 12 00:00:44,240 --> 00:00:55,540 So there were two episodes about how to choose an area of life to target and how to approach change with some specific goals and strategies. 13 00:00:56,009 --> 00:01:02,369 We had episodes about improving regulation and about communicating and connecting. 14 00:01:02,979 --> 00:01:09,629 So today we have an episode focused on household living and the culture of the household. 15 00:01:10,400 --> 00:01:10,690 Now, 16 00:01:10,699 --> 00:01:13,250 before we dive into the topic for today, 17 00:01:13,260 --> 00:01:20,519 I want to invite you to check out the resources on my website at adult in geriatric autism dot com. 18 00:01:20,959 --> 00:01:28,410 There are posts and videos for many different types of listeners and learners including clinicians. 19 00:01:29,019 --> 00:01:29,529 Also, 20 00:01:29,540 --> 00:01:31,610 you may find one of my books helpful, 21 00:01:31,620 --> 00:01:32,580 many of you know, 22 00:01:32,589 --> 00:01:39,069 that my first book called Understanding Autism in Adults and Aging Adults is in the second edition. 23 00:01:39,500 --> 00:01:40,589 And if you don't know, 24 00:01:40,599 --> 00:01:44,550 I have a second book called Understanding Autistic Behaviors, 25 00:01:44,559 --> 00:01:47,250 which is more of a workbook format. 26 00:01:47,540 --> 00:01:55,809 So it explains the neurology ... kind of the neurologic-why of some of the behavioral patterns. 27 00:01:55,819 --> 00:02:02,110 And it outlines ways to work toward increased well-being if someone's in a season of struggle. 28 00:02:04,419 --> 00:02:07,430 So let's focus on household living. 29 00:02:07,470 --> 00:02:16,449 So I want to highlight this topic because many people talk to me about the complexities of living in a household with other people. 30 00:02:16,949 --> 00:02:22,330 Most often this has to do with spouses or partners or with couples who have Children. 31 00:02:22,690 --> 00:02:27,350 Not only is the individual trying to increase their own self awareness. 32 00:02:27,360 --> 00:02:27,559 You know, 33 00:02:27,570 --> 00:02:29,050 this is how I'm wired, 34 00:02:29,059 --> 00:02:30,529 this is what makes me tick, 35 00:02:30,539 --> 00:02:31,770 this is what I need. 36 00:02:32,059 --> 00:02:33,830 But in a household, 37 00:02:33,860 --> 00:02:41,160 this is really next level awareness because there's now this demand to be aware of yourself, 38 00:02:41,169 --> 00:02:46,289 multiple other people and the interplay between all of the people. 39 00:02:46,500 --> 00:02:47,630 And on top of that, 40 00:02:47,639 --> 00:02:52,100 the needs and interplay change from day to day and from life, 41 00:02:52,110 --> 00:02:53,770 season to life season. 42 00:02:54,789 --> 00:03:00,240 It's so so easy to default to this kind of household interaction. 43 00:03:00,449 --> 00:03:02,039 Stop doing that. 44 00:03:02,050 --> 00:03:03,440 Why are you doing that? 45 00:03:03,449 --> 00:03:08,440 I've told you 100 times to X Y Z. 46 00:03:08,860 --> 00:03:09,800 Oh my gosh, 47 00:03:09,809 --> 00:03:12,440 you are so loud, 48 00:03:12,449 --> 00:03:21,630 messy clingy and guess what this focus on telling people to be different every day is just not that effective. 49 00:03:21,960 --> 00:03:27,679 And that's why we find ourselves saying the same things every day over and over. 50 00:03:27,690 --> 00:03:28,770 And not only that, 51 00:03:28,910 --> 00:03:35,339 but these repetitive interactions cause a strain on the relationships in the household. 52 00:03:35,369 --> 00:03:40,940 And they create this kind of adversarial connection rather than a partnering connection. 53 00:03:41,330 --> 00:03:50,050 So the big message is I want you to be different now rather than I want to partner with you to make things better, 54 00:03:50,110 --> 00:03:51,339 better for you, 55 00:03:51,350 --> 00:03:53,839 better for me and better for the household. 56 00:03:54,520 --> 00:04:01,009 So let's talk about some specific areas of focus and strategy that might help. 57 00:04:01,820 --> 00:04:05,509 The first thing we're gonna talk about is focus on the other. 58 00:04:05,889 --> 00:04:06,199 Now, 59 00:04:06,210 --> 00:04:07,690 during the previous episode, 60 00:04:07,699 --> 00:04:14,910 we talked about the importance of expanding our awareness from only what do I need right now, 61 00:04:14,919 --> 00:04:22,100 which actually can be difficult to figure out to what does the other person need right now. 62 00:04:22,399 --> 00:04:24,170 And when we add that element, 63 00:04:24,420 --> 00:04:28,109 we can get away from this push and pull of, 64 00:04:28,119 --> 00:04:31,769 stop doing that to oh, 65 00:04:31,779 --> 00:04:35,309 things might be able to go smoother in this area. 66 00:04:35,660 --> 00:04:42,910 I wonder what the need is that's connected with that behavior and how could I support change? 67 00:04:43,250 --> 00:04:46,109 So as we're talking about households, 68 00:04:46,119 --> 00:05:00,899 this concept of focus on the other then becomes expanded and that makes things a little more complex but also much more important and potentially really helpful, 69 00:05:00,950 --> 00:05:04,730 especially if this becomes the culture of the household, 70 00:05:04,760 --> 00:05:09,079 meaning that this is how we do things it becomes more automatic. 71 00:05:09,089 --> 00:05:13,880 It becomes something that everyone's focusing on as best they can. 72 00:05:14,980 --> 00:05:28,660 Let's imagine that a gentleman who's on the autism spectrum is also a dad and a husband and he's coming home from work after what's been a really draining and complex day, 73 00:05:29,059 --> 00:05:36,130 he's had work demands but also lots of other layers of unexpected changes in his schedule, 74 00:05:36,140 --> 00:05:38,230 detours on the route home. 75 00:05:38,600 --> 00:05:43,970 There were lots of sensory overload moments and a disagreement with a work colleague. 76 00:05:44,750 --> 00:05:51,579 So he comes home and mom who is home with three kids is not on the spectrum, 77 00:05:51,589 --> 00:05:55,070 but she does have sensory processing sensitivities, 78 00:05:55,200 --> 00:05:56,220 stickiness, 79 00:05:56,230 --> 00:05:58,529 and kids hanging on her and noise. 80 00:05:58,540 --> 00:06:02,600 And she's getting to the point that that has been really overwhelming today. 81 00:06:03,359 --> 00:06:05,149 She is home with three kids. 82 00:06:05,160 --> 00:06:21,200 A daughter who is eight has been home from school with the stomach flu but is feeling better and is now running around the house in her tutu singing and spinning and waving her magic wand around an autistic son who is 11, 83 00:06:22,160 --> 00:06:25,049 is melting down while doing his math homework. 84 00:06:25,070 --> 00:06:32,630 And another son is 15 and is playing loud music in his room with the door shut. 85 00:06:34,019 --> 00:06:35,790 So the first approach, 86 00:06:35,799 --> 00:06:41,040 the one that is our most typical go to may look like this. 87 00:06:41,549 --> 00:06:42,899 Dad walks in. 88 00:06:43,059 --> 00:06:46,480 Mom is yelling at her two youngest kids to be quiet. 89 00:06:46,660 --> 00:06:51,549 She's juggling hot food in the kitchen while trying to get food ready for dinner. 90 00:06:52,700 --> 00:06:58,130 The youngest daughter runs up to dad and wants to show off her tutu and her magic wand. 91 00:06:58,540 --> 00:07:03,549 And dad hears the loud music coming from upstairs and mom is thinking, 92 00:07:03,559 --> 00:07:06,059 thank goodness he is home. 93 00:07:06,220 --> 00:07:07,549 I need some help. 94 00:07:07,559 --> 00:07:14,130 I need some relief and dad is thinking I can't wait to get out of here and go for my bike ride. 95 00:07:16,299 --> 00:07:23,519 So mom and dad get in a fight about how he comes home and goes off by himself and she's been there all day, 96 00:07:23,529 --> 00:07:24,309 et cetera. 97 00:07:25,209 --> 00:07:28,279 So dad feels the pressure to make things right. 98 00:07:28,510 --> 00:07:30,950 He yells at his oldest son saying, 99 00:07:30,959 --> 00:07:34,070 why don't you turn off your music and come down and help your mother. 100 00:07:34,390 --> 00:07:40,850 And he yells at the middle son and says that math really isn't that hard and he should stop crying. 101 00:07:42,920 --> 00:07:55,970 We all get that right like we are at the end of our rope and we just want to make the chaos stop and calm down and we want other people to do their part. 102 00:07:58,119 --> 00:08:00,250 Let's think about a second approach. 103 00:08:01,019 --> 00:08:17,299 This is increased awareness that all of these people have really legitimate needs and a realization that there needs to be a way to figure out what they are and then to try to work together to do something. 104 00:08:19,170 --> 00:08:22,100 Mom is overwhelmed with sensory inputs. 105 00:08:22,109 --> 00:08:26,929 She's drained from the whole day of being the only adult at home, 106 00:08:27,079 --> 00:08:33,700 which means that she has been the go to person for everyone's needs in the household. 107 00:08:34,559 --> 00:08:37,588 So she needs quiet alone time. 108 00:08:37,838 --> 00:08:39,598 She needs compliments, 109 00:08:39,609 --> 00:08:41,059 she needs support. 110 00:08:41,900 --> 00:08:44,830 The youngest daughter suddenly feeling better. 111 00:08:45,239 --> 00:08:54,210 She needs to run off some of her nonsick energy and be recognized as someone who's beautiful and magical with her wand. 112 00:08:55,409 --> 00:08:59,330 The middle son has also been very drained from the day. 113 00:08:59,669 --> 00:09:06,080 He gets overwhelmed with the social and sensory environment at school and he has a math learning disability. 114 00:09:06,719 --> 00:09:17,369 So he has gone from a draining environment to a draining environment and he's doing a task that he just knows he can't have success with. 115 00:09:18,260 --> 00:09:21,840 He's unable to get his bearings to calm, 116 00:09:22,059 --> 00:09:23,469 to reenter, 117 00:09:23,479 --> 00:09:25,869 he needs some regulation help. 118 00:09:27,960 --> 00:09:39,880 The oldest son is feeling the angst of being a teen and this comes with easy irritation thinking his parents don't know anything and the loud music releases some of his irritability. 119 00:09:40,000 --> 00:09:43,450 It establishes his identity as his own person. 120 00:09:43,619 --> 00:09:46,969 So that is a lot. 121 00:09:49,590 --> 00:09:51,229 In this case, 122 00:09:51,900 --> 00:10:07,090 it often helps to have some type of planned huddle uh between the couple or with the family about what is the status right now and what do you need? 123 00:10:09,809 --> 00:10:18,659 The huddle is just a coming together to talk briefly about what are we gonna do next? 124 00:10:18,900 --> 00:10:20,820 What's going on and what are we gonna do? 125 00:10:21,979 --> 00:10:26,710 The status is really high chaos for everyone in this family right now. 126 00:10:27,979 --> 00:10:35,590 And sometimes families make up kind of humorous labels for levels of chaos or crisis. 127 00:10:35,880 --> 00:10:50,049 One family might use a color code where a code red is the most chaos or sometimes a movie related code where the most chaos is the Lord of the Rings scene where the orcs come. 128 00:10:51,070 --> 00:10:54,030 The status could also be a factual description. 129 00:10:54,190 --> 00:10:55,340 Bad day at work, 130 00:10:55,349 --> 00:10:57,619 really drained or bad day at home, 131 00:10:57,630 --> 00:10:58,539 really drained. 132 00:10:58,710 --> 00:11:02,919 And I'm at my breaking point at the highest level of chaos. 133 00:11:02,929 --> 00:11:05,309 Both mom and dad really need alone time. 134 00:11:05,669 --> 00:11:06,280 Now, 135 00:11:06,289 --> 00:11:07,820 what do the kids need? 136 00:11:08,450 --> 00:11:08,929 Well, 137 00:11:08,940 --> 00:11:11,000 you may have a quick family huddle, 138 00:11:11,320 --> 00:11:12,780 what do you need? 139 00:11:13,210 --> 00:11:21,960 Or the parents may have a sense already of what the kids would probably need to regulate and regroup. 140 00:11:22,349 --> 00:11:27,219 One helpful thing in this scenario might look like the following. 141 00:11:27,840 --> 00:11:36,130 Dad could go on his bike ride but also take the 11 year old son who's on the autism spectrum on the ride as well. 142 00:11:37,150 --> 00:11:42,070 They both really feel better after they get some pressure input, 143 00:11:42,080 --> 00:11:45,929 that's proprioceptive input and movement input, 144 00:11:45,940 --> 00:11:47,330 vestibular input. 145 00:11:47,669 --> 00:11:53,450 You can see our episode about sensory inputs for regulation. 146 00:11:54,070 --> 00:11:57,539 And this is why the bike ride is so important. 147 00:11:57,760 --> 00:12:03,200 If we tell dad not to go on the bike ride because the house is in chaos, 148 00:12:03,599 --> 00:12:07,409 he's not going to be able to regulate himself. 149 00:12:07,590 --> 00:12:09,849 So we want a dad who comes back, 150 00:12:09,859 --> 00:12:12,979 regulated centered calm. 151 00:12:13,239 --> 00:12:14,640 Um not at, 152 00:12:14,650 --> 00:12:15,890 at the breaking point. 153 00:12:16,539 --> 00:12:30,619 This bike ride also gives time for their mind to settle and it's a kind of together activity where they actually don't have to talk So it's the thing they like to do and we're together, 154 00:12:30,630 --> 00:12:36,780 but we don't have to say anything and that's very calming and regulating for them. 155 00:12:38,750 --> 00:12:40,349 Perhaps in this scenario, 156 00:12:40,359 --> 00:12:51,559 mom chooses a bubble bath with headphones and music and gives the 15 year old a task to keep him busy and to acknowledge his independence. 157 00:12:52,200 --> 00:13:01,650 So there's a small corner store about three blocks away and she gives him $15 to walk to the corner store and to take the eight year old, 158 00:13:03,049 --> 00:13:11,119 the eight year old can spin and sing and walk with her wand and he gets to choose whatever he wants for, 159 00:13:11,130 --> 00:13:13,539 quote dessert for the family. 160 00:13:14,460 --> 00:13:18,489 He chooses lots of movie candy like now and laters, 161 00:13:18,500 --> 00:13:21,059 Mike and Ike and Swedish fish. 162 00:13:21,070 --> 00:13:25,109 And he lets his sister pick out a Princess Pez dispenser. 163 00:13:25,700 --> 00:13:27,390 Then they walk home, 164 00:13:27,400 --> 00:13:29,330 mom's done with their bath. 165 00:13:29,340 --> 00:13:38,270 Dad and son are home and this is a regrouping time that acknowledges as many people's needs as possible. 166 00:13:38,609 --> 00:13:44,409 And then there can be a huddle at that point about how the rest of the night might go. 167 00:13:46,419 --> 00:13:54,750 But we at least want to problem solve when as many people as possible are more centered and less close to the breaking point. 168 00:13:57,289 --> 00:14:06,520 So this focus and strategy is uh really pinpointing what other people need people in the household. 169 00:14:06,869 --> 00:14:12,479 And it uses the huddle concept to come together and make a plan. 170 00:14:12,849 --> 00:14:14,979 So it's a quick coming together. 171 00:14:14,989 --> 00:14:16,690 It's not like a family meeting, 172 00:14:16,700 --> 00:14:18,739 where we talk through things, 173 00:14:18,859 --> 00:14:21,580 it's what's going on and what do we need to do. 174 00:14:23,190 --> 00:14:23,679 Now, 175 00:14:23,690 --> 00:14:26,760 we all know that this doesn't make everything easy, 176 00:14:26,780 --> 00:14:35,969 but it often makes things better and it creates partnerships within the household rather than really strained relationships. 177 00:14:40,070 --> 00:14:44,280 Let's look at another approach to household culture. 178 00:14:44,419 --> 00:14:51,020 So the second one is focusing on tradition and structure in order to interact, 179 00:14:52,859 --> 00:14:55,090 individuals with autistic neurology, 180 00:14:55,099 --> 00:15:04,099 often prefer structured topic based activities rather than hanging out or sharing about their day or sharing about feelings. 181 00:15:04,510 --> 00:15:10,869 These are typically more enjoyable to them than just unstructured together time. 182 00:15:12,219 --> 00:15:16,950 It might involve harnessing their knowledge about something that they love. 183 00:15:19,450 --> 00:15:25,099 And once you know who in the family really likes this kind of interaction. 184 00:15:25,109 --> 00:15:26,320 And you can say, 185 00:15:26,479 --> 00:15:29,049 I know this is what we enjoy best. 186 00:15:29,380 --> 00:15:35,059 This awareness can help increase the number of nice family memories or interactions. 187 00:15:35,380 --> 00:15:37,239 So for example, 188 00:15:37,250 --> 00:15:46,159 let's take a family um who likes to socially connect at the dinner table by sharing about their day, 189 00:15:46,380 --> 00:15:47,929 how the practice went, 190 00:15:47,940 --> 00:15:49,409 how their soccer game? 191 00:15:49,419 --> 00:15:53,669 Did uh did your friend feel good about their science project? 192 00:15:53,679 --> 00:15:56,809 How is your boss's husband doing since his surgery, 193 00:15:56,820 --> 00:15:57,510 et cetera? 194 00:15:58,900 --> 00:16:02,880 In contrast to another family with neurodiversity, 195 00:16:02,890 --> 00:16:03,359 now, 196 00:16:03,369 --> 00:16:10,299 they may prefer something more structured and less about how people felt or responded, 197 00:16:10,780 --> 00:16:14,119 less open ended or broad questions about the day. 198 00:16:14,340 --> 00:16:15,919 So what might that look like? 199 00:16:17,909 --> 00:16:25,080 This family might start a tradition at the dinner table where they each share an interesting fact that they learned that day. 200 00:16:25,159 --> 00:16:30,159 So perhaps the eight year old learned that most fish don't have eyelids. 201 00:16:30,580 --> 00:16:33,000 The 15 year old learned that on average, 202 00:16:33,010 --> 00:16:36,739 every person on earth owns 86 Lego Bricks. 203 00:16:40,210 --> 00:16:42,320 Let's look at another example. 204 00:16:42,330 --> 00:16:44,059 Let's take a spouse. 205 00:16:44,400 --> 00:16:56,059 We're looking at a woman who feels dissatisfied because her husband doesn't engage in conversations during times like car rides or while at a restaurant and waiting on their meal. 206 00:16:56,739 --> 00:17:03,609 She's realized though that they can have a really good social interaction if it's structured about a topic. 207 00:17:04,250 --> 00:17:12,939 She's also noticed that they have a good time interacting if they take online quizzes or play trivia together during these times. 208 00:17:13,660 --> 00:17:22,630 So the passenger in the car can ask the driver trivia questions and then they can switch and she notices that they really end up laughing, 209 00:17:22,640 --> 00:17:24,089 they learn new things. 210 00:17:24,099 --> 00:17:25,530 It works out well. 211 00:17:25,540 --> 00:17:28,380 It's actually a really connecting time, 212 00:17:28,689 --> 00:17:34,829 uh much better than the silence of sitting together without interacting. 213 00:17:37,680 --> 00:17:39,530 Let's take a third family. 214 00:17:39,619 --> 00:17:53,829 This family has teens and it's been struggling because the kids are a bit more moody than they were as youngsters and they're too old for some of the things that they used to do as a family when they were younger. 215 00:17:54,099 --> 00:17:54,380 You know, 216 00:17:54,390 --> 00:17:57,170 they don't like going to the zoo anymore. 217 00:17:58,119 --> 00:18:05,349 This family realized that structuring some traditions for activities has worked better than small talk. 218 00:18:05,359 --> 00:18:13,849 Like how with school they might have a Friday night tradition of board games and pizza or they might rotate, 219 00:18:13,859 --> 00:18:16,530 who gets to pick the Friday night activity. 220 00:18:16,979 --> 00:18:21,810 One teen may pick a movie and chooses the snacks next week, 221 00:18:21,819 --> 00:18:26,089 another chooses a board game and challenges kids against parents. 222 00:18:26,579 --> 00:18:31,229 And the next week mom chooses a Lock Drew mystery for the family to solve together. 223 00:18:32,780 --> 00:18:43,729 So this approach harnesses the fact that individuals with autistic neurology may really enjoy each other within the context of some structure, 224 00:18:43,739 --> 00:18:53,310 topic and activity rather than these loose connecting moments or open ended questions like how is your day and what's going on in your life. 225 00:18:56,209 --> 00:19:00,420 There's so much that goes into the culture of a household. 226 00:19:00,790 --> 00:19:18,670 But these two tips of helping people get their needs met and coming together with structure and topic focused activities can be part of what helps shift things in a good direction for many families and it really protects those partnering kinds of relationships. 227 00:19:19,989 --> 00:19:24,660 Thank you for joining me today to talk about households and families, 228 00:19:24,819 --> 00:19:27,060 protecting the wellness of our family. 229 00:19:27,069 --> 00:19:32,709 Connections can help us feel more supported and resilient overall. 230 00:19:33,530 --> 00:19:42,430 And next time we will round out this series by focusing on adding meaning and growth to areas of special interest. 231 00:19:42,619 --> 00:19:44,219 I hope you can join me then.  

Do you want to live with more intention to achieve your goals? In this 4th episode in a series on Intentional Living, Dr. Regan identifies ways to use communication to create connection and help you achieve the life goals you aim for.   Resources mentioned in the podcast:  Talking About Autism podcast series The Science of Making Friends: book Better Small Talk: book Crucial Conversations: book   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript here: 1 00:00:03,809 --> 00:00:04,659 Hi there. 2 00:00:04,670 --> 00:00:06,679 This is Doctor Theresa Regan. 3 00:00:06,969 --> 00:00:11,510 I'm joining you for an episode of autism in the Adult podcast. 4 00:00:11,800 --> 00:00:13,619 I'm a neuropsychologist, 5 00:00:13,859 --> 00:00:19,120 the founder and director of an autism diagnostic clinic in Central Illinois. 6 00:00:19,290 --> 00:00:21,959 And I'm the parent of a teen on the spectrum. 7 00:00:22,680 --> 00:00:27,440 Did you know that I did a podcast series on talking about autism? 8 00:00:27,659 --> 00:00:30,420 This was in February of 2022. 9 00:00:30,559 --> 00:00:43,909 It had three episodes where I covered things like how to talk to other people about your journey to seek a diagnostic evaluation or how to tell people that you've received a new diagnosis of autism. 10 00:00:44,340 --> 00:00:53,270 We cover topics about how to process and navigate the emotions of other people during conversations about autism. 11 00:00:53,909 --> 00:01:01,279 And we also reviewed how to talk to someone that you are familiar with --someone in your family, 12 00:01:01,290 --> 00:01:05,739 someone that you know -- about the possibility that they are on the spectrum. 13 00:01:06,089 --> 00:01:08,930 Maybe they haven't thought about it that way, 14 00:01:08,940 --> 00:01:12,319 but you recognize some characteristics in them. 15 00:01:13,010 --> 00:01:18,069 I'm going to put a link to this series talking about autism in the show notes. 16 00:01:18,599 --> 00:01:26,940 But today you are joining me for episode number four in a series about intentional living on the autism spectrum, 17 00:01:28,309 --> 00:01:33,629 we all get into rhythms and routines that have a life of their own. 18 00:01:33,900 --> 00:01:36,000 Sometimes our schedules, 19 00:01:36,010 --> 00:01:37,540 what we typically do, 20 00:01:37,550 --> 00:01:41,440 what we don't do... things that crop up in our lives. 21 00:01:41,449 --> 00:01:56,860 They catch us up in their momentum and sometimes it's just nice to pause and to step back and really see if the life that we're living lines up with where we'd like to be in the future. 22 00:01:57,389 --> 00:02:01,150 Are we choosing this life? 23 00:02:01,160 --> 00:02:07,860 Are we being swept away without really pausing to make some choices and decisions? 24 00:02:08,440 --> 00:02:14,639 And certainly we can't have the final say in everything that our life entails. 25 00:02:14,649 --> 00:02:22,020 But we really will be able to capture more of our dreams and visions for the future 26 00:02:22,029 --> 00:02:27,259 if we pause and make choices that line up with those... 27 00:02:27,690 --> 00:02:29,339 those goals that we have. 28 00:02:31,770 --> 00:02:38,740 This need to pause and reevaluate our intentions and choices is a universal human need. 29 00:02:39,470 --> 00:02:49,300 But we're spending some time talking about this in the context of autism because sometimes the individual on the spectrum will struggle more with this, 30 00:02:49,750 --> 00:03:03,759 possibly because they have difficulty switching gears from the typical routine or maybe this individual has problems finding the energy or the momentum to get going with something new. 31 00:03:04,820 --> 00:03:12,910 This person may feel like it's challenging to get out of the hyper focus of the moment and to try to think long term. 32 00:03:13,919 --> 00:03:16,889 So in the first episode for this series, 33 00:03:16,899 --> 00:03:25,009 we talked about how to get to the point where you can actually choose a goal that is difficult in itself. 34 00:03:26,360 --> 00:03:35,020 We outlined several life categories that you could analyze to see if you would like to think of a goal in these categories. 35 00:03:35,940 --> 00:03:36,190 Now, 36 00:03:36,199 --> 00:03:41,110 the second episode was about how to make specific goals within a category. 37 00:03:41,990 --> 00:03:50,080 So we want the goal to help us shift from our current place and leave the boundaries of our comfort zone. 38 00:03:50,440 --> 00:03:58,820 But we don't want it to be overwhelming or self defeating because we picked a goal that's just too difficult, 39 00:03:58,830 --> 00:03:59,720 too big... 41 00:03:59,960 --> 00:04:02,059 feels insurmountable. 42 00:04:03,929 --> 00:04:16,660 The third episode in this series about living with intention had to do with strategies to reach goals within the area of health and wellness specifically with regulation. 43 00:04:17,278 --> 00:04:25,069 And this is often a good place to start in our lives when we're trying to grow and challenge ourselves. 44 00:04:25,079 --> 00:04:29,028 Because if we're setting goals, 45 00:04:29,199 --> 00:04:34,989 this is really us setting a goal to do difficult things. 46 00:04:35,290 --> 00:04:39,399 And if we're not regulated when we start these goals, 47 00:04:39,410 --> 00:04:41,750 if we're not feeling grounded, 48 00:04:41,760 --> 00:04:42,859 centered, 49 00:04:42,869 --> 00:04:45,609 calm and psychologically present, 50 00:04:45,750 --> 00:04:47,880 attentive and rested, 52 00:04:48,480 --> 00:04:56,290 it's really difficult to leave our comfort zone in any other area to really have intentional living. 53 00:04:56,619 --> 00:05:04,480 So it is often nice to make sure that we're really well regulated before we jump into any other goals. 54 00:05:05,790 --> 00:05:16,679 So now today you are listening to the fourth episode and we're going to focus on intentional living within communication and relationships. 55 00:05:17,359 --> 00:05:21,399 And you may be asking why do I need to have social goals? 56 00:05:21,570 --> 00:05:22,010 Well, 57 00:05:22,019 --> 00:05:22,950 you don't, 58 00:05:23,149 --> 00:05:30,350 your communication and your social network don't have to match any particular template that others use. 59 00:05:30,420 --> 00:05:32,489 But at the same time, 60 00:05:32,500 --> 00:05:35,619 if you have a vision for your future, 61 00:05:36,269 --> 00:05:44,089 you may need to grow in certain areas of communication or connection so that you can meet the goals that you do have. 62 00:05:45,309 --> 00:05:46,640 For example, 63 00:05:46,649 --> 00:05:52,359 one person may want to become a history teacher because they love history. 64 00:05:52,959 --> 00:05:54,299 That is a great goal. 65 00:05:54,309 --> 00:05:59,600 It's a way of sharing your love of a topic with other people. 66 00:06:00,269 --> 00:06:04,579 But you'll also need to have some skills for communication, 67 00:06:04,589 --> 00:06:08,549 updates with your work team and with your students and families. 68 00:06:08,579 --> 00:06:11,079 Maybe about projects or grades, 69 00:06:11,350 --> 00:06:18,500 you'll have to have communication skills to interact with people who are really upset with you or disagree with you. 70 00:06:19,329 --> 00:06:26,329 Maybe you'll be put in charge of a major project for the school and you'll have to present on the topic. 71 00:06:27,269 --> 00:06:29,600 If you already have these skills, 72 00:06:29,609 --> 00:06:30,709 that's super, 73 00:06:30,720 --> 00:06:32,869 you don't need to grow in this area. 74 00:06:33,239 --> 00:06:43,220 But if you don't focusing on this area of growth may help you in the future as you take your path toward your ultimate goals. 75 00:06:44,989 --> 00:06:55,670 Another example would be someone who's just retired and maybe they're finding it difficult to connect or get along with their partner now that they're both at home a lot. 76 00:06:56,190 --> 00:07:01,600 So perhaps this person has a goal to connect in a more effective way. 77 00:07:01,709 --> 00:07:09,320 She may have a goal for communication and connecting in the home with this new life season of retirement. 78 00:07:11,369 --> 00:07:12,309 In contrast, 79 00:07:12,320 --> 00:07:15,920 you may be someone who's all set in this area. 80 00:07:16,170 --> 00:07:17,190 But in the future, 81 00:07:17,200 --> 00:07:26,429 you may want to have some things tucked away for different tasks or goals that crop up along the way this episode may be for you. 82 00:07:27,339 --> 00:07:39,309 So let's focus on three things to keep in mind that may help you reach a goal for more effective communication and connection in a particular area of your life. 83 00:07:40,220 --> 00:07:41,350 And let's face it, 84 00:07:41,359 --> 00:07:46,690 you are probably already super good at communicating about topics, 85 00:07:46,700 --> 00:07:47,929 facts, 86 00:07:47,940 --> 00:07:49,149 details, 87 00:07:49,380 --> 00:07:58,790 things like teaching about history or telling your partner that we're out of milk and somebody's got to get this supply at the store. 88 00:07:59,600 --> 00:07:59,910 Well, 89 00:07:59,920 --> 00:08:07,660 the trickier area of communication more often shows up when we're in an interaction and we start thinking, 90 00:08:07,670 --> 00:08:08,250 wow, 91 00:08:08,260 --> 00:08:10,339 what just happened here? 92 00:08:10,920 --> 00:08:16,299 What did this person react to in this conversation? 93 00:08:16,309 --> 00:08:18,799 I'm not even sure where they're coming from. 94 00:08:18,970 --> 00:08:21,399 I don't know what this person wants from me. 95 00:08:22,059 --> 00:08:23,109 After all, 96 00:08:23,119 --> 00:08:25,549 I was right about what I said. 97 00:08:26,040 --> 00:08:29,429 So why all this emotion or all this up and down? 98 00:08:30,100 --> 00:08:36,469 Let's look at a few areas of focus that can balance out that connection piece. 99 00:08:36,989 --> 00:08:38,070 First of all, 100 00:08:38,080 --> 00:08:42,669 I want to introduce and bring more into your awareness, 101 00:08:42,679 --> 00:08:45,349 this focus on the other. 102 00:08:46,200 --> 00:08:49,210 So when you are communicating with someone, 103 00:08:49,219 --> 00:08:51,409 whether that is a history teacher, 104 00:08:51,419 --> 00:08:55,380 talking to a parent or a woman who's just retired, 105 00:08:55,390 --> 00:08:56,710 talking to her partner. 106 00:08:57,080 --> 00:09:05,799 There is a difference between communication that's factually correct and communication that is effective. 107 00:09:07,400 --> 00:09:09,309 It helps to be correct. 108 00:09:10,020 --> 00:09:13,549 But we also want communication that's more than correct. 109 00:09:13,559 --> 00:09:15,630 We want it to be productive, 110 00:09:15,739 --> 00:09:16,489 helpful, 111 00:09:16,500 --> 00:09:18,710 valuable and fruitful. 112 00:09:19,380 --> 00:09:21,880 So remember what your goals are, 113 00:09:22,369 --> 00:09:36,729 is your goal to strengthen your relationship with your partner? is your goal to be a history teacher? ...and all these other goals you might have where communication and connection are important to meet that goal. 114 00:09:37,030 --> 00:09:52,440 One way to improve the effectiveness of our communication is to be able to pause during an interaction and focus on the other person rather than on the topic. 115 00:09:53,280 --> 00:09:55,710 And sometimes to be honest, 116 00:09:56,559 --> 00:10:03,530 this whole interaction happens and we never pause and we're a bit surprised and taken aback. 117 00:10:03,710 --> 00:10:08,690 And we process things after that's OK too. 118 00:10:09,489 --> 00:10:16,400 The goal eventually will be able to pause and process a bit during the interaction to adjust. 119 00:10:16,760 --> 00:10:22,270 But we may start by analyzing and thinking through things after the fact, 120 00:10:23,789 --> 00:10:26,580 focus on the other person. 121 00:10:26,590 --> 00:10:32,859 So ask yourself things like what does this person need from me right now? 122 00:10:33,369 --> 00:10:37,549 Other than being correct about the facts, 123 00:10:37,559 --> 00:10:38,150 I'm saying, 124 00:10:38,159 --> 00:10:44,359 what do they need from me in the social conversation? 125 00:10:46,299 --> 00:11:04,739 Maybe they need to feel heard or they need you to understand how difficult their day has been or they need you to know and really recognize their contribution to the team even though you've decided to take the work project in another direction. 126 00:11:05,359 --> 00:11:05,830 Now, 127 00:11:05,840 --> 00:11:11,169 these kinds of wonderings and kind of exploring these questions, 128 00:11:11,179 --> 00:11:17,400 this could be something that we do in a counseling or therapy session really in depth, 129 00:11:17,409 --> 00:11:17,979 right? 130 00:11:18,250 --> 00:11:24,849 So if you are trying to um process your relationship with your partner, 131 00:11:24,979 --> 00:11:29,270 maybe you process interactions with a therapist. 132 00:11:29,719 --> 00:11:38,489 But there are also probably a few things to say during these interactions that might help um you focus on the other, 133 00:11:38,669 --> 00:11:40,450 the other person's needs. 134 00:11:41,150 --> 00:11:43,260 So you could say things like, 135 00:11:43,510 --> 00:11:51,989 tell me more about how you're doing and what I can do to help? if somebody has come up to you and they're upset, 136 00:11:52,010 --> 00:11:53,450 they're emotional, 137 00:11:53,700 --> 00:11:56,630 they're in really a confrontational moment. 138 00:11:57,479 --> 00:12:05,929 -- Letting them know that you'd like to know how they're doing and what you can do to help ... can be a connecting moment. 139 00:12:07,650 --> 00:12:14,340 What do you want me to know that you feel like I don't understand about what your experience is. 140 00:12:15,489 --> 00:12:18,020 What are your needs in this situation? 141 00:12:18,030 --> 00:12:25,270 Tell me what you need... or I really value you and I do want to be part of the solution, 142 00:12:25,280 --> 00:12:26,530 not the problem. 143 00:12:28,989 --> 00:12:32,109 Do you need to say these specific words? 144 00:12:32,169 --> 00:12:32,840 No, 145 00:12:33,109 --> 00:12:40,169 it's important to make them your own and to match them to the person that you're talking to in the context. 146 00:12:40,179 --> 00:12:54,169 But the sentiment is there that you want good things to come out of this conversation that you want to know where they're coming from and what you can do um to advance things, 147 00:12:54,179 --> 00:12:54,849 support them, 148 00:12:54,859 --> 00:12:56,070 make things better. 149 00:12:58,150 --> 00:13:05,010 The basic idea is to pause and to ask for input about what they need in this situation. 150 00:13:05,380 --> 00:13:09,359 And it doesn't mean you have to change your opinion or your decisions. 151 00:13:09,369 --> 00:13:16,159 But in the midst of factual things like projects and chores making plans, 152 00:13:16,169 --> 00:13:23,619 there's still value that is found in recognizing the needs of the other during these interactions. 153 00:13:24,030 --> 00:13:31,809 And that can help bridge the gap from conversation that is factual to conversation, 154 00:13:31,820 --> 00:13:33,460 that is effective. 155 00:13:33,909 --> 00:13:36,419 The second thing I'd like you to keep in mind. 156 00:13:36,429 --> 00:13:45,219 And this is also a way of focusing on connecting with the other is the use of compliments and gratitude. 157 00:13:46,400 --> 00:13:55,640 This is another way that we can attend to the person and set the stage for the communication and the relationship. 158 00:13:56,309 --> 00:14:00,119 So some would say this person's only doing their job, 159 00:14:00,130 --> 00:14:03,520 why do I have to compliment them or thank them? 160 00:14:03,830 --> 00:14:05,400 I don't need that. 161 00:14:05,460 --> 00:14:06,460 I don't want that. 162 00:14:06,469 --> 00:14:07,859 I don't even like that. 163 00:14:09,039 --> 00:14:17,140 But this is a relatively easy thing that helps attend to what the other person needs even if you don't need it. 164 00:14:17,489 --> 00:14:22,489 So it sets the stage for people to understand how you view them. 165 00:14:23,099 --> 00:14:26,729 And when difficult things do happen in the relationship, 166 00:14:26,750 --> 00:14:33,030 the way that we interpret those may have to do with how this stage has been set in the past. 167 00:14:33,179 --> 00:14:34,150 For example, 168 00:14:34,159 --> 00:14:40,770 if is this a person who really knows for multiple examples in the past that you value them. 169 00:14:41,070 --> 00:14:45,000 And therefore this glitch in communication or this disagreement, 170 00:14:45,289 --> 00:14:46,669 it's tough, 171 00:14:47,150 --> 00:14:50,669 maybe it's unpleasant but it's not monumental. 172 00:14:51,500 --> 00:14:56,039 Or is this someone who really doesn't know that you value them? 173 00:14:56,049 --> 00:15:00,760 And therefore every communication glitch is really a big deal. 174 00:15:01,109 --> 00:15:04,580 So compliments and gratitude set the stage. 175 00:15:04,590 --> 00:15:07,260 This is how I think about you. 176 00:15:07,270 --> 00:15:09,419 This is how I think about our team. 177 00:15:09,479 --> 00:15:10,080 Again, 178 00:15:10,090 --> 00:15:11,140 I see you, 179 00:15:11,200 --> 00:15:16,099 I value you and it doesn't have to be mushy and emotional. 180 00:15:16,109 --> 00:15:18,840 It should fit the context and the person. 181 00:15:19,070 --> 00:15:19,789 But again, 182 00:15:19,799 --> 00:15:28,119 just a very uh brief uh effective way of adding to that connection during communication. 183 00:15:29,119 --> 00:15:32,179 Let's talk about two levels of compliment. 184 00:15:32,419 --> 00:15:40,890 One is a compliment about a skill or achievement and one is a compliment about a personal attribute. 185 00:15:41,530 --> 00:15:44,820 So the second one is really a higher level. 186 00:15:45,080 --> 00:15:52,830 Um and it gives a stronger message that I see you and I value you, 187 00:15:52,900 --> 00:15:56,789 not only do I see your product and I appreciate the product, 188 00:15:56,799 --> 00:16:00,590 but I see the person that produced that and, 189 00:16:00,599 --> 00:16:03,210 and I value your contribution. 190 00:16:04,179 --> 00:16:04,440 Now, 191 00:16:04,450 --> 00:16:11,880 they're both powerful and you can choose the type that you use based on how well you know the person, 192 00:16:11,890 --> 00:16:17,549 what your goal is in that social interaction and what else is happening in the context. 193 00:16:18,559 --> 00:16:19,530 For example, 194 00:16:19,539 --> 00:16:26,830 a partner who's trying to improve his relationship with his spouse could either say this is a delicious dinner. 195 00:16:26,840 --> 00:16:33,270 It's great to come home after all these pressured meetings to a really pleasant meal. 196 00:16:33,280 --> 00:16:35,549 And I thank you so much for fixing it. 197 00:16:36,700 --> 00:16:47,549 That would be a really nice way to set the relationship stage that you see the work that went into this and you've enjoyed the meal and you're grateful. 198 00:16:48,489 --> 00:16:48,900 Now, 199 00:16:48,909 --> 00:16:53,099 if it's a partner use this next level of compliment, 200 00:16:53,559 --> 00:17:04,060 he may have said you are such a great cook and you seem to know just what would help me unwind from a long and pressured day at work. 201 00:17:04,069 --> 00:17:06,140 I so appreciate that about you. 202 00:17:07,819 --> 00:17:14,420 Compliments and thank yous this gratitude and acknowledgement of the other, 203 00:17:14,739 --> 00:17:17,199 what they've brought the skill sets, 204 00:17:17,209 --> 00:17:19,609 they have individual attributes. 205 00:17:19,930 --> 00:17:27,670 This can all help set the stage for a relationship that the other person feels safe and happy with. 206 00:17:32,109 --> 00:17:36,300 The third way of adding to this communication, 207 00:17:36,310 --> 00:17:49,010 that's not only factual but also effective is to think about to identify and discuss topics and life events that are important to the other person, 208 00:17:49,290 --> 00:17:51,800 even when they are not important to you, 209 00:17:51,810 --> 00:17:54,119 you really honestly don't care about them. 210 00:17:55,420 --> 00:17:56,170 But again, 211 00:17:56,180 --> 00:17:59,310 we're looking for communication that's effective. 212 00:17:59,349 --> 00:18:11,849 And you're choosing those moments when you are really working toward your longer term goals that I do want to have a better work team relationship. 213 00:18:11,859 --> 00:18:16,250 I do want to be able to be an effective teacher. 214 00:18:16,569 --> 00:18:29,770 So listen for things that are important to the other person and this might be things about their family it's good to know with people that you see or work with on a regular basis. 215 00:18:29,780 --> 00:18:31,449 What's their partner's name? 216 00:18:31,459 --> 00:18:32,829 What are their kids' names? 217 00:18:32,839 --> 00:18:35,770 What family are they interacting with? 218 00:18:35,780 --> 00:18:37,280 Who do they live with? 219 00:18:37,420 --> 00:18:41,880 Maybe they're talking about taking their son to his soccer tournament this weekend. 220 00:18:43,329 --> 00:18:47,650 This may be topics that they're passionate about but you are not. 221 00:18:48,040 --> 00:18:55,550 Maybe they love sci-fi movies or quilting might even be milestones in their life. 222 00:18:55,560 --> 00:18:59,459 It could be that they've had a birthday recently or a marriage anniversary. 223 00:18:59,910 --> 00:19:04,699 Maybe they've moved into a new apartment or purchased their first home. 224 00:19:05,670 --> 00:19:08,849 Even though these things are not important to you, 225 00:19:09,140 --> 00:19:18,819 they are important to the other and connecting in a more effective way with this person is part of your intentional life choice. 226 00:19:19,500 --> 00:19:27,630 You may consider making an effort to interact with this person once a week or once a month just to ask about things that are important to them. 227 00:19:28,849 --> 00:19:34,180 You don't have to know about the topic in order to bring it up in conversation. 228 00:19:34,329 --> 00:19:35,579 So people will say, 229 00:19:35,589 --> 00:19:36,119 well, 230 00:19:36,150 --> 00:19:39,599 not only do I not know about sci-fi movies, 231 00:19:39,609 --> 00:19:44,859 but I'm really not at all interested and I don't know what I would say. 232 00:19:45,969 --> 00:19:47,300 Um That's ok, 233 00:19:47,829 --> 00:19:49,219 this is about them. 234 00:19:49,229 --> 00:19:54,540 The goal is not to add content and correct factual information. 235 00:19:54,550 --> 00:20:03,560 The goal is to connect effectively and to set the stage of connection and you can do that without any factual knowledge. 236 00:20:04,680 --> 00:20:08,869 So you could say I don't know much about that topic. 237 00:20:09,329 --> 00:20:09,349 Uh, 238 00:20:09,359 --> 00:20:11,550 what do you like most about it? 239 00:20:11,729 --> 00:20:13,750 What first got you interested in, 240 00:20:14,270 --> 00:20:15,489 in that area? 241 00:20:16,180 --> 00:20:18,310 What's coming up related to that topic? 242 00:20:18,319 --> 00:20:18,410 So, 243 00:20:18,420 --> 00:20:22,829 let's say this is the sci-fi lover and you might say, 244 00:20:22,839 --> 00:20:23,369 hey, 245 00:20:23,510 --> 00:20:26,630 any big movies coming up that you're gonna go see. 246 00:20:27,290 --> 00:20:28,660 I'm not, 247 00:20:28,670 --> 00:20:28,920 um, 248 00:20:28,930 --> 00:20:30,920 up on what's at the movie theater. 249 00:20:31,260 --> 00:20:31,579 Um, 250 00:20:31,589 --> 00:20:42,010 so then this invites them to talk about their favorite topic And then later you could ask them how the movie was or someone who has, 251 00:20:42,020 --> 00:20:42,319 um, 252 00:20:42,329 --> 00:20:52,209 a real love for fish tanks and fish and little um villages in the fish tank that they build. 253 00:20:52,219 --> 00:20:53,170 Um You could say, 254 00:20:53,180 --> 00:20:53,420 hey, 255 00:20:53,430 --> 00:20:55,920 any new fish in your fish tank lately, 256 00:20:55,930 --> 00:20:57,229 what if you got that's new? 257 00:20:57,239 --> 00:20:58,510 Do you have a picture? 258 00:20:59,290 --> 00:21:04,520 So the purpose is not to contribute to a topic. 259 00:21:04,530 --> 00:21:06,969 The purpose is not to be correct. 260 00:21:07,000 --> 00:21:09,329 The purpose is to say, 261 00:21:09,339 --> 00:21:09,739 hey, 262 00:21:09,750 --> 00:21:10,500 I see you. 263 00:21:10,510 --> 00:21:11,500 I hear you. 264 00:21:11,839 --> 00:21:16,969 Um And I'm really acknowledging what's important to you. 265 00:21:17,359 --> 00:21:18,319 You could say, 266 00:21:18,329 --> 00:21:18,540 hey, 267 00:21:18,550 --> 00:21:21,260 how did the move to your new apartment go this weekend? 268 00:21:21,270 --> 00:21:22,959 Did you get hit with the rain? 269 00:21:24,160 --> 00:21:28,770 You can acknowledge what a big job it is to move and say, 270 00:21:28,780 --> 00:21:29,140 hey, 271 00:21:29,150 --> 00:21:31,209 I hope you feel settled in soon. 272 00:21:31,859 --> 00:21:33,250 You could say, 273 00:21:33,260 --> 00:21:35,650 how did your son's soccer tournament go? 274 00:21:35,969 --> 00:21:37,550 Did he feel good about it? 275 00:21:38,199 --> 00:21:41,689 Did you get to visit any interesting places or? 276 00:21:41,699 --> 00:21:44,109 I'm so glad you guys have that opportunity. 277 00:21:44,219 --> 00:21:45,790 What a big commitment that is, 278 00:21:45,800 --> 00:21:56,670 but I'm sure you'll have lots of great memories and perhaps you set a goal where you're going to ask someone on your work team, 279 00:21:56,680 --> 00:22:04,550 a follow up question once a week or three times a week and you're gonna rotate people. 280 00:22:05,400 --> 00:22:16,810 This is a way to make the goal real and to keep that intentionality in mind while working toward the goals that you do have. 281 00:22:17,229 --> 00:22:17,579 Now, 282 00:22:17,589 --> 00:22:22,260 there is so much we could cover about communicating and connecting. 283 00:22:22,599 --> 00:22:29,119 But hopefully this episode gives you some concrete things to use today in your relationships. 284 00:22:29,380 --> 00:22:36,319 We've reviewed the importance of pausing during an interaction to think about or ask the person what they need. 285 00:22:36,790 --> 00:22:45,790 We reviewed types of compliments and ways of expressing gratitude and how these can set the stage for helping with future interactions. 286 00:22:46,280 --> 00:22:57,229 And we reviewed that acknowledging what topics and life events are important to the other person can also really increase the value and fruitfulness of an interaction. 287 00:22:58,829 --> 00:23:03,979 If you want to dive deeper into communication and connection topics, 288 00:23:04,199 --> 00:23:06,560 there are great resources out there. 289 00:23:07,050 --> 00:23:07,420 Now, 290 00:23:07,430 --> 00:23:11,130 I don't have any financial interest in any of these products. 291 00:23:11,170 --> 00:23:16,859 I'm just offering some ideas of things that have helped or helped my clients in the past. 292 00:23:17,619 --> 00:23:25,219 I've linked some of my favorites in the show notes and one is a great book called The Science of Making Friends, 293 00:23:25,250 --> 00:23:30,760 which highlights strategies from the peers program that's out of U C L A. 294 00:23:31,160 --> 00:23:34,910 And there are chapters on finding and choosing good friends, 295 00:23:35,339 --> 00:23:37,579 elements of good conversations, 296 00:23:37,949 --> 00:23:39,680 dealing with arguments, 297 00:23:39,689 --> 00:23:41,290 handling and addressing, 298 00:23:41,300 --> 00:23:43,569 teasing and cyberbullying, 299 00:23:43,890 --> 00:23:48,239 minimizing rumors and gossip and changing a bad reputation. 300 00:23:48,589 --> 00:23:48,959 Now, 301 00:23:48,969 --> 00:23:53,699 this is a book that's focused on an audience of teens and young adults. 302 00:23:54,239 --> 00:24:00,270 I like to take those kind of books and apply the basic concepts to whatever age group I'm working with. 303 00:24:00,489 --> 00:24:03,550 But if you really don't relate to books in that way, 304 00:24:03,560 --> 00:24:09,130 and it's going to be distracting if people in the examples are from a different generation, 305 00:24:09,199 --> 00:24:10,989 that book may not be for you. 306 00:24:11,479 --> 00:24:16,920 There are also well known books such as Better Small Talk by Patrick King, 307 00:24:17,319 --> 00:24:25,550 How To Win Friends and Influence people by Dale Carnegie and Crucial Conversations by multiple people, 308 00:24:25,560 --> 00:24:27,959 Joseph Granny Carri Patterson, 309 00:24:28,000 --> 00:24:30,569 Ron mcmillan and Switzer. 310 00:24:31,390 --> 00:24:40,640 This book is a great tool to expand your skills at persuasion without being abrasive and to engage in conversations. 311 00:24:40,650 --> 00:24:44,439 Even when emotions are really running high, 312 00:24:44,770 --> 00:24:46,979 we're gonna need to know how to do that. 313 00:24:46,989 --> 00:24:51,859 If we're gonna be in connecting relationships that are really fruitful. 314 00:24:52,339 --> 00:24:58,449 There are many other great sources out there as well and I encourage you to find some that speak to you. 315 00:24:58,530 --> 00:24:58,839 Well, 316 00:24:58,849 --> 00:25:04,819 thanks again for joining me for this fourth episode of The Living With Intention Series. 317 00:25:04,849 --> 00:25:10,410 If you have goals that require you to expand your repertoire for communicating and connecting, 318 00:25:10,589 --> 00:25:15,030 I hope these tips and resources are a great place to start. 319 00:25:15,819 --> 00:25:22,310 Join me next time as we continue this series about intentional living on the autism spectrum.    

Want to live with more intention in order to achieve your goals? You may wish to start with steps to improve your core resilience so you can challenge yourself in other life areas. In this third episode in a series on intentional living, Dr. Regan identifies ways to improve resilience by using physical inputs to calm and center the nervous system.    As referenced in the current episode:  Dr. Regan's Zur Institute courses for clinicians Autism in the Adult regulation series- episode one The Alert Program The Alert Program: Your Best Self Online Course   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript here: 1 00:00:05,710 --> 00:00:06,119 Hi, 2 00:00:06,130 --> 00:00:06,800 everyone. 3 00:00:06,809 --> 00:00:11,319 This is Dr Regan, host of the podcast Autism in the Adult. 4 00:00:11,539 --> 00:00:13,239 I'm a neuropsychologist, 5 00:00:13,250 --> 00:00:17,729 a certified autism specialist and mom to a teen on the spectrum. 6 00:00:18,149 --> 00:00:25,360 It's my great pleasure to direct an autism diagnostic clinic in Central Illinois for adolescents, 7 00:00:25,370 --> 00:00:27,360 adults and aging adults. 8 00:00:27,790 --> 00:00:32,139 If you are a clinician wanting to increase your knowledge of autism, 9 00:00:32,150 --> 00:00:34,259 in order to better serve your clients, 10 00:00:34,490 --> 00:00:38,250 you may want to check out my courses at Zur Institute, 11 00:00:38,349 --> 00:00:40,409 Z U R Institute. 12 00:00:40,759 --> 00:00:44,880 The links will be in the show notes for this podcast episode. 13 00:00:45,520 --> 00:00:48,130 If you're a regular follower of the podcast, 14 00:00:48,139 --> 00:00:54,569 you will know that we are in the third episode in a series about living with intention on the spectrum. 15 00:00:55,400 --> 00:01:00,009 I would encourage you to listen to the first two episodes to get the most information. 16 00:01:00,139 --> 00:01:03,849 Although this episode can be stand alone as well. 17 00:01:04,300 --> 00:01:04,750 Today, 18 00:01:04,760 --> 00:01:10,569 we'll be talking about a goal within the area of health and wellness and specifically, 19 00:01:10,580 --> 00:01:16,230 we're going to focus on improving regulation using sensory inputs. 20 00:01:16,389 --> 00:01:16,699 Now, 21 00:01:16,709 --> 00:01:21,449 I have several other episodes about regulation and I'll link them in the show notes, 22 00:01:21,900 --> 00:01:33,330 but in short regulation refers to the ability to stay centered balanced to get that just right state to be both calm and attentive. 23 00:01:33,339 --> 00:01:34,349 At the same time, 24 00:01:35,419 --> 00:01:38,050 this regulation can look like a meltdown, 25 00:01:38,059 --> 00:01:39,209 a panic attack, 26 00:01:39,220 --> 00:01:44,309 an outburst or it could look like withdrawal from a place or activity. 27 00:01:44,319 --> 00:01:45,230 For example, 28 00:01:45,239 --> 00:01:50,510 I need to quit this conversation or I need to go to my room off by myself. 29 00:01:50,519 --> 00:01:52,180 I can't attend work today. 30 00:01:52,190 --> 00:01:53,519 I can't go to school. 31 00:01:54,300 --> 00:01:56,809 It can also look like freeze, 32 00:01:57,209 --> 00:02:01,470 like shutting down feeling offline or dissociating. 33 00:02:02,309 --> 00:02:03,080 And finally, 34 00:02:03,089 --> 00:02:13,020 disregulation can look like the experience of physical symptoms that are not rooted or at least not completely caused by a physical condition, 35 00:02:13,250 --> 00:02:15,520 injury or disease process. 36 00:02:16,020 --> 00:02:21,479 Individuals on the spectrum are more likely to struggle with dysregulation in some form. 37 00:02:21,789 --> 00:02:30,639 Although what the dysregulation looks like can be different from one person to the next and can also change over the lifespan of the individual. 38 00:02:30,649 --> 00:02:52,699 So we can see how important the wellness topic of regulation is and why we're talking about regulation as a goal first because for some people on the spectrum regulation needs to improve before they can experience enough resiliency to get out of their comfort zone in other areas of life, 39 00:02:52,710 --> 00:02:58,130 like relationships or working or other areas that we've discussed in the series. 40 00:02:58,139 --> 00:02:58,860 So far, 41 00:02:59,470 --> 00:03:08,910 the tricky thing is that there are often more limitations to the success of regulation strategies on the spectrum than for the neurotypical. 42 00:03:09,089 --> 00:03:17,360 And the go to strategies are often some combination of counseling or talking through the difficulty, 43 00:03:17,369 --> 00:03:20,089 maybe reasoning through problems, 44 00:03:20,339 --> 00:03:27,479 we might add medication for the support of regulation or use punishment and reward programs. 45 00:03:28,350 --> 00:03:38,270 It's not that there's anything wrong with these approaches and they can be helpful as part of a layer in an overall program to help with regulation. 46 00:03:38,279 --> 00:03:39,470 However, 47 00:03:39,750 --> 00:03:42,919 if these are the only approaches we're relying on, 48 00:03:42,970 --> 00:03:46,100 there are likely to be some pretty big limitations. 49 00:03:47,050 --> 00:03:49,550 So let's think about how the nervous system works. 50 00:03:49,559 --> 00:03:52,699 If an infant is screaming, 51 00:03:52,710 --> 00:03:54,500 relentlessly crying, 52 00:03:54,509 --> 00:03:55,500 very upset, 53 00:03:55,509 --> 00:03:57,029 can't calm down. 54 00:03:57,320 --> 00:03:58,039 In other words, 55 00:03:58,050 --> 00:03:59,660 they can't regulate. 56 00:04:00,460 --> 00:04:05,610 We don't try to reason with them about how they're completely safe. 57 00:04:05,619 --> 00:04:07,509 They've just been fed, 58 00:04:07,520 --> 00:04:12,589 they're not in any danger or that their crying is really too loud. 59 00:04:12,600 --> 00:04:13,869 It's bedtime. 60 00:04:14,690 --> 00:04:17,260 We don't go reasoning through all that. 61 00:04:17,998 --> 00:04:23,368 We don't give them medication for depression or for anxiety. 62 00:04:23,959 --> 00:04:28,348 We don't use rewards or punishments in the traditional sense. 63 00:04:28,799 --> 00:04:29,239 Again, 64 00:04:29,248 --> 00:04:31,928 it's not that I don't recommend these approaches. 65 00:04:31,938 --> 00:04:34,588 I think they can be very helpful at times. 66 00:04:34,598 --> 00:04:40,098 But I'm pointing out that there is another way for humans to regulate their nervous system. 67 00:04:40,378 --> 00:04:43,428 And if you picture what we do for the infant, 68 00:04:44,070 --> 00:04:46,149 we hold them. 69 00:04:46,359 --> 00:05:02,649 Sometimes we swaddle the infant in a blanket and the holding or swaddling gives them pressure inputs that gives them this snug hug and then what do we do? 70 00:05:02,660 --> 00:05:02,920 Well, 71 00:05:02,929 --> 00:05:09,059 typically we rack them and this gives their brain some movement to input. 72 00:05:10,410 --> 00:05:13,260 This isn't always a magic way of calming an infant. 73 00:05:13,269 --> 00:05:18,619 But it often helps quite a bit as an approach to help the infant regulate, 74 00:05:18,630 --> 00:05:19,820 to center, 75 00:05:19,920 --> 00:05:21,470 to feel calm. 76 00:05:21,630 --> 00:05:26,179 Because the infant relies on the adult for regulation. 77 00:05:26,730 --> 00:05:29,140 This approach of using pressure, 78 00:05:29,420 --> 00:05:34,540 which we call proprioceptive inputs and movement. 79 00:05:34,579 --> 00:05:35,579 In this case, 80 00:05:35,589 --> 00:05:38,799 I'm talking about vestibular inputs. 81 00:05:39,170 --> 00:05:48,589 This approach of getting these inputs into the nervous system helps people of all ages and with all variations of nervous connections, 82 00:05:48,600 --> 00:05:49,859 nervous systems, 83 00:05:50,410 --> 00:05:53,359 uh whether you are neurotypical, 84 00:05:53,369 --> 00:05:55,850 whether you are neuro diverse, 85 00:05:55,859 --> 00:05:57,380 it doesn't matter we do. 86 00:05:57,390 --> 00:05:59,890 This is how our nervous system works. 87 00:06:00,049 --> 00:06:08,470 That's why therapists working with little kids on regulation may have them do heavy work like carrying or pushing something heavy. 88 00:06:08,690 --> 00:06:10,679 That's for the pressure input. 89 00:06:11,630 --> 00:06:15,489 It's why some individuals like weighted blankets for calming, 90 00:06:15,750 --> 00:06:17,679 that's pressure as well. 91 00:06:18,480 --> 00:06:22,820 Other individuals like to ride their bike after work or go jogging. 92 00:06:22,970 --> 00:06:23,279 Well, 93 00:06:23,290 --> 00:06:25,179 that's movement input. 94 00:06:25,290 --> 00:06:34,579 So we all tap into some of these inputs without really realizing why we like them or what role they have in helping us feel centered. 95 00:06:34,790 --> 00:06:35,309 Today, 96 00:06:35,320 --> 00:06:47,570 we'll focus on increasing your awareness of what your nervous system may need as far as physical inputs to help with regulation as well as how and when to use them. 97 00:06:48,450 --> 00:06:58,929 One place to start can be to think about what you have historically been drawn to perhaps as a child or in school or most recently, 98 00:06:59,600 --> 00:07:03,250 you can get pressure in the muscles or the joints, 99 00:07:03,260 --> 00:07:11,390 proprioceptive inputs into the brain pressure in the muscles could be from a massage or laying in a hammock. 100 00:07:11,399 --> 00:07:13,579 You get that squeeze input, 101 00:07:14,049 --> 00:07:16,429 laying under a weighted blanket, 102 00:07:16,779 --> 00:07:20,070 draping over an exercise ball, 103 00:07:20,679 --> 00:07:22,609 curling up in a chair. 104 00:07:22,619 --> 00:07:25,950 When we say I just want to curl up and read a good book. 105 00:07:26,320 --> 00:07:28,140 That's when we're giving ourselves, 106 00:07:28,149 --> 00:07:43,269 that kind of squeeze input being in the fetal position helps us have that squeeze hugs or bear hugs can give us that input laying on the ground or flapping on the ground. 107 00:07:43,869 --> 00:07:48,160 Pressure into the joints could be from things like pushing, 108 00:07:48,190 --> 00:07:49,000 pulling, 109 00:07:49,010 --> 00:07:49,950 hanging, 110 00:07:50,329 --> 00:07:54,200 anything that offers resistance through the joints, 111 00:07:54,829 --> 00:07:56,970 hanging from a pull up bar, 112 00:07:56,980 --> 00:07:58,559 shoveling snow, 113 00:07:58,709 --> 00:07:59,750 swimming, 114 00:08:00,019 --> 00:08:03,670 stretching a Farrah band or resistance band, 115 00:08:04,079 --> 00:08:08,959 riding a bike pressure through the jaw by chewing, 116 00:08:08,970 --> 00:08:14,140 resistive foods can also be pressure input for the nervous system. 117 00:08:14,459 --> 00:08:29,549 Maybe somebody loves to attack some beef jerky or crunchy food or chew gum pressure through the hands or feet by using a stress ball or rolling your foot over a tennis ball. 118 00:08:30,959 --> 00:08:34,729 You'll get the most input for the nervous system. 119 00:08:34,770 --> 00:08:37,530 When you're doing whole body activities, 120 00:08:37,539 --> 00:08:40,890 then when you're using the jaw or hands and feet, 121 00:08:41,119 --> 00:08:44,390 but we can't always do whole body activities. 122 00:08:44,789 --> 00:08:56,200 Maybe we're in a classroom and all we can do is have some gum that we're gonna chew on and maybe squeeze a stress ball under the desk movement. 123 00:08:56,210 --> 00:09:02,099 Input like the rocking baby gives vestibular input into the brain, 124 00:09:02,789 --> 00:09:08,140 the brain does not get vestibular input when we move our arms and legs, 125 00:09:08,150 --> 00:09:10,619 but we stand or sit still. 126 00:09:11,049 --> 00:09:13,049 There's no vestibular input. 127 00:09:13,059 --> 00:09:14,479 When we're on a treadmill, 128 00:09:14,489 --> 00:09:15,590 for example, 129 00:09:15,880 --> 00:09:18,700 or we're using a stationary bike, 130 00:09:19,299 --> 00:09:22,369 the fluid in our ears has to be moving. 131 00:09:22,559 --> 00:09:24,739 So when we're moving through space, 132 00:09:24,750 --> 00:09:26,719 like running through the neighborhood, 133 00:09:26,729 --> 00:09:29,450 swinging or riding a bike outside, 134 00:09:29,530 --> 00:09:32,059 then we're getting vestibular input. 135 00:09:32,849 --> 00:09:34,700 So those who say, 136 00:09:34,710 --> 00:09:34,900 oh, 137 00:09:34,909 --> 00:09:36,539 I love riding my bike, 138 00:09:36,549 --> 00:09:39,349 but I will not ride a stationary bike. 139 00:09:39,520 --> 00:09:44,690 What they may be saying is that their nervous system really needs that movement, 140 00:09:44,700 --> 00:09:47,890 that vestibular input through space. 141 00:09:48,950 --> 00:09:53,469 There are three types of vestibular input linear. 142 00:09:54,030 --> 00:09:57,369 So going in a relatively straight line, 143 00:09:57,380 --> 00:10:00,690 like if you're jumping up and down on a trampoline, 144 00:10:00,840 --> 00:10:06,750 swinging front and back or rocking left and right or front to back, 145 00:10:07,650 --> 00:10:10,919 rotary is spinning or twirling. 146 00:10:10,929 --> 00:10:14,020 That's the second kind of vestibular input. 147 00:10:14,710 --> 00:10:19,919 And the third kind are inversions which involves being upside down, 148 00:10:19,929 --> 00:10:21,840 like hanging upside down, 149 00:10:21,849 --> 00:10:26,429 doing a forward bend or doing a down dog position. 150 00:10:26,440 --> 00:10:27,080 In yoga. 151 00:10:27,900 --> 00:10:31,719 The movement inputs can be alerting or calming, 152 00:10:31,859 --> 00:10:35,929 intense or gentle as an individual. 153 00:10:35,940 --> 00:10:40,390 You can see what helps your nervous system at any given time. 154 00:10:40,799 --> 00:10:45,210 Someone who wants to feel calm or may want to rock in a rocking chair, 155 00:10:45,940 --> 00:10:57,330 sometimes people like to ride in the car and that just helps them feel centered and calm babies or little kids might fall asleep in the car. 156 00:10:57,340 --> 00:11:01,530 Even when they were so upset when they were actually getting in the car, 157 00:11:01,809 --> 00:11:07,580 another person may really feel calmer when they've been swinging again. 158 00:11:07,590 --> 00:11:15,320 We have the swings for infants that they can rock in and get that gentle front and back motion. 159 00:11:17,619 --> 00:11:24,390 Someone who wants to feel more alert and activated like I need energy, 160 00:11:24,400 --> 00:11:26,809 I need momentum to get going. 161 00:11:27,169 --> 00:11:31,609 They may want to ride their bike down a hill or jump on a trampoline. 162 00:11:31,940 --> 00:11:35,349 That vigorous movement input is often more alerting. 163 00:11:35,909 --> 00:11:37,250 So someone might say, 164 00:11:37,260 --> 00:11:37,630 oh, 165 00:11:37,640 --> 00:11:38,820 now, 166 00:11:38,900 --> 00:11:40,669 now I'm really awake. 167 00:11:41,099 --> 00:11:46,719 Every nervous system though responds a bit uniquely to these different kinds of inputs. 168 00:11:46,809 --> 00:11:57,619 So it's really important to know your own system to try different things safely and to gradually develop your own insight about what you need. 169 00:11:57,630 --> 00:12:03,809 And when there are some activities that provide both pressure and movement input, 170 00:12:04,169 --> 00:12:09,510 riding a bike gives pressure through the joints as well as movement through space. 171 00:12:10,119 --> 00:12:10,890 Climbing, 172 00:12:10,900 --> 00:12:18,349 a rock wall provides really intense pressure in the joints as well as gentle movement up the wall, 173 00:12:19,200 --> 00:12:22,619 swimming provides resistance through the joints. 174 00:12:22,640 --> 00:12:32,409 Some mild pressure on the muscles from the water pressure and some movement which could be mild or more intense depending on the speed of movement. 175 00:12:32,419 --> 00:12:35,530 Whether the person is going upside down. 176 00:12:35,570 --> 00:12:39,450 Are they diving off of a height or going down a water slide? 177 00:12:39,700 --> 00:12:43,289 If you think back to what you have really loved to do, 178 00:12:43,869 --> 00:12:47,750 you may get clues about what your nervous system prefers. 179 00:12:48,280 --> 00:12:54,820 One person may have a history of a love for diving and they've been on the swim team during school, 180 00:12:55,140 --> 00:12:59,880 but maybe they don't have any source of inputs since they graduated. 181 00:13:00,510 --> 00:13:05,349 They haven't even realized how important these inputs were to their regulation. 182 00:13:06,130 --> 00:13:09,520 Another person may have a love of roller coasters, 183 00:13:09,530 --> 00:13:10,880 fast motorcycles, 184 00:13:10,890 --> 00:13:11,989 skydiving, 185 00:13:12,150 --> 00:13:15,780 their system loves intense vestibular inputs. 186 00:13:16,440 --> 00:13:18,479 Another may love weightlifting, 187 00:13:18,489 --> 00:13:20,289 cracking their knuckles. 188 00:13:20,489 --> 00:13:25,159 This is another source of joint pressure and heavy work, 189 00:13:25,169 --> 00:13:26,219 like yard work, 190 00:13:26,229 --> 00:13:26,799 gardening, 191 00:13:26,809 --> 00:13:30,750 household projects involving a lot of lifting of supplies. 192 00:13:31,570 --> 00:13:34,270 If you can pinpoint what your system has liked, 193 00:13:34,280 --> 00:13:35,260 historically, 194 00:13:35,359 --> 00:13:40,359 you may have a place to start in experimenting with what your system needs. 195 00:13:40,369 --> 00:13:44,599 Now also take into account your current health, 196 00:13:44,609 --> 00:13:49,640 your physical abilities or restrictions and your doctor's advice. 197 00:13:49,690 --> 00:13:53,020 If you can't pinpoint what you've liked in the past, 198 00:13:53,030 --> 00:13:57,380 start making a list of things to try a little bit at a time. 199 00:13:58,010 --> 00:14:00,520 Perhaps some waits on one day, 200 00:14:00,530 --> 00:14:03,979 a walk through nature the next or swinging at the park. 201 00:14:04,760 --> 00:14:09,630 Once you identify an area of inputs that your system benefits from. 202 00:14:09,859 --> 00:14:10,429 And again, 203 00:14:10,440 --> 00:14:12,690 the benefit is feeling more centered, 204 00:14:12,700 --> 00:14:16,710 calm and fully present than before the activity, 205 00:14:16,849 --> 00:14:18,380 then start thinking, 206 00:14:18,390 --> 00:14:21,510 how else could I get inputs like this? 207 00:14:22,090 --> 00:14:23,549 If you love bike riding, 208 00:14:23,559 --> 00:14:27,130 perhaps try swinging for movement and pressure. 209 00:14:27,489 --> 00:14:32,530 If you love a way to blanket over you while rocking in a rocking chair, 210 00:14:32,630 --> 00:14:44,960 you may want to investigate a whole body swing that can be hung from the ceiling and just envelops you like a cocoon in the fabric while you move gently or vigorously. 211 00:14:45,330 --> 00:14:47,799 It can even spin in rotation. 212 00:14:48,840 --> 00:14:50,289 If you like weights, 213 00:14:50,299 --> 00:14:53,820 you might wanna try rock climbing for intense joint pressure. 214 00:14:54,159 --> 00:15:03,729 Some people who like vestibular input like to join aerial fitness gyms that allow them to hang upside down in a safe and controlled environment. 215 00:15:04,440 --> 00:15:11,190 Be creative and develop some awareness of what your system responds positively toward and again, 216 00:15:11,200 --> 00:15:12,010 make sure you know, 217 00:15:12,020 --> 00:15:13,140 your own body, 218 00:15:13,150 --> 00:15:17,669 your limitations and any recommendations from your own physician. 219 00:15:18,309 --> 00:15:19,960 So let's regroup. 220 00:15:19,969 --> 00:15:20,719 So far, 221 00:15:20,729 --> 00:15:23,570 you've learned about pressure and movement inputs, 222 00:15:24,140 --> 00:15:30,710 the variations of intensity and exercise versus restorative based inputs. 223 00:15:30,979 --> 00:15:34,809 So exercise could be something like riding a bike, 224 00:15:35,000 --> 00:15:35,919 restorative, 225 00:15:35,929 --> 00:15:40,580 could be something like laying in a hammock swing or a hammock. 226 00:15:42,780 --> 00:15:46,979 You've considered what you have liked or not liked historically. 227 00:15:46,989 --> 00:15:52,630 And perhaps you have a list of things to try in order to build up a repertoire of options. 228 00:15:53,479 --> 00:16:03,950 The next key to growing in the area of regulation is this don't wait to do the activities until you feel like you need it. 229 00:16:04,440 --> 00:16:05,950 This is crucial. 230 00:16:06,200 --> 00:16:06,770 Now, 231 00:16:06,780 --> 00:16:14,489 this doesn't mean that you shouldn't listen to your body if you're ill or injured and not able to do a specific activity that day. 232 00:16:14,909 --> 00:16:18,929 But what often happens for the autistic is that they feel great, 233 00:16:18,940 --> 00:16:19,500 great, 234 00:16:19,510 --> 00:16:20,330 great. 235 00:16:20,609 --> 00:16:23,299 And then they feel really off center. 236 00:16:23,309 --> 00:16:26,880 And a lot of times they'll say I just did not see that coming. 237 00:16:27,359 --> 00:16:32,650 So by the time they use their as needed inputs, 238 00:16:32,919 --> 00:16:35,169 they're already deregulated. 239 00:16:35,489 --> 00:16:37,250 So that's not the goal, 240 00:16:37,260 --> 00:16:53,179 the goal is to do the activities and give regular nervous system inputs that are regulating so that the episodes of disregulation decrease in number and they're easier to recover from. 241 00:16:53,919 --> 00:17:01,450 So think about ways to give yourself centering inputs multiple times a day and that will be individual to you. 242 00:17:02,090 --> 00:17:04,979 Some people might do this three times a day, 243 00:17:04,989 --> 00:17:06,239 maybe at the beginning, 244 00:17:06,250 --> 00:17:07,300 middle and end, 245 00:17:07,660 --> 00:17:16,099 they may need some pressure and movement in the morning to wake up to become energized and to also feel calm and attentive, 246 00:17:16,780 --> 00:17:20,349 they may need inputs over the lunch hour or midday. 247 00:17:20,359 --> 00:17:21,689 And then again at night, 248 00:17:22,069 --> 00:17:26,869 perhaps restorative inputs like a rocking chair or a weighted blanket, 249 00:17:27,050 --> 00:17:28,910 maybe some nighttime yoga. 250 00:17:30,459 --> 00:17:34,349 Then when you do become deregulated on any given day, 251 00:17:34,359 --> 00:17:39,810 think ahead of time about what your as needed inputs might be. 252 00:17:40,310 --> 00:17:43,000 So when you're in the moment of disregulation, 253 00:17:43,010 --> 00:17:46,089 it's really difficult to figure out what you need. 254 00:17:46,760 --> 00:17:50,150 So you may be able to think to yourself ahead of time. 255 00:17:50,489 --> 00:17:50,829 You know, 256 00:17:50,839 --> 00:17:52,619 when I get dis regulated, 257 00:17:52,630 --> 00:17:55,239 this is what that looks and feels like. 258 00:17:55,459 --> 00:17:59,160 And when I start to see myself in that place, 259 00:17:59,170 --> 00:18:08,060 I can try these handful of things to see if it helps in that moment of crisis or kind of surprise. 260 00:18:08,119 --> 00:18:08,260 Uh, 261 00:18:08,270 --> 00:18:09,579 off centering, 262 00:18:10,239 --> 00:18:11,290 you may say, 263 00:18:11,300 --> 00:18:11,729 ok, 264 00:18:11,739 --> 00:18:14,099 I've had a particularly intense day. 265 00:18:14,109 --> 00:18:16,609 I'm feeling more off center than usual. 266 00:18:16,699 --> 00:18:26,630 I'm going to walk around my work building three times or I'm going to do forward bends and shake my head back and forth or listen to music with my headphones. 267 00:18:26,910 --> 00:18:30,449 This can be what as needed inputs look like. 268 00:18:30,880 --> 00:18:34,569 So you can see that like with the music and headphones, 269 00:18:34,579 --> 00:18:41,739 sometimes the regulating inputs could be also um a sensory input from another domain. 270 00:18:41,770 --> 00:18:43,790 What do you like to listen to? 271 00:18:43,800 --> 00:18:46,810 What scent do you like to smell like? 272 00:18:46,819 --> 00:18:48,550 Lavender or vanilla? 273 00:18:48,920 --> 00:18:54,790 But usually the big regulating inputs will involve movement and pressure. 274 00:18:56,229 --> 00:18:57,680 So today, 275 00:18:57,689 --> 00:19:02,069 we have chosen a growth area within health and wellness. 276 00:19:02,099 --> 00:19:16,849 This may be a good place for you to start as you live life with intention because feeling more grounded can help you feel more resilient as you try to stretch your comfort zone in other areas. 277 00:19:17,270 --> 00:19:18,060 Remember, 278 00:19:18,069 --> 00:19:23,439 the general approach we discussed in episode two when developing this program. 279 00:19:23,900 --> 00:19:28,569 So try to set up small reachable steps forward, 280 00:19:28,859 --> 00:19:31,849 use strategy to find your momentum. 281 00:19:32,339 --> 00:19:37,130 And once you've integrated the physical inputs into your daily routine, 282 00:19:37,469 --> 00:19:41,599 that momentum will kick in and it'll help you. 283 00:19:41,609 --> 00:19:45,550 Um not feel that this whole thing is effortful. 284 00:19:45,560 --> 00:19:49,010 It'll be just what you do on a regular basis. 285 00:19:49,599 --> 00:19:54,290 You'll also reap the benefits of having a more regulated nervous system. 286 00:19:55,109 --> 00:19:57,050 Be sure to check out the show notes, 287 00:19:57,060 --> 00:20:01,969 I have various links that we've mentioned here in the episode. 288 00:20:02,020 --> 00:20:06,089 One is a link to the Z Institute courses, 289 00:20:06,099 --> 00:20:11,619 Z U R for clinicians to learn more about autism in adolescents, 290 00:20:11,630 --> 00:20:13,489 adults and aging adults. 291 00:20:14,020 --> 00:20:21,680 I also have links to my podcast episodes about regulation if you'd like to do a deeper dive. 292 00:20:22,030 --> 00:20:39,989 And I'm also including links to the alert program put together by occupational therapists who have expertise in teaching people about using sensory inputs like movement or pressure to help regulate the nervous system, 293 00:20:40,000 --> 00:20:42,310 to feel calmer and more attentive. 294 00:20:43,599 --> 00:20:51,569 There's also a link specifically for their for All Program alert program four. 295 00:20:51,579 --> 00:20:52,880 That's the number four, 296 00:20:52,890 --> 00:20:57,469 not the word all dot com alert program for all dot com. 297 00:20:57,800 --> 00:20:59,890 That is a self guided study. 298 00:20:59,900 --> 00:21:05,400 You can purchase for a deeper dive into your own nervous system, 299 00:21:05,410 --> 00:21:08,469 figuring out what kind of inputs help you regulate. 300 00:21:08,890 --> 00:21:13,630 And I will have all four of those links in the show notes. 301 00:21:15,270 --> 00:21:17,359 Thank you for joining me today. 302 00:21:17,489 --> 00:21:34,439 I hope you will be able to enjoy the benefits of a more regulated nervous system and be sure to listen to our next episode as we continue this series on living with intention making goals and leaving our comfort zone.  

You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this second episode in a series on intentional living, Dr. Regan identifies ways to create steps toward a goal, identify strategies, and monitor success.    As referenced in the current episode:  First Episode in Momentum for Behavior series   Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript below:   1 00:00:01,830 --> 00:00:02,250 Hi, 2 00:00:02,259 --> 00:00:02,960 everyone. 3 00:00:02,970 --> 00:00:04,380 This is your host, 4 00:00:04,389 --> 00:00:04,829 Dr. 5 00:00:04,840 --> 00:00:05,980 Theresa Regan, 6 00:00:06,250 --> 00:00:11,579 introducing this next episode of autism in the adult podcast. 7 00:00:11,939 --> 00:00:13,779 I'm a neuropsychologist. 8 00:00:13,789 --> 00:00:20,729 So I specialize in understanding how the health of the brain and the connections of the brain impact, 9 00:00:20,739 --> 00:00:21,370 thinking, 10 00:00:21,379 --> 00:00:22,020 skills, 11 00:00:22,030 --> 00:00:22,700 emotions, 12 00:00:22,709 --> 00:00:23,319 behavior, 13 00:00:23,329 --> 00:00:24,569 and personality. 14 00:00:24,790 --> 00:00:30,540 I've worked in hospitals for over 30 years and I'm the mother of a teen on the spectrum. 15 00:00:31,649 --> 00:00:39,250 And did you know that I have a series of three podcast episodes about momentum for activity. 16 00:00:39,619 --> 00:00:43,869 One is about exhaustion and finding balance in momentum. 17 00:00:44,189 --> 00:00:53,000 One of the episodes is about how to gain momentum for activity and the third is how to keep momentum for activity. 18 00:00:53,430 --> 00:00:59,430 You can find these three episodes as episodes number 21, 19 00:00:59,650 --> 00:01:04,489 and 23 In September and October of 2021. 20 00:01:05,000 --> 00:01:07,410 I'll put the link in the show notes. 21 00:01:09,010 --> 00:01:09,449 Today, 22 00:01:09,459 --> 00:01:23,959 we have our second episode of a series about finding some intentionality in um areas of our life where we'd like to grow and maybe challenge ourselves. 23 00:01:23,970 --> 00:01:42,660 Sometimes life is so fast and furious and we get in survival mode or we just get used to living a certain way that we realize we're not really making choices in all the areas of where we put our attention, 24 00:01:42,989 --> 00:01:46,269 uh whether we wanna grow or shift gears. 25 00:01:46,650 --> 00:01:56,300 So the previous episode was this introduction of thinking about where are we in our life right now? 26 00:01:56,650 --> 00:02:02,059 And if you can identify areas where you would like to find more meaning, 27 00:02:02,449 --> 00:02:04,260 uh a bit more challenge. 28 00:02:04,269 --> 00:02:06,160 If you'd like to change direction, 29 00:02:06,370 --> 00:02:10,770 then we're going to focus together on living intentionally. 30 00:02:11,520 --> 00:02:23,789 The first episode covered a few things and one is that I think the first step toward being intentional is having this increased self-awareness. 31 00:02:24,149 --> 00:02:37,429 And I feel like that's one of the greatest blessings of understanding our neurology and going through the diagnostic process about autism to see what, 32 00:02:37,440 --> 00:02:41,460 how am I wired and what does my system need? 33 00:02:41,779 --> 00:02:43,649 How do I interact with people? 34 00:02:43,660 --> 00:02:46,210 What do I find uh joy in, 35 00:02:46,220 --> 00:02:46,770 in life? 36 00:02:46,779 --> 00:02:54,289 What drains me and we have this elevated understanding of ourselves. 37 00:02:54,300 --> 00:02:57,289 Um That is part of that process. 38 00:02:58,300 --> 00:03:02,229 So I think after that process of self awareness, 39 00:03:02,699 --> 00:03:09,410 if we do identify areas where we would like to grow or expand in some way, 40 00:03:09,919 --> 00:03:11,309 one way to do that. 41 00:03:11,320 --> 00:03:17,339 And we covered this in the initial episode is to think of categories in our life. 42 00:03:17,380 --> 00:03:24,490 And I invited you to do this um to see where you might want to shift. 43 00:03:26,479 --> 00:03:32,490 One of the categories we talked about was within the area of a special interest. 44 00:03:33,270 --> 00:03:37,470 The second was within the area of health and wellness. 45 00:03:38,250 --> 00:03:40,559 The third was regulation, 46 00:03:40,889 --> 00:03:46,699 that means the ability to stay centered with things like alertness, 47 00:03:46,889 --> 00:03:49,880 attention and emotions. 48 00:03:50,809 --> 00:03:53,380 We also talked about 1/4 category, 49 00:03:53,389 --> 00:03:54,729 relationships. 50 00:03:55,169 --> 00:04:04,699 1/5 as everyday tasks kind of like staying on top of those chores and daily things that can be hard to get a rhythm for. 51 00:04:05,130 --> 00:04:10,600 And the sixth would be something like family and household culture. 52 00:04:10,880 --> 00:04:14,130 So if you're living in a household with other people, 53 00:04:14,350 --> 00:04:19,170 and these are people who are wired differently than each other. 54 00:04:19,179 --> 00:04:26,690 Sometimes focusing on the culture of the household can be a rewarding area of growth. 55 00:04:29,399 --> 00:04:30,410 Today, 56 00:04:30,420 --> 00:04:38,470 I would like you to bring your thoughts of what areas you would like to find more meaning in and to have more intention for. 57 00:04:38,730 --> 00:05:01,500 And we're going to talk about some basic um guidelines for making goals that you can stick with and that you can see change um in these areas without feeling overwhelmed and without kind of stopping in the middle and like our um New Year's resolutions. 58 00:05:01,510 --> 00:05:01,980 We don't want to, 59 00:05:02,059 --> 00:05:03,109 to be like that, 60 00:05:03,440 --> 00:05:12,369 but we want you to have this intention towards something and to give you some structure of how big should the goal be and, 61 00:05:12,779 --> 00:05:16,399 and how quickly should I work toward it and all of these things, 62 00:05:16,410 --> 00:05:20,869 I just want to give you some framework to see if this framework helps you. 63 00:05:21,730 --> 00:05:26,579 The first thing I'd like you to do is to take stock of where you are now. 64 00:05:27,059 --> 00:05:30,279 So if you chose a health and wellness goal, 65 00:05:30,290 --> 00:05:33,709 if you chose a household culture goal, 66 00:05:33,799 --> 00:05:40,970 I just want you to think about where you are right now in this area. 67 00:05:41,260 --> 00:05:45,100 So don't focus on the end goal. 68 00:05:45,109 --> 00:05:47,350 Let's just focus on where you are. 69 00:05:49,690 --> 00:05:53,500 Someone may say for health and wellness. 70 00:05:53,510 --> 00:05:53,980 Well, 71 00:05:53,989 --> 00:06:00,299 where I'm at is that I probably walk 10 minutes after work twice a week. 72 00:06:00,989 --> 00:06:13,000 Another person in the area of everyday tasks may want to really stay on top of bill paying and financial management. 73 00:06:13,010 --> 00:06:14,989 And so they may say, 74 00:06:15,000 --> 00:06:15,279 well, 75 00:06:15,290 --> 00:06:26,760 where I'm at right now is that I tend to um go overboard and spend more than I have in my bank account about four times a month. 76 00:06:26,989 --> 00:06:38,209 So we're just taking stock whatever your category is for growth and meaning maybe take stock of where you are now. 77 00:06:39,250 --> 00:06:47,000 And um knowing that you would like to be in a different spot at some point in the future. 78 00:06:48,059 --> 00:06:55,269 The next step is to create a goal where you're just going to take that one step forward. 79 00:06:56,130 --> 00:07:02,420 Um What we want to do is to make this goal really achievable. 80 00:07:02,429 --> 00:07:05,779 We want to set ourselves up for success. 81 00:07:05,790 --> 00:07:13,829 We want to be able to see the end of the goal and we want the goal to be on the lower side of effort. 82 00:07:14,720 --> 00:07:23,880 One way to create this type of goal is to think about time spent toward your ultimate destination. 83 00:07:26,269 --> 00:07:27,730 For example, 84 00:07:27,739 --> 00:07:32,179 in the area of movement and exercise. 85 00:07:32,190 --> 00:07:44,149 Someone may realize that they're walking a certain amount after work every week and they may add time to that current routine. 86 00:07:44,700 --> 00:07:50,730 So someone who wants to have more movement in their life or to get outdoors more frequently, 87 00:07:50,869 --> 00:07:52,529 perhaps they say, 88 00:07:52,540 --> 00:07:52,869 well, 89 00:07:52,880 --> 00:08:04,049 I'm going to add 15 minutes a week to my current routine of being outside or of walking in the neighborhood and moving. 90 00:08:04,290 --> 00:08:04,570 Um, 91 00:08:04,579 --> 00:08:06,829 just getting that movement in, 92 00:08:06,839 --> 00:08:08,549 maybe that's their goal. 93 00:08:10,040 --> 00:08:16,630 Another person who wants to work toward achieving skills in a certain area, 94 00:08:16,640 --> 00:08:26,850 maybe they're working toward a promotion or they would like to learn a new skill for fun within perhaps within their special interests. 95 00:08:27,929 --> 00:08:35,580 The goal may be to spend a certain amount of time per week learning this new skill. 96 00:08:36,440 --> 00:08:39,690 If they're currently not learning anything about it, 97 00:08:39,700 --> 00:08:42,750 they might want to start with 20 minutes a week. 98 00:08:43,030 --> 00:08:45,190 If they're already doing 20, 99 00:08:45,200 --> 00:08:48,049 they might want to increase by 15, 100 00:08:48,849 --> 00:08:54,260 whatever the stepwise time goal might be for you, 101 00:08:54,270 --> 00:08:57,780 that would make sense in your area of interest. 102 00:08:58,530 --> 00:09:02,979 That may be a way that you'd like to construct what your actual goal is. 103 00:09:04,049 --> 00:09:13,780 You can also think of it as doing a certain fraction or a certain percentage of the work toward the ultimate goal. 104 00:09:14,739 --> 00:09:20,969 If someone would like to have intentionality in the area of their special interest, 105 00:09:21,580 --> 00:09:22,479 publishing, 106 00:09:22,489 --> 00:09:32,570 some of their short stories may be a goal where they're at currently is they have a collection of 50 short stories, 107 00:09:33,049 --> 00:09:36,549 most of which are within a science fiction genre. 108 00:09:37,950 --> 00:09:45,770 They've never taken a class on creative writing or on marketing for their own business. 109 00:09:46,549 --> 00:09:58,960 What they might do is sit down with a friend and talk about all the steps that they might want to take to make this publishing goal most successful. 110 00:10:00,289 --> 00:10:02,719 They may identify 10, 111 00:10:02,729 --> 00:10:03,460 15, 112 00:10:03,469 --> 00:10:04,760 20 steps. 113 00:10:05,460 --> 00:10:10,059 One might be taking a free online course in creative writing. 114 00:10:11,330 --> 00:10:20,020 Another might be joining a local writers group in their community to become part of a network for writers. 115 00:10:22,270 --> 00:10:29,919 Another goal might be learning how to create a website or how to publish their own material online. 116 00:10:30,919 --> 00:10:35,179 They would want to take one of these multiple steps. 117 00:10:35,239 --> 00:10:37,679 So if they've identified 20, 118 00:10:38,179 --> 00:10:49,909 they may just want to take one goal then they'd have to figure out is this goal small enough that I can see the end. 119 00:10:50,270 --> 00:11:05,979 I know I can have success and it doesn't feel too effortful if they're going to sign up for a free online class in creative writing that may feel super easy or it may feel too big. 120 00:11:07,239 --> 00:11:08,880 If it's too big, 121 00:11:09,049 --> 00:11:13,400 you would want to break that task down. 122 00:11:13,739 --> 00:11:23,239 So the first step might be to investigate some free online options to choose from. 123 00:11:25,359 --> 00:11:37,309 If someone has a goal to participate in additional community activities or to get out of the house a bit more often, 124 00:11:38,000 --> 00:11:57,130 they may make a goal to attend one community event per month uh with a friend Or they may make a goal to spend 15 minutes at a community event before they decide whether they want to come home. 125 00:11:57,559 --> 00:12:00,200 This just gives a bit of structure, 126 00:12:00,309 --> 00:12:12,630 but the whole process is meant to just help make one step forward and not to have a goal that's too big or too effortful. 127 00:12:12,679 --> 00:12:14,849 So we should be able to see the end. 128 00:12:14,859 --> 00:12:19,989 We should know that it takes some effort that it takes us out of our comfort zone, 129 00:12:20,000 --> 00:12:23,359 but that we also are set up for success. 130 00:12:24,559 --> 00:12:27,710 The next step would be thinking of a timeline. 131 00:12:29,359 --> 00:12:41,849 If someone has a goal in the area of regulation and they identify that they would like to be more intentional about their sleep wake cycle. 132 00:12:43,400 --> 00:12:50,000 They may determine that they'll watch how they do with their goal across two weeks. 133 00:12:50,690 --> 00:12:58,320 Perhaps their goal is to get up at the same time every day and after two weeks, 134 00:12:58,330 --> 00:13:10,919 they can evaluate how easy or difficult that goal was to achieve for someone who's wanting to stay on top of the dishes every day. 135 00:13:11,250 --> 00:13:24,380 They may also pick a week or two weeks as a time frame that they can monitor their success or stop and reevaluate if the stepwise goal feels like it's been too difficult. 136 00:13:24,880 --> 00:13:32,059 But here comes the most important step we've looked at creating that step forward goal, 137 00:13:32,710 --> 00:13:34,520 creating a time frame. 138 00:13:35,140 --> 00:13:43,190 And this third part I would say is the most important this is picking a strategy to have success. 139 00:13:44,140 --> 00:13:47,270 What does not work is just saying, 140 00:13:47,280 --> 00:13:47,630 well, 141 00:13:47,640 --> 00:13:48,880 I'm going to do it. 142 00:13:49,159 --> 00:13:50,630 I've made the goal, 143 00:13:50,640 --> 00:13:54,690 I'm intentional about the goal and I have this time frame. 144 00:13:54,700 --> 00:13:56,710 I'm just going to do it this time, 145 00:13:57,039 --> 00:13:59,890 even though it's been really hard in the past. 146 00:14:00,559 --> 00:14:04,690 What happens with that is that we're able to spurt towards some goal, 147 00:14:04,700 --> 00:14:05,919 success there, 148 00:14:05,929 --> 00:14:08,090 but it's very difficult to maintain. 149 00:14:09,590 --> 00:14:12,719 So what I'd like you to do when you have a goal, 150 00:14:12,729 --> 00:14:14,099 you have a time frame, 151 00:14:14,109 --> 00:14:16,359 you have a little chunk that you're gonna work on. 152 00:14:17,320 --> 00:14:18,630 Say to yourself, 153 00:14:18,640 --> 00:14:22,549 what's my strategy for accomplishing this goal? 154 00:14:23,780 --> 00:14:26,390 Never move forward without a strategy. 155 00:14:26,659 --> 00:14:28,349 If you can't think of one, 156 00:14:28,359 --> 00:14:30,710 ask a friend or a family member, 157 00:14:34,210 --> 00:14:42,869 one strategy could be in the area of remembering how can I remember to take my supplies to school? 158 00:14:42,979 --> 00:14:46,979 How can I remember to do the dishes before I go to bed? 159 00:14:48,650 --> 00:14:53,409 Another strategy may have to do with adding fun to the task. 160 00:14:53,770 --> 00:14:56,340 How can I make this task less, 161 00:14:56,349 --> 00:14:57,260 boring, 162 00:14:57,270 --> 00:14:58,750 less mundane? 163 00:14:59,320 --> 00:15:04,469 Maybe I could do it while music is playing or an audio book, 164 00:15:04,760 --> 00:15:11,419 maybe I could make a race out of it to see if I can get it done within a certain amount of time. 165 00:15:12,340 --> 00:15:22,229 Perhaps there are ways that I could use a strategy to make the task easier learning about how to streamline the task, 166 00:15:22,289 --> 00:15:26,640 looking at other ways people do the task to make it easier, 167 00:15:26,650 --> 00:15:28,140 take up less time. 168 00:15:30,210 --> 00:15:35,460 Another strategy I could use is offering myself a reward for success. 169 00:15:36,200 --> 00:15:40,710 Maybe I say if I'm successful for eight weeks in a row, 170 00:15:40,969 --> 00:15:46,030 I get to buy myself this thing that is not too expensive, 171 00:15:46,039 --> 00:15:47,179 but usually, 172 00:15:47,340 --> 00:15:47,630 you know, 173 00:15:47,640 --> 00:15:49,510 that would be off limits for me. 174 00:15:49,520 --> 00:15:54,429 But I'm gonna reward myself after I reach this time frame. 175 00:15:55,450 --> 00:15:57,719 After you've chosen a strategy, 176 00:15:58,099 --> 00:15:59,659 you have a time frame, 177 00:15:59,669 --> 00:16:03,179 you have a small goal that you're set up for success with. 178 00:16:03,190 --> 00:16:08,789 Then it's time to put your plan into action after the week or two weeks. 179 00:16:08,799 --> 00:16:15,830 What you're going to do is to kind of have an evaluation and debriefing with yourself. 180 00:16:15,840 --> 00:16:21,020 The first part of the evaluation is I achieve my goal. 181 00:16:21,190 --> 00:16:36,049 Also think about how effortful was it to achieve what I did achieve if you achieve the goal and you were consistent about it across two weeks and it did not feel too hard or effortful. 182 00:16:36,229 --> 00:16:42,700 You may decide that you're ready to add another step forward goal to your momentum. 183 00:16:43,010 --> 00:16:47,739 If you did 10% of the small task toward your goal, 184 00:16:47,750 --> 00:16:58,530 you could add on another 10% goal or you could add on another 15 minutes of the type of task you were doing to meet your goal. 185 00:16:58,539 --> 00:17:05,660 Remember to keep a strategy if you need to shift based on your new goal, 186 00:17:05,670 --> 00:17:07,530 your new step forward goal, 187 00:17:07,540 --> 00:17:08,949 be sure to do that. 188 00:17:12,650 --> 00:17:16,459 If you achieved your goal, 189 00:17:16,699 --> 00:17:23,500 but you pulled it off and are really tired and don't know if you could do that again, 190 00:17:24,098 --> 00:17:30,218 then you probably need to evaluate whether the goal is small enough, 191 00:17:30,229 --> 00:17:37,869 whether it's easy enough in the sense that we all have areas of our life that we would say, 192 00:17:38,509 --> 00:17:39,088 you know, 193 00:17:39,098 --> 00:17:40,489 for whatever reason, 194 00:17:40,499 --> 00:17:42,909 this area really wipes me out. 195 00:17:42,918 --> 00:17:48,759 I just have a huge struggle in this category of my life. 196 00:17:48,769 --> 00:17:51,568 Maybe you need to start in a different category. 197 00:17:52,280 --> 00:17:55,569 But if you can make the step forward goal easier, 198 00:17:55,930 --> 00:17:56,930 do that. 199 00:17:57,510 --> 00:18:00,780 If you can use a strategy that will help you more, 200 00:18:00,849 --> 00:18:02,089 go ahead and do that, 201 00:18:05,170 --> 00:18:18,390 you wouldn't want to add on to your plan until you got that goal achieved in a way that starts to feel pretty effortless like I'm doing this because this is what I do. 202 00:18:18,560 --> 00:18:19,979 I have momentum for it. 203 00:18:19,989 --> 00:18:27,150 It's built into my routine and then you don't have to effort as much to keep it going. 204 00:18:27,479 --> 00:18:30,609 That's when you add just a little bit more to it. 205 00:18:32,439 --> 00:18:35,170 What do you do if you did not meet your goal? 206 00:18:35,209 --> 00:18:35,530 Well, 207 00:18:35,540 --> 00:18:36,859 that's fine too. 208 00:18:37,020 --> 00:18:42,079 You would step back and evaluate why you may ask yourself. 209 00:18:42,089 --> 00:18:46,449 Did I use the strategy that I created for this goal? 210 00:18:46,459 --> 00:18:52,020 If you did and you were not successful with the goal, 211 00:18:52,089 --> 00:19:00,119 you probably have to reevaluate the strategy or you may need to add another strategy on top of that. 212 00:19:01,040 --> 00:19:04,150 Maybe you used a remembering goal, 213 00:19:04,310 --> 00:19:06,969 but that wasn't enough to give you the momentum. 214 00:19:06,979 --> 00:19:12,750 You need to just get that new behavioral set into your repertoire. 215 00:19:13,130 --> 00:19:15,849 Maybe you also need to make it easier, 216 00:19:15,859 --> 00:19:19,030 make it fun or give yourself a reward. 217 00:19:19,500 --> 00:19:21,829 Maybe you need someone to be accountable to, 218 00:19:21,839 --> 00:19:23,589 maybe that's your strategy. 219 00:19:24,430 --> 00:19:26,130 You should also ask yourself, 220 00:19:26,140 --> 00:19:28,089 did I use my strategy? 221 00:19:28,859 --> 00:19:30,949 If I didn't reach my goals? 222 00:19:30,959 --> 00:19:38,089 Maybe it was because I had the intention of using reminders or making it fun. 223 00:19:38,209 --> 00:19:41,680 But I didn't actually follow through with that. 224 00:19:43,589 --> 00:19:44,130 Well, 225 00:19:44,140 --> 00:19:46,849 then you would evaluate that as well. 226 00:19:47,130 --> 00:19:49,209 Is this strategy too hard? 227 00:19:49,910 --> 00:19:54,449 Is it too complex and involved in energy draining? 228 00:19:54,800 --> 00:19:57,290 What other strategies could you think of? 229 00:19:57,599 --> 00:20:03,280 Do you need to layer something in or do you have to scrap the first strategy and try again? 230 00:20:04,209 --> 00:20:08,239 What strategies do other people use or find successful? 231 00:20:08,869 --> 00:20:12,020 What ideas can you glean from other people? 232 00:20:12,030 --> 00:20:16,920 You're always able to say no to someone's suggestion of a strategy, 233 00:20:16,949 --> 00:20:19,640 but only if you have a counter offer. 234 00:20:19,800 --> 00:20:21,000 If your boss says, 235 00:20:21,010 --> 00:20:21,260 hey, 236 00:20:21,270 --> 00:20:22,839 this still isn't working. 237 00:20:22,959 --> 00:20:25,199 I'd like you to try this strategy. 238 00:20:25,619 --> 00:20:26,540 You can say no, 239 00:20:26,550 --> 00:20:28,660 I'd rather not use that strategy, 240 00:20:28,670 --> 00:20:31,339 but only if you have a counter offer. 241 00:20:32,189 --> 00:20:37,089 If you can say I've thought of this other strategy, 242 00:20:37,099 --> 00:20:38,729 then you can run with that. 243 00:20:39,609 --> 00:20:40,020 Now, 244 00:20:40,030 --> 00:20:49,469 the nice thing about this process is you're learning not only perhaps a new skill that is your goal. 245 00:20:49,479 --> 00:20:54,829 Um learning how to create a family culture that works in your home. 246 00:20:55,229 --> 00:20:59,780 Uh Learning how to stay regulated in a way that matches you. 247 00:21:00,430 --> 00:21:02,199 You're not only learning those things, 248 00:21:02,209 --> 00:21:06,890 but you're learning this process of growth. 249 00:21:07,150 --> 00:21:12,650 So I wish I were in a different place in this area of my life. 250 00:21:13,739 --> 00:21:17,280 How can I start that shift? 251 00:21:17,290 --> 00:21:22,510 How can I think about doing it without feeling overwhelmed or like, 252 00:21:22,520 --> 00:21:24,689 I just can't get any, 253 00:21:25,069 --> 00:21:25,939 um, 254 00:21:26,219 --> 00:21:30,790 I can't get any forward momentum toward change. 255 00:21:30,910 --> 00:21:31,410 Well, 256 00:21:31,420 --> 00:21:38,089 this is a way that you can practice a process for living with more intention. 257 00:21:38,510 --> 00:21:40,420 Where would I like to be? 258 00:21:40,430 --> 00:21:42,500 Where am I right now? 259 00:21:42,819 --> 00:21:47,060 How can I make small steps forward to guarantee that? 260 00:21:47,069 --> 00:21:48,959 I know I can have success. 261 00:21:49,459 --> 00:21:56,979 How can I create strategy and timelines and then evaluate what needs to be shifted? 262 00:21:57,729 --> 00:22:03,819 And what you'll notice too is you may get a great momentum for your goal. 263 00:22:03,829 --> 00:22:10,810 Maybe you are doing the dishes every night or you're moving for 15 minutes after work every day. 264 00:22:11,079 --> 00:22:17,500 What will happen is you'll have momentum for that for maybe a long period of time. 265 00:22:18,290 --> 00:22:19,839 Then at some point, 266 00:22:19,849 --> 00:22:31,000 something in your life will change and you'll realize that now the strategies you were using aren't really gonna work quite as well anymore. 267 00:22:31,170 --> 00:22:34,630 And that's really part of that normal human process too. 268 00:22:34,920 --> 00:22:36,369 And because you know, 269 00:22:36,380 --> 00:22:49,859 the process of creating strategies of evaluating things of making these small steps forward that can be successful when you do need to reevaluate and get back on board with the goal. 270 00:22:50,290 --> 00:23:00,040 That's something that you can go back to that skill in itself is something you keep with you and you can use in lots of different areas of life. 271 00:23:00,050 --> 00:23:03,780 We will continue to talk about living with intention, 272 00:23:03,790 --> 00:23:09,844 meaning growth and having success with all steps forward. 273 00:23:09,954 --> 00:23:17,564 Next time when we talk more about strategies and goals within these different categories, 274 00:23:17,574 --> 00:23:20,025 we mentioned special interests, 275 00:23:20,035 --> 00:23:22,135 health and wellness regulation, 276 00:23:22,194 --> 00:23:23,255 relationships, 277 00:23:23,265 --> 00:23:26,785 everyday tasks and family and household culture. 278 00:23:27,255 --> 00:23:28,785 I hope you'll join me then.    

You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this first episode in a series on intentional living, Dr. Regan identifies ways to plan the foundation of change so that you experience growth without becoming overwhelmed.  As referenced in the current episode:  adultandgeriatricautism.com Autism and Regulation podcast episode #1   Dr. Regan's online presentations with Zur Institute March, 2023: Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses Autism Assessment: The Seven Diagnostic Criteria Brought to Life   Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians      

Join Dr. Regan for this episode on the neurodiversity movement, autism affirming services, and the importance of allowing for complexity in our understanding of autism.    Dr. Regan's online presentations with Zur Institute March, 2023: Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses Autism Assessment: The Seven Diagnostic Criteria Brought to Life Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript here:   1 00:00:07,050 --> 00:00:10,400 Welcome to the podcast Autism in the Adult. 2 00:00:10,540 --> 00:00:12,310 I'm Dr Theresa Regan, 3 00:00:12,320 --> 00:00:14,060 a neuropsychologist, 4 00:00:14,100 --> 00:00:16,150 the mother of a teen on the spectrum, 5 00:00:16,160 --> 00:00:22,680 and the founder and director of an autism diagnostic clinic in Central Illinois for adolescents, 6 00:00:22,690 --> 00:00:24,720 adults and aging adults. 7 00:00:26,490 --> 00:00:32,300 Sometimes I get emails from people asking if I perform autism assessments for adults. 8 00:00:32,310 --> 00:00:33,080 And indeed, 9 00:00:33,080 --> 00:00:35,030 that's my full time job. 10 00:00:35,040 --> 00:00:36,850 So I go to work every day. 11 00:00:36,850 --> 00:00:42,730 I see patients and clients in a medical setting for evaluations and recommendations. 12 00:00:44,260 --> 00:00:58,920 Then I also have other things that I've chosen to do in the topic area of autism because I'm passionate about the people impacted and the positive things that can happen when we understand more about the autistic neurology. 13 00:01:00,000 --> 00:01:12,240 I do have a few online presentations coming up through Zur Institute which is a continuing education program for professionals. 14 00:01:12,250 --> 00:01:20,970 I'll include a link in the podcast show notes to these programs so you can look at the descriptions and registration links. 15 00:01:21,340 --> 00:01:26,440 And the first one is Tuesday March 7th 2023. 16 00:01:26,440 --> 00:01:27,740 For one hour. 17 00:01:27,760 --> 00:01:34,100 The presentation covers information about the basic foundational rules of the autism. 18 00:01:34,100 --> 00:01:45,750 Diagnostic criteria Will be dispelling myths about the foundations and requirements that may prevent people from being referred for assessment appropriately. 19 00:01:45,870 --> 00:01:48,740 And the second presentation is on Saturday, 20 00:01:48,750 --> 00:01:50,210 March 25, 21 00:01:50,220 --> 00:02:02,410 that's for two hours and this presentation will highlight the seven diagnostic criteria what they mean and also what they look like in a clinical case of a young adult female, 22 00:02:02,410 --> 00:02:05,580 just to illustrate some of the concepts. 23 00:02:05,900 --> 00:02:08,860 So if you are a clinician or you know, 24 00:02:08,870 --> 00:02:13,420 of professionals in your area who are wanting to learn more about autism, 25 00:02:13,430 --> 00:02:16,420 this may be a good resource opportunity. 26 00:02:16,940 --> 00:02:22,020 The topic of the podcast today is actually not the topic that I had been working on. 27 00:02:22,030 --> 00:02:23,860 Uh to record, 28 00:02:23,870 --> 00:02:29,120 I've had multiple interactions about a different topic over the last few weeks. 29 00:02:29,120 --> 00:02:35,460 And it really struck me as perhaps something that would be timely to talk about or helpful to process. 30 00:02:35,470 --> 00:02:37,090 And so in this episode, 31 00:02:37,090 --> 00:02:47,760 I wanted to talk about neurodiversity and autism affirming approaches to serving those on the spectrum. 32 00:02:47,770 --> 00:02:54,790 I'm gonna talk about three things within the context of this episode. 33 00:02:54,790 --> 00:02:57,480 One is just what are we talking about? 34 00:02:57,480 --> 00:03:01,050 What's the definition when we talk about neuro diversity? 35 00:03:01,060 --> 00:03:11,630 The second is what kinds of conditions or characteristics might we want to include under the umbrella of neuro diversity? 36 00:03:11,640 --> 00:03:30,220 And the third has to do with a viewpoint that some put forward that says that only individuals who have diagnoses of neuro divergence should be offering services to those on the spectrum. 37 00:03:30,230 --> 00:03:32,820 When we talk about neuro diversity, 38 00:03:32,830 --> 00:03:40,800 we're basically talking about the idea that people experience and interact with the world around them in many different ways. 39 00:03:40,810 --> 00:03:44,570 And this concept of course, 40 00:03:44,570 --> 00:03:47,450 neuro being neurology and diversity, 41 00:03:47,460 --> 00:03:48,760 meaning diversity. 42 00:03:48,760 --> 00:03:58,080 So we all have variations in our neurologic wiring and there's no one quote right way of thinking, 43 00:03:58,090 --> 00:04:05,700 learning and behaving and that all neurologic differences should be appreciated as part of natural variation. 44 00:04:06,370 --> 00:04:10,350 And I explain those concepts, 45 00:04:10,360 --> 00:04:16,990 knowing and wanting to communicate that people will defined neuro diversity differently. 46 00:04:16,990 --> 00:04:23,630 And so I'm trying to use phrases that are commonly used um in describing what that means, 47 00:04:23,640 --> 00:04:25,750 one person can say that, 48 00:04:25,760 --> 00:04:26,230 you know, 49 00:04:26,230 --> 00:04:31,060 that isn't really what it means to me and that's completely fine. 50 00:04:31,070 --> 00:04:39,020 It's such a complex topic that getting it right as everyone would define it is difficult. 51 00:04:39,020 --> 00:04:40,260 But basically, 52 00:04:40,270 --> 00:05:06,220 it is this understanding that there's variations on our wiring and there's this emphasis that there's not one right way to be connected neurologically um at its best when we're talking about neuro diversity as a concept and autism affirmation as a concept. 53 00:05:06,230 --> 00:05:29,960 It really helps ward against an approach to intervention that may focus on correcting or fixing behaviors in the neuro diverse individual only because the behaviors are unusual or atypical. When a therapist is neuro diversity affirming or autism affirming, 54 00:05:29,970 --> 00:05:44,310 this is often used to emphasize that they understand that neuro divergence itself is not a flaw or an illness that needs to be fixed or corrected. 55 00:05:44,640 --> 00:05:47,820 And we're gonna talk about this a little bit more later. 56 00:05:47,820 --> 00:05:52,640 But neuro divergence often refers to autism, 57 00:05:52,640 --> 00:05:56,030 but it is a much larger umbrella right now. 58 00:05:56,030 --> 00:05:58,020 And so we'll talk about that as well. 59 00:05:58,800 --> 00:06:02,940 However, 60 00:06:04,180 --> 00:06:05,410 at the same time, 61 00:06:05,410 --> 00:06:23,080 we hope that the autism affirming therapist can also acknowledge some parts of autism that really may create a lot of difficulty or pain for the person that's presenting for care. 62 00:06:23,090 --> 00:06:25,230 So at its best, 63 00:06:25,230 --> 00:06:39,420 we really hope there's this balance of understanding of the gifts and strengths in the autistic experience in the struggles and difficulties that someone may really inherently experience, 64 00:06:39,430 --> 00:06:43,960 not because of the attitudes of society or, 65 00:06:43,970 --> 00:06:44,690 or anything, 66 00:06:44,690 --> 00:06:51,640 but because this neurologic piece is really giving them difficulty. At it's extreme, 67 00:06:52,260 --> 00:07:24,600 there may be some in the autism affirming community or the neuro divergence community that really emphasize that the autistic experience is very positive in its essence that the diverse experience should always be emphasized as strength and the variation doesn't involve any inherent struggle. 68 00:07:25,560 --> 00:07:28,740 I think that when 69 00:07:28,740 --> 00:07:32,970 we get to that categorical kind of description, 70 00:07:32,980 --> 00:07:39,740 whether someone is talking about the autistic experience is all bad... or all good, 71 00:07:40,010 --> 00:07:40,430 you know, 72 00:07:40,430 --> 00:07:49,340 I think we're missing the complexity of the human experience and specifically here, 73 00:07:49,340 --> 00:07:51,210 the autistic experience. 74 00:07:51,220 --> 00:08:05,430 So what I would say about the movement and the concept of neuro diversity is it's really best when we're able to stay centered in the complexity... in the center, 75 00:08:05,430 --> 00:08:07,550 not those two extreme categories, 76 00:08:07,550 --> 00:08:18,990 but in the center of this mix of good and difficult where most often the truth lies in that center in that complexity. 77 00:08:19,990 --> 00:08:24,140 Let me explain what the DSM 5, 78 00:08:24,140 --> 00:08:32,620 that's the diagnostic manual for many of the conditions that people refer to as neurodivergent... 79 00:08:32,630 --> 00:08:39,240 I want to talk about the criteria they use for when something is called a diagnosis. 80 00:08:39,240 --> 00:08:41,880 So this is not specific to autism. 81 00:08:41,890 --> 00:08:46,040 This could include learning disability, 82 00:08:46,050 --> 00:08:47,250 autism, 83 00:08:47,260 --> 00:08:48,360 psychosis, 84 00:08:48,360 --> 00:08:49,400 depression, 85 00:08:49,410 --> 00:08:50,960 lots of different things. 86 00:08:50,960 --> 00:09:01,810 And there are two things that they really focus on as being present in order for a diagnosis to be relevant. 87 00:09:01,810 --> 00:09:04,760 And so one is that the condition, 88 00:09:04,770 --> 00:09:19,440 the constellation of characteristics, is statistically atypical ... that it's not the most common constellation that we see in the daily human experience. 89 00:09:19,450 --> 00:09:23,410 It's not the most common state. 90 00:09:24,060 --> 00:09:24,340 Now, 91 00:09:24,340 --> 00:09:33,970 the second thing though is that the atypical constellation of characteristics must cause some form of difficulty for the individual, 92 00:09:33,980 --> 00:09:34,490 you know, 93 00:09:34,490 --> 00:09:36,500 does it work against their physical health? 94 00:09:36,500 --> 00:09:39,580 Does it reduce their safety in some situations? 95 00:09:39,590 --> 00:09:43,320 Is it associated with internal distress, 96 00:09:43,320 --> 00:09:46,810 does it prevent the person from reaching goals for daily living, 97 00:09:46,810 --> 00:09:48,290 like maintaining work? 98 00:09:48,550 --> 00:09:51,660 Is it associated with pain and relationships? 99 00:09:51,660 --> 00:10:01,860 So it has to have some functional impact that has worked against the well being of this individual. 100 00:10:01,870 --> 00:10:02,490 So, 101 00:10:02,490 --> 00:10:08,070 both things according to the diagnostic manual must be present for a diagnosis. 102 00:10:08,080 --> 00:10:11,530 There has to be this atypical constellation, 103 00:10:11,530 --> 00:10:20,590 but there also has to be ... that this atypical constellation has been the root of some functional struggle. 104 00:10:21,450 --> 00:10:31,440 So if there are individuals who have the autistic neurology and it has never been a source of functional difficulty, 105 00:10:31,450 --> 00:10:36,950 they actually don't meet the criteria for a diagnosis as defined in the in the manual. 106 00:10:36,960 --> 00:10:40,710 So when we're talking about having an official diagnosis, 107 00:10:40,720 --> 00:10:42,010 that would be part of it, 108 00:10:42,010 --> 00:10:43,540 that in some season, 109 00:10:43,540 --> 00:10:44,700 in some way, 110 00:10:44,710 --> 00:10:50,130 there's really been a struggle associated with those neurologic characteristics. 111 00:10:50,790 --> 00:10:51,680 And this is why, 112 00:10:51,680 --> 00:10:52,560 for example, 113 00:10:52,560 --> 00:10:57,680 depression is a diagnosis as well. It's not rare, 114 00:10:57,690 --> 00:11:00,650 but ... it's not the most typical mood state. 115 00:11:00,650 --> 00:11:04,600 And when people get stuck in that atypical mood state, 116 00:11:04,610 --> 00:11:08,230 it causes these functional areas of difficulty. 117 00:11:08,230 --> 00:11:09,330 It's hard to get up, 118 00:11:09,330 --> 00:11:10,470 it's hard to go to work, 119 00:11:10,470 --> 00:11:12,660 it's hard to maintain relationships. 120 00:11:12,850 --> 00:11:22,610 And so that's where we shift from saying something is diverse to something that 121 00:11:22,620 --> 00:11:29,740 we're calling a diagnosis... that rather than just being mood-diversity where gosh, 122 00:11:29,740 --> 00:11:31,410 I've had a bad day, 123 00:11:31,930 --> 00:11:37,590 but it's really not impacted functionally how I'm doing across time... 124 00:11:37,600 --> 00:11:48,460 but when I get stuck in this mood state and it's really interfering with wellness in my daily life, 125 00:11:48,460 --> 00:11:50,440 that's when it's a diagnosis. 126 00:11:51,270 --> 00:11:51,660 Now, 127 00:11:51,660 --> 00:12:01,130 autism as a diagnosis does require that difficulty at some point in your life that you've really had the autistic neurology, 128 00:12:01,140 --> 00:12:07,590 making it hard to function in a way that's comfortable where you're achieving your goals. 129 00:12:08,030 --> 00:12:08,440 Now, 130 00:12:08,440 --> 00:12:13,360 autism as a diagnosis occurs in 2% of individuals, 131 00:12:13,370 --> 00:12:15,290 they would meet the full criteria. 132 00:12:15,300 --> 00:12:27,890 The neurologic characteristics hang together in those individuals because they hang together anatomically and they have also impacted the individual's well being their goals, 133 00:12:27,890 --> 00:12:29,390 their functional life. 134 00:12:29,910 --> 00:12:30,170 Now, 135 00:12:30,170 --> 00:12:36,400 does this mean that the neurology of autism causes pain or distress in every way? 136 00:12:36,410 --> 00:12:37,870 Absolutely not. 137 00:12:37,880 --> 00:12:43,160 Does it mean that the difficulty is constant throughout the whole lifespan? 138 00:12:43,580 --> 00:12:44,440 No. 139 00:12:44,450 --> 00:12:46,100 So in my viewpoint, 140 00:12:46,110 --> 00:12:52,160 all humans have characteristics that work for them in some ways and against them in some ways. 141 00:12:52,170 --> 00:12:54,870 And this is true in autism as well. 142 00:12:54,880 --> 00:12:55,870 For example, 143 00:12:55,870 --> 00:13:00,570 the attention to detail can be a great strength in some work projects. 144 00:13:00,570 --> 00:13:08,360 Whereas it can really create difficulty when the ultimate goal is speed and generalization rather than detail. 145 00:13:09,070 --> 00:13:22,980 So much of the benefit for the autistic individual and those who love them is this increased awareness of how their characteristics may work for them or against them in different contexts or across life seasons? 146 00:13:23,510 --> 00:13:23,790 Now, 147 00:13:23,790 --> 00:13:25,180 having said that again, 148 00:13:25,180 --> 00:13:40,460 remember that individuals who meet that full criteria by definition have had a level of neurologic difference that really increases the risk of difficulty and a lot of these functional areas compared with someone with a different neurology, 149 00:13:41,100 --> 00:13:45,930 we know that every human will have this mix of gifts and weaknesses, 150 00:13:45,930 --> 00:13:47,270 strengths and struggles, 151 00:13:47,280 --> 00:13:49,510 abilities and limitations. 152 00:13:49,520 --> 00:13:51,510 And for one person, 153 00:13:51,520 --> 00:13:52,070 you know, 154 00:13:52,070 --> 00:13:57,780 he may excel in athletics but struggle to read at functional levels. 155 00:13:57,790 --> 00:14:05,040 So he can't read a contract or release or a medical form without struggling and getting taken advantage of, 156 00:14:05,040 --> 00:14:09,390 that's a neurologic difference in that reading comprehension. 157 00:14:09,790 --> 00:14:18,050 Another person may be able to produce wonderful needlework that requires really good fine motor skills appreciation of color 158 00:14:18,050 --> 00:14:18,770 palettes, 159 00:14:18,770 --> 00:14:20,660 creativity and design. 160 00:14:20,670 --> 00:14:21,450 However, 161 00:14:21,450 --> 00:14:30,420 they might struggle to keep blood sugar levels even and their pancreas just isn't helping them with this task as much as we would wish. 162 00:14:30,430 --> 00:14:33,810 And maybe they take insulin shots because of this. 163 00:14:34,400 --> 00:14:39,960 I bring these examples up just to say that in our human form, 164 00:14:39,970 --> 00:14:48,650 we all have gifts and strengths and triumphs and skill sets. 165 00:14:48,660 --> 00:14:59,580 And we also will have some form of limitation or struggle at some part in our life and my struggle, 166 00:14:59,580 --> 00:15:03,850 my limitation in my human form may be different than yours. 167 00:15:04,100 --> 00:15:12,010 But I know that the commonality of the human experience is that you also will have some strength, 168 00:15:12,010 --> 00:15:16,520 some gift in your human form and some limitation, 169 00:15:16,520 --> 00:15:19,500 some struggle in that human form. 170 00:15:19,510 --> 00:15:27,980 And for some their area of gift and struggle may involve aspects of this autistic neurology. 171 00:15:29,200 --> 00:15:34,380 I think we do best for each other when we appreciate all sides of our humanity, 172 00:15:34,420 --> 00:15:36,550 that these are my strengths, 173 00:15:36,550 --> 00:15:38,030 these are my limitations, 174 00:15:38,030 --> 00:15:39,710 this is my humanity, 175 00:15:39,870 --> 00:15:43,840 this mix of good and difficult and strong and weak. 176 00:15:43,850 --> 00:15:55,770 And I'll always have a mix of this and this is what it is to be human and to truly show honor and respect and appreciation to the personhood of each individual. 177 00:15:55,780 --> 00:16:00,960 We allow all those things in the mix to be viewed and discussed. 178 00:16:01,030 --> 00:16:04,340 There's no reason to only talk about easy things, 179 00:16:04,340 --> 00:16:05,120 bright things, 180 00:16:05,120 --> 00:16:06,220 successful things. 181 00:16:06,220 --> 00:16:13,630 We can talk about all the messiness of each of our humanity and still affirm that every single person, 182 00:16:13,640 --> 00:16:15,420 no matter their age, 183 00:16:15,430 --> 00:16:16,030 culture, 184 00:16:16,030 --> 00:16:17,340 health abilities, 185 00:16:17,340 --> 00:16:18,580 spirituality, 186 00:16:18,590 --> 00:16:19,340 gender, 187 00:16:19,340 --> 00:16:20,880 any of these things, 188 00:16:20,890 --> 00:16:38,020 every single person is filled with inherent value and is deserving of honor and respect because that is inherent to their personhood and having a gift does not make them any more valued in having limitations. 189 00:16:38,020 --> 00:16:41,120 Does not take away any of their value. 190 00:16:41,550 --> 00:16:44,140 When someone is celebrating and rejoicing, 191 00:16:44,140 --> 00:16:47,220 we can come alongside and celebrate too. 192 00:16:47,420 --> 00:16:49,440 And when someone is grieving, 193 00:16:49,450 --> 00:16:54,530 when someone is struggling with something or coming across their own limitations, 194 00:16:54,530 --> 00:16:58,540 we also come alongside them in this as well. 195 00:16:58,550 --> 00:17:00,860 We can acknowledge the struggle, 196 00:17:00,870 --> 00:17:03,640 we can offer community assistance, 197 00:17:03,650 --> 00:17:10,640 anything that we can bring to the table in this moment of of humanity and coming together. 198 00:17:10,650 --> 00:17:13,890 So let's talk about the second topic, 199 00:17:13,890 --> 00:17:25,000 which is What kinds of diagnoses or characteristics do we want to consider as under that neuro diversity umbrella. 200 00:17:25,010 --> 00:17:38,640 So the neuro diversity movement began in the 90s as a way of talking about autism and sometimes attention deficit and the real benefit of it was that it, 201 00:17:38,650 --> 00:17:56,780 it championed the humanity of everyone with neuro diverse characteristics and made sure that they weren't being looked at as less than or somehow not as valued in society. 202 00:17:57,410 --> 00:18:07,690 Examples of conditions that are currently considered under the neuro diversity umbrella often include in addition to autism and attention deficit, 203 00:18:07,700 --> 00:18:10,370 things like obsessive compulsive disorder, 204 00:18:10,370 --> 00:18:11,680 bipolar disorder, 205 00:18:11,680 --> 00:18:13,020 dyslexia, 206 00:18:13,030 --> 00:18:14,800 and dyspraxia. 207 00:18:15,870 --> 00:18:16,950 But now, 208 00:18:16,960 --> 00:18:18,640 even though in the beginning, 209 00:18:18,640 --> 00:18:26,350 we often would talk about autism or attention deficit as being a large part of neuro diversity. 210 00:18:26,360 --> 00:18:27,010 Now, 211 00:18:27,010 --> 00:18:43,020 there's a much bigger umbrella that people um talk about as involving these kinds of conditions and it's kind of growing all the time and there's not an inherent  difficulty with that, 212 00:18:43,020 --> 00:19:02,280 but there are some challenges with having the umbrella be very narrow or having it be really um inclusive because neuro diversity at its most inclusive is anything that has diverse neurology as part of its definition. 213 00:19:02,290 --> 00:19:03,510 So, 214 00:19:03,710 --> 00:19:08,910 if we're going to expand it beyond autism and attention deficit, 215 00:19:08,910 --> 00:19:18,120 that we're really going to um be expanding it to include everything with diverse neurology. 216 00:19:18,120 --> 00:19:23,850 And so that's going to include things like spinal cord injury, 217 00:19:23,860 --> 00:19:24,710 stroke, 218 00:19:24,720 --> 00:19:25,970 cerebral palsy, 219 00:19:25,970 --> 00:19:28,150 parkinson's traumatic brain injury, 220 00:19:28,150 --> 00:19:29,230 encephalitis, 221 00:19:29,240 --> 00:19:30,430 brain tumor, 222 00:19:30,430 --> 00:19:31,750 multiple sclerosis, 223 00:19:31,750 --> 00:19:32,820 hydrocephalus, 224 00:19:32,830 --> 00:19:34,020 Alzheimer's disease, 225 00:19:34,020 --> 00:19:35,920 and all other forms of dementia, 226 00:19:35,930 --> 00:19:37,980 all learning difficulties, 227 00:19:37,990 --> 00:19:40,880 intellectual disability and so on. 228 00:19:41,500 --> 00:19:46,300 If we're going to use the umbrella to be all inclusive of neurologic diversity, 229 00:19:46,310 --> 00:19:51,090 we are essentially going to be talking about all neurologic conditions. 230 00:19:51,340 --> 00:19:52,170 In which case, 231 00:19:52,170 --> 00:19:56,240 we really kind of lost the meaning of the term itself. 232 00:19:56,250 --> 00:20:01,010 So I'm not sure that it's as powerful a term or meaningful a term. 233 00:20:01,800 --> 00:20:04,120 But if that's what we prefer, 234 00:20:04,120 --> 00:20:05,900 we certainly can do this. 235 00:20:05,910 --> 00:20:07,620 I just think at some point, 236 00:20:07,620 --> 00:20:15,560 we'll need to decide what meaning do we want the term to include and to be specific, 237 00:20:15,560 --> 00:20:28,640 knowing that there are a lot of neuro diverse conditions that would have to be under the umbrella if we're going to be all inclusive for neuro diverse conditions. 238 00:20:29,480 --> 00:20:29,910 So, 239 00:20:29,910 --> 00:20:30,620 in summary, 240 00:20:30,620 --> 00:20:31,600 so far, 241 00:20:31,610 --> 00:20:38,470 I would suggest that we think about what kind of meaning we want the term to have as far as neurology. 242 00:20:38,470 --> 00:20:48,170 And then also are we able to approach autism in a way that acknowledges all the strengths and the struggles that each individual presents with? 243 00:20:48,180 --> 00:20:51,240 Always understanding that in all of this mix, 244 00:20:51,250 --> 00:21:06,870 every person is filled with inherent value and you are important and your importance is never defined by strengths or limitations and you will always have a mix of both because you are human. 245 00:21:07,660 --> 00:21:08,000 Now, 246 00:21:08,000 --> 00:21:23,280 in this final section will be addressing an opinion that some have put forth that states that it's really not okay for individuals without an autism diagnosis or some form of neurodivergent diagnosis. 247 00:21:23,290 --> 00:21:23,700 Again, 248 00:21:23,700 --> 00:21:25,270 this is ill defined, 249 00:21:25,460 --> 00:21:34,370 but it's not all right for these individuals to provide services or input to autistic individuals essentially, 250 00:21:34,370 --> 00:21:38,750 only autistic providers should serve those on the spectrum. 251 00:21:38,760 --> 00:21:40,780 Uh For example, 252 00:21:40,780 --> 00:21:51,550 there are some workplaces that serve neurodivergent clients and only hire those with neurodivergent diagnoses. 253 00:21:52,110 --> 00:21:57,940 I think my response to this is similar to my response to the topics that we've covered so far, 254 00:21:57,940 --> 00:22:12,740 which is basically that I think the truth and the life and the best outcomes are often found in the center rather than um at either categorical opinion. 255 00:22:13,020 --> 00:22:17,950 So anytime we're tempted to go for that uh kind of simple, 256 00:22:17,950 --> 00:22:18,870 straightforward, 257 00:22:18,880 --> 00:22:21,550 only this and never that kind of thought process, 258 00:22:21,550 --> 00:22:28,380 we're really limiting the truth and limiting the good that we'll find in the complex middle. 259 00:22:29,030 --> 00:22:30,200 And in this case, 260 00:22:30,200 --> 00:22:44,190 I think the wonderful thing about this approach is it does emphasize uh welcoming all kinds of diverse inputs to discussion services and program development as far as they do go, 261 00:22:44,200 --> 00:22:51,260 which is neuro diversity that we bring together the neuro diverse to serve the neuro diverse. 262 00:22:52,500 --> 00:22:53,030 Now, 263 00:22:53,030 --> 00:22:55,620 I love to hear people's stories, 264 00:22:55,630 --> 00:22:56,580 their opinions, 265 00:22:56,580 --> 00:23:01,170 their perspectives and whether those are from the autistic individual, 266 00:23:01,170 --> 00:23:01,940 their friends, 267 00:23:01,940 --> 00:23:03,320 their family members, 268 00:23:03,330 --> 00:23:07,320 whether those are from individuals and a helping profession, 269 00:23:07,320 --> 00:23:08,550 anyone, 270 00:23:08,560 --> 00:23:12,350 it enriches me over and over and over again. 271 00:23:13,700 --> 00:23:14,390 However, 272 00:23:14,390 --> 00:23:24,700 I think saying that only autistic providers should come alongside the autistic to provide input is limiting in a way that would work against the greatest good. 273 00:23:24,710 --> 00:23:31,330 Not because the autistic providers viewpoint is not valid or in some way less than others viewpoint. 274 00:23:31,340 --> 00:23:44,400 But because the breadth of specialization and experience that benefits individuals is so huge that no one group of individuals can ever cover all of that information. 275 00:23:44,410 --> 00:23:54,020 And I think if we tap into our diverse knowledge and experience that we will have the richest information to share. 276 00:23:54,030 --> 00:23:59,240 So having occupational therapists and neurologists and neuropsychologist, 277 00:23:59,250 --> 00:24:02,290 experts in academic learning and nutrition, 278 00:24:02,300 --> 00:24:05,200 all of these things are so beneficial, 279 00:24:05,210 --> 00:24:13,150 such richness of knowledge and experience that it's the exchange here that brings the blessing. 280 00:24:13,160 --> 00:24:18,030 It's increasing the diversity of input that brings the blessing. 281 00:24:18,490 --> 00:24:27,720 And some of these individuals in their specialization will be on the spectrum and some will not in other examples. 282 00:24:27,730 --> 00:24:28,200 You know, 283 00:24:28,200 --> 00:24:36,470 if I had multiple sclerosis and I would only receive care from a neurologist who had the same diagnosis. 284 00:24:36,480 --> 00:24:41,670 I would be limiting some of my um options. 285 00:24:41,670 --> 00:24:43,740 There may not be someone available. 286 00:24:43,750 --> 00:24:47,690 Uh This person may not be as experienced as someone else. 287 00:24:47,700 --> 00:24:52,030 Um I may be limiting where I could have a whole team of people. 288 00:24:52,030 --> 00:24:53,090 Maybe I'm saying no, 289 00:24:53,090 --> 00:24:54,870 I just want this one person. 290 00:24:55,300 --> 00:24:59,490 It would get even more difficult if I had two conditions, 291 00:24:59,490 --> 00:24:59,930 right? 292 00:24:59,930 --> 00:25:04,870 That I have multiple sclerosis and congestive heart failure. 293 00:25:04,880 --> 00:25:05,390 Now, 294 00:25:05,390 --> 00:25:12,550 do I have to find a provider that has both or I can see a heart provider that also has congestive heart failure? 295 00:25:13,230 --> 00:25:22,290 It's not that there's not value in getting input from others who share characteristics about your life and have walked in your shoes and get it. 296 00:25:22,300 --> 00:25:25,220 I think that's really valuable. 297 00:25:25,700 --> 00:25:32,230 But there's also value in getting input from those who don't share the same characteristics, 298 00:25:32,230 --> 00:25:40,150 but they have areas of expertise that they can offer some input that you wouldn't get in other places. 299 00:25:40,250 --> 00:25:41,190 Essentially, 300 00:25:41,190 --> 00:25:46,240 we're talking about the benefits of diversity and getting diverse input. 301 00:25:46,240 --> 00:25:50,810 When you have some struggles or limitations in any form of your life, 302 00:25:51,140 --> 00:25:57,930 then you get to take in the perspectives of all those other people and you decide what's helpful to you. 303 00:25:57,940 --> 00:26:03,160 But you have a lot of diverse input and rather than limiting the input, 304 00:26:03,160 --> 00:26:04,140 you're getting, 305 00:26:04,150 --> 00:26:11,020 you get to take in this information process it and say this has really helped me. 306 00:26:11,030 --> 00:26:17,290 This is not helpful to me and you get to be the filter for what you take into your own life. 307 00:26:17,810 --> 00:26:20,720 This is a really complex topic. 308 00:26:20,730 --> 00:26:23,220 There's a lot of emotions involved. 309 00:26:23,230 --> 00:26:24,410 I think in the end, 310 00:26:24,410 --> 00:26:38,470 what I'm saying is just that being able to be in the center of complexity helps me the most to understand the good and the difficult, 311 00:26:38,480 --> 00:26:43,220 the strength and the struggle of all kinds of human experience. 312 00:26:43,230 --> 00:26:54,750 And I would emphasize that the inherent value of the person is in their personhood and that never changes. 313 00:26:54,760 --> 00:27:02,820 So whether we're working with someone on something that they're celebrating or something that they're grieving, 314 00:27:02,830 --> 00:27:07,200 we can come along either way and say you are important, 315 00:27:07,580 --> 00:27:09,110 your personhood, 316 00:27:09,120 --> 00:27:11,300 you have this inherent value. 317 00:27:11,310 --> 00:27:13,600 I value that you've come, 318 00:27:13,610 --> 00:27:21,320 I value your story and your input and let me come alongside you and add what I can to your journey. 319 00:27:22,070 --> 00:27:31,790 I'm glad that you joined me today and that you're part of this podcast community and I hope you join me next time for another great topic.  

Join Dr. Regan for this episode on the quest for balance on the autism spectrum. Whether it's emotional regulation, attention, sleep, social interactions, task initiation, finances and more, finding the "just right" state is difficult for many on the spectrum. Book: The Science of Making Friends   Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the Transcript Here:    1 00:00:07,240 --> 00:00:11,610 Hello and welcome back to the podcast Autism in the Adult. 2 00:00:11,620 --> 00:00:12,730 I am your host, 3 00:00:12,730 --> 00:00:14,390 Dr Theresa Regan, 4 00:00:14,400 --> 00:00:16,120 a neuropsychologist, 5 00:00:16,130 --> 00:00:18,470 a certified autism specialist. 6 00:00:18,480 --> 00:00:23,930 The director of an autism diagnostic clinic for adolescents, 7 00:00:23,940 --> 00:00:29,590 adults and aging adults in central Illinois and the mother of a teen on the spectrum. 8 00:00:30,660 --> 00:00:48,140 I'm glad you're joining me today for this episode that I'm going to call autism and "just right."  This is actually a great topic that was suggested by a listener from Finland and I hope that I am pronouncing the name correctly. 9 00:00:48,140 --> 00:01:07,680 I think it's Maya ... Maya wrote about questions and struggles within the topic of balance in life when you have that autistic neurology, 10 00:01:07,690 --> 00:01:09,270 Maya wrote this. 11 00:01:09,670 --> 00:01:23,030 I would so much love to hear what you have to say about autistic people and the struggle we have with striking a balance in situations where we have to create an appropriate view on or understanding of things? 12 00:01:23,040 --> 00:01:29,350 I am convinced that this is the major autistic difficulty that I personally struggle with. 13 00:01:30,110 --> 00:01:34,570 It shows up in different forms for me and on many levels. 14 00:01:35,700 --> 00:01:39,890 I could take a few examples so that you understand what I mean? 15 00:01:39,900 --> 00:01:44,520 Because most often this is not linked to intelligence, 16 00:01:44,530 --> 00:01:46,350 for example, 17 00:01:46,350 --> 00:01:47,490 is this person, 18 00:01:47,500 --> 00:01:50,100 a friend who respects me or not, 19 00:01:50,740 --> 00:01:53,230 am I too skinny or even to fat? 20 00:01:53,240 --> 00:01:58,050 Should I contact a doctor because of this thing that I'm feeling right now. 21 00:01:58,570 --> 00:02:01,470 How far should I stand by this person's side? 22 00:02:01,660 --> 00:02:04,500 How much should I help him or her? 23 00:02:05,210 --> 00:02:10,820 Exactly how well should I perform in this university course in order to pass. 24 00:02:11,910 --> 00:02:15,030 I want to thank Maya for writing about that. 25 00:02:15,040 --> 00:02:29,300 Um this is something I've thought about as well and I think it's one of those really great ways to conceptualize autism aside from specific details. 26 00:02:29,310 --> 00:02:34,510 So sometimes to get the most meaning out of what you're feeling, 27 00:02:34,510 --> 00:02:47,890 it can help to step back and say how is it that all these little pieces of the autistic experience hang together in some ways it can feel so granular, 28 00:02:47,900 --> 00:02:51,500 like so many things are impacted. 29 00:02:51,510 --> 00:02:59,120 Why do these things happen at the same time and when we have ways of conceptualizing it? 30 00:02:59,480 --> 00:03:02,450 Um I think it brings meaning. 31 00:03:02,460 --> 00:03:10,290 It helps these little pieces come together as why do I have trouble with these 12 things? 32 00:03:10,300 --> 00:03:11,380 Well, 33 00:03:11,390 --> 00:03:19,090 these 12 things have a thread that go through and when we can step back and see that thread that joins things, 34 00:03:19,100 --> 00:03:23,020 I think it really makes things more meaningful. 35 00:03:23,030 --> 00:03:26,210 Um and so that's what I want to do with this topic. 36 00:03:26,210 --> 00:03:32,870 Today I call this the just right state. 37 00:03:32,880 --> 00:03:35,570 So she was talking about balance. 38 00:03:35,570 --> 00:03:38,230 That's another great way to term it. 39 00:03:38,240 --> 00:03:43,950 Um A lot of times with the neurology that we're talking about, 40 00:03:43,950 --> 00:03:55,770 somebody will have difficulty finding that just right spot of balance where whatever they're attempting is not too much or too little. 41 00:03:56,130 --> 00:04:24,560 And ideally our neurology should help us flow in these areas that we can flow and adjust and we have this innate sense of where we should land to be just right for this context for this person for this topic and we can shift because just right will look different in one setting that it will in another setting or across time. 42 00:04:25,100 --> 00:04:30,320 So there's a lot of innit nous and flow in this ability to find just right. 43 00:04:31,650 --> 00:04:35,920 We've talked about difficulty with regulation in a very broad sense. 44 00:04:35,920 --> 00:04:47,530 We did a series on regulation issues having to do with alertness and attention and emotions and getting to that just rate state in those areas. 45 00:04:47,540 --> 00:04:59,270 But I think what Maya is pointing out is that regulation and balance and just right is a thread that goes through a lot of other areas with autism as well. 46 00:04:59,280 --> 00:05:04,170 So let's take a few areas and see how this just right. 47 00:05:04,400 --> 00:05:08,330 Uh this quest for just right is difficult. 48 00:05:08,950 --> 00:05:10,990 Let's take the social area. 49 00:05:11,590 --> 00:05:19,020 So some things that were struggling with that would capture this difficulty with just right would be, 50 00:05:19,030 --> 00:05:22,400 how much should I be speaking right now to this person? 51 00:05:22,410 --> 00:05:24,690 How much detail should I be giving? 52 00:05:24,700 --> 00:05:27,830 How much personal information should I share? 53 00:05:27,840 --> 00:05:34,660 What is the just right intensity and level of excitement for this context or person? 54 00:05:35,020 --> 00:05:41,240 What is just right as I'm interacting with a boss versus an acquaintance? 55 00:05:41,250 --> 00:05:43,090 How much eye contact? 56 00:05:43,100 --> 00:05:44,700 Too much or too little? 57 00:05:44,710 --> 00:05:55,420 How much emotional expression should I be using without looking false or like I'm putting on a show or that I don't care at all. 58 00:05:56,380 --> 00:05:57,410 For example, 59 00:05:57,420 --> 00:06:01,380 opening gifts without looking just flat or board, 60 00:06:01,390 --> 00:06:07,660 but without looking like an actor that's pretending to be happy with a gift. 61 00:06:08,690 --> 00:06:11,720 How much should I give this person? 62 00:06:12,830 --> 00:06:15,130 How long should I stand by them? 63 00:06:15,140 --> 00:06:17,200 How much money should I loan them? 64 00:06:17,210 --> 00:06:20,490 How many times should I give them a ride or a lift? 65 00:06:20,500 --> 00:06:24,040 How much leeway should I give in a relationship? 66 00:06:24,050 --> 00:06:25,270 For example, 67 00:06:25,280 --> 00:06:31,540 I know people are complex and I can be friends with people who do things that I don't agree with. 68 00:06:31,550 --> 00:06:34,120 But at what point do I say? 69 00:06:34,120 --> 00:06:34,420 Yeah, 70 00:06:34,420 --> 00:06:37,970 this is really not a healthy relationship for me. 71 00:06:37,970 --> 00:06:40,130 I need to end this relationship. 72 00:06:41,290 --> 00:06:44,200 How close should I make this relationship? 73 00:06:44,210 --> 00:06:52,470 And how soon what is the just right closeness and the timing of a relationship? 74 00:06:52,480 --> 00:07:03,690 So some people on the spectrum struggle because they really want some definition to the relationship quickly because this in between state, 75 00:07:03,690 --> 00:07:06,770 this undefined state feels really uncomfortable. 76 00:07:07,600 --> 00:07:08,600 So they might say, 77 00:07:08,600 --> 00:07:20,770 well let's just get married right away because we know we're right for each other and in essence defining and structuring the relationship feels better than this. 78 00:07:20,770 --> 00:07:21,300 Huh? 79 00:07:21,310 --> 00:07:23,600 I don't know what's gonna happen with this relationship. 80 00:07:23,610 --> 00:07:27,070 It feels safer and more defined and more predictable. 81 00:07:28,080 --> 00:07:36,130 Others will break up a relationship because they don't want to be in that undefined spot that in between place. 82 00:07:36,140 --> 00:07:42,420 Um So how much is just right as far as closeness in a relationship. 83 00:07:43,810 --> 00:07:52,850 What is the just right number of times to text or phone someone if they don't call you back or to extend an invitation to someone. 84 00:07:52,860 --> 00:07:58,530 Now sometimes there are rules of thumb for something like that. 85 00:07:58,540 --> 00:08:06,670 There's a nice book that I like called the Science of Making Friends that I'll link in the show notes that talks about, 86 00:08:06,680 --> 00:08:06,970 you know, 87 00:08:06,970 --> 00:08:14,120 you don't text or call again once you've done so twice without a return text or call. 88 00:08:17,250 --> 00:08:28,880 I once worked with a couple and we were trying to really increase his ability to bring some nurturance and emotional content to the relationship. 89 00:08:28,890 --> 00:08:38,330 And I worked with him on being aware that one way to show his wife love is to compliment her. 90 00:08:38,340 --> 00:08:40,960 So we kind of worked on that as a goal, 91 00:08:40,960 --> 00:08:41,780 practiced it, 92 00:08:41,780 --> 00:08:45,090 role played it and he put it into action. 93 00:08:45,820 --> 00:08:48,310 The problem was then his wife said, 94 00:08:48,310 --> 00:08:50,820 well now he's complimenting me too much. 95 00:08:53,000 --> 00:08:54,570 It is the difficulty, 96 00:08:54,570 --> 00:08:55,820 isn't it? 97 00:08:55,870 --> 00:08:58,880 Like I can learn a strategy, 98 00:08:58,890 --> 00:09:02,390 I can apply new knowledge, 99 00:09:03,300 --> 00:09:08,690 but the getting the just right amount, 100 00:09:08,690 --> 00:09:09,880 the just right moment, 101 00:09:09,880 --> 00:09:11,970 the just right compliment boy. 102 00:09:11,970 --> 00:09:13,510 That's really difficult. 103 00:09:13,520 --> 00:09:15,260 It's difficult for anyone. 104 00:09:15,270 --> 00:09:16,010 Uh, 105 00:09:16,010 --> 00:09:18,580 and even more so on the spectrum, 106 00:09:20,830 --> 00:09:24,280 let's look at finances for that just right state. 107 00:09:25,130 --> 00:09:39,340 It seems common for individuals on the spectrum to either lean toward spending too much perhaps on their special interests or other things that cut their eye or to spend too little. 108 00:09:40,490 --> 00:09:41,090 Um, 109 00:09:41,100 --> 00:09:56,050 there are people that have lots of money in a savings account or other type of account but they don't want to withdraw anything to fix the roof or to buy an updated phone. 110 00:09:57,660 --> 00:10:01,970 What is the amount of spending that is just right. 111 00:10:02,830 --> 00:10:12,100 There are guides for budgeting but it can still feel really elusive to get just right in specific personal situations. 112 00:10:12,110 --> 00:10:13,490 So yeah, 113 00:10:13,490 --> 00:10:14,840 this is the principle, 114 00:10:14,840 --> 00:10:16,080 this is the guideline, 115 00:10:16,080 --> 00:10:17,750 this is the percentage, 116 00:10:17,760 --> 00:10:25,380 but it is hard to have to look that framework up and not have a sense, 117 00:10:25,380 --> 00:10:29,070 an innate sense like yeah, 118 00:10:29,070 --> 00:10:33,180 I really need to get this roof repaired some will say, 119 00:10:33,190 --> 00:10:33,730 yeah, 120 00:10:33,730 --> 00:10:35,960 I know that I can ask for advice, 121 00:10:35,960 --> 00:10:41,950 I know that I can use this budget but I wish I had this innate sense of yeah, 122 00:10:41,950 --> 00:10:46,440 I really need to update this in my home or boy, 123 00:10:46,440 --> 00:10:51,570 I've spent too much on this area and not enough on this other area. 124 00:10:53,460 --> 00:10:54,240 They'll say, 125 00:10:54,240 --> 00:10:54,540 you know, 126 00:10:54,540 --> 00:11:02,840 it's difficult to have a feel for it instead of having to stick to some type of formula and maybe feeling like, 127 00:11:02,850 --> 00:11:09,360 well what would that rule of thumb look like in this situation and how would it apply to this other case. 128 00:11:11,270 --> 00:11:16,490 Let's look at just right as it relates to task completion on the spectrum. 129 00:11:17,020 --> 00:11:22,400 What is the just right amount of completion for some people on the spectrum, 130 00:11:22,410 --> 00:11:30,960 completion is very important but when is something complete and what is the just right amount of accuracy and detail? 131 00:11:30,970 --> 00:11:44,080 Some may feel like I need to finish one task before I start another task or I can't go to bed until I read all of these pages assigned from the class of the previous day. 132 00:11:45,060 --> 00:11:49,120 What is the right amount of detail? 133 00:11:49,130 --> 00:11:51,290 What is the right amount of speed? 134 00:11:53,480 --> 00:11:57,100 Have I done enough that this assignment is complete, 135 00:11:57,140 --> 00:12:03,440 especially when we get to adulthood tasks don't have a clear cut off. 136 00:12:04,510 --> 00:12:16,370 It's not like there are five math problems and we finish each one and we know the task is complete and maybe that we have a research paper or we have a software project. 137 00:12:16,380 --> 00:12:16,830 Well, 138 00:12:16,840 --> 00:12:18,040 when is it complete? 139 00:12:18,040 --> 00:12:19,620 When is it good enough? 140 00:12:23,130 --> 00:12:25,020 That difficulty knowing? 141 00:12:25,020 --> 00:12:25,480 Hey, 142 00:12:25,480 --> 00:12:29,120 I haven't attended a task B at all, 143 00:12:29,120 --> 00:12:33,420 but I've overworked on task A and how do I balance that? 144 00:12:33,420 --> 00:12:35,030 When do I know that? 145 00:12:35,030 --> 00:12:36,560 That's the difficulty. 146 00:12:38,750 --> 00:12:50,450 One person I worked with said I've always had the strong feeling that a newspaper needs to be read completely from cover to cover from every page that there, 147 00:12:50,460 --> 00:12:53,030 there is a completion that's important. 148 00:12:53,840 --> 00:12:56,700 You can't just read an article here and there. 149 00:12:56,750 --> 00:12:58,630 That's just not right. 150 00:12:59,420 --> 00:13:06,680 Another person may feel I have to finish this test completely before I start this other project. 151 00:13:07,650 --> 00:13:18,980 Even though the first task was something a coworker asked me about and this next one I have to complete is something my boss asked me to work on. 152 00:13:22,510 --> 00:13:32,520 It's difficult sometimes for the individual with that autistic neurology to understand that all details do not have the same importance. 153 00:13:33,110 --> 00:13:38,970 Um There are people um on the spectrum who feel like, 154 00:13:38,980 --> 00:13:48,350 well every detail is going to be important so it has to be included and the neurology there just isn't helping the person know like Yeah, 155 00:13:48,350 --> 00:13:54,010 but in this instance this part is not as important as this part, 156 00:13:56,290 --> 00:14:06,880 it can be really hard to get the neurology to shift uh to adjust if a task needs to be done quickly but does not need to be as accurate. 157 00:14:07,390 --> 00:14:12,510 So meeting deadlines might really be difficult if your boss says to you, 158 00:14:12,510 --> 00:14:15,910 hey this project needs to be done quickly. 159 00:14:15,920 --> 00:14:21,720 It doesn't really need to be detailed but I have to have it ready for a meeting tomorrow at noon. 160 00:14:21,730 --> 00:14:24,990 I just want to give a broad overview. 161 00:14:25,000 --> 00:14:29,830 Details are not important that can feel actually very stressful. 162 00:14:29,840 --> 00:14:32,990 Well what does a broad overview look like? 163 00:14:33,000 --> 00:14:34,600 And will, 164 00:14:34,610 --> 00:14:41,230 will I feel okay stopping when there are other details available. 165 00:14:43,910 --> 00:14:49,200 This is also related to the topic that maya brought up about working on a course, 166 00:14:49,210 --> 00:14:50,780 a university class. 167 00:14:50,790 --> 00:14:57,460 How much work do I need to do in order to do a good job? 168 00:14:57,470 --> 00:15:00,290 What if I could have done more? 169 00:15:00,300 --> 00:15:01,820 Could have done better. 170 00:15:03,090 --> 00:15:06,500 How many a's do I need to get to be a good student? 171 00:15:06,500 --> 00:15:11,730 How can I hit the mark of balance with accuracy and speed? 172 00:15:12,910 --> 00:15:14,800 How can I balance that? 173 00:15:14,800 --> 00:15:18,460 Everything doesn't have the same importance at the same time, 174 00:15:20,530 --> 00:15:26,400 something may be able to go undone while something else cannot wait another minute. 175 00:15:26,400 --> 00:15:27,490 So triaging, 176 00:15:27,490 --> 00:15:32,400 how do I triage quickly based on importance? 177 00:15:33,210 --> 00:15:36,360 How thorough do I need to be on this project? 178 00:15:36,870 --> 00:15:41,420 If the professor said I need to cite 10 sources, 179 00:15:42,200 --> 00:15:44,070 Can my brain let go? 180 00:15:44,070 --> 00:15:52,440 The other 25 sources I might be able to get and how can I just innately have a feel for? 181 00:15:52,450 --> 00:15:53,360 Okay, 182 00:15:53,370 --> 00:15:54,250 this is done, 183 00:15:54,260 --> 00:15:58,120 this is this project is finished and it's good to go. 184 00:15:59,020 --> 00:16:11,500 Maya also noted in her email that sometimes the approach to dealing with this difficulty is to get input from others about what might be just right in a situation, 185 00:16:12,310 --> 00:16:15,570 but that approach doesn't always feel practical. 186 00:16:15,580 --> 00:16:23,180 Like who could I ask or there's a deadline and people aren't around this just isn't practical. 187 00:16:23,190 --> 00:16:25,520 It also takes a lot of energy. 188 00:16:25,530 --> 00:16:32,760 And do I always bother the same person or how many times do I ask for input and who do I ask? 189 00:16:34,050 --> 00:16:35,610 So first of all, 190 00:16:35,620 --> 00:16:40,850 let's talk about that difficulty finding the just right state. 191 00:16:41,510 --> 00:16:46,470 So this could be within alertness and behavioral activation, 192 00:16:46,480 --> 00:16:49,310 it can be within attention. 193 00:16:49,320 --> 00:16:52,790 Like what is the just right amount of attention. 194 00:16:52,800 --> 00:16:56,210 It's somewhere between distractible and hyper focus. 195 00:16:56,220 --> 00:17:08,840 What is the just right space for our emotions while it's to be psychologically present and um clearheaded and calm. 196 00:17:09,520 --> 00:17:12,010 What is just right for test completion, 197 00:17:12,010 --> 00:17:15,280 finances working out nutrition, 198 00:17:15,280 --> 00:17:17,130 dieting all of these things. 199 00:17:18,280 --> 00:17:26,470 Let me give you an example for my own life that has to do with another physical just rate dilemma. 200 00:17:27,400 --> 00:17:35,250 So one of the things that I think about that I think also highlights this is that personally, 201 00:17:35,260 --> 00:17:42,950 it's kind of a joke in my family that I have really bad depth perception and again, 202 00:17:42,950 --> 00:17:51,470 it's kind of a joke because at some point you just have to laugh and luckily I always think I have less room. 203 00:17:51,480 --> 00:17:55,770 So it's not that I go around hitting things with the car, 204 00:17:56,070 --> 00:17:57,870 but you know, 205 00:17:57,880 --> 00:18:01,350 there's lots of room left and it does get kind of funny, 206 00:18:02,960 --> 00:18:12,470 I wish so in the back of my mind that I could learn to compensate for that because I do get tired of laughing at myself and having to be a good sport about this, 207 00:18:12,490 --> 00:18:18,620 just silly thing that I've parked so far away from where I could have parked, 208 00:18:20,790 --> 00:18:29,250 I realized that I always leave two ft from where I could have pulled up. 209 00:18:29,780 --> 00:18:37,640 So there's this remarkable consistency for me in that area that I can't tell what's just right, 210 00:18:37,650 --> 00:18:42,600 but somehow I'm always two ft from where I probably should be. 211 00:18:42,600 --> 00:18:43,650 So I thought, 212 00:18:43,660 --> 00:18:45,100 okay, 213 00:18:45,110 --> 00:18:57,570 well I will compensate for this difficulty with just right by going an extra two ft because I actually think I can Gauge what two ft would be. 214 00:18:59,020 --> 00:19:06,830 So I started to do that and lo and behold I that just does not work. 215 00:19:06,840 --> 00:19:16,110 I cannot compensate to get to intellectually get to the where the just right status. 216 00:19:16,120 --> 00:19:31,770 So as you can imagine I'm either to end up touching the wall or the um edge of the parking space with my car or I end up still being well below where I could be. 217 00:19:33,350 --> 00:19:48,420 So for me that's just another example that if my eyes in my brain are not able to show me the just rate state, 218 00:19:50,120 --> 00:19:54,700 there's not much I can do about that unfortunately. 219 00:19:55,990 --> 00:20:02,700 Um And even though I intellectually think of a strategy to compensate, 220 00:20:02,710 --> 00:20:06,940 it still doesn't mean that I can hit the just right spot. 221 00:20:06,950 --> 00:20:08,680 Well I should do this more, 222 00:20:08,680 --> 00:20:10,140 I should do this less. 223 00:20:10,150 --> 00:20:29,430 Um So I actually believe and in my experience with clients I think that ability that flow for that feel for the just rate state is something that is very difficult to compensate for. 224 00:20:29,440 --> 00:20:33,770 And I'm not sure that there are great ways to do that. 225 00:20:34,900 --> 00:20:46,350 I think what we typically do is we suggest intellectual compensations kind of like what I tried to do for my uh driving and parking. 226 00:20:46,360 --> 00:21:15,230 Um And I think those things are helpful in some ways but there's still this gap between where we would want to be as far as having a flow and an efficiency a feel for that would be so great rather than having to try to gauge to hit that spot a little bit better. 227 00:21:17,430 --> 00:21:23,400 Some of the compensations that are helpful would be, 228 00:21:23,410 --> 00:21:24,330 um, 229 00:21:24,340 --> 00:21:28,280 I think having the self awareness is helpful. 230 00:21:28,290 --> 00:21:29,750 So for example, 231 00:21:29,760 --> 00:21:33,660 I know that I have this difficulty, 232 00:21:33,660 --> 00:21:36,480 so if I have a passenger in the car and they're like, 233 00:21:36,480 --> 00:21:37,040 you know, 234 00:21:37,050 --> 00:21:42,450 you can pull up some more because I have that self awareness. 235 00:21:42,460 --> 00:21:45,850 I have a place for that to integrate that comment. 236 00:21:45,850 --> 00:21:47,070 And I can say, 237 00:21:47,800 --> 00:21:49,080 oh yeah, 238 00:21:49,080 --> 00:21:50,320 I probably can, 239 00:21:50,330 --> 00:21:51,520 I can't really tell you, 240 00:21:51,520 --> 00:21:52,840 tell me when to stop. 241 00:21:53,470 --> 00:21:54,000 Um, 242 00:21:54,010 --> 00:21:57,510 so I'm able to say yes to that comment. 243 00:21:57,520 --> 00:21:58,060 Like, 244 00:21:58,070 --> 00:21:58,480 oh yeah, 245 00:21:58,480 --> 00:21:59,640 I have a place for that. 246 00:21:59,640 --> 00:22:00,680 That makes sense. 247 00:22:00,690 --> 00:22:01,900 I have that awareness. 248 00:22:01,900 --> 00:22:05,930 I have that understanding of myself and I can't compensate myself. 249 00:22:05,940 --> 00:22:09,010 But if you're here and you're willing to help, 250 00:22:09,010 --> 00:22:09,940 let's do that. 251 00:22:11,310 --> 00:22:14,460 So having a place to put comments like, 252 00:22:14,470 --> 00:22:15,650 um, 253 00:22:15,660 --> 00:22:16,350 you know, 254 00:22:16,350 --> 00:22:25,390 you don't have to call me so many times or um I really don't think that person is mad at you. 255 00:22:25,400 --> 00:22:25,840 You know, 256 00:22:25,840 --> 00:22:27,590 when we get feedback like that, 257 00:22:27,590 --> 00:22:30,950 it it does help us to have a place where we say, 258 00:22:30,960 --> 00:22:31,650 oh, 259 00:22:32,250 --> 00:22:33,400 I didn't realize that, 260 00:22:33,400 --> 00:22:39,570 but I do know I can make errors in that in that area sometimes. 261 00:22:40,420 --> 00:22:41,170 Um, 262 00:22:41,810 --> 00:22:47,440 I also think that the awareness can be about what we lean toward. 263 00:22:47,450 --> 00:22:50,780 So if we have trouble finding the just right spot, 264 00:22:50,780 --> 00:23:03,780 sometimes we lean toward going toward too much or too little and in my case I lean toward uh leaving too much room or thinking I don't have enough room. 265 00:23:03,780 --> 00:23:05,790 So I lean in the same direction. 266 00:23:07,100 --> 00:23:07,800 Um, 267 00:23:07,810 --> 00:23:17,440 in the case of autism and the categories that we've talked about sometimes that's true for individuals in those categories as well. 268 00:23:17,450 --> 00:23:28,640 So I have clients that always lean toward thinking that they haven't done enough or they always lean toward thinking, 269 00:23:28,900 --> 00:23:29,500 um, 270 00:23:29,510 --> 00:23:36,160 someone's mad at them or thinking that they shouldn't spend money on something. 271 00:23:36,170 --> 00:23:40,680 So they have a way that they lean so they can say to themselves, 272 00:23:40,690 --> 00:23:46,090 I realize about myself that when I am off of just right, 273 00:23:46,090 --> 00:23:48,780 I'm usually in this direction in this category. 274 00:23:50,230 --> 00:23:51,840 That's also helpful. 275 00:23:51,850 --> 00:23:52,600 Um, 276 00:23:52,610 --> 00:23:54,780 because I do think again, 277 00:23:54,780 --> 00:23:56,510 it gives us a place to put things. 278 00:23:56,510 --> 00:24:06,800 So let's say that someone is working on a university project and there's nobody there to guide them through and they're thinking, 279 00:24:08,050 --> 00:24:14,600 I've checked all these specific boxes that the professor asked for, 280 00:24:14,610 --> 00:24:17,390 but I just have this feeling that I should do more. 281 00:24:17,390 --> 00:24:19,290 I know I could do more, 282 00:24:19,300 --> 00:24:21,910 at least they're able to say to themselves, 283 00:24:21,910 --> 00:24:22,590 you know, 284 00:24:22,600 --> 00:24:26,720 when I'm uncertain about whether I've done enough, 285 00:24:26,720 --> 00:24:29,410 usually I've already done too much. 286 00:24:29,420 --> 00:24:30,060 Um, 287 00:24:30,060 --> 00:24:34,730 so that can be a guide for them of sorts where they could say, 288 00:24:34,730 --> 00:24:35,150 okay, 289 00:24:35,150 --> 00:24:36,170 I'm gonna, 290 00:24:36,180 --> 00:24:38,730 I'm gonna complete this task, 291 00:24:38,730 --> 00:24:42,370 I'm gonna call it completed because um, 292 00:24:43,210 --> 00:24:47,890 I know I lean in that direction and I feel like I've ticked the basic boxes. 293 00:24:52,170 --> 00:24:58,140 Another thing that can be helpful then is to have some way to communicate. 294 00:24:58,150 --> 00:25:06,210 Maybe some uh sentences or phrases or ways of putting things that you've practiced ahead of time, 295 00:25:06,890 --> 00:25:13,520 that communicate to others about your difficulty finding just right in a specific area. 296 00:25:15,040 --> 00:25:17,880 So let's take some examples. 297 00:25:17,890 --> 00:25:26,920 And this could be communication beforehand or uh in the midst or after something has happened, 298 00:25:27,960 --> 00:25:29,720 an example would be, 299 00:25:29,730 --> 00:25:42,750 let's say someone is starting a new romantic relationship and they have the self awareness that sometimes when they come home from work, 300 00:25:42,750 --> 00:25:48,130 they are really shut down psychologically and they're in their own head, 301 00:25:48,140 --> 00:25:48,780 you know, 302 00:25:48,780 --> 00:25:53,590 that they don't talk a lot to their partners, 303 00:25:53,590 --> 00:25:59,110 they don't interact much and sometimes partners need something that they aren't, 304 00:25:59,120 --> 00:26:00,180 aren't giving. 305 00:26:00,190 --> 00:26:02,410 So with that awareness, 306 00:26:02,420 --> 00:26:06,300 they could say to the partner ahead of time, 307 00:26:06,930 --> 00:26:07,640 hey, 308 00:26:07,640 --> 00:26:17,420 I'm I've been learning about myself uh and one of the things I've learned is that I guess I tend to be shut down after work when I come home. 309 00:26:17,430 --> 00:26:20,940 So if you need help with something, 310 00:26:20,950 --> 00:26:23,620 if you um you know, 311 00:26:23,620 --> 00:26:27,580 want to tell me a specific story or something that's happened, 312 00:26:27,580 --> 00:26:39,820 you might really just have to um have me look you in the eye and tell me exactly what you need because I might not read the situation very well on my own. 313 00:26:40,550 --> 00:26:43,360 So that would be a case where, 314 00:26:43,370 --> 00:26:44,020 you know, 315 00:26:44,020 --> 00:26:45,950 you have difficulty finding just right, 316 00:26:45,950 --> 00:26:49,600 you're not going to be able to compensate after work, 317 00:26:49,600 --> 00:26:52,210 you're already kind of offline, 318 00:26:52,220 --> 00:27:02,410 but you could explain a bit of the context even though you can't compensate yourself or shift that you could give some context. 319 00:27:03,990 --> 00:27:08,890 I think the value of that is not only giving the person that information, 320 00:27:08,890 --> 00:27:15,040 but I think telling people that you're trying to learn more about yourself, 321 00:27:15,050 --> 00:27:19,350 I think is just a really good thing to communicate. 322 00:27:19,360 --> 00:27:32,340 People value that we all know we're imperfect humans and we're learning about ourselves and we're growing and that we're open to feedback. 323 00:27:32,350 --> 00:27:33,350 So, 324 00:27:33,360 --> 00:27:33,830 you know, 325 00:27:33,830 --> 00:27:36,280 if feel free to give me feedback, 326 00:27:36,280 --> 00:27:49,630 if I'm if I'm offline and and I can try to adjust an example of communicating after the fact or maybe in the midst of a fact. 327 00:27:49,640 --> 00:27:52,540 So let's take a different example. 328 00:27:52,540 --> 00:28:06,350 We're going to take the example of being at work and there is a project that you've been put in charge of and you miss the deadline and your boss is gonna do coaching with you about that. 329 00:28:07,400 --> 00:28:15,290 Um So you get feedback from your boss who is frustrated that the deadline was missed. 330 00:28:15,860 --> 00:28:16,890 That you know, 331 00:28:16,890 --> 00:28:25,660 he he really needs to be able to count on someone that can meet deadlines because these are very important to the bottom line of their department. 332 00:28:25,670 --> 00:28:30,540 And if you can't be a team player and get those deadlines done, 333 00:28:30,540 --> 00:28:34,670 then the whole team suffers again. 334 00:28:34,670 --> 00:28:39,980 This would be an opportunity for you to say in your head, 335 00:28:39,990 --> 00:28:40,380 you know, 336 00:28:40,380 --> 00:28:43,970 to think uh here here, 337 00:28:43,970 --> 00:28:44,860 this comes up. 338 00:28:44,860 --> 00:28:53,530 I know that I do tend to focus on accuracy more than speed and I didn't realize it, 339 00:28:53,530 --> 00:28:58,300 but uh that's come into play here and so out loud to your boss, 340 00:28:58,310 --> 00:29:01,140 you could say a similar thing, 341 00:29:01,140 --> 00:29:02,330 you could say, 342 00:29:03,230 --> 00:29:04,700 you know, 343 00:29:04,710 --> 00:29:07,410 I'm really sorry that that happened, 344 00:29:07,420 --> 00:29:31,260 I've been learning about myself that I really do tend toward getting into the detail and sometimes I sacrifice speed without really meaning to and what I realize helps me is and then you can give a specific thing that you would like. 345 00:29:31,270 --> 00:29:36,870 Um so one of the things an employee might ask for would be, 346 00:29:36,880 --> 00:29:55,720 it would help me if I could set uh deadlines for parts of the project rather than the completion so that I really stay on pace and what I'd like to do for this next project you've given me is break it into six parts and I'm going to, 347 00:29:55,730 --> 00:29:56,390 you know, 348 00:29:56,390 --> 00:30:04,290 give you dates for my deadlines for each of these parts and you can tell me if the deadlines need to be adjusted. 349 00:30:04,800 --> 00:30:11,090 Um so what you're doing is saying I have this self awareness and I'm growing in this area, 350 00:30:11,630 --> 00:30:19,600 you're showing that you're open to feedback and then you're also showing that you're going to try a new strategy. 351 00:30:20,650 --> 00:30:31,310 So sometimes there can be ways of trying to um navigate this difficulty with just right, 352 00:30:31,320 --> 00:30:38,760 we talked before about how another navigation tool might might be rules of thumb or general principles. 353 00:30:38,760 --> 00:30:40,900 So here's my budget, 354 00:30:40,900 --> 00:30:50,230 this is what I'm supposed to spend or not spend or um rules of thumb for completing a university course. 355 00:30:51,540 --> 00:31:10,790 But I think the truth of that struggle of not having that innate feel for just right really is something core in the autism neurology that I haven't found um a way to shift. 356 00:31:10,790 --> 00:31:20,690 I think that's really a core neurologic piece that I'm either too much or too little and if I hit just right, 357 00:31:20,700 --> 00:31:21,590 that's great. 358 00:31:21,590 --> 00:31:23,760 But I have such a hard time staying there. 359 00:31:25,490 --> 00:31:39,900 I want to thank my again for that insight and um I think even when there aren't answers to correct a challenge or to kind of make it easier over time, 360 00:31:39,910 --> 00:31:46,180 I think that awareness that conceptualization that oh why do I do this? 361 00:31:46,180 --> 00:31:48,650 Why am I really good at detail? 362 00:31:48,650 --> 00:31:50,590 But I really struggle with deadlines. 363 00:31:50,600 --> 00:31:54,390 Well this all hangs together neurologically, 364 00:31:54,390 --> 00:32:05,120 it's part of that difficulty finding just right and I do think that that conceptualization that self awareness is important in and of itself. 365 00:32:05,130 --> 00:32:10,960 Um and I do think the understanding that that crosses over categories, 366 00:32:10,970 --> 00:32:21,170 social and task completion and sleep and attention and all of these other things that are really difficult to balance. 367 00:32:22,410 --> 00:32:26,960 Thank you Maya and I hope you all join me for our next episode     

Join Dr. Regan for this episode on neurodiversity and holiday celebrations. Sometimes the most memorable moments come from holding tightly to our foundations and releasing other things that don't fit our season of life or individual needs.  Planning a Merry Holiday on the Autism Spectrum, podcast episode 2020   Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians    

Join Dr. Regan for the final episode in this series on autism misdiagnosis. This episode focuses on anxiety-related conditions and when their diagnosis may mean that autism is never considered. Wrapping up this series, Dr. Regan also discusses that after all assessments are concluded, there will be instances when no diagnosis of autism can or should be made. Previous episode -- Abuse, Neglect, and Relational Pain on the Autism Spectrum   Dr. Regan's Resources Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the transcript here: 1 00:00:06,730 --> 00:00:07,190 Hello, 2 00:00:07,190 --> 00:00:09,130 this is Dr Theresa Regan. 3 00:00:09,140 --> 00:00:11,790 I am the host of this podcast, 4 00:00:11,800 --> 00:00:13,320 autism in the adult. 5 00:00:13,330 --> 00:00:15,480 I'm a neuropsychologist, 6 00:00:15,490 --> 00:00:23,650 the director of an adult diagnostic autism clinic in central Illinois and a certified autism specialist. 7 00:00:24,330 --> 00:00:32,480 You are joining me for the 4th and final episode of a series on autism and misdiagnosis. 8 00:00:32,490 --> 00:00:36,480 The first episode covered foundational information. 9 00:00:36,490 --> 00:00:39,320 Why does misdiagnosis occur? 10 00:00:40,390 --> 00:00:47,110 That is, why is autism missed while other conditions may be diagnosed Instead. 11 00:00:48,040 --> 00:01:02,860 The next episode focused on personality disorders and we specifically reviewed information about borderline personality and narcissistic personality as potential misdiagnoses for autism. 12 00:01:03,640 --> 00:01:12,730 The 3rd episode covered information about bipolar disorder and depression and today's episode will focus on anxiety. 13 00:01:14,620 --> 00:01:25,760 I should say that we could continue this misdiagnosis series for quite some time and cover other really common areas of misdiagnosis ... like schizophrenia, 14 00:01:25,760 --> 00:01:27,390 psychotic conditions, 15 00:01:27,400 --> 00:01:34,810 dementia and those involving behavioral dysregulation things like oppositional defiant disorder. 16 00:01:35,930 --> 00:01:52,250 I'm not going to dive into all the possible categories because I feel like we've covered several common misdiagnoses and also because the main goal of the series has been to just introduce the concept that misdiagnosis does occur. 17 00:01:52,260 --> 00:02:08,990 And also to illustrate why ... essentially to point out what kinds of elements in the neurology of autism may lead to diagnoses describing these single points but missing the big picture diagnosis of autism. 18 00:02:12,090 --> 00:02:32,480 So we covered the possible misdiagnosis of depression last episode and we're going to talk about anxiety today ... and so I'll share with you my own thoughts based on my personal experiences that anxiety seems to stem at least in part from the neurobiology of autism. 19 00:02:33,040 --> 00:02:39,560 Whereas depressed mood as I would define it with this component of emotional struggle, 20 00:02:39,570 --> 00:02:40,790 hopelessness, 21 00:02:40,790 --> 00:02:41,520 helplessness, 22 00:02:41,520 --> 00:02:42,540 worthlessness, 23 00:02:42,550 --> 00:02:44,950 loss of pleasure in activities. 24 00:02:44,960 --> 00:02:51,540 This seems to be more reactive in the autistic individual to difficult life circumstances. 25 00:02:52,320 --> 00:02:59,000 It seems to me that most individuals on the spectrum do experience difficulty with anxiety, 26 00:02:59,010 --> 00:03:07,470 although the strength of this anxiety and how much it impacts their daily life can vary across life seasons. 27 00:03:10,860 --> 00:03:34,090 There is research that has attempted to capture information on the prevalence of anxiety disorders and autism and there are such wide ranging findings that it is a little difficult to really come to a conclusion about the percentage of autistic individuals who do experience noticeable anxiety. 28 00:03:34,970 --> 00:03:43,560 One thing about the research is that many studies focus on individuals who meet full criteria for a certain anxiety disorder. 29 00:03:43,570 --> 00:03:54,510 So, many individuals who experience anxiety and are impacted by this may not meet full criteria and may not be counted in the studies.  Also, 30 00:03:54,510 --> 00:03:59,620 I find that it's really common for some individuals to have significant anxiety, 31 00:03:59,630 --> 00:04:01,920 but it looks like something else. 32 00:04:01,930 --> 00:04:03,160 For example, 33 00:04:03,160 --> 00:04:08,990 meltdowns and outbursts are often triggered by anxiety in the autistic, 34 00:04:09,000 --> 00:04:13,460 but they're interpreted as opposition or conduct disorders. 35 00:04:14,360 --> 00:04:18,000 A flight reaction or a freeze reaction... 36 00:04:18,190 --> 00:04:24,260 These are often so quiet that the anxiety piece of the reaction gets missed. 37 00:04:25,840 --> 00:04:26,490 So, 38 00:04:26,500 --> 00:04:33,850 my experience is that anxiety is more prevalent than it might at first seem in autism and it's also true, 39 00:04:33,850 --> 00:04:34,290 however, 40 00:04:34,290 --> 00:04:40,860 that I should keep in mind that people do seek appointments with me when they have a season of struggle, 41 00:04:40,870 --> 00:04:49,150 they're coming to a clinic setting because something has really hit them at a time that they need input. 42 00:04:49,370 --> 00:04:59,050 And so it's certainly true that my point of view might be skewed as far as working in this particular setting. 43 00:04:59,050 --> 00:05:05,660 Now, rather than going through each anxiety disorder separately as listed in the diagnostic manual, 44 00:05:05,670 --> 00:05:10,610 let's consider the grouping of generalized anxiety disorder, 45 00:05:10,620 --> 00:05:12,720 social anxiety disorder, 46 00:05:12,720 --> 00:05:16,160 separation anxiety, and agoraphobia together. 47 00:05:18,530 --> 00:05:28,900 It's easy to see that individuals who have this baseline anxiousness, and as I said... 48 00:05:28,910 --> 00:05:33,790 some of which seems to be neurobiological degenerated, 49 00:05:34,360 --> 00:05:37,680 that "my system really leans toward anxiety," 50 00:05:37,710 --> 00:05:43,870 that this could easily be diagnosed as generalized anxiety disorder. 51 00:05:44,470 --> 00:05:46,530 The social anxiety disorder. 52 00:05:46,530 --> 00:05:47,250 Again, 53 00:05:47,260 --> 00:05:59,170 very understandable why the individual on the spectrum may have anxiety related to social interactions and possibly being evaluated negatively. 54 00:05:59,180 --> 00:06:09,960 Many people on the spectrum have a fear of being misunderstood and they don't feel solid enough in their interactions and their comprehension of what's going on... to feel like, 55 00:06:09,970 --> 00:06:10,300 "Yeah, 56 00:06:10,300 --> 00:06:11,290 that really went well, 57 00:06:11,290 --> 00:06:16,430 I feel calm and confident about my social interaction." 58 00:06:16,440 --> 00:06:21,440 So that can lead to this anxiety that brings them in for assistance. 59 00:06:22,370 --> 00:06:27,920 Separation anxiety again could be seen in the autistic individual. 60 00:06:27,930 --> 00:06:36,280 It's often the case that the person on the spectrum would really love to feel safe and connected with someone who's supportive. 61 00:06:36,290 --> 00:06:49,760 This might be a parent in younger years, it could also be a particular friend or a sibling that they don't want to go out you know unless they're paired with them, and it could also be a spouse. 62 00:06:50,710 --> 00:06:56,820 And agoraphobia is also something that could be diagnosed for the person on the spectrum. 63 00:06:56,820 --> 00:07:01,270 In the sense that this could be a person who doesn't like to leave their home, 64 00:07:01,280 --> 00:07:03,110 feels overwhelmed in crowds, 65 00:07:03,110 --> 00:07:08,800 wants to be in their own space and just have time alone in their own setting. 66 00:07:11,060 --> 00:07:20,680 So we can see how an individual with autistic neurology may acquire one or more of these diagnoses based on a few elements of their experience. 67 00:07:20,690 --> 00:07:26,120 The problem ends up being not that those features aren't present. 68 00:07:26,120 --> 00:07:28,830 For example there is a social anxiety, 69 00:07:28,830 --> 00:07:30,230 there is an agoraphobia. 70 00:07:30,230 --> 00:07:31,270 However, 71 00:07:31,280 --> 00:07:37,890 once those are diagnosed the diagnostic picture stops. 72 00:07:37,900 --> 00:07:46,170 So um, they don't say "hey, we should also look for autism." And that's the piece that's difficult. 73 00:07:46,180 --> 00:07:50,230 We want autism to be in that differential at the beginning. 74 00:07:51,970 --> 00:07:55,740 For more information on differentials and what that means. 75 00:07:55,750 --> 00:07:58,520 See the first episode in this series. 76 00:07:58,530 --> 00:08:06,090 But essentially what we're saying is that if someone is being evaluated for a diagnosis of generalized anxiety, 77 00:08:06,100 --> 00:08:07,250 social anxiety, 78 00:08:07,250 --> 00:08:16,090 separation anxiety, or agoraphobia ... there should be a trigger in our minds that also puts autism in that assessment process. 79 00:08:18,400 --> 00:08:23,960 The current edition of the diagnostic manual does not include PTSD or OCD 82 00:08:24,420 --> 00:08:26,500 under anxiety disorders. 83 00:08:26,510 --> 00:08:37,930 Instead the manual gives these their own sections including trauma and stress or related disorders, and obsessive compulsive and related disorders. 84 00:08:38,610 --> 00:08:39,660 However, 85 00:08:39,670 --> 00:08:42,770 for the cohesiveness of our talk, 86 00:08:42,770 --> 00:08:47,280 I am going to include them in this episode on anxiety. 87 00:08:48,680 --> 00:08:50,780 With regard to PTSD, 88 00:08:50,790 --> 00:08:57,500 you may wish to refer to my previous episode entitled Abuse, Neglect, and Relational Pain 89 00:08:57,500-> 00:09:01,700 On the Autism Spectrum in May of 2021. 90 00:09:02,600 --> 00:09:18,890 I'll link the episode in the show notes today. In summary, trauma is a more frequent experience for those on the spectrum than for neurotypical and there are a lot of reasons that this probably occurs. For one, 91 00:09:18,900 --> 00:09:31,280 some infants and children on the spectrum really have difficulty regulating ...and what that means is their ability to feel steady and calm and safe. 92 00:09:31,860 --> 00:09:37,400 This difficulty can be quite a struggle and it can be very externalized. 93 00:09:37,410 --> 00:09:41,350 So the child may be crying and not sleeping. 94 00:09:41,360 --> 00:09:52,500 They might have frequent or prolonged meltdowns, may struggle with everyday aspects of life like wearing socks or eating food. Because of these high levels of needs, 95 00:09:52,500 --> 00:09:58,480 the caregivers of the child may also struggle to get enough sleep, to stay calm... 96 00:09:58,490 --> 00:10:05,470 This may lead to difficult interactions both emotionally and psychologically ... and sometimes physically, 97 00:10:06,820 --> 00:10:14,370 The individual on the spectrum may also struggle to recognize risk interpersonally... when they do encounter this. 98 00:10:14,370 --> 00:10:15,830 So for example, 99 00:10:15,840 --> 00:10:28,330 many females on the spectrum report that they've been in dating situations and really haven't realized the sexual overtures until they found themselves in a really sexually traumatic situation. 100 00:10:29,390 --> 00:10:38,420 There are other reasons that individuals on the spectrum may experience trauma. And PTSD may not be a misdiagnosis at all. 101 00:10:38,430 --> 00:10:45,900 However many times once this diagnosis is entered in someone's chart, 102 00:10:45,900 --> 00:10:48,170 once it's made... a lot of times, 103 00:10:48,180 --> 00:11:00,150 everything about the person is attributed to trauma reactions and there's been no investigation done to see if the underlying neurologic framework for autism can be detected. 104 00:11:01,460 --> 00:11:09,290 Now ... sometimes the trauma has been so extensive that trauma and neurology just can't be teased apart very easily. 105 00:11:10,010 --> 00:11:14,480 But more often there has never even been a consideration of autism. 106 00:11:14,480 --> 00:11:30,770 Nobody has tried to make this distinction, and there's been this overall conclusion that everything the person experiences and the way they react has to do with the trauma experience. And finally, obsessive compulsive disorder. 107 00:11:32,150 --> 00:11:38,330 Now there are seven diagnostic criteria for autism and the first three are social in nature. 108 00:11:38,370 --> 00:11:46,340 They all must be met. And the last four are described as restricted and repetitive patterns of behavior. 109 00:11:46,350 --> 00:11:48,490 Only two of those need to be met. 110 00:11:49,080 --> 00:11:55,420 Now these criteria include elements of thoughts and behaviors that can be labeled as OCD 113 00:11:55,900 --> 00:11:58,250 if someone's not looking at the big picture. 114 00:11:59,170 --> 00:12:13,910 Examples of these kinds of behaviors or elements might include scrupulosity. For example, being very particular about details, thinking in a black and white manner about what's good and what's bad, 115 00:12:13,910 --> 00:12:15,400 what's right and wrong. 116 00:12:16,110 --> 00:12:18,590 This can include literal thinking. 117 00:12:18,600 --> 00:12:20,470 For those on the spectrum. 118 00:12:20,480 --> 00:12:27,300 They may correct others when they're wrong about something and get upset when people break the rules. 119 00:12:27,310 --> 00:12:30,310 They might want to get all the details correct 120 00:12:30,320 --> 00:12:33,930 rather than being able to move on to more important things. 121 00:12:35,160 --> 00:12:46,160 These individuals may repeat certain sequences of movements or speech and they may want objects lined up and arranged in particular patterns or a particular order. 122 00:12:46,470 --> 00:12:49,280 They may care about symmetry and repetition. 123 00:12:49,880 --> 00:12:54,480 So this focus on repetition and ritual can resemble OCD 126 00:12:55,310 --> 00:13:00,190 Which can mean that the diagnosis of autism is never explored. 127 00:13:01,310 --> 00:13:02,240 So now, 128 00:13:02,240 --> 00:13:06,250 if we step back and we think about all the episodes in this series, 129 00:13:06,260 --> 00:13:11,550 we can see how an individual who presents with a history of multiple diagnoses, 130 00:13:11,640 --> 00:13:14,740 let's say social anxiety disorder, 131 00:13:14,740 --> 00:13:16,090 bipolar disorder, 132 00:13:16,090 --> 00:13:17,780 borderline personality. 133 00:13:17,790 --> 00:13:18,380 Well, 134 00:13:18,380 --> 00:13:25,840 they may actually have one diagnosis that has never even been considered and that is autism. 135 00:13:27,700 --> 00:13:28,170 Now, 136 00:13:28,170 --> 00:13:30,490 before we end this series entirely, 137 00:13:30,490 --> 00:13:41,920 let me add a caveat to balance out this information. Because autism often doesn't get enough attention with clinicians when they're performing assessments, 138 00:13:41,920 --> 00:13:44,330 particularly those perhaps with adults, 139 00:13:44,350 --> 00:13:54,250 I do focus a lot on the importance of autism assessment and also the fact that these diagnoses can be specifically included in a differential. 140 00:13:55,400 --> 00:13:59,910 Since I've emphasized evaluation and differential diagnosis so much, 141 00:13:59,920 --> 00:14:10,880 I also want to say that in reality there will be times when a skilled clinician will not be able to identify whether autism is present or not. 142 00:14:12,670 --> 00:14:12,990 Now, 143 00:14:12,990 --> 00:14:19,840 autism is identified by a specific pattern in the results and for many reasons, 144 00:14:19,840 --> 00:14:28,710 there will be subsets of patients who present without a clear pattern of features and this may reflect how complex their background is, 145 00:14:28,720 --> 00:14:30,680 how much distress they're in. 146 00:14:30,690 --> 00:14:35,910 But if an autistic pattern is not present or it's obscured by other issues, 147 00:14:35,930 --> 00:14:41,130 then the clinician will not be able to rule in or out the diagnosis of autism. 148 00:14:41,140 --> 00:14:43,640 And rightly so. Now, 149 00:14:43,640 --> 00:14:44,340 ultimately, 150 00:14:44,340 --> 00:14:51,040 our first goal needs to be that autism is included in the differential assessment process. 151 00:14:51,150 --> 00:14:55,440 The second goal is that everyone has a correct diagnosis, 152 00:14:55,450 --> 00:14:57,470 whether that's bipolar, 153 00:14:57,480 --> 00:14:59,990 social anxiety, or autism... 154 00:15:01,350 --> 00:15:01,660 Now, 155 00:15:01,670 --> 00:15:04,690 if the autism pattern is not clearly present, 156 00:15:04,700 --> 00:15:07,770 a diagnosis can't and shouldn't be given. 157 00:15:08,430 --> 00:15:18,080 Some individuals will receive feedback that the autism pattern is clearly not present and this is an important piece of information for them. 158 00:15:18,790 --> 00:15:22,600 Others will receive feedback that autism features are present, 159 00:15:22,600 --> 00:15:25,460 but not all the criteria are met. 160 00:15:25,470 --> 00:15:28,000 So a full diagnosis is not made. 161 00:15:29,030 --> 00:15:29,530 Third, 162 00:15:29,530 --> 00:15:41,950 there will be individuals who receive feedback that there are things obscuring any kind of pattern and figuring out how to untangle these things may really actually be impossible. 163 00:15:43,060 --> 00:15:43,900 Lastly, 164 00:15:43,900 --> 00:15:50,190 about 2% of individuals will receive the feedback that they meet full criteria for autism. 165 00:15:51,170 --> 00:15:57,850 Whatever the conclusions are, dedication toward including neurology in the assessment process, 166 00:15:57,860 --> 00:15:58,900 for example, 167 00:15:58,900 --> 00:16:09,220 including autism in the differential ... it can add to the self awareness that clients receive and awareness is key to well-being and growth. 168 00:16:10,590 --> 00:16:23,270 I thank you for joining me for this series on misdiagnosis, those times when people receive a diagnosis that's describing one little element of their presentation, 169 00:16:23,270 --> 00:16:25,160 but not their whole experience. 170 00:16:25,170 --> 00:16:29,040 And autism is one of those big picture diagnoses. 171 00:16:30,660 --> 00:16:32,420 Thanks again for listening, 172 00:16:32,420 --> 00:16:34,490 and I hope you join me next time.      

Join Dr. Regan for the third in this series on autism misdiagnosis. This episode focuses on the misdiagnosis of mood conditions for the autistic individual. Specifically bipolar disorder and depression are reviewed.   Exhaustion in Autism: Balancing Momentum for Daily Activities Recognizing Dysregulation on the Autism Spectrum: Fight, Flight, Freeze Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians  

Join Dr. Regan for the second in this series on autism misdiagnosis. This episode focuses on how often and why autism may be misdiagnosed as a personality disorder. Although there are 10 personality disorders outlined in the DSM-5, Dr. Regan focuses on two in this episode: borderline personality and narcissistic personality. Netherlands study of over 1000 autistic individuals Italian study: misdiagnosis Norway case study Borderline Personality Disorder misdiagnosis Recognizing dysregulation on the autism spectrum: podcast episode Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the episode transcript --  1 00:00:07,070 --> 00:00:08,390 Hello everyone. 2 00:00:08,400 --> 00:00:12,770 This is Dr Theresa Regan joining you for the podcast, 3 00:00:12,780 --> 00:00:14,560 autism in the adult. 4 00:00:15,800 --> 00:00:18,180 I am a neuropsychologist. 5 00:00:18,190 --> 00:00:24,480 I specialize in understanding how the brain impacts personality emotions, 6 00:00:24,480 --> 00:00:26,720 behavior and thinking skills. 7 00:00:26,730 --> 00:00:38,440 I'm a certified autism specialist and the director of an adult diagnostic autism clinic in central Illinois and I'm the parent of a child on the spectrum. 8 00:00:39,400 --> 00:00:49,180 You are joining us for the second episode of a series we're doing on misdiagnosis for those who are on the autism spectrum. 9 00:00:50,210 --> 00:00:53,070 If you did not listen to the first episode, 10 00:00:53,070 --> 00:00:54,890 I really encourage you to do that. 12 00:00:55,670 --> 00:01:04,100 There are foundational things that I think will really be illuminating and that I'm not going to be repeating in this episode. 13 00:01:05,230 --> 00:01:06,550 For today's episode, 14 00:01:06,550 --> 00:01:15,940 we're going to focus about when the misdiagnosis has to do with the category of personality disorders. 15 00:01:17,120 --> 00:01:17,340 Now, 16 00:01:17,340 --> 00:01:34,990 personality disorders originally really focused on the impact of the environment and early life experiences and parenting and the development of the personality structure. 17 00:01:35,650 --> 00:01:55,910 And when I was in graduate school back in the 90s there was a focus on the fact that there were some studies coming out suggesting that some of the personality disorder categories actually had some influence in genetics. 18 00:01:55,910 --> 00:02:06,170 So this was through adoptive studies and looking at the personality traits of adopted Children as compared to their biological parents. 19 00:02:07,020 --> 00:02:31,810 So that at the time was actually news because the personality theories that dominated the literature had a lot to do with parenting and that personality was a learned experientially based um long term way of interacting with the world. 20 00:02:32,890 --> 00:02:42,420 Now today a lot of the literature explaining that personality disorders are likely caused by multifactorial issues. 21 00:02:42,430 --> 00:02:49,460 So issues of biochemistry and genetics and experience are more prominent. 22 00:02:49,470 --> 00:03:10,390 So the original foundations of personality disorders being in that theory about early life experiences and of course autism being in the category of physically based in the neurology of the individual and really impacted by the genetic code. 23 00:03:11,350 --> 00:03:15,850 There are three clusters of personality disorders, 24 00:03:15,850 --> 00:03:17,060 cluster a, b, and c. 25 00:03:17,670 --> 00:03:25,220 And there are a total of 10 conditions listed in the current diagnostic manual. 26 00:03:25,230 --> 00:03:35,380 So what will the scope of our discussion today be about as regards personality disorders and autism? 27 00:03:36,320 --> 00:03:47,230 What will not happen in this episode is that you will not be able to distinguish autism from personality disorders at the end of the episode, 28 00:03:47,240 --> 00:03:50,990 that's really not in the scope of what we can focus on. 29 00:03:51,260 --> 00:03:58,390 And it takes an expert clinician with many years of training and study to do that well. 30 00:03:58,400 --> 00:04:05,400 But what we are going to focus on is why this happens and how often it seems to happen. 31 00:04:05,410 --> 00:04:09,950 So why does this misdiagnosis occur? 32 00:04:09,960 --> 00:04:14,180 And and how many people does that impact? 33 00:04:15,910 --> 00:04:17,270 As you probably know, 34 00:04:17,270 --> 00:04:22,200 a lot of the literature about autism focuses on early childhood and development. 35 00:04:23,230 --> 00:04:29,790 And more of the literature is beginning to focus on autism across the lifespan. 36 00:04:30,820 --> 00:04:45,170 And there are some articles out there about autism and misdiagnosis And what you'll see when you look for them is that these are often scattered internationally. 37 00:04:45,170 --> 00:04:45,360 So, 38 00:04:45,360 --> 00:04:54,790 the first article that I want to talk about actually was published last year 2021 and it came from the Netherlands. 39 00:04:54,790 --> 00:04:59,070 And I have a link in the show notes if you'd like to read more about it. 40 00:05:00,930 --> 00:05:01,550 So, 41 00:05:01,550 --> 00:05:07,810 this article was based in their national health system. 42 00:05:07,820 --> 00:05:12,940 They have a database of individuals who are on the autism spectrum. 43 00:05:12,950 --> 00:05:19,490 And then they contacted individuals to ask them about their diagnostic history. 44 00:05:20,790 --> 00:05:27,370 They surveyed a 1019 adults in this way, 45 00:05:27,950 --> 00:05:33,550 and it was very nearly an even split between males and females. 46 00:05:35,360 --> 00:05:51,020 And what they found was that about 50% of the 1019 adults reported that they had previous mental health diagnoses prior to being diagnosed with autism, 47 00:05:52,810 --> 00:06:00,900 They report that 63% of the females and 37% of the males had a previous diagnosis. 48 00:06:02,940 --> 00:06:07,810 Females had more previous diagnoses than males. 49 00:06:07,820 --> 00:06:16,220 So they had a larger number of diagnoses on their list in the mental health area. 50 00:06:17,770 --> 00:06:28,000 And this suggests that men in their sample were more likely to be diagnosed correctly the first time rather than carrying incorrect mental health diagnoses. 51 00:06:30,320 --> 00:06:30,810 Now, 52 00:06:30,810 --> 00:06:36,500 the top categories in their list of frequently misdiagnosed 53 00:06:36,510 --> 00:06:42,270 conditions for the autistic were mood disorders. 54 00:06:42,280 --> 00:06:45,260 And it didn't specifically say, 55 00:06:45,260 --> 00:06:48,980 I'm assuming this may include depression and bipolar. 57 00:06:50,190 --> 00:06:53,670 and then the second category was personality disorder. 58 00:06:53,670 --> 00:06:53,930 So, 59 00:06:53,930 --> 00:07:05,170 26% of the total sample had a history of mood disorder diagnosis and 20% had a history of personality disorders. 60 00:07:07,080 --> 00:07:11,140 They also asked the individuals who did have previous diagnoses. 61 00:07:11,140 --> 00:07:17,090 So that was 512 people out of the 1019, 62 00:07:17,100 --> 00:07:25,260 if any of their previous diagnoses were then removed from their list once autism was diagnosed. 63 00:07:25,270 --> 00:07:29,910 So this is really getting at that phenomenon of misdiagnosis, 64 00:07:29,910 --> 00:07:30,420 where, 65 00:07:30,430 --> 00:07:30,680 oh, 66 00:07:30,680 --> 00:07:36,760 now that we know that what we're actually looking at here is autism. 67 00:07:36,770 --> 00:07:38,770 What diagnoses, 68 00:07:38,780 --> 00:07:39,540 if any, 69 00:07:39,550 --> 00:07:41,490 might we removed from the list 70 00:07:41,490 --> 00:07:50,240 ...these were misdiagnoses. Of the 512 participants who did have a previous diagnosis, 71 00:07:50,250 --> 00:07:59,700 382 reported that one or more of the diagnoses were removed once autism was diagnosed. 72 00:08:00,550 --> 00:08:07,630 So that's 75% of the participants who did have a history of diagnosis. 73 00:08:08,680 --> 00:08:15,930 And the authors also report this as 38% of the total sample of 1,019. 74 00:08:15,940 --> 00:08:19,560 I'm not sure that this is as meaningful because of course, 75 00:08:19,560 --> 00:08:25,940 people who did not have a prior diagnosis would not report that a diagnosis was removed. 76 00:08:25,950 --> 00:08:26,590 So, 77 00:08:26,590 --> 00:08:26,960 to me, 78 00:08:26,960 --> 00:08:35,470 it makes the most sense to to show that half the people had at least one previous mental health diagnoses. 79 00:08:36,400 --> 00:08:38,330 And of these participants, 80 00:08:38,340 --> 00:08:44,600 75% reported that at least one of the diagnoses were removed, 81 00:08:44,610 --> 00:08:44,880 then, 82 00:08:44,880 --> 00:08:59,570 once autism was diagnosed. And personality disorders were the most frequent of the diagnoses that were removed and that's the category that we'll be speaking about today, 83 00:09:01,830 --> 00:09:05,300 I'm gonna look at two other articles before we keep going. 84 00:09:06,970 --> 00:09:20,300 Uh there is an article that came out of Italy in March of 2022 and it had a much smaller sample size that was only 161 individuals and only 47 were females. 85 00:09:20,300 --> 00:09:23,580 So I don't feel like it's quite as representative. 86 00:09:23,590 --> 00:09:27,550 Probably not something that we can generalize as much from. 87 00:09:28,670 --> 00:09:35,030 But one thing that was interesting that they found was that the age, 88 00:09:35,040 --> 00:09:44,440 the median age of first evaluation by a mental health professional for these individuals was age 13. 89 00:09:45,320 --> 00:09:55,380 And then there was a gap of averaging about 11 years before any autism evaluation was even performed or considered. 90 00:09:55,380 --> 00:09:55,970 So, 91 00:09:55,980 --> 00:10:13,800 these individuals had presented with some distress or having some struggle 11 years prior to the consideration of autism in that diagnostic arena for the differential. In their sample, 92 00:10:13,810 --> 00:10:21,060 a third of participants had never received a psychiatric diagnosis prior to autism diagnosis. 93 00:10:21,060 --> 00:10:26,260 So two thirds of their sample did have a history of mental health diagnoses. 94 00:10:27,940 --> 00:10:38,360 The next article we're going to focus on is about borderline personality disorder, and I did want to focus on that for today's episode. 95 00:10:38,370 --> 00:10:41,690 In addition to narcissistic personality. 96 00:10:41,700 --> 00:10:42,230 Now, 97 00:10:42,230 --> 00:10:51,570 these are the two personality disorders that I see most often in my clinic as misdiagnoses for the autism spectrum, 98 00:10:51,770 --> 00:10:58,990 But really I have seen all 10 of them listed incorrectly for the autistic in the past, 99 00:11:00,000 --> 00:11:06,050 but let's take a look at borderline personality and talk about why 100 00:11:06,060 --> 00:11:12,930  there may be a misdiagnosis of this condition. 101 00:11:14,380 --> 00:11:30,480 So the concept of borderline personality refers to a constellation of characteristics and one of the prime characteristics has to do with difficulty connecting appropriately in relationships. 102 00:11:31,780 --> 00:11:39,800 So it says a pattern of unstable and intense interpersonal relationships characterized by extremes. 103 00:11:41,320 --> 00:12:01,450 Um and also these efforts to avoid abandonment and relationships. What we can see for the autistic is that often there is this desire to connect with the supportive other ... that I do want to be connected. 104 00:12:01,450 --> 00:12:03,330 I want to be in a relationship. 105 00:12:03,340 --> 00:12:04,870 And of course, 106 00:12:04,870 --> 00:12:07,990 there can be difficulties in that connection, 107 00:12:07,990 --> 00:12:13,760 particularly when they're trying to maintain this relationship over time. 108 00:12:14,040 --> 00:12:14,400 Now, 109 00:12:14,400 --> 00:12:20,930 that is not to say that the autistic individual doesn't have close relationships, 110 00:12:20,940 --> 00:12:29,180 but there may be some history of dissatisfaction with the ability to connect or feeling like the relationships didn't work out, 111 00:12:29,190 --> 00:12:32,370 Maybe the person isn't quite sure why or what happened. 112 00:12:32,380 --> 00:12:42,380 So this area of difficulty maintaining relationships may overlap in someone's concept... 113 00:12:42,390 --> 00:12:49,080 and if you did listen to the first episode of the series, 114 00:12:49,090 --> 00:12:57,000 it's kind of like looking at what's right in front of you without seeing the big autistic picture. 115 00:12:57,000 --> 00:13:07,910 You can see that if someone is trying to interact with a client who has a history of relationships that have not been maintained over time, 116 00:13:07,920 --> 00:13:24,680 that there can be perhaps the question of whether borderline should be in the differential... in addition to that there can be this element in borderline of chronic feelings of emptiness and also just identity disturbance. 117 00:13:24,680 --> 00:13:37,310 Like I don't really know who I am or I feel like I'm different people when I'm with various groups or I have an unstable self image or sense of self. 118 00:13:37,320 --> 00:13:47,780 So for the autistic that can be present in the sense that it can be difficult to um delve into the internal world. 119 00:13:47,790 --> 00:13:49,600 Like what am I feeling? 120 00:13:49,600 --> 00:13:49,990 What, 121 00:13:50,000 --> 00:13:52,390 what is going on inside of me? 122 00:13:52,390 --> 00:13:54,680 How do people perceive me? 123 00:13:54,690 --> 00:13:57,400 What is their evaluation of me? 124 00:13:57,410 --> 00:13:59,700 How would people describe me? 125 00:13:59,700 --> 00:14:14,100 What's going on in the core of myself scanning the internal for what's going on in my internal world and the world of the other person that I'm with. 126 00:14:14,110 --> 00:14:18,190 That's part of a neurologic ability called Theory of Mind, 127 00:14:18,200 --> 00:14:31,920 where we can scan and have this um exploration of what's inside me and then we can have a theory of what's in the mind of the other. 128 00:14:32,910 --> 00:14:33,290 So, 129 00:14:33,290 --> 00:14:35,100 you can see again, 130 00:14:35,100 --> 00:14:49,930 if you are a clinician or diagnostician and you hear these explanations of having difficulty uh knowing who you are or feeling like you're different people in various groups. 131 00:14:49,940 --> 00:14:51,280 This of course, 132 00:14:51,280 --> 00:14:54,750 can have to do with the masking and autism. 133 00:14:55,260 --> 00:15:04,110 You can see how that one piece may trigger someone to think about a borderline personality. 134 00:15:05,790 --> 00:15:12,370 There also is this characteristic lability of mood and emotions. 135 00:15:12,370 --> 00:15:13,540 So by that, 136 00:15:13,540 --> 00:15:19,380 I just mean that this kind of roller coaster of intense emotions. 137 00:15:19,390 --> 00:15:25,970 Um so it talks about um difficulty controlling anger, 138 00:15:25,970 --> 00:15:27,950 frequent displays of temper, 139 00:15:27,950 --> 00:15:29,320 constant anger, 140 00:15:29,330 --> 00:15:39,430 recurrent physical fights for the individual on the spectrum who has dis regulation that looks external realized. 141 00:15:39,440 --> 00:15:40,000 So, 142 00:15:40,000 --> 00:15:45,320 if you've listened to the dysegulation series, and I'll put a link in the show notes, 143 00:15:45,330 --> 00:15:47,110 you'll know that for that... 144 00:15:47,120 --> 00:15:56,320 Everyone on the autism spectrum will have difficulty feeling centered with their emotions and behavior. 145 00:15:56,320 --> 00:15:58,680 And that is called dysregulation. 146 00:15:59,130 --> 00:16:04,410 And that's neurologically based for the autistic... and for some people, 147 00:16:04,420 --> 00:16:07,130 this regulation is very quiet. 148 00:16:07,140 --> 00:16:11,190 It's this shutting down. 149 00:16:11,200 --> 00:16:16,940 It could be a disassociative episode which can also occur in borderline. 150 00:16:17,520 --> 00:16:21,280 It can be a very quiet withdrawal. 151 00:16:21,290 --> 00:16:22,810 I'm going to my room, 152 00:16:22,810 --> 00:16:24,550 I'm quitting this relationship, 153 00:16:24,550 --> 00:16:26,250 I can't make it to work. 154 00:16:26,260 --> 00:16:32,000 Um but it can also be this externalized reaction, 155 00:16:32,010 --> 00:16:34,470 this explosive reaction, 156 00:16:34,480 --> 00:16:35,520 a meltdown, 157 00:16:35,520 --> 00:16:36,130 a crying  158 00:16:36,130 --> 00:16:37,650 spell... shaking. 159 00:16:38,220 --> 00:16:42,720 And for people who have that externalized reaction, 160 00:16:42,730 --> 00:16:49,200 this can look like borderline to a clinician who's not looking at the big neurologic picture. 161 00:16:50,730 --> 00:16:51,630 And finally, 162 00:16:51,630 --> 00:17:02,180 one of the aspects of borderline personality can be this recurrent self harm behavior or impulsive, 163 00:17:02,190 --> 00:17:04,470 self damaging behavior. 164 00:17:04,480 --> 00:17:22,050 You can get elements of that on the autism spectrum in the sense of ... it would not be unusual for clients to in the midst of their dysregulation to do things like hitting themselves or biting themselves, 165 00:17:22,050 --> 00:17:23,340 cutting themselves, 166 00:17:23,340 --> 00:17:24,490 banging their head. 167 00:17:24,500 --> 00:17:25,490 Um, 168 00:17:25,500 --> 00:17:27,070 and that is part of, 169 00:17:27,080 --> 00:17:29,810 of dysregulation for the autistic. 170 00:17:29,820 --> 00:17:30,570 Um, 171 00:17:30,580 --> 00:17:38,900 and so there are certainly differences in borderline personality as compared to autism, 172 00:17:38,940 --> 00:17:43,020 in this dynamic of when dysregulation occurs. 173 00:17:43,190 --> 00:17:43,560 Uh, 174 00:17:43,560 --> 00:17:49,500 and also what you don't see in the borderline is the broader neurologic picture. 175 00:17:49,510 --> 00:17:50,300 So, 176 00:17:50,300 --> 00:17:52,270 these sensory elements, 177 00:17:52,270 --> 00:17:54,610 these stereotyped behaviors. 178 00:17:54,620 --> 00:17:55,480 Again, 179 00:17:55,480 --> 00:18:01,400 we're not going to end on a note where people know how to distinguish the two conditions, 180 00:18:01,400 --> 00:18:05,150 but I do want you to have a sense of why this occurs. 181 00:18:05,150 --> 00:18:17,480 Why does this mistake happen where someone looks at pieces of an individual and their history and comes up with borderline instead of autism. 182 00:18:18,480 --> 00:18:32,040 This article that I do want to share is actually a case study of a gentleman who had been diagnosed with borderline personality and then was correctly diagnosed with autism. 183 00:18:32,050 --> 00:18:34,620 And the link is in the show notes, 184 00:18:34,630 --> 00:18:46,900 this article was published in Norway In February of 2022 and I'll just read you some elements that I think are important. 185 00:18:48,780 --> 00:18:57,950 The patient received treatment for borderline personality disorder without any observable improvement in his difficulties for several years. 186 00:18:59,320 --> 00:19:00,290 And that's end, 187 00:19:00,290 --> 00:19:00,870 quote. 188 00:19:02,470 --> 00:19:12,920 The authors note that the case highlights the need for mental health professionals to have the quote knowledge necessary to recognize and diagnose autism. 189 00:19:12,990 --> 00:19:14,250 End quote, 190 00:19:14,300 --> 00:19:21,990 they suggest that the evaluation for autism may be warranted in patients with non suicidal self injury. 191 00:19:22,000 --> 00:19:24,680 So that's the cutting the banging, 192 00:19:24,690 --> 00:19:35,030 those kinds of things that we talked about and assumed personality disorder who are not benefiting from the treatments that have been used. 193 00:19:35,980 --> 00:19:37,340 So essentially, 195 00:19:38,720 --> 00:19:48,490 they're suggesting that if there's a patient that has been diagnosed with a personality disorder but is not benefiting from the treatment. 197 00:19:49,650 --> 00:19:51,500 and staff feel like, 198 00:19:51,510 --> 00:19:51,940 gosh, 199 00:19:51,940 --> 00:19:56,690 I just feel like we're missing something...that might be a good trigger. 200 00:19:56,700 --> 00:20:02,290 I would say any time borderline personality is on the table, 201 00:20:02,300 --> 00:20:10,290 autism should specifically be in the differential because of some of these features that can look similar. 202 00:20:10,300 --> 00:20:13,280 And if you want to know more about differentials, 203 00:20:13,290 --> 00:20:27,300 go ahead and listen to the first episode in our series. With regard to the young adult that they were describing in the article. 204 00:20:28,690 --> 00:20:29,580 Um, 205 00:20:29,590 --> 00:20:38,210 they could see that there were characteristics of several different personality disorder conditions. 206 00:20:38,220 --> 00:20:39,040 Um, 207 00:20:39,040 --> 00:20:45,250 but nothing that really hit the spot with any one personality disorder. 208 00:20:45,260 --> 00:20:45,900 Uh, 209 00:20:45,910 --> 00:20:47,600 so they looked at schizoid, 210 00:20:47,600 --> 00:20:50,350 avoidant. dependent, and borderline, 211 00:20:52,060 --> 00:20:57,110 but there were not sufficient symptoms to meet criteria for any of those. 212 00:20:57,120 --> 00:20:58,970 And it was noted that, 213 00:20:58,980 --> 00:20:59,340 quote, 214 00:20:59,340 --> 00:21:05,900 his difficulties with regard to social engagement were pervasive rather than transient. 215 00:21:05,910 --> 00:21:25,110 So what they're trying to say is that really they did an in depth assessment for autism and they saw that really he was not able to navigate neurologically the theory of mind issues and the nonverbals, and 216 00:21:25,120 --> 00:21:28,100 social reciprocity and conversation. 217 00:21:28,100 --> 00:21:36,890 So they concluded that his social difficulties really were not the result of his intense personality, 218 00:21:36,890 --> 00:21:48,430 but more the result of a neurologic wiring that it was different and he was not able to navigate social interactions in that context. 219 00:21:50,920 --> 00:22:03,090 They also state he did not display a pattern of attachment and rejection in interpersonal relationships, and his non suicidal self injury. 220 00:22:03,100 --> 00:22:09,890 (And for him this was cutting) rarely occurred as a response to an interpersonal conflict. 221 00:22:09,900 --> 00:22:18,380 So they're also just trying to point out that although he had dysregulation, and he had self harm in that context, 222 00:22:18,390 --> 00:22:19,390 it didn't have... 223 00:22:19,400 --> 00:22:25,700 it wasn't triggered by the same kinds of things that a borderline personality might be triggered by. 224 00:22:27,680 --> 00:22:28,080 Now, 225 00:22:28,080 --> 00:22:29,500 in my own clinic, 226 00:22:29,510 --> 00:22:36,290 what I see is that in addition to the borderline personality as a common misdiagnosis, 227 00:22:36,300 --> 00:22:46,280 I also frequently see narcissism or narcissistic personality disorder uh as a misdiagnosis as well. 228 00:22:47,240 --> 00:22:52,550 So where does this misdiagnosis stem from? 229 00:22:53,800 --> 00:22:54,330 Well, 230 00:22:54,330 --> 00:22:59,930 if you listened to the episode two sessions ago, 231 00:22:59,940 --> 00:23:03,030 it was called why pattern is important. 232 00:23:03,040 --> 00:23:10,920 And in our episode today we are making some generalizations about how the autistic neurology, 233 00:23:10,920 --> 00:23:13,300 when it has a certain pattern, 234 00:23:13,310 --> 00:23:18,340 it can lend itself to misdiagnosis of certain conditions. 235 00:23:18,580 --> 00:23:36,700 So what we've done so far is we've talked about how some people on the spectrum have a pattern of neurology that fits within that autism schema and that also could look in some aspects like a borderline personality. 236 00:23:37,330 --> 00:23:49,780 Now here we're looking at a different pattern and how some aspects of the autism neurology may be heightened in an individual in a way that looks like narcissism. 237 00:23:51,430 --> 00:24:11,470 So one of the reasons for that can be that if you have an individual on the spectrum who uh is very passionate about topics and they have a great value for fact and rightness and correctness. 238 00:24:11,480 --> 00:24:12,380 Um, 239 00:24:12,380 --> 00:24:20,150 and they love um certain pieces of information so that their special interest, 240 00:24:20,150 --> 00:24:24,780 maybe politics or religion or the environment and ... boy, 241 00:24:24,780 --> 00:24:27,110 they deep dive into this. 242 00:24:27,110 --> 00:24:37,850 They love talking about this particular topic or handful of topics and being correct about the facts is also very important to them. 243 00:24:37,860 --> 00:24:43,700 And so they have this deep commitment to being right now. 244 00:24:43,700 --> 00:24:51,670 What they are less attuned to neurologically is understanding the internal of the other person. 245 00:24:51,680 --> 00:24:56,800 How does this conversation affect the personhood... 246 00:24:56,810 --> 00:24:57,750 The person, 247 00:24:57,750 --> 00:25:01,710 the internal person of this individual I'm speaking with. 248 00:25:01,710 --> 00:25:05,620 So they have less of a sense of do they feel criticized? 249 00:25:05,620 --> 00:25:29,490 How does that impact our relationship because to them we're talking because this topic is important and their whole reason sometimes for talking with you about it is to uh enlighten you or instruct you or help you understand what the right facts are. 250 00:25:30,010 --> 00:25:37,200 And some of the autistic individuals with this pattern may say, 251 00:25:37,210 --> 00:25:45,340 well I will shift my beliefs if someone proves that I'm wrong but I'm not wrong. 252 00:25:45,350 --> 00:25:46,360 Um, 253 00:25:46,370 --> 00:25:54,850 and so that quality of having difficulty with thinking in gray areas. 254 00:25:54,850 --> 00:26:00,410 So someone who may have that black and white thinking this is right and this is wrong. 255 00:26:00,630 --> 00:26:12,460 Someone who has difficulty shifting and giving um like they are committed to a thought or an idea or an opinion and it really does. 256 00:26:12,470 --> 00:26:14,740 Uh they're not wishy washy, 257 00:26:14,750 --> 00:26:15,310 you know, 258 00:26:15,310 --> 00:26:24,950 their strength is that they have this very strong commitment and so when they have that and they're gonna stick to it neurologically, 259 00:26:24,950 --> 00:26:32,340 and they don't have as much sense of what you need during a conversation as the other person. 260 00:26:32,350 --> 00:26:40,260 Uh then you can get the sense of narcissism and somebody may say they want to lecture me or talk to me, 261 00:26:40,260 --> 00:26:44,520 but they don't want my opinion or they don't want me to participate. 262 00:26:44,910 --> 00:26:50,670 Um and that could be a feeling that lends itself to this descriptor, 263 00:26:52,160 --> 00:26:55,850 another piece of this really... 264 00:26:55,860 --> 00:27:05,970 ... if you do have that black and white thinking that this is right and this is wrong and you do want to commit to be right. 265 00:27:05,980 --> 00:27:08,160 Um one of the things can, 266 00:27:08,170 --> 00:27:32,020 that can happen with that neurology is that there's a strong um commitment to being correct and if they are wrong or they fail something or they lose a competition that can be extremely difficult um with their emotional regulation because they want to be in the good category. 267 00:27:32,030 --> 00:27:34,570 And if the only thing left, 268 00:27:34,580 --> 00:27:37,970 once they make a mistake is the bad category, 269 00:27:37,980 --> 00:27:48,870 that's just so difficult for them to land there because their brain really doesn't show them any in between or any complexity that yeah, 270 00:27:48,870 --> 00:27:55,750 I'm this mix of good things and difficult things and I have achieved, 271 00:27:55,760 --> 00:27:56,910 um, 272 00:27:56,920 --> 00:27:58,600 correct things here, 273 00:27:58,600 --> 00:28:00,590 but I really missed the boat here. 274 00:28:00,600 --> 00:28:01,290 Um, 275 00:28:01,300 --> 00:28:09,870 so you can have this real resistance to losing or being wrong or falling short. 276 00:28:12,060 --> 00:28:17,370 There's another feature in the list of narcissistic personality, 277 00:28:17,380 --> 00:28:17,910 um, 278 00:28:17,920 --> 00:28:21,350 criteria and that is lacks empathy, 279 00:28:21,360 --> 00:28:26,800 is unwilling to recognize or identify with the feelings and needs of others. 280 00:28:26,810 --> 00:28:27,340 Now, 281 00:28:27,340 --> 00:28:28,750 for the autistic, 282 00:28:28,750 --> 00:28:31,260 that is really not the case. 283 00:28:31,260 --> 00:28:33,020 It's not that they're unwilling. 284 00:28:33,030 --> 00:28:36,810 And some people have a deep empathy for, 285 00:28:37,260 --> 00:28:38,260 um, 286 00:28:38,270 --> 00:28:38,850 you know, 287 00:28:38,850 --> 00:28:43,350 wanting every person to be good and to be doing well. 288 00:28:43,360 --> 00:28:43,940 Um, 289 00:28:43,950 --> 00:28:52,070 but sometimes in their mind you will be doing really well if you have the correct facts, 290 00:28:52,080 --> 00:28:58,700 so they may not be in tune with the internal emotions and relational needs of the other person. 291 00:28:58,710 --> 00:28:59,620 Um, 292 00:28:59,630 --> 00:29:04,850 but it's not that they're unwilling to recognize the feelings or needs of others. 293 00:29:07,070 --> 00:29:08,470 And as I mentioned, 294 00:29:08,470 --> 00:29:15,460 there are many other personality disorders that end up being misdiagnoses for autism. 295 00:29:16,960 --> 00:29:29,190 But hopefully this gives you a flavor of how someone might see the interaction style and behavioral pattern of someone presenting for, 296 00:29:29,190 --> 00:29:29,650 let's say, 297 00:29:29,650 --> 00:29:58,410 counseling or some type of assistance and they may look at that pattern of neurology that fits within the autism spectrum and make conclusions about personality and therefore assign a personality diagnosis when if they really knew what the autism flags were and could add that to the differential and specifically assess for autism. 298 00:29:58,410 --> 00:30:01,880 When considering these other personality structures, 299 00:30:01,890 --> 00:30:07,200 then we would get a much more beneficial diagnostic process. 300 00:30:07,470 --> 00:30:15,030 We don't want someone with another mental health condition to be mistakenly diagnosed as autistic and vice versa. 301 00:30:15,040 --> 00:30:28,550 So we want the diagnoses that are used to really empower you and people around you to improve your well being and to really get you to those goals that you want. 302 00:30:29,500 --> 00:30:36,950 Thank you for joining me today as we talked about personality disorders as misdiagnoses for autism. 303 00:30:36,960 --> 00:30:38,570 We reviewed borderline, 304 00:30:38,570 --> 00:30:54,310 we reviewed narcissism and we reviewed some of the research and publications that are emerging both on a statistical level and also with regard to case studies about why it's really impactful to the individual. 305 00:30:54,310 --> 00:30:56,660 To get these diagnoses correct. I hope you can join me for the next episode.   

Join Dr. Regan for the first in a series on autism misdiagnosis. This episode focuses on why autism is misdiagnosed and how we can do better. Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the episode transcript below: 1 00:00:01,890 --> 00:00:04,590 Hello and welcome to autism. 2 00:00:04,590 --> 00:00:06,170 In the adult podcast. 3 00:00:06,180 --> 00:00:07,450 I am your host, 4 00:00:07,450 --> 00:00:08,890 Dr Theresa Regan. 5 00:00:08,900 --> 00:00:10,830 I'm a neuropsychologist. 6 00:00:10,840 --> 00:00:19,210 The director of an adult diagnostic autism clinic in central Illinois and the parent of an autistic teen. 7 00:00:19,220 --> 00:00:27,060 I am going to be starting a new series today and that's going to focus on misdiagnosis... 8 00:00:27,060 --> 00:00:27,360 So... 9 00:00:27,360 --> 00:00:35,630 people who are on the autism spectrum, who have that autistic neurology, but are diagnosed with something else... 10 00:00:35,640 --> 00:00:42,180 typically a mental health diagnosis and oftentimes several diagnoses. 11 00:00:42,950 --> 00:00:50,480 We're going to talk about why that happens and how to understand how we can do better. 12 00:00:51,620 --> 00:00:53,560 As we're starting off, 13 00:00:53,570 --> 00:01:02,030 I am going to tell you a story and the story is called The Parable of the Elephant. 14 00:01:02,040 --> 00:01:04,890 And this is a very ancient parable. 15 00:01:04,900 --> 00:01:08,320 It has a few variations across cultures. 16 00:01:08,330 --> 00:01:09,370 But it really, 17 00:01:09,370 --> 00:01:15,260 I think. speaks to this dilemma that we have about misdiagnosis. 18 00:01:16,520 --> 00:01:23,610 There was an ancient village and they had never seen an elephant before. 19 00:01:23,620 --> 00:01:30,450 And you can imagine that when someone brought an elephant into their village it was a big deal. 20 00:01:30,460 --> 00:01:36,070 People wanted to know "what does a creature called an elephant look like?" 21 00:01:36,540 --> 00:01:46,990 And there was also this group of villagers there who were blind and they thought well we aren't going to be able to see the elephant, 22 00:01:46,990 --> 00:01:56,670 but we could put out our hands and we could perceive the elephant through touch and this will let us know what the elephant is like. 23 00:01:58,350 --> 00:02:02,660 So indeed the villagers went to the center of town. 24 00:02:02,670 --> 00:02:06,250 They stood around this creature called an elephant. 25 00:02:06,260 --> 00:02:12,830 In each person put out their hand and they were able to experience the elephant. 26 00:02:14,020 --> 00:02:17,690 So what happened is that the first person said, 27 00:02:17,700 --> 00:02:19,650 oh I get it. 28 00:02:19,660 --> 00:02:22,470 An elephant is like a fan, 29 00:02:22,480 --> 00:02:28,900 I've put out my hand and I can feel that it's broad and wavy and thin. 30 00:02:28,910 --> 00:02:31,150 An elephant is like a fan. 31 00:02:32,000 --> 00:02:37,980 And here the person had felt the ear of the elephant. 32 00:02:37,990 --> 00:02:40,510 Well the next person said, 33 00:02:40,520 --> 00:02:52,780 I do not know what you're talking about because I am right here feeling the elephant and I can tell you that the elephant is broad and tall and wide. 34 00:02:52,790 --> 00:02:55,130 I can't even put my arms out, 35 00:02:55,130 --> 00:03:00,660 but I can just say that that an elephant is like a wall, 36 00:03:00,670 --> 00:03:04,400 it's so big and massive and strong. 37 00:03:05,390 --> 00:03:07,820 The next person disagreed as well, 38 00:03:08,750 --> 00:03:10,290 this person said no, 39 00:03:10,290 --> 00:03:10,480 no, 40 00:03:10,480 --> 00:03:11,150 no, 41 00:03:11,160 --> 00:03:14,660 it's... I can put my arms around it, 42 00:03:14,670 --> 00:03:24,490 it's thick and tall but there is an end to it and and it's kind of like a tree trunk or a pillar. 43 00:03:24,500 --> 00:03:30,010 And this person was experiencing the leg ... touching the leg of the elephant. 44 00:03:30,410 --> 00:03:32,740 The next person was at the tail. 45 00:03:32,750 --> 00:03:34,100 They said no, 46 00:03:34,100 --> 00:03:34,890 no, 47 00:03:34,900 --> 00:03:36,850 not like that at all. 48 00:03:36,860 --> 00:03:38,400 This is thin, 49 00:03:38,410 --> 00:03:41,370 it's really... an elephant is like a rope, 50 00:03:41,380 --> 00:03:44,200 it's corded and thin and long. 51 00:03:44,210 --> 00:03:46,900 No said the next person, 52 00:03:47,220 --> 00:03:58,960 the elephant is like a snake and they were there at the trunk and they said it's thick and curvy and I can just feel all the textures of the skin, 53 00:03:58,960 --> 00:04:01,670 it's really like a snake, 54 00:04:01,680 --> 00:04:03,820 that's what an elephant is like. 55 00:04:03,830 --> 00:04:08,290 And the last person was feeling the tusk and said, 56 00:04:08,290 --> 00:04:08,610 no, 57 00:04:08,610 --> 00:04:10,440 not like a snake at all. 58 00:04:10,450 --> 00:04:12,220 It's curved a bit, 59 00:04:12,220 --> 00:04:22,020 but it's really hard and ah strong and smooth, and I would say an elephant is like a sword or a spear. 60 00:04:24,250 --> 00:04:30,670 So the parable is meant to teach that here, 61 00:04:30,680 --> 00:04:35,080 every person was correct about what was right in front of them, 62 00:04:35,640 --> 00:04:48,340 but they were all incorrect because they were only experiencing a piece of what an elephant is and an elephant is not like a snake or a rope or a wall. 63 00:04:48,400 --> 00:04:58,730 It's really many things put together in that description and an elephant is a whole creature with many of those features. 64 00:04:58,740 --> 00:05:06,480 So that is the lesson and it applies really well to this process of diagnosis regarding autism. 65 00:05:07,250 --> 00:05:07,570 So, 66 00:05:07,570 --> 00:05:13,530 what happens in the area of diagnosis is that a client or patient will present, 67 00:05:13,540 --> 00:05:18,800 they'll have concerns and some characteristics that maybe they're struggling with. 68 00:05:18,810 --> 00:05:24,670 And the clinician will see that one little piece and label it with a diagnosis, 69 00:05:24,680 --> 00:05:28,360 but they won't see the big picture diagnosis, 70 00:05:28,370 --> 00:05:29,810 which is autism. 71 00:05:30,640 --> 00:05:30,950 So, 72 00:05:30,950 --> 00:05:35,600 let me step away from the animal analogy for a moment, 73 00:05:35,600 --> 00:05:41,130 but we're going to go back and kind of weave this image through to make some other points. 74 00:05:41,140 --> 00:05:48,130 One point I want to make is that we define diagnoses based on certain criteria. 75 00:05:48,140 --> 00:05:55,320 So these are pieces of the condition or the diagnosis. 76 00:05:55,330 --> 00:05:55,890 So, 77 00:05:55,890 --> 00:05:58,920 depression has a list of criteria. 78 00:05:58,920 --> 00:06:00,290 Things that we look for. 79 00:06:00,290 --> 00:06:04,590 Do you have these features? and then we diagnose depression. 80 00:06:04,600 --> 00:06:07,650 Alzheimer's has a list of criteria, 81 00:06:07,660 --> 00:06:09,820 bipolar has a list of criteria, 82 00:06:09,830 --> 00:06:12,140 autism has a list of criteria. 83 00:06:12,150 --> 00:06:23,700 Now the reason for having criteria is to make certain that we're talking about the same thing and also to help us research this diagnosis. 84 00:06:23,700 --> 00:06:25,810 We really want to know more about it. 85 00:06:25,820 --> 00:06:27,530 We want to help people, 86 00:06:27,530 --> 00:06:35,330 we want to understand what kinds of things are not helpful and we want to know the prognosis. 87 00:06:36,310 --> 00:06:39,900 So we have to agree on some language for it. 88 00:06:39,900 --> 00:06:41,350 And some criteria. 89 00:06:42,280 --> 00:06:44,020 When will we call something 90 00:06:44,020 --> 00:06:48,730 Alzheimer's? When will we call something bipolar instead of something else? 91 00:06:51,140 --> 00:06:53,510 In the example of the parable of the elephant, 92 00:06:53,520 --> 00:07:00,810 each person who encountered the elephant described a small element of one large thing. 93 00:07:00,820 --> 00:07:05,290 They defined it on the basis of one piece rather than the whole. 94 00:07:05,300 --> 00:07:11,330 So in this case it was like creating criteria for an elephant ear. 95 00:07:11,710 --> 00:07:21,430 And then calling the ear the elephant... an elephant is like a fan because I've experienced this piece, 96 00:07:21,440 --> 00:07:26,250 this ear. or a criteria for the tusk, 97 00:07:26,260 --> 00:07:29,800 and saying that an elephant is something with the tusk. 98 00:07:29,810 --> 00:07:38,880 Instead of realizing that a tusk is a little piece of an elephant that does not define the elephant. 99 00:07:38,880 --> 00:07:50,960 So you get the picture that there is a problem with defining such a large creature based on one feature or one experience with ... 100 00:07:50,970 --> 00:07:58,710 with the characteristic. So related to diagnoses ... autism like the elephant ... the big picture. 101 00:07:58,720 --> 00:08:08,110 It's the diagnosis with seven diagnostic criteria and each of the criteria could be diagnosed separately as something else. 102 00:08:08,700 --> 00:08:20,220 So if the tribe of people were encountering our concept of autism and they had never come across autism before and one individual encountered the social criteria, 103 00:08:20,240 --> 00:08:22,650 they might diagnose social anxiety. 104 00:08:22,660 --> 00:08:24,010 Well that's what autism is ... 105 00:08:24,010 --> 00:08:25,040 social anxiety, 106 00:08:25,040 --> 00:08:28,080 let's just call this social anxiety. 107 00:08:28,250 --> 00:08:35,920 Another person could encounter autism and say actually... really autism is a difficulty with flexibility, 108 00:08:35,930 --> 00:08:37,770 difficulty with change. 109 00:08:37,780 --> 00:08:41,910 The person wanting to repeat things... for things to be predictable, 110 00:08:41,910 --> 00:08:44,150 perhaps having rituals for the day. 111 00:08:44,730 --> 00:08:46,510 So let's call this OCD. 114 00:08:48,680 --> 00:08:53,680 They're looking at this one piece of the larger autistic picture. 115 00:08:54,540 --> 00:09:01,490 Another individual may encounter the executive function difficulty that an individual on the spectrum has. 116 00:09:01,500 --> 00:09:02,960 And they may say, 117 00:09:02,960 --> 00:09:06,540 well look this is executive function difficulty. 118 00:09:06,540 --> 00:09:07,670 I know what this is. 119 00:09:07,680 --> 00:09:08,320 It's ADD. 122 00:09:10,550 --> 00:09:23,300 Another person may encounter problems that the individual presents with ... emotional regulation, with sleep, and sometimes a really encompassing obsessive interest in an activity. 123 00:09:23,310 --> 00:09:33,580 And they might say wow it looks like this person is kind of manic and emotionally labile and...  and I think this is actually bipolar disorder. 124 00:09:33,590 --> 00:09:36,690 That's what this creature is. 125 00:09:36,690 --> 00:09:39,710 That's what this autistic experiences. 126 00:09:43,190 --> 00:09:53,060 So it's akin to having the tribe's person encounter the ear of the elephant and labeling this as a fan or the tail and labeling it as a rope. 127 00:09:53,070 --> 00:10:24,090 In this case a clinician might encounter autism but not be familiar with it and not see the big picture and then label a piece of autism as if that were the whole. The way that we ensure that as clinicians we're seeing the big picture instead of just one piece of something is to make sure we're really doing a thorough differential diagnostic process. 128 00:10:24,100 --> 00:10:33,040 A differential is a list of diagnoses to consider that could be present based on the few things that we first encounter. 129 00:10:33,050 --> 00:10:35,490 So let's take the animal example. 130 00:10:35,490 --> 00:10:36,050 Again, 131 00:10:36,240 --> 00:10:41,100 if we encounter a huge, gray, lumbering animal with eyes, 132 00:10:41,110 --> 00:10:41,720 ears, 133 00:10:41,720 --> 00:10:43,390 four legs and a tail, 134 00:10:43,400 --> 00:10:44,420 someone may say, 135 00:10:44,420 --> 00:10:48,020 well that's all the criteria for a rhinoceros. 136 00:10:48,770 --> 00:10:52,660 So I think this animal is a rhinoceros. 137 00:10:54,200 --> 00:11:02,640 But the person who understands the importance of differentials will say... other animals also have these features. 138 00:11:02,640 --> 00:11:05,250 You're right ... a rhinoceros does. 139 00:11:05,260 --> 00:11:07,100 But you know, 140 00:11:07,110 --> 00:11:13,000 there are also things to consider such as an elephant or a hippo. 141 00:11:13,010 --> 00:11:15,800 So based on what we know, 142 00:11:15,800 --> 00:11:19,140 we can't quite conclude that this is a rhinoceros, 143 00:11:19,150 --> 00:11:21,670 we have to do a little more detective work. 144 00:11:23,960 --> 00:11:28,640 The differential then is rhinoceros, elephant, hippo. 145 00:11:28,650 --> 00:11:35,360 That's the list of considerations in our consideration of diagnosis. 146 00:11:35,370 --> 00:11:38,330 A person may struggle with executive function. 147 00:11:38,340 --> 00:11:39,290 Yes, ADD 150 00:11:39,670 --> 00:11:41,300 Could be diagnosed. 151 00:11:41,310 --> 00:11:47,300 But after all... there is executive function difficulty in other conditions as well. 152 00:11:47,310 --> 00:11:47,920 ADD 155 00:11:48,310 --> 00:11:49,370 Is one. 156 00:11:49,920 --> 00:11:50,520 However, 157 00:11:50,520 --> 00:11:56,730 every autistic individual will also have some pattern of executive function difficulty, 158 00:11:57,430 --> 00:12:05,760 we would also want to know... has this person had any recent injury or illness, because this can also cause executive function difficulty. 159 00:12:05,770 --> 00:12:08,110 And how old is this person? 160 00:12:08,110 --> 00:12:09,970 What characteristics do they have? 161 00:12:09,980 --> 00:12:13,990 Is this someone who's showing some early signs of dementia? 162 00:12:14,270 --> 00:12:16,070 Also have there been an MRI or any other neurologic features? 166 00:12:18,580 --> 00:12:20,590 Perhaps this is part of a demyelinating process like multiple sclerosis. 169 00:12:23,810 --> 00:12:29,510 So that could be the differential ... rather than seeing executive function problems, 170 00:12:29,520 --> 00:12:31,110 noting that that's what ADD 173 00:12:31,530 --> 00:12:32,780 Is and calling it ADD 176 00:12:33,480 --> 00:12:45,610 We can invite more complexity in and realize that we really need to have a detailed analysis to get to that big picture... that just right description of what the big picture is. 177 00:12:48,860 --> 00:13:00,710 The clinician using the process of differential diagnosis is differentiating autism from other states with similar features. 178 00:13:02,190 --> 00:13:04,650 Although it's true that a rhino is large, 179 00:13:04,650 --> 00:13:05,710 has four legs, 180 00:13:05,720 --> 00:13:06,290 ears, 181 00:13:06,290 --> 00:13:07,160 reproduces, 182 00:13:07,170 --> 00:13:08,300 eats and urinates. 183 00:13:08,330 --> 00:13:18,100 We can't define the creature based on that description without differentiating it from other animals with the same features such as hippos or elephants. 184 00:13:18,150 --> 00:13:25,170 Now it's not that we would mistake a hippo for an elephant if we really could see the big picture. 185 00:13:25,460 --> 00:13:29,530 But if we're only presented with little clues at the beginning, 186 00:13:29,540 --> 00:13:34,740 we know that there are distinct creatures that may have similar elements. 187 00:13:34,780 --> 00:13:42,370 Not that the creatures are so similar that they can't be distinguished when we see the whole big picture, 188 00:13:42,380 --> 00:13:47,820 but that if we're only seeing a few elements present at a time, 189 00:13:47,830 --> 00:13:50,810 we need to know what kind of detective work to do. 190 00:13:51,790 --> 00:13:53,190 For example, 191 00:13:53,200 --> 00:13:56,540 how fast does this animal run? 192 00:13:56,560 --> 00:14:05,020 A Rhino runs faster than an elephant or a hippo at about 34 mph or 55 km/h. 193 00:14:06,220 --> 00:14:09,040 All three are found on the african continent, 194 00:14:09,040 --> 00:14:13,760 but hippos gravitate toward environments with aquatic elements nearby. 195 00:14:13,990 --> 00:14:14,580 Now, 196 00:14:14,580 --> 00:14:18,060 both rhinos and elephants have horns or tusks. 197 00:14:18,070 --> 00:14:18,930 However, 198 00:14:18,930 --> 00:14:22,650 the material in the horn of a rhino is more like our fingernails, 199 00:14:22,660 --> 00:14:27,100 while the tusk of the elephant is made of material closer to our teeth, 200 00:14:27,130 --> 00:14:32,830 Of course an elephant has that distinctive trunk not found in the other creatures. 201 00:14:33,990 --> 00:14:37,720 So this process is the differential process. 202 00:14:37,730 --> 00:14:40,180 If we're only seeing a few elements. 203 00:14:40,180 --> 00:14:51,480 At first we do detective work and we say what other creatures or diagnoses have these same features. 204 00:14:53,000 --> 00:14:57,790 We're aware that certain elements are present that occur in one category, 205 00:14:57,790 --> 00:15:00,020 whether that's a species or a diagnosis, 206 00:15:00,020 --> 00:15:08,660 but we realize that this needs to be tested to differentiate it between other categories with those features as well. 207 00:15:08,670 --> 00:15:12,640 So the differential process for diagnosis should be similar. 208 00:15:12,650 --> 00:15:13,440 For example, 209 00:15:13,450 --> 00:15:17,200 if an individual presents with emotional regulation difficulty, 210 00:15:17,380 --> 00:15:21,710 let's say in this case that looks like mood swings or anger outbursts, 211 00:15:21,720 --> 00:15:28,600 although in others it could look much quieter like dissociation or fleeing, 213 00:15:28,920 --> 00:15:30,030 withdrawing. 214 00:15:30,630 --> 00:15:31,640 But in this case, 215 00:15:31,650 --> 00:15:34,080 if there's mood swings or anger outbursts, 216 00:15:34,090 --> 00:15:43,160 a clinician might diagnose bipolar and maybe even show the person that all the criteria for bipolar are present. 217 00:15:44,000 --> 00:15:45,020 However, 218 00:15:45,030 --> 00:15:49,130 no one has checked whether there's social reciprocity, 219 00:15:49,130 --> 00:15:52,500 difficulty or sensory processing characteristics, 220 00:15:52,510 --> 00:15:54,430 stereotyped movements. 221 00:15:54,550 --> 00:15:55,890 In other words, 222 00:15:55,890 --> 00:16:03,100 nobody has done detective work to see if a different big picture is actually present in this case, 223 00:16:03,100 --> 00:16:05,510 the big picture being autism. 224 00:16:07,750 --> 00:16:13,130 Another individual may present with difficulty understanding "who am I? 225 00:16:13,130 --> 00:16:16,360 I just don't have the stable sense of who I am, 226 00:16:16,370 --> 00:16:19,910 I can't reach my internal state, 227 00:16:19,920 --> 00:16:22,120 what's going on inside of me?" 228 00:16:22,860 --> 00:16:26,960 They also have difficulty keeping an even keeled mood. 229 00:16:26,970 --> 00:16:36,800 They struggle to start and maintain and understand relationships well. A person may present with these features and the clinician will say, 230 00:16:36,800 --> 00:16:37,330 look, 231 00:16:37,340 --> 00:16:41,880 all the criteria for borderline personality disorder have been met. 232 00:16:43,800 --> 00:16:45,190 That may be true. 233 00:16:45,200 --> 00:16:46,220 However, 234 00:16:46,230 --> 00:16:49,690 even though all the criteria for one condition may be met, 235 00:16:49,700 --> 00:17:01,860 the diagnostic manual stresses that you make that diagnosis only if the characteristics are not better explained by a different diagnosis, 236 00:17:02,750 --> 00:17:05,670 it's not that the features aren't present. 237 00:17:05,680 --> 00:17:13,900 It's whether the big picture of features is explained best by that diagnosis or by a different one. 238 00:17:13,910 --> 00:17:15,990 If these features are present, 239 00:17:15,990 --> 00:17:19,110 but there are also stereotype verbalization, 240 00:17:19,120 --> 00:17:20,560 ritualistic behaviors, 241 00:17:20,560 --> 00:17:23,220 difficulty processing social information, 242 00:17:23,230 --> 00:17:26,050 all of which have been present in childhood, 243 00:17:26,060 --> 00:17:29,690 then the better big picture diagnosis is autism. 244 00:17:31,960 --> 00:17:43,030 So the crux of the problem is this autism is rarely, rarely, rarely included in a clinician's differential process. 245 00:17:44,170 --> 00:17:46,250 This is improving somewhat. 246 00:17:46,260 --> 00:17:51,870 But most patients I see who have been misdiagnosed carry often multiple diagnoses, 247 00:17:51,880 --> 00:17:55,110 all of which reflect core autistic characteristics. 248 00:17:55,120 --> 00:17:57,550 It maybe schizophrenia, 249 00:17:57,560 --> 00:18:00,720 maybe borderline personality, eating disorder, 250 00:18:00,720 --> 00:18:01,750 social anxiety, 251 00:18:01,750 --> 00:18:01,850 OCD 254 00:18:03,230 --> 00:18:10,500 But really the suspicion should be that all of these together maybe describing the big picture diagnosis of autism. 255 00:18:10,510 --> 00:18:13,890 But autism has never been considered. 256 00:18:13,950 --> 00:18:19,650 It's not been ruled out and the better diagnosis assigned. 257 00:18:19,660 --> 00:18:22,570 No it's just never been considered. 258 00:18:23,730 --> 00:18:32,580 Someone has seen the characteristics they are familiar with and they have not met this creature called autism. 259 00:18:32,960 --> 00:18:38,400 So they assign diagnoses to the parts based on what they're familiar with. 260 00:18:38,410 --> 00:18:42,430 Not realizing that autism can also present similarly. 261 00:18:42,430 --> 00:18:43,960 But for different reasons. 262 00:18:43,970 --> 00:18:53,890 And of course that the big picture of autism is different than the pieces that they've labeled schizophrenic, OCD... 265 00:18:54,930 --> 00:18:56,990 Just as in the case of animals, 266 00:18:56,990 --> 00:19:00,330 it's not that bipolar and autism are so similar. 267 00:19:00,330 --> 00:19:02,010 We just can't tell the difference. 268 00:19:02,020 --> 00:19:06,840 Well no, we can tell that an elephant is not a hippo. 269 00:19:06,840 --> 00:19:28,610 If we see the whole creature... it's just that if we're presented with pieces on an initial visit and we don't know how to see the big picture and we've never encountered an elephant, or in this case autism... then we look at what we see and what we know and we label that instead. 270 00:19:28,610 --> 00:19:46,200 And that's how we get into this problematic situation of misdiagnoses... the person hasn't considered or ruled out autism, and therefore we have this collection of piecemeal diagnoses that really don't capture the accurate neurologic picture. 271 00:19:46,640 --> 00:19:53,580 I'm not going to get into the nitty gritty of when autism and another diagnosis should be made together. 272 00:19:53,590 --> 00:19:56,950 There are rules and guidelines for that as clinicians, 273 00:19:56,960 --> 00:20:02,870 but there are situations where you will have more than one diagnosis. 274 00:20:02,870 --> 00:20:06,290 So let's say autism and bipolar, 275 00:20:07,340 --> 00:20:16,810 essentially a second diagnosis would be made if there's a constellation of characteristics that are not entirely accounted for by autism. 276 00:20:16,820 --> 00:20:18,230 So for example, 277 00:20:18,230 --> 00:20:22,410 in over 500 patients that I've diagnosed, 278 00:20:22,420 --> 00:20:38,870 I believe I've made an additional diagnosis of bipolar twice because I did not feel the sleep disturbance and emotional regulation difficulty and other features were explained entirely by autism. 279 00:20:39,460 --> 00:20:40,340 Likewise, 280 00:20:40,340 --> 00:20:43,560 I believe I also made a diagnosis of OCD 283 00:20:44,610 --> 00:20:45,560 At least once, 284 00:20:45,560 --> 00:20:46,680 perhaps twice. 285 00:20:46,690 --> 00:20:50,430 And borderline essentially the same...  once or twice. 286 00:20:51,160 --> 00:20:52,120 In addition, 287 00:20:52,130 --> 00:21:00,340 a second diagnosis may be appropriate if ... even though the characteristics are rooted in autism ... 288 00:21:00,350 --> 00:21:12,950 if this second thing becomes an area of such concern for the person's well being and health that we really need to go after intervention specifically for this thing. 289 00:21:12,960 --> 00:21:14,920 For example, 290 00:21:15,270 --> 00:21:24,000 even though many individuals on the spectrum have differences in their eating profiles that can lead to restricted eating, 291 00:21:24,490 --> 00:21:38,440 ... actually eating disorder should still be diagnosed if this really gets to the point where medical problems and health difficulties are stemming from really extreme nutritional deficits. 292 00:21:38,440 --> 00:21:43,380 So even though we know it's not separate from autism neurology, 293 00:21:43,390 --> 00:21:50,560 it still has become an area of significant and distinct concern that needs its own intervention. 294 00:21:51,260 --> 00:21:51,820 However, 295 00:21:51,820 --> 00:21:56,160 the intervention should be made in light of the neurologic base. 296 00:21:58,940 --> 00:22:02,990 Similarly for depression or PTSD. 297 00:22:03,000 --> 00:22:10,190 Sometimes people have these diagnoses ... and they are misdiagnoses for what is actually autism. 298 00:22:10,190 --> 00:22:11,360 However, 299 00:22:11,370 --> 00:22:19,110 certainly if autism has been diagnosed or if it has been assessed and ruled out, 300 00:22:19,120 --> 00:22:25,480 you can still also have depression or post traumatic stress disorder. 301 00:22:27,220 --> 00:22:55,830 These are things that in themselves create distress and symptomotology that need to be addressed specifically for the individual's well being. Another challenge that we have because of this history of mixing diagnoses and missing autism is that the research that occurs does not really reflect in a reliable way 303 00:22:57,110 --> 00:23:00,600 the differences between autism and other diagnoses. 304 00:23:01,400 --> 00:23:05,760 The reason for that is that a study will take, 305 00:23:05,760 --> 00:23:06,550 for example, 306 00:23:06,550 --> 00:23:12,590 people who have been diagnosed with autism and people who have been diagnosed with bipolar and compare them. 307 00:23:12,600 --> 00:23:13,570 However, 308 00:23:13,570 --> 00:23:16,800 when you really read how that process has gone, 309 00:23:16,810 --> 00:23:26,160 nobody has culled through this group of bipolar individuals to make sure that none of them are actually misdiagnosed autistics. 310 00:23:26,160 --> 00:23:26,320 So, 311 00:23:26,320 --> 00:23:36,990 you've got really strong potential for an autistic group being compared to a group of mixed diagnosis, 312 00:23:36,990 --> 00:23:40,640 perhaps bipolar and autism, 313 00:23:40,650 --> 00:23:43,910 ... similarly for other diagnoses. 314 00:23:45,970 --> 00:23:50,060 Other research studies don't even use diagnosed groups. 315 00:23:50,060 --> 00:24:05,710 Sometimes they'll use people who self report autistic qualities or who complete a questionnaire reflecting autistic qualities to see if higher autistic qualities compares in some way with people who have a different diagnosis. 316 00:24:05,810 --> 00:24:14,920 The group with the different diagnosis or even no diagnosis has not been specifically assessed and autism ruled out. 317 00:24:15,080 --> 00:24:16,080 And secondly, 318 00:24:16,080 --> 00:24:29,200 you can't really conclude much on the basis of a questionnaire of autistic characteristics if you're wanting to compare the actual diagnostic threshold with another state, 319 00:24:29,210 --> 00:24:30,920 another diagnosis. 320 00:24:32,060 --> 00:24:33,850 For example, 321 00:24:33,860 --> 00:24:36,210 a lot of people with ADD 324 00:24:36,850 --> 00:24:38,450 Say well I know ADD 327 00:24:38,840 --> 00:24:41,240 Can include social difficulties. 328 00:24:41,250 --> 00:24:41,390 ADD 331 00:24:41,820 --> 00:24:43,480 Can include sensory issues. 332 00:24:43,480 --> 00:24:43,610 ADD 335 00:24:43,980 --> 00:24:45,920 Can include hyper focus. 336 00:24:47,180 --> 00:24:53,100 ... That may be true but we actually don't know that it's true because the ADD 339 00:24:53,470 --> 00:25:02,890 group has not been actually professionally assessed for people missing a correct diagnosis of autism. 340 00:25:03,400 --> 00:25:09,400 So many of my clients that come for diagnosis have had a diagnosis of ADD 343 00:25:09,870 --> 00:25:12,400 since very early in their life. 344 00:25:12,410 --> 00:25:22,480 And not everyone ... but you do get this problematic mixing and so you can't really be sure what the overlap is. 345 00:25:23,000 --> 00:25:30,520 We do know that people with these other diagnoses have been misdiagnosed to some extent. 346 00:25:30,520 --> 00:25:39,520 We don't know how much because we don't have a correct diagnosis of autism across adulthood and across the lifespan yet. 347 00:25:39,530 --> 00:25:42,380 So we're moving in a good direction, 348 00:25:42,390 --> 00:25:44,540 but these are the complexities. 349 00:25:44,550 --> 00:25:48,240 If we want to talk about diagnosis and why it gets missed, 350 00:25:48,250 --> 00:25:50,080 why it gets misunderstood, 351 00:25:50,090 --> 00:25:54,380 and how come the research can be a little difficult to interpret. 352 00:25:55,730 --> 00:25:59,660 This is foundational knowledge about misdiagnosis. 353 00:25:59,670 --> 00:26:03,920 We are going to be doing a series of a few more episodes, 354 00:26:03,920 --> 00:26:08,300 looking at some of the common misdiagnoses in more detail. 355 00:26:09,230 --> 00:26:13,060 I'm glad you could join me for this conversation about autism, 356 00:26:13,070 --> 00:26:14,230 diagnosis, 357 00:26:14,240 --> 00:26:16,120 elephants and hippos, 358 00:26:16,130 --> 00:26:23,480 and I hope it was illustrative to just set that foundation for the complexity that we are diving into. 359 00:26:24,190 --> 00:26:25,840 I hope you join me next time.  

Join Dr. Regan for an episode about what "spectrum" means and why the pattern of neurologic characteristics in each individual is so important to understand.  Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the episode transcript:  1 00:00:05,930 --> 00:00:07,750 Hello and welcome. 2 00:00:07,760 --> 00:00:09,690 This is Dr Theresa Regan, 3 00:00:09,690 --> 00:00:11,610 your host for this podcast, 4 00:00:11,620 --> 00:00:13,310 autism in the adult. 5 00:00:13,320 --> 00:00:15,600 I am a neuropsychologist, 6 00:00:15,610 --> 00:00:18,080 a certified autism specialist, 7 00:00:18,090 --> 00:00:27,620 the parent of an autistic teenager and the director of an adult diagnostic autism clinic in central Illinois. 8 00:00:28,240 --> 00:00:33,720 I am happy that you're joining me today for our episode about spectrum. 9 00:00:33,730 --> 00:00:35,590 What does that mean? 10 00:00:35,600 --> 00:00:39,010 And Why is pattern important? 11 00:00:39,900 --> 00:00:47,540 So let me explain a little bit of background as far as where I'm coming from with spectrum and pattern. 12 00:00:48,380 --> 00:00:50,720 So as a neuropsychologist, 13 00:00:50,730 --> 00:00:58,270 I specialize in understanding how brain pathways and brain health impact things like thinking, 14 00:00:58,270 --> 00:01:01,080 skills but also emotions, 15 00:01:01,080 --> 00:01:11,420 personality and behavior by looking at how someone's brain is able to process verbal information or learn new information, 16 00:01:11,430 --> 00:01:16,910 pay attention how they're able to balance emotions or plan for the future. 17 00:01:16,920 --> 00:01:29,250 The neuropsychologist can make conclusions about the health of the brain or specific ways that the brain has connected informed pathways across different locations. 18 00:01:30,400 --> 00:01:42,550 So we know that the brain is divided up into various areas and the locations can have specific functions specific jobs. 19 00:01:42,550 --> 00:01:48,990 So the left hemisphere versus the right hemisphere or the center of the brain versus the outside. 20 00:01:49,090 --> 00:01:56,820 There are also specific nuclei in the center of the brain and there are lobes that we talk about the frontal lobe, 21 00:01:56,820 --> 00:01:57,430 the parietal lobe, 22 00:01:57,430 --> 00:01:58,570 etcetera. 23 00:02:00,000 --> 00:02:08,790 So the brain is really special in that the neurology is patterned and localized and there's a function to it. 24 00:02:10,010 --> 00:02:22,300 So one of the ways that a neuropsychologist makes conclusions about those patterns and what's going on in the brain is by looking at the way that the brain behaves. 25 00:02:22,310 --> 00:02:24,780 So how does it do with reading? 26 00:02:24,780 --> 00:02:28,660 How does it do with um staying calm and centered? 27 00:02:28,660 --> 00:02:35,240 And that gives um revelation about the connections, 28 00:02:35,250 --> 00:02:36,230 the anatomy, 29 00:02:36,230 --> 00:02:37,760 how the brain is wired. 30 00:02:39,440 --> 00:02:43,220 So a huge focus of what neuropsychologist analyze is. 31 00:02:43,220 --> 00:02:46,370 Not any one score. 32 00:02:46,380 --> 00:02:53,070 Like let's say we give a memory task and a reading task and we look at something called praxis, 33 00:02:53,080 --> 00:02:56,900 we're not gonna look at any one score. 34 00:02:56,900 --> 00:02:58,530 What did this person get correct? 35 00:02:58,530 --> 00:02:59,960 What did they get wrong? 36 00:02:59,970 --> 00:03:01,050 Um No, 37 00:03:01,050 --> 00:03:05,470 we're looking for this data to fall into a pattern. 38 00:03:05,480 --> 00:03:10,020 It's the pattern that is really where the revelation is. 39 00:03:10,140 --> 00:03:15,940 And once we get a significant amount of data from a checkup, 40 00:03:16,500 --> 00:03:21,290 we look for how these pieces of data hang together. 41 00:03:21,300 --> 00:03:27,400 So the pattern should be consistent with the way that the brain is organized anatomically. 42 00:03:27,410 --> 00:03:38,490 So in the same way that a neurologist would check your vision or reflexes your walking patterns to make conclusions about the health and functioning of the brain. 43 00:03:38,670 --> 00:03:45,400 A neuropsychologist also uses information um about patterns. 44 00:03:45,400 --> 00:03:47,620 So we look at cognitive scores, 45 00:03:47,630 --> 00:03:55,560 we make behavioral observations and we uh make conclusions about how the brain is functioning. 46 00:03:57,360 --> 00:04:08,640 Different types of situations will have different patterns because various pathways might be impacted uh in a sequence that's really kind of unique. 47 00:04:08,650 --> 00:04:10,000 For example, 48 00:04:10,000 --> 00:04:38,930 if someone has a traumatic brain injury with a left sided brain bleed and a diffuse axonal injury ... that has a different neuropsychological pattern than someone who presents with the Parkinson's condition and because of this neuropsychologist are very practiced at looking for pattern and understanding how important pattern is and understanding the neurology of the individual. 49 00:04:41,600 --> 00:04:44,220 In the case of the autism spectrum. 50 00:04:44,230 --> 00:04:53,000 Certain neurologic characteristics hang together in one person because of differences in the development of the nervous system. 51 00:04:54,040 --> 00:05:00,680 The characteristics hang together behaviourally because they fall within specific pathways. 52 00:05:00,680 --> 00:05:29,740 They cluster together anatomically in some way because scientists have noted that these neurologic characteristics sometimes hang together and one person they say oh we should call this cluster of neurology something so that we can start talking about it and learning more about it and then it's been decided that we'll call this clustering the autism spectrum. 53 00:05:31,120 --> 00:05:36,310 So when do we actually call that neurology autism. 54 00:05:37,330 --> 00:05:46,890 So what the scientific community has done is determined seven diagnostic criteria to look at in the assessment process. 55 00:05:46,900 --> 00:05:59,490 And they've also developed general guidelines and as with any of um the diagnostic conditions that we have in the D. 56 00:05:59,490 --> 00:05:59,730 S. 57 00:05:59,730 --> 00:05:59,960 M. 58 00:05:59,960 --> 00:06:00,470 Five, 59 00:06:00,480 --> 00:06:04,380 the diagnostic and statistical manual fifth edition. 60 00:06:04,390 --> 00:06:16,970 You know there are committees that get together and they look through research and our current understanding and they determine then what the criteria are. 61 00:06:16,980 --> 00:06:33,290 But there are always discussions and disagreements about uh when do we call this autism when do we call this depression when do we call this dyslexia whatever the state is that they're trying to describe. 62 00:06:33,830 --> 00:06:38,250 So one thing is to know that there are seven diagnostic criteria. 63 00:06:38,260 --> 00:06:40,940 And then there are also uh, 64 00:06:40,950 --> 00:06:45,590 disagreements and discussions about whether other things should be included, 65 00:06:45,600 --> 00:06:46,230 um, 66 00:06:46,230 --> 00:06:47,200 etcetera. 67 00:06:48,230 --> 00:06:49,520 But for our purpose, 68 00:06:49,520 --> 00:06:54,260 what I want to emphasize is that there's this structure, 69 00:06:54,440 --> 00:07:02,860 these criteria and the first three are social in nature and all three of those must be met. 70 00:07:03,800 --> 00:07:09,520 The last four criteria are grouped into what's called repetitive and restricted behaviors, 71 00:07:09,560 --> 00:07:12,710 and only two of the four must be met. 72 00:07:13,430 --> 00:07:30,400 So one type of pattern that we see in autism is that individuals may have unique patterns of which specific criteria are met in order to get this to meet this diagnostic threshold. 73 00:07:30,410 --> 00:07:35,570 And that can mean that individuals on the spectrum can really present differently. 74 00:07:35,580 --> 00:07:39,190 So one person may meet all seven criteria. 75 00:07:39,200 --> 00:07:42,550 Another may meet five or six criteria, 76 00:07:42,550 --> 00:07:46,320 depending on how many of that last grouping they present with. 77 00:07:47,480 --> 00:07:48,820 Think about this. 78 00:07:48,830 --> 00:07:52,430 There could be two people who both meet five criteria, 79 00:07:52,440 --> 00:07:59,440 but they meet different groupings of the criteria and therefore they present with somewhat different characteristics. 80 00:07:59,450 --> 00:08:05,770 So they may meet all three of the social criteria. 81 00:08:05,780 --> 00:08:08,940 And then two of the last four. 82 00:08:08,950 --> 00:08:10,300 But which two? 83 00:08:10,310 --> 00:08:16,070 And that brings this uniqueness of what the features are for these individuals. 84 00:08:17,250 --> 00:08:23,540 So the combination of which criteria are met will create a pattern for that individual. 85 00:08:23,540 --> 00:08:27,110 And this is part of what I consider. 86 00:08:27,120 --> 00:08:29,150 When I'm thinking about spectrum? 87 00:08:29,160 --> 00:08:30,650 What does spectrum mean? 88 00:08:30,660 --> 00:08:31,110 Well, 89 00:08:31,110 --> 00:08:31,460 to me, 90 00:08:31,460 --> 00:08:41,160 it's pattern and that the pattern in one person versus another person who meets criteria for the threshold of diagnosis, 91 00:08:41,170 --> 00:08:44,310 that's gonna have some unique flavors to it. 92 00:08:44,320 --> 00:08:46,920 So the neurologic foundation, 93 00:08:47,150 --> 00:08:50,640 the criteria are met in both individuals, 94 00:08:50,640 --> 00:08:54,820 but they can be met with a different pattern of features. 95 00:08:56,970 --> 00:09:10,420 It is not true that individuals with seven criteria met have more significant impact in their daily life than someone where five criteria are met. 96 00:09:10,430 --> 00:09:14,930 This does not have to do with how much someone is impacted. 97 00:09:14,940 --> 00:09:18,930 It just has to do with the breadth of the neurologic features. 98 00:09:18,940 --> 00:09:19,650 Um, 99 00:09:19,650 --> 00:09:23,630 some of which will really be beneficial to that individual. 100 00:09:23,630 --> 00:09:29,230 They'll help in their daily life and other things that will be challenges. 101 00:09:29,240 --> 00:09:31,950 But the number of criteria, 102 00:09:31,960 --> 00:09:34,730 those do not determine, 103 00:09:35,040 --> 00:09:35,860 uh, 104 00:09:35,870 --> 00:09:38,580 what some people call quote severity, 105 00:09:38,590 --> 00:09:39,430 um, 106 00:09:39,440 --> 00:09:40,530 of autism. 107 00:09:40,530 --> 00:09:44,900 A lot of people who come for a diagnosis want information about, 108 00:09:44,910 --> 00:09:46,250 about severity. 109 00:09:46,250 --> 00:09:47,980 And that's not what we're talking about. 110 00:09:47,980 --> 00:09:50,670 We're talking about pattern because, 111 00:09:50,670 --> 00:09:51,040 you know, 112 00:09:51,040 --> 00:10:00,890 it's so important to understand each person as an individual and it's not enough to go for a diagnosis and then be told, 113 00:10:00,890 --> 00:10:01,070 well, 114 00:10:01,070 --> 00:10:02,220 yes or no, 115 00:10:02,230 --> 00:10:06,230 you fit the criteria or you don't really, 116 00:10:06,230 --> 00:10:09,880 what you're coming for is revelation of this pattern. 117 00:10:09,890 --> 00:10:10,410 Well, 118 00:10:10,410 --> 00:10:12,530 what does this look like in me? 119 00:10:13,080 --> 00:10:15,650 How does this impact my daily life? 120 00:10:15,660 --> 00:10:20,510 What are my strengths and challenges within this neural neurologic pattern. 121 00:10:20,520 --> 00:10:23,000 And that's where the gold is. 122 00:10:23,000 --> 00:10:24,540 That's where the spectrum is. 123 00:10:24,540 --> 00:10:31,020 That's where self awareness and understanding lie in this revelation of pattern. 124 00:10:32,630 --> 00:10:36,580 In addition to the pattern across the seven criteria, 125 00:10:36,580 --> 00:10:40,920 we also want to look at the pattern within each criteria. 126 00:10:40,930 --> 00:10:43,400 So there are different layers of pattern. 127 00:10:43,410 --> 00:10:49,880 Let's say someone meets the same five criteria that another person meets, 128 00:10:49,890 --> 00:10:55,400 but they can still meet each individual criteria with unique features. 129 00:10:55,400 --> 00:10:57,470 So let's take this and talk about it. 130 00:10:58,250 --> 00:10:59,320 For example, 131 00:10:59,320 --> 00:11:01,730 let's take the first criteria. 132 00:11:01,740 --> 00:11:14,400 And this has to do with difficulty in the area of social approach social reciprocity and the back and forth flow of conversation during social interactions. 133 00:11:14,410 --> 00:11:19,560 And usually this criteria is called the social reciprocity criteria. 134 00:11:19,560 --> 00:11:22,450 And reciprocity means exchange. 135 00:11:22,720 --> 00:11:32,010 Um so what we're looking for here is not whether someone can exchange information about topics and facts, 136 00:11:32,020 --> 00:11:42,360 but whether they lean toward being able to exchange information for social purposes for emotional purposes and to take turns. 137 00:11:42,360 --> 00:11:48,010 So there's kind of an equal exchange um in connecting with another person, 138 00:11:48,750 --> 00:11:56,920 one autistic individual may meet this criteria because he rarely approaches others at all for any kind of social exchange. 139 00:11:56,920 --> 00:11:58,600 So this approach, 140 00:11:58,600 --> 00:12:05,060 piece of the criteria may be very limited when he does approach, 141 00:12:05,070 --> 00:12:09,500 he really only wants answers to questions directly asked. 142 00:12:09,510 --> 00:12:14,530 Um or he will uh answer a question if somebody else asks it, 143 00:12:14,530 --> 00:12:18,300 but he basically exchanges facts and data, 144 00:12:18,300 --> 00:12:24,170 but he doesn't really fully engage in exchanging social and emotional information? 145 00:12:25,480 --> 00:12:26,320 For example, 146 00:12:26,320 --> 00:12:30,020 if someone is explaining why they're looking forward to christmas, 147 00:12:30,110 --> 00:12:43,450 this autistic individual may say something like uh huh rather than really fully engaging in that social peace um or saying something like I've always loved christmas too. 148 00:12:43,450 --> 00:12:45,730 What's your favorite christmas tradition? 149 00:12:48,100 --> 00:12:54,750 In contrast to the autistic individual who does not tend to approach or engage socially, 150 00:12:54,760 --> 00:13:05,020 another individual may do so to really an extreme level a level that does not create good social exchange because it's done too frequently. 151 00:13:05,440 --> 00:13:22,480 This individual may respond to the Christmas comment by talking in a monologue for 15 minutes about the differences in Christmas traditions across the world and the impact of Pagan practices and celebrations on current Christmas traditions. 152 00:13:23,220 --> 00:13:32,830 Now the first and the second individual both struggle to appropriately exchange the social piece of interaction, 153 00:13:32,840 --> 00:13:43,820 one because of infrequent exchange and the other because of too much approach and exchange and too much talking, 154 00:13:43,830 --> 00:13:48,480 not taking turns and asking for the other person's input. 155 00:13:48,830 --> 00:13:58,720 Um and really allowing there to be the social emotional piece instead of uh kind of a large exchange of factual information. 156 00:13:59,610 --> 00:14:03,980 So this is an example of the pattern within a criteria. 157 00:14:03,990 --> 00:14:08,210 Um so it can look unique from person to person on the spectrum. 158 00:14:09,510 --> 00:14:15,750 Another example of an internal pattern within a criteria would be the 7th criteria, 159 00:14:15,750 --> 00:14:18,770 which is about sensory processing. 160 00:14:19,570 --> 00:14:24,090 Now this criteria does not have to be present for a diagnosis, 161 00:14:24,100 --> 00:14:25,740 but when it is present, 162 00:14:25,740 --> 00:14:33,030 the pattern may be one of high levels of reactivity to sensory information. 163 00:14:33,040 --> 00:14:34,040 So this could be, 164 00:14:34,040 --> 00:14:35,280 for example, 165 00:14:35,290 --> 00:14:40,650 someone that's really very sensitive to touch or light. 166 00:14:41,510 --> 00:14:46,490 It could be a pattern of under reactivity to sensory information. 167 00:14:46,490 --> 00:14:51,480 So when they experience something from the sensory environment, 168 00:14:51,480 --> 00:14:54,920 they just don't notice it as much as other people would. 169 00:14:55,990 --> 00:15:02,420 And it could also include an unusual fascination with sensory aspects of the environment. 170 00:15:02,430 --> 00:15:09,640 So really loving to watch visual movement or to smell certain objects, 171 00:15:09,640 --> 00:15:11,820 that this sensation, 172 00:15:11,820 --> 00:15:15,280 this part of the environment is really fascinating. 173 00:15:16,970 --> 00:15:22,140 So one autistic individual may show extreme sensitivity to sound, 174 00:15:22,160 --> 00:15:29,380 a very narrow range of food textures in their diet and an extreme need for high levels of movement. 175 00:15:29,390 --> 00:15:32,160 This vestibular sensory process, 176 00:15:32,750 --> 00:15:38,960 but a second individual may show a different pattern within sensory processing. 177 00:15:38,990 --> 00:15:52,780 So they might show a very high pain tolerance that they don't even notice that their finger was broken until they realized they couldn't hold a pencil to complete a form even though the injury occurred the day before. 178 00:15:54,100 --> 00:16:06,330 Ah This person may also be highly sensitive to movement to the point where they'd rather sit still and do table work than moving around or playing sports or going outside. 179 00:16:07,400 --> 00:16:11,110 So even though people meet the same criteria, 180 00:16:11,120 --> 00:16:13,870 they certainly may meet those in different ways. 181 00:16:13,880 --> 00:16:17,660 And that individual pattern is really important. 182 00:16:19,780 --> 00:16:23,310 Given these examples of patterns across the criteria, 183 00:16:23,310 --> 00:16:24,210 for example, 184 00:16:24,220 --> 00:16:25,930 how many are met, 185 00:16:25,940 --> 00:16:28,290 what pattern of criteria are met. 186 00:16:28,300 --> 00:16:30,900 and also within each criteria. 187 00:16:30,910 --> 00:16:35,070 What do the specific sensory differences look like for this individual? 188 00:16:35,070 --> 00:16:36,160 For example, 189 00:16:36,170 --> 00:16:39,700 you can get a sense of what spectrum can look like. 190 00:16:40,080 --> 00:16:43,510 So this is how I view the term spectrum, 191 00:16:43,520 --> 00:16:53,160 I really don't find it useful uh as any kind of um continuum of what people would call severity. 192 00:16:53,170 --> 00:17:01,590 Um but rather spectrum is a way of knowing that the same neurologic criteria are met for all of these individuals, 193 00:17:01,590 --> 00:17:05,900 but the specific neurologic manifestations, 194 00:17:05,900 --> 00:17:27,550 the way that this neurology manifests will vary from person to person and that level of individual insight with people that's so important to um kind of reveal that it's not enough just to have a global uh term that we're going to call things, 195 00:17:27,550 --> 00:17:30,920 we really want to know people on an individual level, 196 00:17:31,700 --> 00:17:59,240 it makes more sense to look at how much struggle someone's having based on a pattern rather than the number of characteristics or to analyze how they are so gifted in this particular academic subject or this particular part of work or life um life skills and ways that that is a manifestation of their unique neurology. 197 00:17:59,740 --> 00:18:03,370 So whether we're looking at struggles or gifts, 198 00:18:03,380 --> 00:18:05,820 challenges or strengths, 199 00:18:05,830 --> 00:18:17,830 we like to know the pattern this person has both and in a unique pattern that's different than this next person that we see on the spectrum. 200 00:18:18,990 --> 00:18:25,150 When we're able to examine what the pattern of neurologic features are for one specific person, 201 00:18:25,170 --> 00:18:30,620 then we can work towards increased self awareness of pattern for that individual, 202 00:18:30,620 --> 00:18:32,320 maybe for family around them, 203 00:18:32,320 --> 00:18:41,050 who want to understand better but feel confused and to focus on strategies that may specifically address um, 204 00:18:41,060 --> 00:18:43,760 the strengths and challenges of this person. 205 00:18:43,770 --> 00:18:44,350 You know, 206 00:18:44,350 --> 00:18:59,260 how can we amplify the things that they're just so strong in and how can we help with things that are challenges or things that are draining and really making some of life more difficult than we wanted to be? 207 00:19:01,350 --> 00:19:01,910 Part of. 208 00:19:01,910 --> 00:19:05,310 What I think is most valuable about the diagnostic process. 209 00:19:05,320 --> 00:19:12,370 Is this kind of feedback from the clinician to the individual about not just yes or no, 210 00:19:12,370 --> 00:19:13,620 Is there a diagnosis, 211 00:19:13,620 --> 00:19:16,520 but what does autism look like in me? 212 00:19:16,520 --> 00:19:18,090 How is that manifest? 213 00:19:18,100 --> 00:19:23,040 And oftentimes people coming in for a diagnosis will know some of that, 214 00:19:23,070 --> 00:19:26,580 but the clinician should be skilled enough to say. 215 00:19:27,250 --> 00:19:29,300 And I also see this in you. 216 00:19:29,310 --> 00:19:39,850 I see that this pattern in your nervous system likes this and I'm wondering about this issue here so that there's more revelation about pattern. 217 00:19:39,860 --> 00:19:42,320 It's more um identified. 218 00:19:42,320 --> 00:19:43,550 It's more specific. 219 00:19:43,550 --> 00:19:44,760 It's clearer. 220 00:19:44,770 --> 00:19:49,990 Um and that is part of what makes the assessment process so valuable. 221 00:19:52,040 --> 00:20:01,220 Let's end with a few more examples just to highlight what I mean by pattern and differences between two individuals on the spectrum. 222 00:20:02,860 --> 00:20:06,220 So let's take Julio who is a 50 year old male. 223 00:20:06,220 --> 00:20:10,250 He's working as a structural engineer for a local company, 224 00:20:10,260 --> 00:20:11,740 he's married to Mona, 225 00:20:11,740 --> 00:20:17,960 they have three daughters and the last of their daughters has just moved out to attend college. 226 00:20:17,960 --> 00:20:22,190 So they are in this early empty nest season. 227 00:20:22,200 --> 00:20:37,880 Life is changing and Mona really starts to spend quite a bit of time alone with Julio when he's not at work and she brings him in to see a psychologist because she feels that Julio is depressed. 228 00:20:39,410 --> 00:20:42,170 Mona notes that with her Children gone, 229 00:20:42,170 --> 00:20:48,180 she's really struck by how limited Julio converses with her at home. 230 00:20:48,230 --> 00:20:52,540 It's very quiet now and she can't really get much out of him. 231 00:20:52,550 --> 00:20:55,160 He's likely to come home after work, 232 00:20:55,170 --> 00:20:55,820 eat dinner, 233 00:20:55,820 --> 00:21:03,320 go to the basement to work on his tabletop Battle replicas most recently highlighting the Battle of the Bulge, 234 00:21:03,330 --> 00:21:05,780 a famous battle from World War Two. 235 00:21:06,680 --> 00:21:17,480 Now when she invites him to watch a tv show with her after dinner instead he'll sit in the rocking chair and watch the show but does not like to talk or a visit during the program. 236 00:21:18,330 --> 00:21:29,330 His facial expressions and tone of voice is either serious or really kind of flat or empty of emotion and she has a hard time gauging what he's thinking. 237 00:21:29,940 --> 00:21:42,740 She's used to the more energetic conversations that she would have with her daughters and she concludes that Julio is depressed during this life season of change. 238 00:21:42,750 --> 00:21:47,890 He's thinking about uh Retirement in the next 10 years. 239 00:21:47,890 --> 00:21:52,390 He is with Mona now in an empty nest. 240 00:21:52,390 --> 00:22:00,960 And she hypothesizes since he doesn't talk very much that his thought process has to do with depressed mood. 241 00:22:04,120 --> 00:22:04,420 Now. 242 00:22:04,420 --> 00:22:08,970 We didn't talk about all the autistic characteristics in Julio, 243 00:22:08,970 --> 00:22:13,230 but you can get a flavor of how this is manifest in their home. 244 00:22:14,330 --> 00:22:15,340 In contrast, 245 00:22:15,340 --> 00:22:18,150 let's take Maddie who was a 27 year old, 246 00:22:18,150 --> 00:22:19,040 single female. 247 00:22:19,040 --> 00:22:24,490 She has no Children and she has always loved to be the center of attention. 248 00:22:24,620 --> 00:22:31,860 She's put on plays and music performances for her family as a child and then she focused on magic tricks. 249 00:22:31,870 --> 00:22:33,350 When she was in middle school. 250 00:22:33,350 --> 00:22:35,690 She really wanted to wow everyone. 251 00:22:36,940 --> 00:22:46,320 And what became apparent is that she really liked to have the role of an entertainer and she liked to have an audience. 252 00:22:46,330 --> 00:22:51,330 Um that could see all of her gifts and talents. 253 00:22:52,760 --> 00:22:57,100 She also liked to take control of the topics of conversation, 254 00:22:57,110 --> 00:23:00,760 so making sure that it's something she's really interested in, 255 00:23:00,760 --> 00:23:05,910 like greek mythology or sewing costumes for theater or cosplay events. 256 00:23:05,940 --> 00:23:10,560 She has a hard time understanding how she impacts others. 257 00:23:10,570 --> 00:23:23,570 What does this person need from me during the interaction and some people feel like maybe she's really controlling because she likes things to go her own way and doesn't care about other people. 258 00:23:24,350 --> 00:23:26,980 But this is really a misunderstanding. 259 00:23:26,990 --> 00:23:34,850 She feels comfortable in a specific social role and she also likes to know what's going to happen next. 260 00:23:34,860 --> 00:23:42,400 So she likes to choose the activities that they do together or the topics that they're talking about. 261 00:23:43,580 --> 00:23:44,760 She over plans, 262 00:23:44,760 --> 00:23:49,660 vacations with family and will hand out a schedule of activities to everyone. 263 00:23:50,470 --> 00:23:55,050 She'll leave the room of someone who wants to talk about their own interests. 264 00:23:55,110 --> 00:23:57,390 And even though she talks successively, 265 00:23:57,390 --> 00:24:02,890 she also complains about noises that other people make when they talk. 266 00:24:02,900 --> 00:24:03,610 Uh, 267 00:24:03,620 --> 00:24:09,510 so she wants people to be quiet and people around her are very confused, 268 00:24:09,520 --> 00:24:14,510 like how can you talk so much and also want us to be quiet. 269 00:24:14,520 --> 00:24:25,900 But that's a very common phenomenon and sensory processing that the person is much more upset by surrounding noise than their own noise. 270 00:24:26,770 --> 00:24:27,950 She wears noise, 271 00:24:27,950 --> 00:24:35,240 canceling headphones around others and people feel because of this pattern that she's very self absorbed. 272 00:24:35,250 --> 00:24:35,850 They really, 273 00:24:35,850 --> 00:24:38,130 she's misunderstood essentially. 274 00:24:38,140 --> 00:24:38,970 Um, 275 00:24:38,980 --> 00:24:42,220 she doesn't ask other people how they're doing or what they need, 276 00:24:42,220 --> 00:24:47,180 how their weakened was she often corrects others when they make errors of detail, 277 00:24:47,180 --> 00:24:52,390 like saying something cost $50 when it actually cost 50-37. 278 00:24:54,170 --> 00:24:59,050 So both of these people did not realize their diagnosis. 279 00:24:59,060 --> 00:25:00,200 Uh, 280 00:25:00,210 --> 00:25:02,660 and then at a certain age in life, 281 00:25:02,660 --> 00:25:16,060 they were given a diagnosis and the information about their neurology helped them understand and those around them what, 282 00:25:16,070 --> 00:25:19,890 how the neurology manifest both in things, 283 00:25:19,890 --> 00:25:35,260 they were really good at the things that were gifts that were strengths and also things that were characteristics that they didn't intend to isolate themselves from anyone or hurt anyone's feelings, 284 00:25:35,260 --> 00:25:41,360 but they really just had different needs socially and with this increased awareness. 285 00:25:41,380 --> 00:25:46,380 People were able to understand and interact in a more satisfying way. 286 00:25:48,600 --> 00:25:52,370 So both individuals struggled to socially connect with others. 287 00:25:52,480 --> 00:25:55,800 But while Julio was under engaged with his wife, 288 00:25:55,810 --> 00:26:03,570 Maddy ended up being over engaged in her social exchanges and she wasn't as attentive to the needs of others. 289 00:26:06,110 --> 00:26:19,070 Being aware of why two autistic individuals can both meet criteria but look quote so different on casual observation can help us connect with the concept of spectrum. 290 00:26:19,730 --> 00:26:35,570 We also can become more aware of why one autistic individual may benefit from one thing as a recommendation while another needs something different that we have this unique patterning and that part is very important. 291 00:26:37,410 --> 00:26:43,370 There are the same neurologic foundations but with different specifics in the characteristics. 292 00:26:45,380 --> 00:26:52,180 So whether we're talking about an autistic individual who is really self aware, 293 00:26:52,190 --> 00:27:18,730 who has strategies that really help them during rough spots and who is able to focus and use their strengths to great advantage and to um really meet their goals and to help others or if we're talking about someone who is not diagnosed or newly diagnosed and still learning this concept of the individual pattern, 294 00:27:18,830 --> 00:27:30,720 The individual spectrum of qualities really is an important revelation to focus on understanding each individual because that's where the power is right. 295 00:27:30,730 --> 00:27:31,860 I see you, 296 00:27:31,860 --> 00:27:32,830 I hear you, 297 00:27:32,830 --> 00:27:34,660 I get you better. 298 00:27:34,660 --> 00:27:36,570 I think we can connect more. 299 00:27:36,580 --> 00:27:37,320 Um, 300 00:27:37,330 --> 00:27:42,870 that's really the magic about thinking about pattern within the spectrum. 301 00:27:44,960 --> 00:27:50,120 I am really glad you joined me to hear about pattern and spectrum today within autism. 302 00:27:50,750 --> 00:27:58,820 And next time we'll be starting a new series and we're going to focus on misdiagnosis on the autism spectrum. 303 00:27:59,790 --> 00:28:05,180 In addition to those who are on the spectrum who don't carry any diagnosis, 304 00:28:05,190 --> 00:28:09,880 many others carry a misdiagnosis or several, 305 00:28:09,890 --> 00:28:10,580 um, 306 00:28:10,580 --> 00:28:13,440 diagnoses that really are not correct. 307 00:28:13,450 --> 00:28:17,280 And often this is within areas of mental health. 308 00:28:17,910 --> 00:28:21,930 So we're going to start by talking about why this occurs on the spectrum. 309 00:28:21,940 --> 00:28:30,680 And then we're going to review various conditions that are common culprits for misdiagnosis such as borderline personality disorder, 310 00:28:30,690 --> 00:28:32,030 bipolar disorder, 311 00:28:32,040 --> 00:28:33,870 attention deficit and more. 312 00:28:34,430 --> 00:28:38,200 I hope you'll join me for our next series on misdiagnosis. 313 00:28:38,210 --> 00:28:39,740 And thanks for tuning in.  

Join Dr. Regan for the second Q and A episode in which she answers listener questions related to CBT therapy, parenting, autism in the workplace, non epileptic seizures, and exercise goals Topics covered in this episode --  askjan.org Workplace Accommodations Time Timers. Link to physical timer here or you can search app stores for Time Timers Regan blog post on non-epileptic seizures Virtual Fitness Challenges Dysregulation podcast series, episode 1 Momentum for Activities podcast series, episode 1   Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the episode transcript here:   2 00:00:02,540 --> 00:00:05,950 Hello and welcome. 3 00:00:05,960 --> 00:00:08,180 This is Dr Theresa Regan. 4 00:00:08,190 --> 00:00:10,560 I'm a neuropsychologist, 5 00:00:10,570 --> 00:00:18,350 a certified autism specialist and the director of an adult diagnostic autism clinic in central Illinois. 6 00:00:18,940 --> 00:00:20,810 I am the author of books, 7 00:00:20,820 --> 00:00:25,260 a speaker and your host for autism in the adult podcast. 8 00:00:26,430 --> 00:00:32,120 Today we're going to continue our question and answer series. 9 00:00:32,120 --> 00:00:33,750 It's kind of a mini series. 10 00:00:33,750 --> 00:00:41,480 This is number two and will be our final part of the question and answer episodes for a bit of time. 11 00:00:41,480 --> 00:00:44,720 We're going to pause on those and in the future. 12 00:00:44,720 --> 00:00:47,260 We will bring back some more episodes. 13 00:00:49,040 --> 00:00:56,260 Today's questions that I'm going to be answering from listeners across the world 15 00:00:57,200 --> 00:00:59,070 are a little eclectic. 16 00:00:59,070 --> 00:01:03,760 So we're just gonna go through various topics and respond to those. 18 00:01:05,040 --> 00:01:11,950 the first question I'm going to tackle is about CBT therapy for those on the spectrum. 19 00:01:11,950 --> 00:01:16,340 And this stands for cognitive behavioral therapy. 20 00:01:16,350 --> 00:01:17,310 Um, 21 00:01:17,320 --> 00:01:33,160 what this refers to is a talk therapy where the individual in the sessions works with a therapist to identify their inner state and their outer state. 22 00:01:33,160 --> 00:01:38,050 So what are my thoughts and feelings and what are my behaviors? 23 00:01:38,440 --> 00:01:43,850 And those three things are linked sometimes they'll add kind of 1/4 category, 24 00:01:43,850 --> 00:01:48,350 which is what am I feeling physically in the moment. 25 00:01:48,940 --> 00:01:49,560 Um, 26 00:01:50,340 --> 00:01:59,600 so the basis of this therapy is to realize that when we feel angry or afraid, 27 00:01:59,610 --> 00:02:00,570 um, 28 00:02:00,580 --> 00:02:09,860 that a lot of times there are thoughts that we have our beliefs that we have that kind of trigger or feed into. 29 00:02:10,240 --> 00:02:11,050 Um, 30 00:02:11,740 --> 00:02:16,260 this outcome of having an emotion that feels difficult. 31 00:02:16,840 --> 00:02:17,580 So, 32 00:02:17,590 --> 00:02:27,910 if I am really believing and thinking in my head that nothing ever goes right for me. 33 00:02:28,180 --> 00:02:31,350 And let's say I have a flat tire on the way to work. 34 00:02:31,740 --> 00:02:33,220 And um, 35 00:02:33,230 --> 00:02:45,370 I just feel so discouraged and hopeless and I'm not really sure why it hit me that much that a flat tire would do that Well. 36 00:02:45,370 --> 00:02:47,060 In this type of therapy, 37 00:02:47,070 --> 00:02:49,270 the therapist would help the person say, 38 00:02:49,270 --> 00:02:49,510 well, 39 00:02:49,510 --> 00:02:54,580 what kinds of things were you thinking related to that emotion? 40 00:02:54,590 --> 00:03:03,520 So the person is trying to train themselves to become more aware of the thoughts that were linked with that emotion of hopelessness. 41 00:03:04,450 --> 00:03:05,930 And you know, 42 00:03:05,930 --> 00:03:10,530 maybe they realize that they are saying to themselves, 43 00:03:10,530 --> 00:03:14,780 this internal mantra of things are never going to get better. 44 00:03:14,790 --> 00:03:17,370 Nothing happens. 45 00:03:17,380 --> 00:03:18,300 Um, 46 00:03:18,310 --> 00:03:19,900 to give me a break, 47 00:03:19,910 --> 00:03:21,450 nothing goes right for me. 48 00:03:22,040 --> 00:03:22,960 So then, 49 00:03:22,970 --> 00:03:23,370 you know, 50 00:03:23,370 --> 00:03:28,280 the person can then challenge those thoughts and they can say, 51 00:03:28,280 --> 00:03:28,870 well, 52 00:03:28,880 --> 00:03:33,460 is it 100% true that nothing ever goes right for you? 53 00:03:33,940 --> 00:03:41,040 And it's not really that the therapy teaches you to replace negative thoughts with positive thoughts. 54 00:03:41,050 --> 00:03:45,590 It's that it teaches you to replace um, 55 00:03:45,600 --> 00:03:50,250 really skewed thoughts to be more realistic thoughts. 56 00:03:50,740 --> 00:03:53,640 So instead of nothing ever goes right for me, 57 00:03:53,650 --> 00:03:58,420 the therapist would challenge you to get a more realistic statement. 58 00:03:58,420 --> 00:03:58,790 And, 59 00:03:58,800 --> 00:04:09,030 and maybe the statement that you come up with is boy having a flat tire really is not what I wished would happen today. 60 00:04:09,040 --> 00:04:10,650 It is an inconvenience. 61 00:04:11,140 --> 00:04:11,570 Um, 62 00:04:11,580 --> 00:04:17,960 it will pass and there actually have been several good things that have happened lately as well, 63 00:04:17,970 --> 00:04:22,130 so that would be kind of this more realistic thought, 64 00:04:22,140 --> 00:04:32,290 which then affects our emotion to be one of more kind of mild discouragement without a tail spin down into a more despondent state. 65 00:04:35,940 --> 00:04:45,560 The listener was asking whether this approach to therapy can um, 66 00:04:46,840 --> 00:05:00,160 kind of treat the person as a collection of symptoms without a psyche and um being more of a person who's conditioned than behaviorally conditioned um, 67 00:05:00,540 --> 00:05:02,360 in their life experience. 68 00:05:03,640 --> 00:05:04,430 So, 70 00:05:05,010 --> 00:05:12,840 what I would say to that is that it's really quite a bit more complex than just behavioral conditioning. 71 00:05:12,840 --> 00:05:13,800 I know that, 72 00:05:13,810 --> 00:05:14,120 you know, 73 00:05:14,120 --> 00:05:18,600 if you studied skinner or read things about Pavlov's dog, 74 00:05:18,610 --> 00:05:20,400 you can get um, 75 00:05:20,410 --> 00:05:25,150 certainly a pretty extreme view of what conditioning um, 76 00:05:25,930 --> 00:05:27,380 kind of is made up of, 77 00:05:27,390 --> 00:05:41,760 but the CBT therapy really focuses more on helping you identify thought patterns and behavioral patterns that are just not very healthy to your well being and then adjusting those. 78 00:05:42,340 --> 00:05:42,960 Um, 79 00:05:43,420 --> 00:05:45,010 the listener was asking whether, 80 00:05:45,010 --> 00:05:55,260 I think this is a good um type of talk counseling for someone on the autism spectrum. 81 00:05:55,840 --> 00:05:59,050 So what happens is um, 82 00:05:59,440 --> 00:06:04,150 in the therapeutic world CBT is often um, 83 00:06:04,540 --> 00:06:07,140 it's really often recommended for everything. 84 00:06:07,150 --> 00:06:07,980 Um, 85 00:06:08,010 --> 00:06:12,660 it's considered a gold standard in various ways. 86 00:06:13,140 --> 00:06:19,350 Um insurance companies think highly of it and will reimburse for it. 87 00:06:20,240 --> 00:06:20,940 Um, 88 00:06:20,950 --> 00:06:22,010 in reality, 89 00:06:22,010 --> 00:06:25,740 when therapists use CBT therapy, 90 00:06:25,750 --> 00:06:32,090 they're probably mixing in a bit more eclectic approaches um, 91 00:06:32,100 --> 00:06:35,490 with regard to autism. 92 00:06:35,500 --> 00:06:39,460 I know there's even at least one book about CBT and autism, 93 00:06:40,040 --> 00:06:49,860 I I use it um intermittently with some of my clients as a piece of what we're layering in, 94 00:06:50,340 --> 00:06:57,530 but I would say it's not even making up 50% of maybe the approach that I would take. 95 00:06:57,540 --> 00:07:14,260 And my concern with it is this that it's really based on the premise that if we teach someone to retrain their thoughts that they will have a different thought and that then, 96 00:07:14,530 --> 00:07:14,960 you know, 97 00:07:14,960 --> 00:07:21,760 this will relieve their anxiety or this will relieve the depression that they're struggling with. 98 00:07:22,140 --> 00:07:25,410 And I think there's some value to that. 99 00:07:25,420 --> 00:07:44,910 Um my concern about using this and autism is that it doesn't really acknowledge that we're talking about a neurologic base and if you're assuming that you can shift every area of distress in a person's life by just having them think differently. 100 00:07:44,920 --> 00:07:45,470 Um, 101 00:07:45,480 --> 00:07:47,860 I think it really kind of sets up, 102 00:07:48,740 --> 00:07:49,660 um, 103 00:07:51,240 --> 00:08:01,150 expectations that aren't very realistic just by teaching someone to have a different intellectual thought. 104 00:08:01,840 --> 00:08:02,520 So, 105 00:08:02,530 --> 00:08:23,300 the neurology of our intellect and what we know as facts doesn't always hang together with that neurology of experience and what I can pull off in my daily life and there can be this great disconnect that's kind of enhanced in neurologic conditions where, 106 00:08:23,310 --> 00:08:24,110 yeah, 107 00:08:24,120 --> 00:08:31,580 I intellectually know but my nervous system is responding differently. 108 00:08:31,580 --> 00:08:42,760 It's still very heightened in its responses. It still overreacts to sound, you know... it still becomes overwhelmed in crowds... and changing the way I think about 109 00:08:42,760 --> 00:08:52,860 It is not going to be as effective as it might for you know the client with my other example I have a neuro typical neurology. 110 00:08:53,340 --> 00:09:00,290 I tend to think extreme negative thoughts about myself and my circumstance and I happen to have a flat tire. 111 00:09:00,300 --> 00:09:17,560 Well that's different than the student who um can't tolerate being in the school building because it's so neurologically overwhelming and asking them to think differently about how overwhelming it is I think would be inappropriate. 112 00:09:18,040 --> 00:09:22,060 So an example of looking at cognitive distortions and C. 113 00:09:22,060 --> 00:09:22,340 B. 114 00:09:22,350 --> 00:09:22,860 T. 115 00:09:22,860 --> 00:09:32,950 Therapy would be for example that a therapist might point out to a client that they have black and white thinking. 116 00:09:33,540 --> 00:09:42,140 So this experience was all bad and this experience was all good and that's not really capturing reality very well. 117 00:09:42,150 --> 00:09:48,960 So let's think of something that's really um not all good or all bad but in the middle. 118 00:09:49,340 --> 00:09:58,320 Well in the autistic client that's a bit of a problem because their neurology does lean toward black and white thinking or categorical thinking. 119 00:09:58,330 --> 00:10:00,150 Uh this is all good. 120 00:10:00,150 --> 00:10:23,670 This is all bad or this was a success and this was a failure and there are degrees to which individuals with the autistic neurology can consider more abstract and complicated kinds of um beliefs and thoughts but in general that's going to be very likely neurologically difficult. 121 00:10:23,680 --> 00:10:25,840 And so when you get in that area, 122 00:10:25,850 --> 00:10:36,910 it's kind of like sending someone to change their thought process uh to help them see colors better. 123 00:10:36,920 --> 00:10:37,860 So, 124 00:10:37,870 --> 00:10:38,660 um, 125 00:10:38,670 --> 00:10:41,160 you're not very good at color recognition. 126 00:10:41,160 --> 00:10:51,860 We're gonna examine all your thoughts and try to get you back on track with your peers when in actuality this person is color blind. 127 00:10:52,140 --> 00:10:52,480 Well, 128 00:10:52,480 --> 00:10:56,310 you're not going to improve color blindness with cognitive behavioral therapy. 129 00:10:56,640 --> 00:11:01,160 You're not going to improve diabetes with cognitive behavioral therapy. 130 00:11:01,170 --> 00:11:11,180 You may be able to work on some of their thoughts about their health, the way they react and engage in diet and that kind of thing. 131 00:11:11,180 --> 00:11:13,460 But um, 132 00:11:13,840 --> 00:11:14,240 you know, 133 00:11:14,240 --> 00:11:16,880 I think if we're using cognitive behavioral therapy, 134 00:11:16,880 --> 00:11:19,860 we should be very aware of its strengths. 135 00:11:20,240 --> 00:11:20,750 Again, 136 00:11:20,750 --> 00:11:26,490 I do use that at times and then also its limitations within different um, 137 00:11:26,500 --> 00:11:27,730 patient groups. 138 00:11:27,740 --> 00:11:30,960 So that would be my thought about that. 139 00:11:31,740 --> 00:11:38,660 So I would focus more in therapy on helping people recognize their neurologic patterns, 140 00:11:38,660 --> 00:11:40,500 increasing that self awareness, 141 00:11:40,510 --> 00:11:46,430 creating strategies that will help the neurology kind of move forward in those areas. 142 00:11:46,430 --> 00:11:50,540 So what are strategies that you can calm your nervous system with? 143 00:11:50,550 --> 00:11:51,450 For example, 144 00:11:53,140 --> 00:11:54,760 that was a great question. 145 00:11:54,760 --> 00:11:56,050 I appreciate that. 146 00:11:57,340 --> 00:11:57,730 Um, 147 00:11:57,730 --> 00:12:01,560 I also had a question from a mother who asked, 148 00:12:02,140 --> 00:12:03,010 um, 149 00:12:03,020 --> 00:12:03,870 you know, 150 00:12:03,880 --> 00:12:18,360 what could I do when my young adult child with a diagnosis is really resisting talking about autism and feeling categorized and kind of pigeonholed. 151 00:12:18,940 --> 00:12:19,480 Um, 152 00:12:19,490 --> 00:12:28,260 if that discussion comes up feeling sick of everything being described through the autistic lens and therefore dehumanized. 153 00:12:30,040 --> 00:12:33,060 So this is such an individualized, 154 00:12:33,840 --> 00:12:34,950 um, 155 00:12:34,960 --> 00:12:36,490 internal state, 156 00:12:36,500 --> 00:12:36,900 right? 157 00:12:36,900 --> 00:12:42,750 We all have kind of different reactions of what we can take in and process how we feel about things. 158 00:12:43,140 --> 00:12:49,760 And essentially this person seems to be saying that they don't really feel seen and heard. 159 00:12:50,140 --> 00:12:50,700 Um, 160 00:12:50,700 --> 00:12:52,660 and that's an awful feeling. 161 00:12:53,240 --> 00:12:53,790 Um, 162 00:12:53,800 --> 00:12:56,360 even if people around them feel like, 163 00:12:56,360 --> 00:12:56,770 yes, 164 00:12:56,770 --> 00:12:57,870 I do see you. 165 00:12:57,870 --> 00:12:58,980 I do hear you. 166 00:12:58,990 --> 00:13:00,100 Um, 167 00:13:00,110 --> 00:13:00,650 you know, 168 00:13:00,650 --> 00:13:03,460 that internal feeling is still difficult. 169 00:13:05,440 --> 00:13:17,160 I think the best outcomes usually are when we allow people the freedom and space to process things differently than we are. 170 00:13:17,540 --> 00:13:18,140 Um, 171 00:13:18,150 --> 00:13:20,450 I have to say that I don't, 172 00:13:20,940 --> 00:13:21,740 um, 173 00:13:21,750 --> 00:13:22,260 you know, 174 00:13:22,260 --> 00:13:36,940 listeners who've been with me for a while probably know that I have an adolescent son on the spectrum and I have to say that I don't really talk about autism that much at home as far as using that word. 175 00:13:36,950 --> 00:13:39,600 So maybe this will help. 176 00:13:39,610 --> 00:13:40,240 Um, 177 00:13:40,250 --> 00:13:45,220 I don't think we have to bring up the term all the time, 178 00:13:45,230 --> 00:13:46,790 but um, 179 00:13:46,790 --> 00:13:49,910 it certainly is something people are free to talk about. 180 00:13:49,910 --> 00:13:51,350 So we give them that freedom. 181 00:13:51,540 --> 00:13:55,000 But what we tend to talk about more in our household is, 182 00:13:55,240 --> 00:13:55,570 you know, 183 00:13:55,570 --> 00:13:57,030 what do you need today? 184 00:13:57,040 --> 00:13:58,780 What does your system need? 185 00:13:58,790 --> 00:14:01,590 And I talk about what my system needs. 186 00:14:01,590 --> 00:14:02,550 And then I ask, 187 00:14:02,550 --> 00:14:02,780 you know, 188 00:14:02,780 --> 00:14:03,520 my husband, 189 00:14:03,520 --> 00:14:03,870 how, 190 00:14:03,880 --> 00:14:05,740 how have things gone for you, 191 00:14:05,740 --> 00:14:06,590 what do you need? 192 00:14:06,600 --> 00:14:20,600 And we try to learn that kind of talk as a family and what my son needs is going to be different than what my husband needs and what I need just because we're individuals and his individuality, 193 00:14:20,610 --> 00:14:23,730 My son's includes the autistic neurology. 194 00:14:23,730 --> 00:14:25,410 It also includes other things. 195 00:14:25,420 --> 00:14:28,110 He's at a different season of life than I am. 196 00:14:28,120 --> 00:14:29,000 His, 197 00:14:29,010 --> 00:14:29,680 um, 198 00:14:29,680 --> 00:14:34,770 school and peer kind of demands on him are different. 199 00:14:34,780 --> 00:14:36,670 The pace of his day is different. 200 00:14:36,670 --> 00:14:38,940 His physical state is different. 201 00:14:38,940 --> 00:14:39,630 And so, 202 00:14:39,640 --> 00:14:40,250 uh, 203 00:14:40,260 --> 00:14:43,450 we kind of process it that way that, 204 00:14:43,840 --> 00:14:44,350 um, 205 00:14:44,360 --> 00:14:46,560 we're each individuals, 206 00:14:47,440 --> 00:14:47,990 um, 207 00:14:47,990 --> 00:14:57,050 and how we're doing is important and how can we work as a group to help each other get what each person needs. 208 00:14:57,540 --> 00:15:00,290 And then there will be some things that, 209 00:15:00,300 --> 00:15:00,640 you know, 210 00:15:00,640 --> 00:15:02,310 are just important to discuss. 211 00:15:02,310 --> 00:15:12,510 We can't shy away from something that's really important for their health or wellness because we don't want to process things about autism. 212 00:15:12,510 --> 00:15:13,520 But um, 213 00:15:13,520 --> 00:15:18,450 a lot of times we can just talk about each person's individuality. 214 00:15:18,450 --> 00:15:18,850 Like, 215 00:15:19,340 --> 00:15:19,720 um, 216 00:15:19,720 --> 00:15:23,660 it looks to me like you've had a really rough day, 217 00:15:24,240 --> 00:15:26,050 would it feel better to talk about it? 218 00:15:26,050 --> 00:15:27,450 Or do you need alone time? 219 00:15:28,240 --> 00:15:30,040 Or you could say, 220 00:15:30,050 --> 00:15:31,270 you know, 221 00:15:31,280 --> 00:15:33,170 we have a lot of stuff coming up, 222 00:15:33,170 --> 00:15:35,070 You've got college applications, 223 00:15:35,070 --> 00:15:37,030 You've got some job interviews. 224 00:15:37,040 --> 00:15:39,840 It's really important to nail some of this down. 225 00:15:39,850 --> 00:15:44,760 But I'm wondering whether you'd like to process that face to face, 226 00:15:44,940 --> 00:15:49,610 whether you'd like to email together about it and you can put together some thoughts. 227 00:15:50,640 --> 00:15:51,350 Um, 228 00:15:51,360 --> 00:15:51,990 you know, 229 00:15:51,990 --> 00:15:58,420 so sometimes again you can process and say this topic is kind of non negotiable, 230 00:15:58,420 --> 00:16:00,260 we have to figure something out, 231 00:16:00,940 --> 00:16:05,050 but how could we talk about this in a way that meets where you're at. 232 00:16:05,740 --> 00:16:06,530 Um, 233 00:16:06,540 --> 00:16:13,840 and also just being sure to talk about a lot of things not related to the nervous system that um, 234 00:16:13,850 --> 00:16:15,570 we give each other compliments, 235 00:16:15,570 --> 00:16:22,340 like you're really good at this and I just I wish I had your eye for detail. 236 00:16:22,340 --> 00:16:25,560 I wish I was as artistic as you are. 237 00:16:25,570 --> 00:16:29,960 I wish um I had some of the spunk that I see in you, 238 00:16:29,960 --> 00:16:39,160 I really love that and this helps them know that we are seeing them as a whole person and we do love them and value them. 239 00:16:39,640 --> 00:16:40,270 Um, 240 00:16:40,280 --> 00:16:51,660 so those can be a few ways that we can round out what you don't want to do is sometimes when someone shuts down or resist or walks away, 241 00:16:52,240 --> 00:16:57,070 what you don't want to do is then have some chasing after them. 242 00:16:57,740 --> 00:17:04,500 This is a really difficult family dynamic and I see it in couples and families and in the workplace, 243 00:17:04,510 --> 00:17:13,290 it's just a very um common thing if someone becomes quiet that we're trying to talk to and they withdraw. 244 00:17:13,300 --> 00:17:18,840 We can have some chasing behaviors whether that's actually physically following them, 245 00:17:18,850 --> 00:17:20,350 whether it's saying, 246 00:17:20,740 --> 00:17:21,180 you know, 247 00:17:21,190 --> 00:17:21,660 no, 248 00:17:21,660 --> 00:17:23,240 you have to talk about this, 249 00:17:23,240 --> 00:17:24,360 this is important. 250 00:17:26,240 --> 00:17:30,570 That kind of chasing in the relationship usually just makes things worse. 251 00:17:30,600 --> 00:17:31,460 So, 252 00:17:31,840 --> 00:17:34,960 um I would focus more on strategy. 253 00:17:34,960 --> 00:17:42,850 Like I can see this conversation is really tough um how and when would you like to process this? 254 00:17:45,540 --> 00:17:46,350 Other than that, 255 00:17:46,350 --> 00:17:58,010 it may just be helpful for the family or the parent or the individual to have a counselor that they can process individualized recommendations with. 256 00:17:58,010 --> 00:17:59,110 That's a tough one. 257 00:17:59,220 --> 00:18:03,270 It's a tough season and difficult things to talk about. 258 00:18:05,540 --> 00:18:09,930 Um the next question from a listener is kind of related, 259 00:18:09,930 --> 00:18:14,660 it's about parenting and this time it's about parenting in neuro diverse couples, 260 00:18:14,660 --> 00:18:20,120 which means that One of the parents is on the spectrum and one is not. 261 00:18:20,130 --> 00:18:22,710 So um you know, 262 00:18:22,710 --> 00:18:28,950 there are differences in their nervous systems and and what they lean toward what their strengths are, 263 00:18:29,340 --> 00:18:33,270 what kinds of things challenge them. 264 00:18:34,040 --> 00:18:41,780 And so this listener is asking this as a parent and part of a couple. 265 00:18:41,780 --> 00:18:46,670 So they're trying to parent their kids and their spouse, 266 00:18:46,680 --> 00:18:49,750 I'm not sure who is who, 267 00:18:49,750 --> 00:18:55,620 but one of them has that autistic neurology and the person is pointing out that, 268 00:18:55,620 --> 00:18:56,480 you know, 269 00:18:56,500 --> 00:19:01,230 parenting is a lot of just loud, 270 00:19:01,230 --> 00:19:02,600 chaotic, 271 00:19:02,610 --> 00:19:03,710 messy, 272 00:19:03,720 --> 00:19:06,700 unexpected things going on. 273 00:19:06,700 --> 00:19:10,460 You've got the need to communicate as parents. 274 00:19:10,840 --> 00:19:13,300 Um the need to be consistent. 275 00:19:13,310 --> 00:19:15,670 You've got sensory overload in the house, 276 00:19:15,670 --> 00:19:19,170 you've got distractions and changes to routine. 277 00:19:19,170 --> 00:19:30,560 So that is a great point that if anything is going to kind of challenge um the neuro diverse couple this, 278 00:19:30,570 --> 00:19:33,430 this is really difficult. 279 00:19:33,440 --> 00:19:38,620 And so my brief answer is I would say a couple of things. 280 00:19:38,620 --> 00:19:49,070 One is what I just talked about for the other listener that sometimes really being direct and forthright about where are you at today? 281 00:19:49,070 --> 00:19:50,060 What do you need? 282 00:19:50,440 --> 00:19:52,140 Or boy, 283 00:19:52,140 --> 00:19:56,560 it looks like this kid is really melting down a lot. 284 00:19:56,940 --> 00:19:58,440 That's the state they're in. 285 00:19:58,440 --> 00:20:00,960 How are we going to get this? 286 00:20:01,340 --> 00:20:05,520 Kids needs met and this other one has homework to do. 287 00:20:05,520 --> 00:20:06,450 How are we gonna? 288 00:20:06,460 --> 00:20:11,470 So kind of taking a survey of the land and we all need to do that, 289 00:20:11,470 --> 00:20:19,990 but sometimes we forget to do it kind of explicitly... we think our spouse will see what needs to be done or agree with us. 290 00:20:19,990 --> 00:20:26,630 And sometimes when couples go to counseling and maybe they're talking about parenting strategies, 291 00:20:27,040 --> 00:20:30,820 um you kind of get the sense that one of the partners is saying, 292 00:20:30,830 --> 00:20:33,010 why can't you be like me? 293 00:20:33,020 --> 00:20:33,590 You know, 294 00:20:33,590 --> 00:20:35,470 why can't you parent like me? 295 00:20:35,470 --> 00:20:41,180 Why can't you see what needs to be done and kind of do it the way I would do it. 296 00:20:41,670 --> 00:20:49,270 So part of that of success and that kind of role is having this increased self awareness. 297 00:20:49,740 --> 00:20:50,370 Okay, 298 00:20:50,370 --> 00:20:51,810 I really get that, 299 00:20:51,810 --> 00:20:54,030 your neurology is different, 300 00:20:54,090 --> 00:20:55,860 these are your strengths, 301 00:20:56,240 --> 00:21:12,460 these are the things that challenge you and that's different from my neurology and so sometimes what can help once you have this increasing awareness and these open discussions about how you each work differently. 302 00:21:13,040 --> 00:21:19,350 Um one of the things that can help is to have a huddle in the morning and in the evening by huddle, 303 00:21:19,350 --> 00:21:25,770 I just mean like there's kind of a brief checking in about the status quo, 304 00:21:26,240 --> 00:21:26,860 like, 305 00:21:27,240 --> 00:21:28,070 what's your day, 306 00:21:28,070 --> 00:21:29,150 like today? 307 00:21:29,160 --> 00:21:31,950 Uh do you have everything you need, 308 00:21:32,440 --> 00:21:34,950 this kid needs to be picked up, 309 00:21:34,960 --> 00:21:35,190 blah, 310 00:21:35,190 --> 00:21:35,800 blah blah. 311 00:21:35,810 --> 00:21:36,280 So, 312 00:21:36,290 --> 00:21:40,340 so there's this coming together in the morning to say, 313 00:21:40,340 --> 00:21:40,700 you know, 314 00:21:40,700 --> 00:21:41,060 again, 315 00:21:41,060 --> 00:21:42,770 like in a sports analogy, 316 00:21:42,780 --> 00:21:52,170 um huddle is this image of um the sports players getting together on the field and saying this is the play we're going to use. 317 00:21:52,560 --> 00:22:00,430 It's so funny because I remember one of our um high school friends at a reunion and he was saying, 318 00:22:00,440 --> 00:22:01,340 you know, 319 00:22:01,350 --> 00:22:04,950 once you go from two kids to three kids, 320 00:22:04,960 --> 00:22:05,570 you know, 321 00:22:05,580 --> 00:22:08,150 it's like you have to go to a zone defense, 322 00:22:08,160 --> 00:22:11,460 you can't be one parent on one kids anymore, 323 00:22:11,470 --> 00:22:13,060 so that's the kind of thing, 324 00:22:13,060 --> 00:22:13,970 like in the morning, 325 00:22:13,970 --> 00:22:15,260 what's our game plan? 326 00:22:15,740 --> 00:22:17,960 How are we going to divide this up? 327 00:22:18,740 --> 00:22:21,250 Um and then in the evening as well, 328 00:22:21,250 --> 00:22:23,960 and sometimes in the evening it's even more important, 329 00:22:24,340 --> 00:22:31,930 so you've had this whole day of experience and you're coming together and there's these things that need to be done. 330 00:22:31,940 --> 00:22:34,960 So part of the evening huddle can be, 331 00:22:35,740 --> 00:22:51,990 my day at work was unexpectedly horrible and I feel like I'm about to collapse and I also see that the kids are laying on the floor screaming and somebody's drawing on the wall with crayons and you, 332 00:22:52,000 --> 00:22:54,670 you're crying and um, 333 00:22:55,140 --> 00:22:57,580 so what, 334 00:22:57,590 --> 00:22:58,930 let's triage, 335 00:22:58,940 --> 00:23:05,600 what is the most important thing we have to do and what do you need? 336 00:23:05,610 --> 00:23:09,370 This is what I need And then getting a game plan, 337 00:23:09,430 --> 00:23:16,670 like I need 20 minutes of no touching and talking and anything and then I'm going to come back out, 338 00:23:17,340 --> 00:23:20,010 you take the kids for a ride and I'm gonna clean, 339 00:23:20,020 --> 00:23:20,740 you know, 340 00:23:20,750 --> 00:23:23,880 so that kind of thing also, 341 00:23:23,880 --> 00:23:27,430 I think that a lot of times when we have this increase of awareness, 342 00:23:28,240 --> 00:23:38,850 we can assign tasks based on the person's strengths rather than hoping that everybody does all of the stuff. 343 00:23:39,340 --> 00:23:40,290 So, 344 00:23:40,300 --> 00:23:40,970 you know, 345 00:23:40,980 --> 00:23:50,960 one spouse may love doing laundry and organizing and throwing things away and this feels really satisfying to them, 346 00:23:51,340 --> 00:23:55,150 but they really have a tough time giving the kids a bath, 347 00:23:55,150 --> 00:23:57,140 like it's sensory overload. 348 00:23:57,140 --> 00:23:59,260 They struggle a lot. 349 00:23:59,740 --> 00:24:02,620 So if there is a way to integrate in, 350 00:24:03,040 --> 00:24:03,680 you know, 351 00:24:03,690 --> 00:24:05,770 one parent might say, 352 00:24:06,240 --> 00:24:06,750 you know, 353 00:24:06,760 --> 00:24:11,570 giving the kids a bath is not hard for me at all. 354 00:24:11,580 --> 00:24:13,210 So I'll do that, 355 00:24:13,220 --> 00:24:14,500 you do what, 356 00:24:14,510 --> 00:24:17,930 what you connect with and then these other stuff, 357 00:24:17,940 --> 00:24:18,230 you know, 358 00:24:18,230 --> 00:24:19,670 the other things that we both, 359 00:24:20,140 --> 00:24:20,970 hey, 360 00:24:20,980 --> 00:24:25,560 we'll just try to share the load and get through some of the stuff we hate. 361 00:24:26,940 --> 00:24:30,770 Um another way is to reduce talking. 362 00:24:31,140 --> 00:24:34,860 I think one of the pieces of advice that I give, 363 00:24:35,740 --> 00:24:41,950 um family members the most is to talk less. 364 00:24:42,640 --> 00:25:00,350 Um I think our go to strategy for improving things is often talking about it again and again or asking or questioning or um nagging or talking and a lot of times for the autistic that makes a difficult situation like more overwhelming. 365 00:25:00,740 --> 00:25:04,660 So you want me to do this and I have to socially communicate about it. 366 00:25:04,660 --> 00:25:05,880 That's really dreaming. 367 00:25:07,540 --> 00:25:10,860 So one way to reduce talking, 368 00:25:11,340 --> 00:25:15,520 you can have a code word that if a person, 369 00:25:15,520 --> 00:25:18,860 one of the parents is about to just meltdown, 370 00:25:18,860 --> 00:25:20,270 they're in dire straits, 371 00:25:20,270 --> 00:25:26,890 they need to stop this conversation or they need to stop being in the room with the kids. 372 00:25:27,060 --> 00:25:28,960 You guys can use a code word. 373 00:25:29,340 --> 00:25:32,330 So you could pick something that's funny, 374 00:25:32,330 --> 00:25:39,450 you can pick something that's um an inside memory or something and if someone says that word, 375 00:25:40,040 --> 00:25:41,660 you don't have to talk it through. 376 00:25:41,660 --> 00:25:45,560 Everybody just knows that that person needs to leave and regroup. 377 00:25:46,140 --> 00:25:48,100 So it could be pineapple, 378 00:25:48,100 --> 00:25:56,770 it could be hawaii or whatever has meaning and then you can cut down some of that talking in the moment. 379 00:25:57,940 --> 00:26:02,690 Also a way to reduce talking is to use refrigerator magnets. 380 00:26:02,700 --> 00:26:08,230 So sometimes people and families will want to know how everyone's doing, 381 00:26:08,230 --> 00:26:12,010 but this conversation about how I'm doing and how are you doing? 382 00:26:12,010 --> 00:26:13,410 That's really draining. 383 00:26:13,420 --> 00:26:15,520 So for instance, 384 00:26:15,520 --> 00:26:23,890 you could use Refrigerator magnets that are from 1 to 10 and you can have it represent anything. 385 00:26:23,890 --> 00:26:31,110 So maybe it's your stress level that everybody has a column on the fridge where they can put their number. 386 00:26:31,120 --> 00:26:47,760 And so if someone comes home from school and they walk in and they don't talk and they pass mom or dad and they put that Number seven out of 10 on there and walk to their room and shut the door. 387 00:26:48,080 --> 00:26:54,160 That is a way of communicating that my day was really overwhelming and I need to be alone. 388 00:26:54,740 --> 00:26:58,360 So the parents feel like they have a sense of what just happened. 389 00:26:58,740 --> 00:27:00,560 There's some communication, 390 00:27:00,570 --> 00:27:03,810 but we don't have to sit down and socially communicate, 391 00:27:03,810 --> 00:27:05,360 which is also draining. 392 00:27:07,140 --> 00:27:07,510 Um, 393 00:27:07,510 --> 00:27:11,210 and also just thinking about as a couple, 394 00:27:11,220 --> 00:27:13,170 you can't always plan, 395 00:27:13,640 --> 00:27:14,400 um, 396 00:27:14,410 --> 00:27:17,190 all the things that happen in a family. 397 00:27:17,190 --> 00:27:17,660 And, 398 00:27:18,040 --> 00:27:19,570 but sometimes, 399 00:27:19,580 --> 00:27:20,280 you know, 400 00:27:20,290 --> 00:27:21,670 when you're together, 401 00:27:21,670 --> 00:27:22,730 newly as a couple, 402 00:27:22,730 --> 00:27:24,060 you can talk about, 403 00:27:24,540 --> 00:27:24,880 oh, 404 00:27:24,880 --> 00:27:26,280 you want six kids. 405 00:27:26,280 --> 00:27:26,900 Well, 406 00:27:27,140 --> 00:27:27,960 I want, 407 00:27:28,340 --> 00:27:29,860 I'm thinking I would want one, 408 00:27:29,860 --> 00:27:33,250 I think it would be really overwhelming for me, 409 00:27:33,260 --> 00:27:33,720 uh, 410 00:27:33,720 --> 00:27:44,760 and and to try to make plans for your family that take into account everyone's temperament and personality and nervous system. 411 00:27:49,240 --> 00:27:53,460 Another listener asked about things related to the workplace. 412 00:27:53,940 --> 00:27:54,540 Um, 413 00:27:54,550 --> 00:27:56,740 one question was about, 414 00:27:56,750 --> 00:27:57,220 you know, 415 00:27:57,220 --> 00:28:07,480 it's really difficult to know how to negotiate about raises or other issues in the workplace because I feel like I'm not sure if I'm being taken advantage of, 416 00:28:07,480 --> 00:28:14,270 I'm not sure if I'm asking for too much or too little and I don't know how far to push things or how to say it. 417 00:28:14,940 --> 00:28:16,440 Um and you know, 418 00:28:16,440 --> 00:28:19,530 this person feels like as an autistic individual, 419 00:28:19,530 --> 00:28:19,820 it, 420 00:28:19,830 --> 00:28:25,990 it feels harder to um just get a feel for the room like what is politics, 421 00:28:25,990 --> 00:28:26,650 what is, 422 00:28:26,660 --> 00:28:29,950 what should not be said in this room? 423 00:28:29,960 --> 00:28:32,270 Um and you know, 424 00:28:32,270 --> 00:28:35,030 that is a really good point. 425 00:28:35,040 --> 00:28:40,850 A lot of negotiation is getting a feel for how hard to push. 426 00:28:42,140 --> 00:28:42,610 You know, 427 00:28:42,610 --> 00:28:53,860 I think taking advantage of all the data approaches that are available in this age of technology can really help in that regard. 428 00:28:53,870 --> 00:28:57,690 I'm not sure about different countries or cultures, 429 00:28:57,690 --> 00:29:01,210 but In the United States there's been a big push, 430 00:29:01,210 --> 00:29:03,310 particularly over the last 10 years, 431 00:29:03,310 --> 00:29:13,540 I would say um to be very data oriented in um comparing salaries across the region, 432 00:29:13,540 --> 00:29:15,150 across the United States, 433 00:29:15,430 --> 00:29:17,770 there's more available on the internet. 434 00:29:18,740 --> 00:29:20,950 Um as far as benchmarking, 435 00:29:20,950 --> 00:29:22,360 what is common, 436 00:29:22,940 --> 00:29:27,460 um I really relate to this listeners challenge. 437 00:29:27,460 --> 00:29:29,800 I'm not really good um, 438 00:29:29,810 --> 00:29:31,130 at those things either. 439 00:29:31,130 --> 00:29:34,720 So what I tend to do is every five years, 440 00:29:34,720 --> 00:29:46,170 there's um an article published about common um benchmarks for neuropsychology salaries and then of course our workplace benchmarks, 441 00:29:46,170 --> 00:29:46,860 things. 442 00:29:46,940 --> 00:29:55,650 I'm hoping that in the future it will become even more transparent that when you see a job ad it will just have the salary in the ad. 443 00:29:55,650 --> 00:30:10,980 And again I don't know if other countries do that but there it's almost like a card game where you're not quite sure um what benchmark the employer might be using, 444 00:30:10,980 --> 00:30:13,970 they don't show all their cards necessarily. 445 00:30:13,980 --> 00:30:21,920 Um But it I do think that as a strategy it can help anyone, 446 00:30:21,920 --> 00:31:07,450 particularly someone that wants to go by data to kind of have data to put it in a proposal and to hand that in to your boss to say you know this is some data that I found and I wanted to talk about that with you and I would also suggest that you give data about yourself and so you can kind of think of um like a state of the union address where um you can give your boss a summary of all the things that you have accomplished um either that year or in the past five years and bosses know that in the moment. 447 00:31:07,460 --> 00:31:13,600 But I do find that giving the summary Snapchat and highlighting all the things you've done. 448 00:31:14,240 --> 00:31:23,850 Um That's data as well and sometimes you know your boss just cannot have all of that in their head. 449 00:31:23,860 --> 00:31:27,990 And they'll often say things like oh my gosh that's right, 450 00:31:27,990 --> 00:31:32,380 you did this and that and you know for someone in sales, 451 00:31:32,380 --> 00:31:36,450 they can say I earned the company this amount of money etcetera. 452 00:31:36,640 --> 00:31:44,300 So you can hand in data points both about salary benchmarking and also highlighting how you've benefited the company, 453 00:31:44,300 --> 00:31:46,350 what kinds of things you've accomplished. 454 00:31:46,360 --> 00:31:48,240 Um So I would start there, 455 00:31:48,250 --> 00:31:51,560 just try try a very data oriented approach. 456 00:31:53,240 --> 00:31:58,290 Another question was about how to pursue accommodations in the workplace. 457 00:31:58,300 --> 00:32:00,990 Um They seem so open ended, 458 00:32:00,990 --> 00:32:04,620 it's difficult to know what's reasonable as a request, 459 00:32:04,620 --> 00:32:05,480 who to talk to, 460 00:32:05,480 --> 00:32:06,160 etcetera. 461 00:32:06,840 --> 00:32:07,250 Um, 462 00:32:07,260 --> 00:32:15,950 so I would say a few things you I would look on the internet for common accommodations for autism or other things. 463 00:32:15,950 --> 00:32:21,750 And the site that I often go to to look is called ask Jan dot org. 464 00:32:21,840 --> 00:32:25,050 JAN stands for job accommodation Network. 465 00:32:25,060 --> 00:32:25,430 Again, 466 00:32:25,430 --> 00:32:27,170 this is in the United States. 467 00:32:27,640 --> 00:32:28,080 Um, 468 00:32:28,080 --> 00:32:29,930 and again, 469 00:32:29,930 --> 00:32:31,900 in the line of having data, 470 00:32:31,910 --> 00:32:40,340 this gives a lot of common accommodations that could be requested for a variety of conditions. 471 00:32:40,350 --> 00:32:47,950 So you would type in autism as you as the condition that you want to ask for accommodations under. 472 00:32:47,950 --> 00:32:57,060 So you have to have kind of a um something that's considered qualifying for that accommodation. 473 00:32:57,920 --> 00:33:03,820 And then what I would say is Jobs want these accommodations to be individualized. 474 00:33:03,820 --> 00:33:09,100 They don't want to just have a list of 200 accommodations that you want. 475 00:33:09,100 --> 00:33:24,570 So I would say look through those and think about your own self awareness and areas that are particularly easy or difficult for you and try try some of the strategies if you can. 476 00:33:24,580 --> 00:33:25,540 So, 477 00:33:25,550 --> 00:33:26,460 um, 478 00:33:26,840 --> 00:33:35,080 if you're going to ask for an accommodation to where noise canceling headphones in your cubicle while you're working, 479 00:33:35,090 --> 00:33:36,410 um you know, 480 00:33:36,410 --> 00:33:41,700 try some of that at home and see if those headphones really help you. 481 00:33:41,710 --> 00:33:43,760 So you can tie it into, 482 00:33:43,760 --> 00:33:48,830 let's say you've gotten feedback that you're really struggling with timeliness, 483 00:33:48,840 --> 00:33:50,850 that things are taking too long, 484 00:33:50,940 --> 00:33:53,600 and that's part of that executive function, 485 00:33:53,610 --> 00:33:55,330 piece of autism. 486 00:33:55,340 --> 00:33:58,220 And you can say, 487 00:33:58,230 --> 00:33:58,870 you know, 488 00:33:58,870 --> 00:34:02,860 I realize um that this has been a struggle for me. 489 00:34:02,860 --> 00:34:14,300 I really listen to that feedback and I want to improve that the strategy that I'd like to pursue as to where these noise canceling headphones, 490 00:34:14,310 --> 00:34:17,210 because it really helps me focus. 491 00:34:17,220 --> 00:34:22,490 Um I don't have to be processing through all of the noise around me. 492 00:34:22,500 --> 00:34:25,780 Uh and then um you know, 493 00:34:25,790 --> 00:34:30,220 if they say yes, 494 00:34:30,220 --> 00:34:31,130 that's great, 495 00:34:31,140 --> 00:34:37,060 you can talk to them about why it kind of just depends on what kind of relationship you have there. 496 00:34:37,440 --> 00:34:39,230 If they just come back with, 497 00:34:39,230 --> 00:34:39,410 well, 498 00:34:39,410 --> 00:34:41,730 that's not part of our dress code. 499 00:34:41,740 --> 00:34:47,960 Uh then you can present documentation of your diagnosis and just say, 500 00:34:47,960 --> 00:34:53,750 how could I get this formalized that I'm formally asking for this accommodation. 501 00:34:54,840 --> 00:35:00,660 They'll probably send you through to HR to human resources and you can do it that way. 502 00:35:04,160 --> 00:35:09,670 There was a question about preventing seizure episodes that are non epileptic. 503 00:35:10,240 --> 00:35:20,660 Um Non epileptic means that the seizures look like seizures when people are watching and observing, 504 00:35:21,040 --> 00:35:25,610 um but they're not electrical so that when the person is hooked up to the E. 505 00:35:25,610 --> 00:35:25,730 E. 506 00:35:25,730 --> 00:35:26,180 G. 507 00:35:26,180 --> 00:35:28,580 And they see the manifestation of the seizure, 508 00:35:28,580 --> 00:35:32,170 they can see that it's not electrically generated through the brain. 509 00:35:32,540 --> 00:35:43,060 And what that means is that it's non epileptic and these are things that are triggered by stress and really being overwhelmed or traumatized. 510 00:35:43,070 --> 00:35:46,760 And um I do have a blog post on that. 511 00:35:46,770 --> 00:35:56,390 Um So I will put the link in the show notes and also I would recommend listening to the podcast episodes. 512 00:35:56,400 --> 00:36:07,350 We have some series about how to help people with regulation and that's how I would address these non epileptic seizures that these are signs. 513 00:36:07,350 --> 00:36:12,240 These are clues that the person is dis regulated that they're overwhelmed. 514 00:36:12,430 --> 00:36:15,790 So rather than trying to talk them through, 515 00:36:15,790 --> 00:36:24,160 I would use the recommendations in the regulation series and I will link to the first of those series. 516 00:36:24,530 --> 00:36:29,150 I think there's four in that podcast series here in the notes. 517 00:36:31,530 --> 00:37:01,440 Um It should be noted too if it interests you that this phenomenon of non epileptic seizures is more common for autistics than for those who are you're a typical Finally there was a question about why diet and motivation for exercise can become harder with age for the autistic who's entering um Their 40's or 50s. 518 00:37:01,830 --> 00:37:16,210 Um I think that that's really tied in a lot with the executive function issue we talked about where um and I guess I'm referring to the podcast series on behavioral motivation, 519 00:37:16,220 --> 00:37:18,320 exhaustion getting going. 520 00:37:18,330 --> 00:37:27,660 So the center and front part of the brain is in charge of executive function that's always somewhat impacted or involved in autism. 521 00:37:27,930 --> 00:37:32,170 And part of that has to do with what's called behavioral initiation. 522 00:37:32,180 --> 00:37:37,000 So how do I get started from this stopped state? 523 00:37:37,000 --> 00:37:38,240 It's really hard. 524 00:37:38,830 --> 00:37:45,870 Not only is the individual probably likely to have difficulty with the getting going part of behavior anyway, 525 00:37:45,880 --> 00:37:50,320 but executive function can become more difficult. 526 00:37:50,330 --> 00:37:50,650 Um, 527 00:37:50,650 --> 00:37:53,950 less efficient and easy with age. 528 00:37:54,330 --> 00:37:58,760 We talked about this in our aging episode where um, 529 00:37:58,770 --> 00:38:03,920 executive function is always going to be a bit harder as people age. 530 00:38:03,920 --> 00:38:06,650 So their thought process might feel slower. 531 00:38:06,660 --> 00:38:08,840 They can't multitask as well. 532 00:38:08,840 --> 00:38:16,340 Some of the details of their memory gets harder and also this behavioral activation can also be impacted. 533 00:38:17,520 --> 00:38:26,170 Another thing I think that makes this difficult and autism is that for many people on the spectrum, 534 00:38:26,250 --> 00:38:32,460 it's difficult to think abstractly about likely outcomes. 535 00:38:32,920 --> 00:38:33,340 Um, 536 00:38:33,350 --> 00:38:40,330 if you ask someone intellectually what's likely to happen if you don't take your medicine or if you don't exercise, 537 00:38:40,720 --> 00:38:43,360 sometimes they can recite a bunch of facts, 538 00:38:43,360 --> 00:38:49,640 but it doesn't really feel real unless they've actually already experienced it. 539 00:38:50,020 --> 00:38:52,860 So if I say that to someone, 540 00:38:52,870 --> 00:38:55,710 uh there may be an autistic individual who says, 541 00:38:55,710 --> 00:38:55,880 well, 542 00:38:55,880 --> 00:38:57,590 how would I know what would happen? 543 00:38:57,600 --> 00:38:58,950 It hasn't happened yet. 544 00:38:59,420 --> 00:39:03,000 Other people can state facts that they've learned, 545 00:39:03,010 --> 00:39:06,310 but in a lot of ways those feel fear radical, 546 00:39:06,310 --> 00:39:08,900 they don't really feel real. 547 00:39:08,910 --> 00:39:12,360 Um and for example, 548 00:39:12,370 --> 00:39:14,900 I have had patients who say, 549 00:39:14,900 --> 00:39:18,430 well I took cholesterol medication for a month, 550 00:39:18,440 --> 00:39:20,390 but I just stopped it. 551 00:39:20,400 --> 00:39:21,690 I didn't feel any better, 552 00:39:21,690 --> 00:39:22,980 I didn't feel anything. 553 00:39:22,990 --> 00:39:31,360 Um so this conceptual hypothesis that it's probably doing something important, 554 00:39:31,370 --> 00:39:35,030 even though you don't feel it or see it or experience it, 555 00:39:35,420 --> 00:39:35,740 you know, 556 00:39:35,740 --> 00:39:43,650 that can just be really difficult to grab hold of um a few suggestions if you want to try them. 557 00:39:44,020 --> 00:39:47,150 Um I love time timers, 558 00:39:47,160 --> 00:39:55,030 you can get the app or you can buy the physical time timer on places like amazon or other websites on the internet. 559 00:39:55,520 --> 00:39:57,580 A time timer is a visual timer. 560 00:39:57,580 --> 00:40:01,620 So if you have difficulty um with time management, 561 00:40:01,620 --> 00:40:06,700 if you have difficulty getting going or transitioning from one activity to another, 562 00:40:06,710 --> 00:40:11,130 like I'm not exercising now and I have to transition to exercise, 563 00:40:11,510 --> 00:40:28,730 um you can set that time timer and see the visual time disappear and for some reason it just feels very real and compelling and concrete in a way that looking at digits or a clock face doesn't quite feel. 564 00:40:28,810 --> 00:40:30,320 I love these, 565 00:40:30,330 --> 00:40:32,910 I use them in my workplace. 566 00:40:32,920 --> 00:40:34,830 Um I use them at home. 567 00:40:35,210 --> 00:40:44,140 Um so you could set the time timer for when you're gonna start the exercise and also for when you're going to end. 568 00:40:44,610 --> 00:40:57,930 So I only have to do this until the red disappears and then it's a very concrete achievable kind of goal as opposed to this feeling like, 569 00:40:57,940 --> 00:40:58,340 oh, 570 00:40:58,340 --> 00:40:59,890 I have to start this and when, 571 00:40:59,900 --> 00:41:20,020 when is it going to end another technique that I think can make things more concrete and doable is to um set up something that feels real instead of this concept that exercises in some way helpful. 572 00:41:20,030 --> 00:41:22,360 And of course as we age, 573 00:41:22,370 --> 00:41:29,620 we see the results of that less like we we exercise and exercise and eat right and gosh, 574 00:41:29,630 --> 00:41:34,410 my body still doesn't look the way that I would like it to and I'm not really sure what this is doing, 575 00:41:34,410 --> 00:41:37,110 but I have faith that it's good. 576 00:41:37,120 --> 00:41:45,650 Um so we can make it more concrete by using things like challenges um or prompts to move. 577 00:41:45,650 --> 00:41:47,980 So there's a lot of technology these days, 578 00:41:47,980 --> 00:41:50,300 like um smartwatches, 579 00:41:50,310 --> 00:41:57,180 they can vibrate once an hour just to remind us to move or get up and walk. 580 00:41:57,190 --> 00:42:02,590 Um there are challenges on the smartwatches, 581 00:42:02,600 --> 00:42:03,600 different ones, 582 00:42:03,600 --> 00:42:04,770 call them different things, 583 00:42:04,770 --> 00:42:06,420 but there can be games, 584 00:42:06,430 --> 00:42:17,990 there might be like a fitness bingo or these things where you get icons lit up if you walk a certain number of steps or have your heart rate going as active. 585 00:42:18,000 --> 00:42:21,430 So those kind of things can make it concrete and fun. 586 00:42:21,440 --> 00:42:24,510 Like I don't know if my cholesterol changed, 587 00:42:24,510 --> 00:42:25,810 but I got this, 588 00:42:25,820 --> 00:42:31,220 I won this game or I finished this challenge and that felt good. 589 00:42:31,900 --> 00:42:35,360 Um there are also since Covid in particular, 590 00:42:35,360 --> 00:42:39,420 a lot of virtual challenges that you can do with people around the world. 591 00:42:39,430 --> 00:42:52,200 So there are challenges where you can sign up to walk through a particular area of the world and people around the world are doing it with you and then you get a medal afterward and again. 592 00:42:52,200 --> 00:42:54,390 That that makes it feel concrete. 593 00:42:54,390 --> 00:42:55,490 I've achieved this. 594 00:42:55,490 --> 00:42:56,520 This was fun. 595 00:42:56,900 --> 00:42:57,770 Um, 596 00:42:57,780 --> 00:43:00,980 one example of that are the conqueror challenges, 597 00:43:00,980 --> 00:43:12,490 but there are a lot of versions of this and you can google what really works for you and what you think might help you get that really concrete goal, 598 00:43:12,500 --> 00:43:13,810 that motivation. 599 00:43:15,500 --> 00:43:21,210 So this wraps up our second and final episode of question and answer. 600 00:43:21,220 --> 00:43:26,540 We're going to go back to some themes of episodes next and then in the future, 601 00:43:26,540 --> 00:43:31,870 we're going to return to more questions and answers from listeners around the world. 602 00:43:31,870 --> 00:43:32,510 Like you. 603 00:43:33,000 --> 00:43:34,950 If you do have questions, 604 00:43:34,950 --> 00:43:44,570 you can email them to adultandgeriatricautism@gmail.com and I will collect those for episodes in the future. 605 00:43:44,580 --> 00:43:48,020 Thanks for tuning in and I hope you join me next time.    

Join Dr. Regan for an episode in which she answers listener questions related to autism and the physical body. Topics include genetics, brain pathways and neurology, nature versus nurture, medications, and nutrition/diet.    Genetics and Autism article Neurogenetics: Smith-Magenis Syndrome Autism and Medication review   Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the Transcript: 00:00:11,040 --> 00:00:14,410 Hello and thanks for joining me. 3 00:00:14,420 --> 00:00:18,220 This is Dr Theresa Regan welcoming you to the podcast, 4 00:00:18,230 --> 00:00:19,960 autism in the adult. 5 00:00:19,970 --> 00:00:22,170 I am a neuropsychologist, 6 00:00:22,180 --> 00:00:24,880 a certified autism specialist. 7 00:00:24,890 --> 00:00:30,150 The director of an autism diagnostic clinic for adolescents, 8 00:00:30,340 --> 00:00:32,100 adults and aging. 9 00:00:32,100 --> 00:00:36,760 Adults in Illinois and the parent of a teen on the spectrum. 10 00:00:39,040 --> 00:00:47,950 Last episode I invited listeners to write in questions they would like me to field in a question and answer podcast. 11 00:00:48,640 --> 00:01:01,940 So what I've done is that I have gone through and tried to group some of the questions into related categories and I won't get to all of the questions in this episode. 12 00:01:01,940 --> 00:01:09,560 But I am going to focus on several questions today that have to do with autism and the physical body. 13 00:01:10,240 --> 00:01:14,150 So we're going to review things like genetics, 14 00:01:14,460 --> 00:01:18,850 neuro anatomy and the physical brain in autism. 15 00:01:19,240 --> 00:01:26,060 We're also going to talk about things like nutrition and diet and other physical aspects, 16 00:01:26,440 --> 00:01:30,160 things that may impact the individual on the spectrum. 17 00:01:30,540 --> 00:01:33,450 Let's take the topic of genetics First. 18 00:01:35,840 --> 00:01:57,660 A recent article about the genetics of autism found that at least 80 percent of the likelihood that someone will have autism neurology is driven by the genetic code and it's the code that impacts the development of the neurology within that individual. 19 00:01:58,040 --> 00:01:58,390 So, 20 00:01:58,390 --> 00:02:04,960 the neurology includes of course the brain and its nuclei and its pathways, 21 00:02:05,440 --> 00:02:07,850 genetics includes code, 22 00:02:07,860 --> 00:02:11,650 parts that are inherited that is, 23 00:02:11,650 --> 00:02:20,340 there are some families with autism characteristics across multiple family members. 24 00:02:20,430 --> 00:02:24,460 Some members may not have any characteristics, 25 00:02:24,520 --> 00:02:28,960 some may have a clustering of autistic characteristics, 26 00:02:28,970 --> 00:02:31,420 but not a formal diagnosis. 27 00:02:31,420 --> 00:02:37,650 They don't meet full threshold for the diagnosis and others will meet full threshold. 28 00:02:38,140 --> 00:02:42,230 So for some people who are diagnosed with autism, 29 00:02:42,230 --> 00:02:44,760 they can see characteristics, 30 00:02:44,760 --> 00:02:49,450 qualities of this neurology and various family members, 31 00:02:49,840 --> 00:02:57,230 genetics also includes possible alterations in the code during development. 32 00:02:57,230 --> 00:03:02,210 So it can also mean that the genetics were not inherited, 33 00:03:02,220 --> 00:03:10,950 but that there were some unexpected alterations of the code as the brain and the nervous system were developing. 34 00:03:11,540 --> 00:03:22,250 That brings forth this autistic neurology and it is not as simple as saying that someone has the gene and someone does not. 35 00:03:22,260 --> 00:03:34,660 This is a hugely complex Condition that is a reflection of at least 200 likely many more genetic contributions. 36 00:03:35,140 --> 00:03:46,850 So that can be part of why we see autism on a spectrum that a certain clustering of genetics may produce certain characteristics, 37 00:03:46,850 --> 00:03:49,800 while another clustering may produce others, 38 00:03:49,800 --> 00:03:51,010 we just don't know, 39 00:03:51,020 --> 00:03:54,410 we're not at the point where we have all of that nailed down, 40 00:03:54,410 --> 00:04:06,960 but what we do know is that genetics plays a role in the development of the nervous system and specifically in the development of the neurology associated with autism. 41 00:04:10,240 --> 00:04:10,670 Also, 42 00:04:10,670 --> 00:04:18,460 autism may co occur with other physical conditions that are related to genetics. 43 00:04:19,140 --> 00:04:21,750 They're related to development. 44 00:04:22,140 --> 00:04:22,680 Um, 45 00:04:22,690 --> 00:04:24,980 as guided by the genetic code. 46 00:04:24,990 --> 00:04:25,670 So, 47 00:04:25,670 --> 00:04:26,550 for example, 48 00:04:26,550 --> 00:04:33,740 some individuals have a difference in the way their heart was formed or the kidneys or their palate, 49 00:04:33,740 --> 00:04:35,250 like a cleft palate. 50 00:04:36,240 --> 00:04:41,850 Also in some Children who have childhood cancers, 51 00:04:41,850 --> 00:04:45,950 there's some association with a genetic difference, 52 00:04:45,950 --> 00:04:52,560 that something in the code has been different and is related to the triggering of this cancer. 53 00:04:56,340 --> 00:05:02,280 What that can mean is that for people with a heart difference, 54 00:05:02,280 --> 00:05:03,200 for example, 55 00:05:03,200 --> 00:05:04,610 that is congenital, 56 00:05:04,610 --> 00:05:07,990 this is something that happened during development. 57 00:05:08,000 --> 00:05:10,150 It has been there since birth. 58 00:05:10,740 --> 00:05:31,460 There can be an increased presence of also a typical neurology that these things that have developed around the same time or secondary to similar parts of the genetic code can co occur. 59 00:05:32,140 --> 00:05:32,700 So, 60 00:05:32,710 --> 00:05:33,760 research shows, 61 00:05:33,760 --> 00:05:34,650 for example, 62 00:05:34,650 --> 00:05:42,620 that about 30% of individuals with some developmental heart conditions are also on the autism spectrum, 63 00:05:42,630 --> 00:05:47,960 because various organ systems can be impacted by the code during development. 64 00:05:51,040 --> 00:06:00,250 The other 20% of the variants that was not assigned to genetics in the research study. 65 00:06:00,840 --> 00:06:00,990 So, 66 00:06:00,990 --> 00:06:04,910 if we're saying 80% is driven by genetics, 67 00:06:04,910 --> 00:06:11,090 the other 20% my understanding is that it includes all of the measurement error. 68 00:06:11,100 --> 00:06:13,650 So that is kind of um, 69 00:06:13,650 --> 00:06:15,760 statistical artifact. 70 00:06:15,770 --> 00:06:28,290 It's just variants that doesn't actually um relate to a causative factor and it can also include things in the environment, 71 00:06:28,300 --> 00:06:31,920 which can include physical things as well. 72 00:06:31,930 --> 00:06:32,760 So, 73 00:06:33,240 --> 00:06:36,890 there have been theories that perhaps for some people, 74 00:06:36,900 --> 00:06:37,250 um, 75 00:06:37,260 --> 00:06:42,830 a virus might interact with the genetics or for some people, 76 00:06:42,840 --> 00:06:43,220 um, 77 00:06:43,220 --> 00:06:52,810 some type of substance in the environment may trigger uh differences in the way that the neurology has developed. 78 00:06:52,970 --> 00:07:00,260 So The 20% is not well defined in in very specific ways. 79 00:07:00,270 --> 00:07:18,050 But the statistics do help us understand the prominence of a genetic factor here and that's one of the reasons that a correct diagnosis of autism can be so important because we see what the foundation of a behavioral pattern might be. 80 00:07:18,440 --> 00:07:31,310 And at its very base we're trying to distinguish and to figure out whether a behavioral pattern is neurologic or whether it falls into what we more traditionally call a mental health diagnosis. 81 00:07:31,310 --> 00:07:33,260 And I know that there, 82 00:07:33,640 --> 00:07:33,980 you know, 83 00:07:33,980 --> 00:07:40,010 as imprecision and how we might separate neurology from mental health. 84 00:07:40,010 --> 00:07:46,210 But let's consider an example of mental health as PTSD, 85 00:07:46,210 --> 00:08:03,600 that we could put that we could put depression into a more traditional mental health category in order to demonstrate why it makes a difference to know if a behavioral pattern is neurologic versus traditionally mental health, 86 00:08:03,610 --> 00:08:05,760 let's consider a different example, 87 00:08:06,140 --> 00:08:12,850 let's say that two separate clients go to a psychology appointment for the same concern. 88 00:08:12,860 --> 00:08:15,050 They both have memory concerns. 89 00:08:15,840 --> 00:08:27,800 Let's suppose that one client has an evaluation of memory and the psychologist concludes that the profile is very classic for an alzheimer's dementia, 90 00:08:27,810 --> 00:08:32,860 a very clear neurologic factor that's impacting memory. 91 00:08:34,440 --> 00:08:47,360 The second client who has the same concern undergoes an evaluation and this person is found to have memory loss due to disassociative episodes secondary to trauma. 92 00:08:47,740 --> 00:09:01,960 So this is a person who has experienced such significant life trauma that their brain kind of goes offline for periods of time in order to protect the person from re experiencing the trauma. 93 00:09:02,540 --> 00:09:06,620 But this is not a physically based memory issue. 94 00:09:06,620 --> 00:09:09,950 This is based in the psychology of trauma. 95 00:09:10,940 --> 00:09:15,830 So even though they're presenting for the same experience and concern, 96 00:09:15,840 --> 00:09:21,350 one is clearly in the neurologic domain and one is clearly in the mental health domain. 97 00:09:21,940 --> 00:09:24,460 Now the implications of that are really important. 98 00:09:24,940 --> 00:09:42,090 So one is that doing talk therapy with a patient with Alzheimer's or telling them that remembering things is very important and they should do so talking through past histories of relationships or trauma or doing E. 99 00:09:42,090 --> 00:09:42,260 M. 100 00:09:42,260 --> 00:09:42,440 D. 101 00:09:42,440 --> 00:09:42,720 R. 102 00:09:42,720 --> 00:09:43,750 For trauma, 103 00:09:43,760 --> 00:09:46,260 reminding them that it's safe to remember. 104 00:09:47,340 --> 00:10:03,430 These aren't going to be effective as far as improving that person's memory but these approaches as part of psychotherapy for the a person who does have disassociative episodes secondary to trauma, 105 00:10:03,430 --> 00:10:06,490 these might really be effective. 106 00:10:06,500 --> 00:10:23,550 So it helps us understand what's likely to be effective and choose um something that's likely to be helpful rather than something that's really not going to change the symptoms because we're not going to change that neurologic base. 107 00:10:24,540 --> 00:10:24,820 Now, 108 00:10:24,820 --> 00:10:40,340 one individual asked me to highlight in a bit more detail what parts of the brain are involved in autism and first I'll state that there's really nobody that can outline everything about the neurology of autism at this point. 109 00:10:40,370 --> 00:10:43,960 There are just so many things to understand from genetics, 110 00:10:44,340 --> 00:10:45,580 cellular mechanics, 111 00:10:45,580 --> 00:10:46,560 biochemistry, 112 00:10:46,560 --> 00:10:48,260 physiological issues. 113 00:10:48,270 --> 00:10:51,360 There's lots of nuclei and pathways in the brain. 114 00:10:52,640 --> 00:10:54,590 And even in the area of genetics. 115 00:10:54,590 --> 00:10:55,210 As I said, 116 00:10:55,210 --> 00:11:00,430 there are hundreds of possible genes involved and the genetics in one individual, 117 00:11:00,430 --> 00:11:02,960 the neurology of one individual. 118 00:11:02,960 --> 00:11:09,910 The biochemistry of one individual is likely to be somewhat different than that and another individual. 119 00:11:09,920 --> 00:11:10,610 However, 120 00:11:10,610 --> 00:11:12,160 in broad strokes, 121 00:11:12,640 --> 00:11:19,150 a lot of the characteristics have to do with the nuclei and the pathways in the center of the brain. 122 00:11:19,740 --> 00:11:23,960 And this area is called the sub cortical area of the brain, 123 00:11:24,440 --> 00:11:29,060 sub meaning under and cortex meaning the outer layer. 124 00:11:29,940 --> 00:11:32,160 In addition to the center of the brain, 125 00:11:32,540 --> 00:11:45,050 the frontal lobes are also densely connected to the sub cortical pathways and these areas are also uh involved with things that are seen on the autism spectrum. 126 00:11:46,240 --> 00:11:48,570 Now this is extremely simplistic, 127 00:11:48,580 --> 00:11:58,560 but it is a place to start in understanding that the sub cortical nuclei in pathways uh and the dense connections to the front of the brain. 128 00:11:59,840 --> 00:12:05,750 The functions that are impacted by these areas include things like executive function, 129 00:12:06,140 --> 00:12:15,730 which everyone on the spectrum will have some difficulty with the ability to start, maintain, and complete behaviors. 130 00:12:15,810 --> 00:12:19,660 Whether that's talking tours tasks, 131 00:12:20,040 --> 00:12:25,300 the ability to switch gears to handle interruptions to deal with, 132 00:12:25,300 --> 00:12:26,060 change, 133 00:12:26,540 --> 00:12:43,430 the ability to show flexibility to think abstractly as opposed to categorically or literally the whole issue of repetition is very key in this part of the brain repetition of speech movements, 134 00:12:43,440 --> 00:12:45,750 rituals behavior patterns. 135 00:12:45,930 --> 00:12:50,750 These sub cortical areas are really involved in that kind of repetition, 136 00:12:51,640 --> 00:12:54,300 motor coordination sequencing. 137 00:12:54,310 --> 00:13:03,340 There's a lot that goes on in the support sub cortical nuclei with that attention to detail versus seeing the big picture, 138 00:13:03,350 --> 00:13:05,780 knowing what is most and least important, 139 00:13:05,790 --> 00:13:06,400 etcetera. 140 00:13:06,400 --> 00:13:19,660 So there are a lot of the behavioral features seen in the autism neurology that are features having to do with those pathways and those nuclei. 141 00:13:20,940 --> 00:13:21,300 Now, 142 00:13:21,300 --> 00:13:27,470 other characteristics of the autism spectrum likely have to do with inter plays between the cortex, 143 00:13:27,470 --> 00:13:31,070 the outside of the brain and the sub cortical areas, 144 00:13:31,070 --> 00:13:34,550 the inside things like social communication, 145 00:13:34,550 --> 00:13:35,470 relationships, 146 00:13:35,470 --> 00:13:36,860 sensory processing. 147 00:13:37,440 --> 00:13:43,930 So really when we're talking about the neurology of autism in broad strokes, 148 00:13:43,940 --> 00:13:55,450 it has a lot to do with the dense connections in the middle of the brain and the front of the brain as well as interplay between more complex areas of the cortex. 149 00:13:56,440 --> 00:14:01,680 Now that genetics and neurology are being understood at a much deeper level. 150 00:14:01,700 --> 00:14:18,730 There is a field called behavioral genetics and it's really interesting and I was able to take genetics in my undergrad and then I took behavioral genetics through an online course at University of Minnesota. 151 00:14:18,730 --> 00:14:20,760 That was also very interesting. 152 00:14:21,840 --> 00:14:32,660 This was a free online course and really gave me a nice flavor of the types of research that is evolving in this area. 153 00:14:34,040 --> 00:14:52,460 I've also gotten to read multiple articles and I've seen patients with various genetic differences and one thing that we're seeing is that patients who had a genetic profile done 10 years ago and they didn't find anything different or unexpected. 154 00:14:52,740 --> 00:14:52,990 You know, 155 00:14:52,990 --> 00:15:01,160 those same patients are going back to have the genetic code redone and they're seeing these, 156 00:15:01,540 --> 00:15:02,130 um, 157 00:15:02,140 --> 00:15:03,140 uh, 158 00:15:03,150 --> 00:15:07,060 these smaller kinds of micro deletions, 159 00:15:07,540 --> 00:15:09,100 micro additions, 160 00:15:09,110 --> 00:15:13,740 so much at a much smaller scale and more detailed scale. 161 00:15:13,750 --> 00:15:17,170 We're able to see some differences in the genetic code. 162 00:15:17,180 --> 00:15:17,620 Now, 163 00:15:17,620 --> 00:15:19,290 the genotype, 164 00:15:19,300 --> 00:15:27,530 if you hear that term is the code itself in the phenotype is the expression of the code. 165 00:15:27,540 --> 00:15:28,210 Uh, 166 00:15:28,220 --> 00:15:33,860 so the phenotype could be eye color or height or hair color. 167 00:15:34,440 --> 00:15:39,750 And sometimes we talk about phenotype as relates to autism. 168 00:15:40,140 --> 00:15:41,300 So, 169 00:15:41,350 --> 00:15:49,860 there are behavioral phenotypes of various genetic conditions or states or combinations of code. 170 00:15:50,740 --> 00:15:51,250 So, 171 00:15:51,260 --> 00:16:10,890 the that's basically a complex way of saying that this code does impact this expression of behavior in an individual sometimes for someone who does not meet full criteria for autism, 172 00:16:10,900 --> 00:16:13,120 but they have characteristics. 173 00:16:13,130 --> 00:16:18,150 Someone might refer to that as the broader autistic phenotype. 174 00:16:18,640 --> 00:16:26,210 That just means that there are these expressions there of neurology that are important to understand, 175 00:16:26,210 --> 00:16:30,830 but the person doesn't meet full criteria for a diagnosis. 176 00:16:30,830 --> 00:16:33,850 So that's the broader autistic phenotype. 177 00:16:35,140 --> 00:16:54,370 one of the interesting lines of research is starting to connect repetitive stereotyped behaviors with genetic codes and repetitive stereotyped behaviors is one of the criteria that may be met within autism, 178 00:16:54,370 --> 00:16:55,960 although it's not required, 179 00:16:56,440 --> 00:16:59,050 but it is a common um, 180 00:16:59,060 --> 00:17:00,530 neurologic expression, 181 00:17:00,530 --> 00:17:02,000 a com common phenotype. 182 00:17:02,000 --> 00:17:17,170 Ipic expression of the neurology and some people are concerned about the word stereotyped because they feel that it might be a disparaging comment about the autistic individual. 183 00:17:18,040 --> 00:17:19,350 Um actually, 184 00:17:19,360 --> 00:17:30,140 stereotyped behaviors are seen all across neurologic states and conditions and they're seen in some conditions, 185 00:17:30,140 --> 00:17:31,160 but not others. 186 00:17:31,540 --> 00:17:37,450 So someone with a traumatic brain injury or a stroke is not likely to show stereotyped behaviors, 187 00:17:37,840 --> 00:17:46,560 but individuals with dementia can start to show these individuals with different genetic or developmental conditions. 188 00:17:46,570 --> 00:17:58,080 I've seen these um expressions of neurology and people who have had infectious disease or autoimmune kinds of responses to an infection. 189 00:17:58,090 --> 00:18:03,060 And so it is just a standard neurologic term. 190 00:18:03,440 --> 00:18:06,150 A stereotyped behavior um, 191 00:18:06,160 --> 00:18:09,670 is expressed in a similar way every time, 192 00:18:10,040 --> 00:18:18,010 even though the environment or the context of the behavior changes. 193 00:18:18,020 --> 00:18:22,520 And so the behavior is not specific to the context, 194 00:18:22,530 --> 00:18:24,860 It's not required by the context. 195 00:18:25,240 --> 00:18:27,870 It may be soothing to the individual. 196 00:18:27,880 --> 00:18:30,670 It may be something the person doesn't even notice, 197 00:18:31,040 --> 00:18:33,420 but it is the same each time. 198 00:18:33,420 --> 00:18:35,860 It's the stereotyped replica. 199 00:18:36,340 --> 00:18:47,550 We could call it a repetitive, replica behavior and you might see that within autism in regards to movement what people say. 200 00:18:47,560 --> 00:18:47,840 So, 201 00:18:47,840 --> 00:18:53,350 verbalization is whether that's echoing or repeating words or phrases. 202 00:18:53,360 --> 00:18:56,940 And you can also see stereotyped use of objects. 203 00:18:56,950 --> 00:19:11,450 That's where you'll uh kind of see when a youngster might line up their toys or an adult may keep a coin in their pocket that they flip back and forth between two of their fingers. 204 00:19:11,940 --> 00:19:14,860 This kind of stereotyped repetition. 205 00:19:14,860 --> 00:19:18,530 This replica um of the behavior, 206 00:19:18,540 --> 00:19:21,190 it may be soothing to the person, 207 00:19:21,200 --> 00:19:23,260 or again they may not notice it. 208 00:19:23,270 --> 00:19:31,680 I've had patients recently who have tongue movements or tongue kind of um curling behaviors that they don't even notice. 209 00:19:31,680 --> 00:19:33,840 And so it could occur either way, 210 00:19:33,850 --> 00:19:35,770 but it's neurologically driven. 211 00:19:36,040 --> 00:19:38,260 If you ask the person to stop it, 212 00:19:38,260 --> 00:19:45,410 they can stop it in the moment but it will just recur and that is common in neurology. 213 00:19:45,410 --> 00:19:49,250 So if we think about um you know, 214 00:19:49,250 --> 00:19:51,450 if I ask you to stop breathing, 215 00:19:51,840 --> 00:19:54,840 you can stop breathing but it's going to then kick in, 216 00:19:54,840 --> 00:20:00,950 it's going to recur ... an example in neurology is in Parkinson's disease. 217 00:20:01,640 --> 00:20:05,940 Part of what you see is changes in the step pattern, 218 00:20:06,000 --> 00:20:08,450 the gait pattern of walking. 219 00:20:08,940 --> 00:20:14,170 And you'll start to see neurologically very small shuffling steps. 220 00:20:14,210 --> 00:20:24,450 That's really classic for a Parkinsonian gait and if you tell the person to lift their feet they can do that. 221 00:20:24,840 --> 00:20:30,270 Um And you know that's what a physical therapist will say now remember to lift your feet. 222 00:20:30,640 --> 00:20:33,830 Um But when the therapist isn't there, 223 00:20:33,840 --> 00:20:37,100 they just and they don't have that verbal cue, 224 00:20:37,110 --> 00:20:39,460 their brain goes back to their default, 225 00:20:39,840 --> 00:20:44,910 which is this um just shuffling gait pattern that's neurologic. 226 00:20:44,910 --> 00:20:47,760 So like other neurologic things. 227 00:20:48,440 --> 00:20:52,200 These are behaviors that repeat. 228 00:20:52,210 --> 00:20:55,670 Um but can be suppressed in the moment. 229 00:20:57,140 --> 00:21:11,300 One of the super interesting things that amazes even me is that genetic studies are starting to link stereotyped behaviors to certain genetic differences. 230 00:21:11,840 --> 00:21:20,410 And this is not a 1-1 correlation where someone with this genetic difference always does this stereotyped behavior. 231 00:21:20,420 --> 00:21:30,760 But sometimes it really is astonishing how connected the code in this particular chromosome is to a behavioral pattern. 232 00:21:32,040 --> 00:21:39,090 I'm going to link in the show notes um a website from the U. 233 00:21:39,090 --> 00:21:39,590 K. 234 00:21:39,590 --> 00:21:47,430 That talks about neuro genetic conditions and they're talking about smith magnus syndrome, 235 00:21:47,440 --> 00:21:53,170 which is a genetic difference that causes the neurology to develop differently. 236 00:21:53,540 --> 00:22:06,270 And one of the things that's interesting about this condition is that there are a few stereotyped behaviors that could easily go unnoticed at first at least. 237 00:22:06,740 --> 00:22:13,180 But that um really are very common in people with this genetic pattern. 238 00:22:13,470 --> 00:22:15,950 And one of these is self hugging. 239 00:22:16,340 --> 00:22:30,460 So the individual will hug themselves many times in response to being happy about something in the same way that someone could have hand flapping in response to being excited or happy. 240 00:22:31,140 --> 00:22:36,560 And at first the self hugging is just delightful in these kids. 241 00:22:36,940 --> 00:22:37,590 But you know, 242 00:22:37,590 --> 00:22:44,080 as they grow older and as this behavior is repeated without specific context, 243 00:22:44,080 --> 00:22:47,610 like it starts to look really unusual. 244 00:22:47,680 --> 00:22:54,950 And indeed it is a repetitive stereotyped behavior that is related to the genetic code. 245 00:22:56,340 --> 00:23:03,710 The other stereotype that's very common within this genetic pattern is called lick and flip. 246 00:23:03,720 --> 00:23:14,960 And this happens when the individual licks their hand or their fingers and then uses it to rapidly turn pages in a book, 247 00:23:15,540 --> 00:23:17,550 lick and flip stereotype. 248 00:23:18,040 --> 00:23:18,800 And again, 249 00:23:18,800 --> 00:23:22,930 it looks delightful in a little kid and they'll say, 250 00:23:22,940 --> 00:23:25,510 oh this person loves reading, 251 00:23:26,440 --> 00:23:28,680 but actually they're not reading. 252 00:23:28,700 --> 00:23:31,880 And turning the pages isn't functional, 253 00:23:31,890 --> 00:23:35,710 but it's a repetitive stereotyped behavior, 254 00:23:35,720 --> 00:23:39,360 it's neurologic and it's related to the genetic code. 255 00:23:41,340 --> 00:23:46,670 So what do I want you to walk away from this information with? 256 00:23:47,140 --> 00:23:52,590 I don't want you to worry about the terminology, 257 00:23:52,600 --> 00:23:53,960 the statistics. 258 00:23:54,640 --> 00:24:16,860 What I would like you to take away is this understanding that there is a physical base for our neurology and that is what is the base of the autistic behavioral pattern and that this physical base is related to the genetic code in some way. 259 00:24:18,540 --> 00:24:22,850 This does not mean that everyone is an automaton. 260 00:24:23,540 --> 00:24:36,680 Um but I think the value of thinking about the physical aspects of behavior is that it balances out our understanding of a very complex interplay between nature, 261 00:24:36,690 --> 00:24:39,750 the physical form of the brain and nurture, 262 00:24:39,750 --> 00:24:42,170 which is our experience in the world, 263 00:24:42,940 --> 00:24:48,360 and the truth lies in the complexity of the interplay of both. 264 00:24:48,840 --> 00:24:56,700 But what we tend to do as humans is think in these categorical ways and in our culture, 265 00:24:56,710 --> 00:25:00,450 we lean very heavily on the nurture point of view, 266 00:25:00,450 --> 00:25:03,720 at least in this time, 267 00:25:03,730 --> 00:25:05,150 this generation, 268 00:25:05,160 --> 00:25:07,290 where um you know, 269 00:25:07,290 --> 00:25:21,930 it really strikes home to me sometimes when um I was recently traveling and I got to walk through high school and there's all these posters up and you know what I'm talking about, 270 00:25:21,930 --> 00:25:26,360 they say things like the sky is the limit, reach for the stars. 271 00:25:26,840 --> 00:25:30,770 The only limit you have is how you limit yourself. 272 00:25:31,940 --> 00:25:33,700 And if you can dream it, 273 00:25:33,700 --> 00:25:34,850 you can achieve it. 274 00:25:35,840 --> 00:25:39,820 So we love that individualistic, 275 00:25:39,830 --> 00:25:42,460 empowered framework. 276 00:25:43,940 --> 00:25:51,460 It appeals to this um part of ourselves that does want to be able to make our way, 277 00:25:52,040 --> 00:25:54,310 I don't want to have limitation, 278 00:25:54,320 --> 00:25:59,770 I really want to be able to achieve anything if I apply myself hard enough. 279 00:26:02,140 --> 00:26:03,060 However, 280 00:26:03,540 --> 00:26:05,920 it's actually not one or the other, 281 00:26:05,930 --> 00:26:12,270 it's not all effort and it's not all fatalistic that everything is determined, 282 00:26:12,940 --> 00:26:14,770 it's not that simplistic, 283 00:26:15,640 --> 00:26:15,960 you know, 284 00:26:15,960 --> 00:26:20,860 it's not as simplistic as thinking that all we need to do is try hard enough, 285 00:26:21,440 --> 00:26:29,270 nor is it as simplistic as thinking that there's nothing we can do because our neurology dictates everything. 286 00:26:30,140 --> 00:26:35,190 It's very hard to hold the complexity of the truth in our minds and as humans, 287 00:26:35,190 --> 00:26:43,460 we love to be able to take aside or categorize opinions and even when we try to stay centered in the complexity, 288 00:26:43,460 --> 00:26:48,770 we often slide from one side to the other no matter what the topic, 289 00:26:49,540 --> 00:26:58,660 but to be able to hold complexity in our minds about something most often is what we need in order to be in the most truth. 290 00:26:59,740 --> 00:27:05,590 We should feel empowered to work hard because we can influence the outcome of our lives, 291 00:27:05,600 --> 00:27:12,260 but we should also feel grounded in the fact that there are going to be things that we just can't change. 292 00:27:12,840 --> 00:27:17,840 And someone pointing out that we have limitations. 293 00:27:17,850 --> 00:27:19,950 That's not a criticism. 294 00:27:20,640 --> 00:27:21,560 You know, 295 00:27:21,570 --> 00:27:30,860 we all have set limitations as a function of being human and my limitations are not the same as yours and vice versa, 296 00:27:31,740 --> 00:27:36,060 But we can't be 10 ft tall if we try hard enough. 297 00:27:37,040 --> 00:27:41,100 And the person who is blind cannot see if they try hard enough. 298 00:27:41,110 --> 00:27:51,550 And the person who wants to live to be 400 isn't going to be able to achieve that with just good attitude and high effort or commitment. 299 00:27:54,240 --> 00:27:59,390 So this brings me to another topic mentioned in the Q and A emails, 300 00:27:59,390 --> 00:28:02,960 which is the topic of whether autism is all good. 301 00:28:03,640 --> 00:28:14,530 That is ... is autism a wonderful reflection of diversity that should always be celebrated or is autism all bad? 302 00:28:14,540 --> 00:28:23,550 The diagnosis is stigmatizing and limiting and it's something to hide or be ashamed of and it represents something that must be fixed. 303 00:28:25,240 --> 00:28:31,310 I think it's really easy to find people on each side of this topic. 304 00:28:31,320 --> 00:28:31,990 But again, 305 00:28:31,990 --> 00:28:40,550 the truth is in the complexity and I want to invite you to dive back into complexity and be able to live there. 306 00:28:42,240 --> 00:28:57,970 Every individual whether they're on the spectrum or not has great deep inherent value as a person being on the spectrum or you're neurotypical does not change any of that. 307 00:28:58,030 --> 00:28:59,860 Every person, 308 00:29:00,440 --> 00:29:06,350 whether on the spectrum or not has gifts and strengths and can bless people around them. 309 00:29:06,740 --> 00:29:08,160 Every individual, 310 00:29:08,170 --> 00:29:11,360 whether on the spectrum or not has limitations, 311 00:29:11,840 --> 00:29:35,860 challenges and struggles and we need to allow there to be gift and challenge in every autistic individual rather than needing it to be all good or trying to convince people that it's all bad. 312 00:29:37,040 --> 00:29:40,150 One of the blessings of knowing that there's autism, 313 00:29:40,150 --> 00:29:59,360 neurology is just understanding the context for this person's strengths and challenges and being able to tap into our understanding of that and also a direction that might be most helpful when things are a challenge. 314 00:30:00,140 --> 00:30:11,560 I'm going to switch gears just a moment to a few other physical questions I received about the spectrum and then we're going to close up and we'll talk about next episode. 315 00:30:13,140 --> 00:30:17,270 So one of the questions I was asked is about medication. 316 00:30:18,040 --> 00:30:27,170 Um and I'll just give a general general kind of summary of medication in autism. 317 00:30:28,940 --> 00:30:35,960 One of the things to know is that there are often four categories if someone is taking a medication. 318 00:30:36,540 --> 00:30:40,890 Um it's often within these four categories Of difficulty. 319 00:30:40,890 --> 00:30:42,760 So one would be attention. 320 00:30:43,640 --> 00:30:50,360 Another category of difficulty that someone may take a medication or supplement for is sleep, 321 00:30:50,940 --> 00:30:56,960 that sleep onset is often very difficult or just getting enough sleep. 322 00:30:59,040 --> 00:31:02,570 Another category is anxiety, 323 00:31:02,580 --> 00:31:09,450 which is often very prevalent on the spectrum and also depression that goes along with. 324 00:31:09,460 --> 00:31:09,790 Um, 325 00:31:09,790 --> 00:31:15,610 some of life experiences and the fourth category has to do with agitation, 326 00:31:15,610 --> 00:31:18,060 irritability or explosiveness. 327 00:31:19,440 --> 00:31:23,460 Not everyone on the spectrum benefits from medication, 328 00:31:23,840 --> 00:31:26,730 but it often can be for some people, 329 00:31:26,740 --> 00:31:31,640 a nice layer of support in one or more of these areas. 330 00:31:31,650 --> 00:31:32,670 However, 331 00:31:33,440 --> 00:31:45,720 medication on the spectrum does not uh show itself as effective um for these challenges as for people who are, 332 00:31:45,720 --> 00:31:57,460 you're a typical and taking the medication and the reason for that is that it doesn't change the neurologic connectivity that has developed in the nervous system, 333 00:31:58,340 --> 00:32:03,860 but it can offer a layer of support that the person didn't have before. 334 00:32:04,640 --> 00:32:15,400 But let's say someone has anxiety related to the autism neurology and another person has anxiety related to something else. 335 00:32:15,410 --> 00:32:21,770 They don't have autism neurology medications likely to work better for that second person. 336 00:32:23,540 --> 00:32:26,990 The reason that's important to know is just that sometimes people are, 337 00:32:27,000 --> 00:32:43,460 are determined to go on a quest to find um this really effective combination of medications that will make things a lot easier and that's not the typical outcome that you'll have. 338 00:32:44,240 --> 00:32:44,660 Now, 339 00:32:44,660 --> 00:32:54,260 the medications that are used for autism a lot of times that's not going to change just because you have a diagnosis and the reason for that is that, 340 00:32:54,740 --> 00:32:55,390 um, 341 00:32:55,400 --> 00:32:55,830 you know, 342 00:32:55,830 --> 00:32:57,410 it's symptom based, 343 00:32:57,430 --> 00:33:02,660 so the medications would be prescribed based on your symptoms, 344 00:33:02,660 --> 00:33:04,730 not based on your diagnosis, 345 00:33:04,780 --> 00:33:08,410 but the expected outcome is different if, 346 00:33:08,410 --> 00:33:08,810 you know, 347 00:33:08,810 --> 00:33:17,950 that you have autistic neurology and there are sometimes um side effects that can be more common on the spectrum. 348 00:33:18,540 --> 00:33:21,360 So if you're taking attention medication, 349 00:33:21,370 --> 00:33:32,260 you may have increased anxiety or some repetitive movements or ticks at a higher rate than someone else. 350 00:33:35,540 --> 00:33:44,260 Another question was about whether marijuana improved social function or other aspects of functioning for the autistic individual. 351 00:33:45,440 --> 00:33:46,130 Um, 352 00:33:46,140 --> 00:34:02,550 my experience and my understanding from the literature and what I've seen with patients and clients is that whether someone's taking CBD oil or smoking marijuana, 353 00:34:02,940 --> 00:34:03,160 um, 354 00:34:03,160 --> 00:34:07,130 I just find people responding differently. 355 00:34:07,140 --> 00:34:17,130 So I have clients that tell me it's extremely helpful and I have clients that tell me it's actually very upsetting and they don't care for it at all. 356 00:34:17,140 --> 00:34:21,960 And I have clients feel like it really just doesn't doesn't do anything for them. 357 00:34:22,340 --> 00:34:47,610 So that ends up being kind of an individualized thing that you would discuss with your medical team and your physicians there are studies looking at compounds um from other substances just to see if they can be used um to help even out the anxiety or to help with social interaction. 358 00:34:47,620 --> 00:34:51,280 Those are really just in a very experimental stages, 359 00:34:51,280 --> 00:34:52,980 sometimes not even with humans. 360 00:34:52,980 --> 00:34:55,760 And so I don't know what the outcome will be, 361 00:34:55,770 --> 00:34:58,060 but everyone's hoping that over time, 362 00:34:58,060 --> 00:35:00,160 as we understand the neurology better, 363 00:35:00,440 --> 00:35:14,470 uh we can have some more things to help people who are struggling with some of those characteristics or seasons of life in the final physical question that I was asked has to do with autism and diet. 364 00:35:15,340 --> 00:35:16,750 And um, 365 00:35:16,760 --> 00:35:19,670 there is a particular diet out there. 366 00:35:19,670 --> 00:35:24,250 The gluten free and casein free... casein is a milk protein. 367 00:35:24,840 --> 00:35:25,240 Um, 368 00:35:25,250 --> 00:35:26,700 if you've heard of lactose, 369 00:35:26,700 --> 00:35:28,470 that's actually a milk sugar. 370 00:35:29,140 --> 00:35:34,660 But typically people find that gluten which is also a protein and casein, 371 00:35:35,040 --> 00:35:41,670 These are the things that some people will target in their diet by removing them. 372 00:35:42,540 --> 00:35:43,120 Um, 373 00:35:43,130 --> 00:35:48,460 and there's not a lot of research support for that. 374 00:35:49,440 --> 00:35:50,360 However, 375 00:35:50,840 --> 00:35:53,520 I will say that in our home, 376 00:35:53,530 --> 00:35:58,360 my son had really extreme difficulties with sleep and colic, 377 00:35:58,840 --> 00:35:59,260 um, 378 00:35:59,260 --> 00:36:02,650 which is just a lot of crying and discomfort. 379 00:36:03,430 --> 00:36:05,430 I was very overwhelmed. 380 00:36:05,430 --> 00:36:07,990 I had tried lots of things. 381 00:36:08,080 --> 00:36:10,340 Somebody said I should try this diet. 382 00:36:10,350 --> 00:36:17,050 I was overwhelmed with the prospect of having to learn a whole new diet and eliminate a bunch of things. 383 00:36:17,430 --> 00:36:18,050 Um, 384 00:36:18,430 --> 00:36:19,350 at 18 months, 385 00:36:19,350 --> 00:36:23,480 I just felt like I had no other choice. 386 00:36:23,480 --> 00:36:24,250 I really, 387 00:36:24,730 --> 00:36:25,350 uh, 388 00:36:26,030 --> 00:36:28,930 I had nothing left to try and I said, 389 00:36:28,930 --> 00:36:37,660 I'm just going to try this for one month and then I'm not even going to think beyond that because the thought of doing it forever. 390 00:36:37,660 --> 00:36:39,920 Just felt overwhelming. 391 00:36:39,920 --> 00:36:40,690 So, 392 00:36:40,700 --> 00:36:41,120 um, 393 00:36:41,130 --> 00:36:43,420 I did do that. 394 00:36:43,430 --> 00:36:47,460 And within 2.5 weeks he was, 395 00:36:47,930 --> 00:36:48,370 um, 396 00:36:48,380 --> 00:36:50,490 well ever since infancy, 397 00:36:50,490 --> 00:36:54,010 he took a 20 minute nap twice a day and that's it. 398 00:36:54,020 --> 00:36:57,050 And he would wake up like five times a night. 399 00:36:57,530 --> 00:36:58,250 Um, 400 00:36:58,630 --> 00:37:02,190 2 1/2 weeks after the diet began, 401 00:37:02,200 --> 00:37:06,000 he started taking an hour and a half nap, 402 00:37:06,010 --> 00:37:07,960 sometimes up to three hours. 403 00:37:08,430 --> 00:37:09,660 Uh and believe me, 404 00:37:09,660 --> 00:37:15,050 we had tried everything before and did nothing different except the diet change. 405 00:37:16,630 --> 00:37:31,510 Um He stayed gluten free and casein free um until really just recently in his high school years and now he seems to do okay with without that elimination. 406 00:37:31,660 --> 00:37:58,550 So he is eating gluten and casein now having said that um it is something that you need to um do in conjunction with your medical team being aware so that your child and get enough nutrients and won't be missing out on calcium or other things that dairy might provide or gluten gluten products. 407 00:37:59,630 --> 00:38:00,620 Also, 408 00:38:00,630 --> 00:38:07,030 what really seems to be true is that many people do not respond to this at all. 409 00:38:07,040 --> 00:38:09,340 They don't get any benefit from it. 410 00:38:09,820 --> 00:38:12,640 And um I don't know why, 411 00:38:13,720 --> 00:38:17,050 I just think it's a very individual kind of response. 412 00:38:17,060 --> 00:38:20,920 So um you know, 413 00:38:20,920 --> 00:38:29,600 if you feel and you've talked to your doctors and medical team that a trial isn't going to harm anyone's health, 414 00:38:29,610 --> 00:38:31,040 you can try that. 415 00:38:31,420 --> 00:38:34,490 Um On the other hand, 416 00:38:34,500 --> 00:38:39,630 I have not seen adults try it to be honest. 417 00:38:39,640 --> 00:38:47,950 I really don't know if adults who try it for the first time as an adult would feel benefit. 418 00:38:48,420 --> 00:38:52,340 Um but that has been my experience with that particular diet. 419 00:38:52,720 --> 00:38:54,170 Other kinds of diets. 420 00:38:54,170 --> 00:38:57,320 You can find lots um Bill, 421 00:38:57,330 --> 00:39:01,270 a lot of them are kind of focusing on being healthy. 422 00:39:01,270 --> 00:39:07,430 So people will take out things like artificial colors or flavors. 423 00:39:07,440 --> 00:39:09,530 There are other kinds of diets. 424 00:39:09,540 --> 00:39:18,800 There's just too many to list off other approaches really talk about decreasing sugar. 425 00:39:18,810 --> 00:39:19,390 Um, 426 00:39:19,390 --> 00:39:21,240 getting good protein. 427 00:39:21,250 --> 00:39:21,650 Um, 428 00:39:21,650 --> 00:39:25,450 so that's a whole um, 429 00:39:25,820 --> 00:39:31,430 a whole broad journey that you can take if you desire. 430 00:39:31,440 --> 00:39:37,610 And I know some people who have really benefited from that and I know other people who have tried really, 431 00:39:37,610 --> 00:39:40,840 really hard and just haven't found uh, 432 00:39:40,850 --> 00:39:43,750 what might help help them feel a little bit better. 433 00:39:45,620 --> 00:39:55,940 So I want to say thank you for the question and answer emails you sent to adult and geriatric autism at gmail dot com. 434 00:39:56,720 --> 00:40:05,900 And thank you for giving me these ideas for a session here about autism and the physical body, 435 00:40:05,900 --> 00:40:07,250 the physical condition. 436 00:40:08,020 --> 00:40:10,160 Next episode, 437 00:40:10,160 --> 00:40:15,480 I'll be formulating some other themes about emails I received. 438 00:40:15,490 --> 00:40:16,300 For example, 439 00:40:16,300 --> 00:40:18,450 I received some questions about parenting, 440 00:40:18,450 --> 00:40:22,120 some questions about autism in the workplace and more. 441 00:40:22,130 --> 00:40:22,950 I'll see you then.    

Join Dr. Regan for the final episode in this series about how autistic characteristics may shift across the lifespan. This episode focuses on the life season of aging, including year 50 and beyond.  Recognizing Dysregulation on the Autism Spectrum Gaining Momentum for Daily Activities Email questions for Q and A podcast episode with Dr. Regan to adultandgeriatricautism@gmail.com Executive function book series (choose the book with the age range you are interested in): Smart But Scattered   Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the transcript:   1 00:00:02,540 --> 00:00:05,010 Hi everyone, 2 00:00:05,020 --> 00:00:19,460 this is dr Regan joining you again for our final episode here on autism in the adult in our series about shifts in the characteristics of autism across the lifespan. 3 00:00:20,330 --> 00:00:21,530 Many of you know, 4 00:00:21,530 --> 00:00:24,160 already that I am a neuropsychologist, 5 00:00:24,540 --> 00:00:27,360 I'm a certified autism specialist, 6 00:00:27,840 --> 00:00:38,850 an author podcast host here at autism in the adult and the founder and director of a diagnostic autism clinic for adolescents, 7 00:00:38,850 --> 00:00:41,960 adults and aging adults in central Illinois. 8 00:00:42,840 --> 00:00:46,760 We're going to get into this final episode of our series. 9 00:00:46,920 --> 00:00:48,560 But before we do that, 10 00:00:49,440 --> 00:00:53,850 I want to talk to you about our next episode. 11 00:00:54,240 --> 00:00:59,760 I do have some ideas for topics for more episodes and another series, 12 00:01:00,140 --> 00:01:06,040 but I'm thinking that what I'd really like to do is to make space for an episode, 13 00:01:06,040 --> 00:01:18,220 answering your questions or talking about um maybe a particular statement or question or term that you would like some feedback about. 14 00:01:18,230 --> 00:01:24,160 So I'm either going to do that for the next episode or sometime soon. 15 00:01:24,440 --> 00:01:30,400 If you do have a question you would like me to cover or something to comment on. 16 00:01:30,940 --> 00:01:42,060 You can email that to me at my professional email which is adultandgeriatricautism@gmail.com. 17 00:01:42,740 --> 00:01:47,260 adultandgeriatricautism@gmail.com. 18 00:01:48,340 --> 00:01:53,480 And I cannot comment on any particular personal issue. 19 00:01:53,480 --> 00:01:56,080 Like I can't give you personal advice. 20 00:01:56,090 --> 00:02:06,290 But if you have a general question about what something looks like in autism or an approach people take for a certain situation, 21 00:02:06,300 --> 00:02:09,760 you can certainly email those questions in. 22 00:02:10,340 --> 00:02:17,700 I will try to get as many as I can and respond to those in an episode. 23 00:02:17,710 --> 00:02:20,930 I may not get to all of the questions, 24 00:02:20,940 --> 00:02:24,860 but I can save them for future episodes. 25 00:02:26,040 --> 00:02:30,480 If there are questions that really should be a whole episode or series, 26 00:02:30,490 --> 00:02:32,850 I'll go ahead and save those as well. 27 00:02:33,440 --> 00:02:41,660 But I hope you will participate and will have kind of a question and answer session for those things that are on your mind. 28 00:02:43,640 --> 00:02:47,960 So as we round out the final episode in our series, 29 00:02:49,140 --> 00:02:53,610 those of you who have followed the other episodes, 30 00:02:53,620 --> 00:03:10,760 you'll know that the way that I've structured my thoughts is that I'm going to present first on issues related to the physical body and changes in the development um or aging of the body and also the biochemistry. 31 00:03:11,340 --> 00:03:20,540 And then I talk about things related to changing life circumstances that as we live life across seasons, 32 00:03:20,630 --> 00:03:27,460 the things that we are in charge of doing or striving to do these kinds of things shift. 33 00:03:27,840 --> 00:03:38,660 And we also just talk about the interchange of both the physical shifting and the changes in life circumstances. 34 00:03:39,840 --> 00:03:41,800 So during adolescence, 35 00:03:41,800 --> 00:03:45,560 we talked about how we have a lot going on in the physical body. 36 00:03:45,940 --> 00:03:58,320 We have development of the body as a whole and of the brain and we have hormone shifts and also a lot of increased demand on the individual with things like academics, 37 00:03:58,330 --> 00:04:04,760 independence and the social environment during pregnancy or menopause for example, 38 00:04:05,440 --> 00:04:18,710 there are lots of physical and biochemical changes and these intersect with this increased demand on the individual and changes in the environment like increased clutter in the household, 39 00:04:18,720 --> 00:04:19,710 more noise, 40 00:04:19,710 --> 00:04:20,550 more visitors, 41 00:04:20,550 --> 00:04:21,250 etcetera. 42 00:04:22,340 --> 00:04:28,140 Today we're going to focus on the life season that has to do with aging. 43 00:04:28,140 --> 00:04:40,550 So we're going to look at age 50 and onward and we'll use that same structure where we'll talk about the physical body and changes and we'll also talk about life seasons, 44 00:04:41,240 --> 00:04:42,560 circumstances, 45 00:04:42,560 --> 00:04:43,410 environments, 46 00:04:43,410 --> 00:04:49,060 etcetera when it comes to physical changes in the body and in the brain. 47 00:04:50,140 --> 00:04:57,250 One of the ways that the aging of the body can impact the autistic is with regard to regulation. 48 00:04:57,840 --> 00:05:01,950 So as we've talked about on other episodes about regulation, 49 00:05:01,950 --> 00:05:12,350 which is the centering of the individual with alertness with attention and with an emotionally calm and resilient state, 50 00:05:13,440 --> 00:05:22,650 the autistic often has to be more intentional about how to get sensory inputs to help them feel centered. 51 00:05:23,640 --> 00:05:24,860 For some people, 52 00:05:24,860 --> 00:05:27,860 these inputs are involving physical activity. 53 00:05:27,870 --> 00:05:30,750 So some may have realized that hey, 54 00:05:31,140 --> 00:05:37,850 I feel the best when I am able to get regular bike rides, 55 00:05:38,630 --> 00:05:41,560 I get that movement input into the brain, 56 00:05:41,560 --> 00:05:43,160 that vestibular input. 57 00:05:43,840 --> 00:05:49,440 And maybe this has even turned into a special interest with owning several bikes, 58 00:05:49,440 --> 00:05:58,440 with going on bike trips with bicycle enthusiasts and entering biking events like races well, 59 00:05:58,440 --> 00:05:59,870 when the body ages, 60 00:05:59,870 --> 00:06:09,860 the individual may feel like not only am I being kind of robbed of my special interest if I can't keep doing these physical things, 61 00:06:10,540 --> 00:06:13,510 which can be a big deal because, 62 00:06:13,520 --> 00:06:13,940 you know, 63 00:06:13,940 --> 00:06:18,360 perhaps life has revolved a lot around this hobby, 64 00:06:18,740 --> 00:06:24,250 but also I'm not able to get the appropriate receptive input, 65 00:06:24,250 --> 00:06:31,250 that pressure in the joints when you're pedaling the bike and the vestibular input into the brain. 66 00:06:31,260 --> 00:06:33,360 That's that movement input. 67 00:06:33,370 --> 00:06:37,810 And the combination of those two things really helped someone. 68 00:06:37,810 --> 00:06:42,550 Let's say that these are the things that their nervous system needed. 69 00:06:43,340 --> 00:06:50,140 These pressure and movement inputs have helped the person get momentum for daily activities. 70 00:06:50,150 --> 00:06:56,660 If you haven't listened to this series yet on daily activities and getting momentum, 71 00:06:57,240 --> 00:07:09,660 I'll put the link in the notes and perhaps this is a person where bike riding has also helped them feel centered emotionally and also more resilient for the day. 72 00:07:11,240 --> 00:07:18,730 So for the individual who experiences this real benefit from bike riding, 73 00:07:18,740 --> 00:07:23,860 aging can present this dilemma of how can I fill this void. 74 00:07:24,240 --> 00:07:32,150 And a lot of people experience this kind of need to shift with aging where oh, 75 00:07:32,150 --> 00:07:38,060 I can't do the same physical things that I have always done and enjoyed. 76 00:07:38,940 --> 00:07:51,500 But for the individual on the spectrum who may really need a lot more intentionality to get these inputs in order to feel just right and to feel okay, 77 00:07:51,510 --> 00:07:52,040 you know, 78 00:07:52,040 --> 00:08:07,610 that can have a big impact on how centered they're able to feel one of the recommendations for the aging individual is to be really intentional about realizing the role that bike riding played, 79 00:08:07,610 --> 00:08:08,660 for example, 80 00:08:09,240 --> 00:08:15,860 and that there's a void that the person may need to get creative to fill. 81 00:08:16,540 --> 00:08:21,750 So the ideal situation would be that the person has the self awareness. 82 00:08:22,340 --> 00:08:22,790 That hey, 83 00:08:22,790 --> 00:08:34,710 the reason that I love this in part is because my system really benefits from movement or it really benefits from pressure, 84 00:08:34,710 --> 00:08:35,620 input, 85 00:08:35,630 --> 00:08:37,390 pressure through my joints, 86 00:08:37,390 --> 00:08:39,050 pressure into the muscles. 87 00:08:40,440 --> 00:08:45,410 If the person is self aware about the role that bike riding plays for them, 88 00:08:45,420 --> 00:08:48,260 but they can't bike bike ride anymore, 89 00:08:48,320 --> 00:08:54,300 then they can start to think how else can I get pressure input, 90 00:08:54,310 --> 00:08:56,760 How else can I get movement input? 91 00:08:58,140 --> 00:09:05,060 So they may need to think about more forgiving ways to get their system, 92 00:09:05,440 --> 00:09:07,450 this type of thing that they need. 93 00:09:08,240 --> 00:09:14,240 Someone could get pressure and movement input by laying in a hammock. 94 00:09:14,240 --> 00:09:17,400 So they have pressure all along their back, 95 00:09:17,410 --> 00:09:21,410 all from the tips of their toes up to their neck, 96 00:09:21,410 --> 00:09:26,450 and their shoulders in their head and some movement rocking back and forth. 97 00:09:27,120 --> 00:09:53,750 Somebody might have a big swing in the backyard and maybe it's um an old fashioned tree swing or they've got um a tire swing that their grandkids plan maybe being able to sit in there and have this movement of swinging that might really hit the spot for their nervous system. 98 00:09:53,760 --> 00:09:56,680 It's not something that we automatically think of, 99 00:09:56,680 --> 00:10:02,960 but it takes this awareness, this intentionality to it doesn't it? 100 00:10:03,440 --> 00:10:07,920 Someone else might try yoga to get pressure in their joints. 101 00:10:07,930 --> 00:10:41,050 A down dog gives a lot of pressure throughout their or different parts of the sun salutation. yin yoga is something that offers a lot of holding of poses and it's supposed to be you know a very restorative kind of practice and that be really match where your body is at during that different life season that I need something that's restorative rather than something that ends up feeling a bit punishing to me at this stage of life. 102 00:10:42,740 --> 00:11:08,780 Some people get inputs through swimming or doing things in a pool where they feel that resistance through the water and that is some pressure input or they're able to you know still slide down the pool slide and that gives them some really nice vestibular input or movement input whatever it is that your nervous system needs. 103 00:11:08,790 --> 00:11:15,960 You may have to have some creativity about how else can I get my system, 104 00:11:15,960 --> 00:11:21,260 what it needs with regard to sensory inputs to feel just right, 105 00:11:23,640 --> 00:11:27,860 this is similar to other life seasons for example, 106 00:11:27,870 --> 00:11:39,890 high schoolers who graduate have to do a lot of that same intentional shifting like oh I used to be on the diving team or um you know I used to go to PE (physical education) 108 00:11:40,070 --> 00:11:40,820 Class, 109 00:11:40,820 --> 00:11:56,590 I used to have to do these running laps or this game or that game and now there isn't this physical activity built in to my existence and if there's not that self awareness, 110 00:11:57,140 --> 00:12:04,960 that movement and pressure played a role in centering and helping this person get going, 111 00:12:04,970 --> 00:12:09,650 helping them calm down when they were too elevated. 112 00:12:10,040 --> 00:12:10,950 You know, 113 00:12:10,960 --> 00:12:12,830 without that self awareness, 114 00:12:12,830 --> 00:12:14,580 they won't be able to shift. 115 00:12:14,590 --> 00:12:19,760 So this is not only something that happens in a later life season, 116 00:12:20,140 --> 00:12:31,390 but it often is part of that shifting mindset of what do I need and how can I get that now? 117 00:12:31,400 --> 00:12:42,740 The physical body is not the only thing that's changing as far as our aging joints or muscles or uh maybe our physical endurance, 118 00:12:42,750 --> 00:12:47,080 but the brain is also an organ that's going to be aging. 119 00:12:47,090 --> 00:12:50,050 Even for people who age really well, 120 00:12:50,060 --> 00:12:54,410 there will be age related changes in the brain as humans. 121 00:12:54,410 --> 00:13:00,560 We just all are going to experience that change as related to aging. 122 00:13:01,240 --> 00:13:07,260 One of the things that happens with the aging of the brain is a slowing of thought process, 123 00:13:07,840 --> 00:13:12,180 a difficulty with the efficiency of recalling information, 124 00:13:12,740 --> 00:13:15,440 that's the tip of the tongue phenomenon, 125 00:13:15,440 --> 00:13:22,850 or I forget the name of this thing or this person or I can't remember why I walked into this room. 126 00:13:24,140 --> 00:13:30,210 These changes have a lot to do with the center of the brain and its connections with the front of the brain. 127 00:13:30,230 --> 00:13:42,860 And one of the reasons there are changes with aging in this area is that the blood vessels that give the brain oxygen and energy are really large and open. 128 00:13:43,250 --> 00:13:56,020 They're the biggest on the outside of the brain and the vessels curve and twist and go deeper and deeper into the brain and as they enter the brain and go deeper, 129 00:13:56,020 --> 00:14:02,980 they also get smaller and smaller and in the center of the brain they end up being very small. 130 00:14:02,980 --> 00:14:21,050 You have little capillaries in there and with age our smallest vessels may have the most difficulty getting blood traffic through and we may have kind of a sensitivity in the areas of the brain that are fed by some of these small vessels. 131 00:14:22,040 --> 00:14:26,960 So we can start to have more problems with the thinking skills related to this area. 132 00:14:27,340 --> 00:14:34,560 And these skills that are related to that area often fall within the domain of executive function skills. 133 00:14:36,240 --> 00:14:36,610 Well, 134 00:14:36,620 --> 00:14:46,050 everyone on the spectrum will have some challenge in the area of executive function already more so than the neuro typical individual will. 135 00:14:46,640 --> 00:14:51,180 I'm planning on doing a series on executive function in the future. 136 00:14:51,740 --> 00:14:55,280 But if you would like a really good resource to look at now, 137 00:14:55,340 --> 00:14:58,640 I look the book series called smart but scattered, 138 00:15:00,140 --> 00:15:03,350 there are also lots of other books and resources out there. 139 00:15:03,540 --> 00:15:10,020 An executive function and you're welcome to choose one that fits your needs in short, 140 00:15:10,020 --> 00:15:15,420 executive function includes lots of brain skills like planning ahead, 141 00:15:15,430 --> 00:15:19,010 understanding what is most and least important. 142 00:15:19,020 --> 00:15:30,560 Thinking quickly getting started with the task finishing multiple steps of a task handling multiple things coming at you in succession. 143 00:15:30,940 --> 00:15:47,200 Retrieving memories etcetera because this is an ability that's sensitive to the aging process and every autistic individual has some pattern of difficulty developmentally. 144 00:15:47,210 --> 00:15:52,950 What we typically see with aging is that these areas of executive function, 145 00:15:53,440 --> 00:16:02,240 they become more difficult because executive function abilities impact thinking skills like attention, 146 00:16:02,240 --> 00:16:08,750 mental organization as well as behavior patterns like getting started with the task. 147 00:16:09,270 --> 00:16:13,800 The individual may show shifts in these areas. 148 00:16:13,810 --> 00:16:17,660 So the shifts are related to aging alone, 149 00:16:18,140 --> 00:16:26,060 although it's aging within an area of your ability that was already sensitive or already weak. 150 00:16:26,740 --> 00:16:35,750 So sometimes what happens is that we do see some increased difficulty with executive function in the autistic, 151 00:16:35,760 --> 00:16:39,760 more so than for the neurotypical, 152 00:16:40,540 --> 00:16:46,490 although everyone who's aging will experience more difficulty in that area than they did in their twenties, 153 00:16:46,490 --> 00:16:47,470 for example, 154 00:16:48,740 --> 00:17:02,570 I've had the privilege of working with autistic individuals into their eighth decade and I've worked with our dementia clinic to determine whether an individual has dementia or an undiagnosed autism spectrum condition, 155 00:17:02,580 --> 00:17:11,670 which is only just impacted by age that there's no um separate disease process that we would call a dementia. 156 00:17:12,240 --> 00:17:13,940 When I'm talking about dementia, 157 00:17:13,940 --> 00:17:20,460 I'm talking about the presence of changes in the cells that advance. 158 00:17:20,460 --> 00:17:25,760 So there's a degeneration that's part of a disease process itself. 159 00:17:26,540 --> 00:17:41,770 So what we're contrasting is that autistics may have increased difficulty with aging even in the absence of any kind of overlay of a new medical process like a dementia. 160 00:17:42,440 --> 00:17:44,150 If you look through the literature, 161 00:17:44,150 --> 00:17:52,270 there really are not good statistics about how frequently dementia occurs in autism, 162 00:17:52,740 --> 00:17:53,690 particularly. 163 00:17:53,690 --> 00:18:04,330 The reason for this is that we have not captured autism in adults and aging adults enough to actually look at this. 164 00:18:04,340 --> 00:18:05,120 Um, 165 00:18:05,130 --> 00:18:15,790 so I can only tell you what my personal experience has been in my own experience in seeing people from the dementia clinic. 166 00:18:15,800 --> 00:18:17,720 Seeing people who are aging, 167 00:18:17,720 --> 00:18:24,950 I don't tend to think that there's any increased risk of a disease process that we would call dementia. 168 00:18:25,340 --> 00:18:25,710 Um, 169 00:18:25,720 --> 00:18:27,350 I haven't seen this. 170 00:18:28,140 --> 00:18:35,500 I have seen people present with concerns that perhaps there is a dementia or disease process. 171 00:18:35,510 --> 00:18:38,100 And after assessing this, 172 00:18:38,110 --> 00:18:45,380 it seems to be that this is part of the aging process and not a separate disease process. 173 00:18:47,640 --> 00:18:52,460 This is not to say that they aren't noticing differences in their home environment. 174 00:18:52,840 --> 00:18:58,010 Executive function certainly does impact day to day life. 175 00:18:58,020 --> 00:19:03,100 So someone may be having more difficulty getting started with tasks, 176 00:19:03,110 --> 00:19:04,860 taking care of themselves, 177 00:19:04,890 --> 00:19:10,960 really engaging in life being active in what they're needing to get done during the day. 178 00:19:11,630 --> 00:19:19,170 This may be a feature that the autistic experiences or expresses during the aging process, 179 00:19:20,440 --> 00:19:20,930 but again, 180 00:19:20,930 --> 00:19:23,840 we don't even know how typical that is. 181 00:19:23,850 --> 00:19:31,300 So all the people that I see are patients who are presenting because they're experiencing some difficulty. 182 00:19:31,310 --> 00:19:45,590 So it would be such a wonderful thing if in the future we're able to capture people with neuro diversity across adulthood and aging and we can actually see, 183 00:19:46,140 --> 00:19:46,690 um, 184 00:19:46,700 --> 00:20:04,550 how many of these clients are really um doing well and aging well and participating in things and have good mood and engagement and how many perhaps are struggling or showing some increased difficulty. 185 00:20:05,140 --> 00:20:11,480 One of the recommendations for the autistic individual is to focus on living a healthy lifestyle. 186 00:20:11,490 --> 00:20:14,410 So this is a good recommendation for anyone, 187 00:20:14,420 --> 00:20:15,090 of course, 188 00:20:15,090 --> 00:20:22,710 but anything that helps the health of the blood vessels will be likely supportive during aging. 189 00:20:22,720 --> 00:20:25,060 And that's true for all of us. 190 00:20:25,540 --> 00:20:25,900 Um, 191 00:20:25,900 --> 00:20:30,650 but especially if a person has a weakness and executive function already, 192 00:20:30,660 --> 00:20:31,430 um, 193 00:20:31,440 --> 00:20:35,520 they may really want to focus on that even more intentionally. 194 00:20:35,530 --> 00:20:37,780 So watching things like cholesterol, 195 00:20:37,790 --> 00:20:38,890 high blood pressure, 196 00:20:38,890 --> 00:20:40,060 diabetes, 197 00:20:40,070 --> 00:20:44,050 these are all things that can stress the blood vessel systems. 198 00:20:44,440 --> 00:20:48,620 And although we can't stop the impact of aging on the blood vessels, 199 00:20:48,630 --> 00:20:54,490 there are probably choices that we can make to just help support the health of the vessels. 200 00:20:54,500 --> 00:20:59,010 And of course this does not constitute medical advice for anyone. 201 00:20:59,020 --> 00:21:04,360 I really encourage you to engage with your doctors about what would be healthy for you. 202 00:21:04,740 --> 00:21:10,510 But certainly if you want to give your body what it needs to age well, 203 00:21:10,520 --> 00:21:15,540 um things like healthy diet and movement and exercise and sleep. 204 00:21:15,550 --> 00:21:20,360 These are all things that may support your body as you age. 205 00:21:21,040 --> 00:21:33,950 Let's shift from talking about changes in the physical body and changes in the brain to talking about changes in our environment or what's going on in life during this season, 206 00:21:35,940 --> 00:21:44,440 one of the things I want to talk about is that there's often less built in structure to our life during that season, 207 00:21:45,340 --> 00:21:53,770 because people often are either cutting down on the number of hours they're working or they've retired, 208 00:21:54,750 --> 00:21:57,220 their kids aren't living at home anymore, 209 00:21:57,220 --> 00:21:58,810 they have an empty nest, 210 00:21:59,540 --> 00:22:08,860 um there are less daily activities to kind of move people forward that I have to get going because I have to go to this place, 211 00:22:09,340 --> 00:22:24,300 so work or the schedule of the Children may have provided some inherent structure to the day and cutting down on the structure that helps people get momentum for their day, 212 00:22:24,310 --> 00:22:29,660 can mean that it's harder for them to get momentum for activities. 213 00:22:30,440 --> 00:22:39,050 The autistic who lean toward anxiety or wanting to know what the day would likely bring benefited from structure because it felt supportive, 214 00:22:40,140 --> 00:22:41,160 in contrast, 215 00:22:41,160 --> 00:22:44,150 the autistic who had trouble with momentum, 216 00:22:44,160 --> 00:22:45,790 like I feel lazy, 217 00:22:45,790 --> 00:22:48,320 I feel like I just can't get going, 218 00:22:48,320 --> 00:23:01,360 I don't know where to start benefited from structure because it helped propel them forward with tasks and daily activities and without the propelling force of a schedule, 219 00:23:02,040 --> 00:23:10,260 this group of people on the spectrum find it really challenging to find an internal source of momentum. 220 00:23:11,640 --> 00:23:14,140 Um they often struggle to say, 221 00:23:14,140 --> 00:23:18,520 oh I can plan my day this way or these are things that need to get done. 222 00:23:18,530 --> 00:23:23,050 Even issues of self care may kind of be put on the back burner, 223 00:23:23,050 --> 00:23:23,360 like, 224 00:23:23,370 --> 00:23:23,630 oh, 225 00:23:23,630 --> 00:23:26,920 I used to take a shower before work every day, 226 00:23:26,920 --> 00:23:28,670 but now I don't have to work. 227 00:23:28,940 --> 00:23:33,170 So can they have this internal momentum towards self care? 228 00:23:34,320 --> 00:23:42,200 Some would say they used to shower and eat breakfast and take medication as part of their morning routine, 229 00:23:42,640 --> 00:23:45,060 but if they're not even leaving the house, 230 00:23:45,060 --> 00:23:48,090 the morning routine doesn't get done as consistently, 231 00:23:48,100 --> 00:23:52,660 so pretty soon doing one activity can really feel demanding, 232 00:23:52,670 --> 00:23:53,210 like, 233 00:23:53,210 --> 00:23:53,360 oh, 234 00:23:53,360 --> 00:23:56,860 I can't get groceries today because I'm also getting a haircut, 235 00:23:57,640 --> 00:23:58,870 whereas before, 236 00:23:58,870 --> 00:24:01,100 when our day was so scheduled, 237 00:24:01,210 --> 00:24:10,850 we had this just internal momentum and we didn't have to get our energy up to do something. 238 00:24:11,540 --> 00:24:18,770 One thing for the individual to consider then is their need to make an artificial structure during retirement. 239 00:24:19,640 --> 00:24:26,560 Some people may wish to volunteer or have other reasons to leave the house on a particular schedule. 240 00:24:27,240 --> 00:24:32,080 They may make a list of life areas that they want to attend to every week. 241 00:24:32,080 --> 00:24:35,340 So one person may say, 242 00:24:35,350 --> 00:24:40,620 I really benefit from saying I want to learn something new every week. 243 00:24:40,630 --> 00:24:45,610 I want to see a friend every week I exercise on the schedule. 244 00:24:45,620 --> 00:24:54,170 I do chores on this schedule in having a schedule or a structure helps them stay engaged in life, 245 00:24:54,540 --> 00:25:02,170 helps them have momentum for what needs to get done in order to have really a balanced and healthy lifestyle. 246 00:25:04,240 --> 00:25:16,560 Another thing that's changing during the season of life is that there's a lot more engagement that's required with doctors and a lot more instruction to change, 247 00:25:17,940 --> 00:25:22,260 even though there's less engagement with the external world. 248 00:25:22,270 --> 00:25:23,710 In some respects, 249 00:25:23,720 --> 00:25:34,670 there's increasing demand to engage in self care to visit and communicate with physicians and to change all of a sudden, 250 00:25:34,670 --> 00:25:41,620 people are telling you to change your lifestyle what you eat or drink what medicines you take, 251 00:25:41,630 --> 00:25:47,090 instructions to change or shift gears can feel really demanding, 252 00:25:47,100 --> 00:25:53,260 and sometimes the individual may kind of bow out of the whole process and say, 253 00:25:53,270 --> 00:25:55,000 I'm just not going to do this. 254 00:25:55,640 --> 00:26:03,860 Doctors and family can try to keep in mind the demands on the individual and how that may feel to the person on the spectrum, 255 00:26:04,640 --> 00:26:08,190 Maybe they're more likely to pick their battles, 256 00:26:08,200 --> 00:26:09,310 so to speak. 257 00:26:09,310 --> 00:26:09,910 So, 258 00:26:09,920 --> 00:26:17,660 understanding how hard it is for the person to engage with people to shift what they're eating. 259 00:26:17,660 --> 00:26:18,770 For example, 260 00:26:19,240 --> 00:26:19,820 you know, 261 00:26:19,820 --> 00:26:25,450 if somebody has lived on pasta because that's all they can tolerate with regard to texture, 262 00:26:26,040 --> 00:26:26,500 um, 263 00:26:26,510 --> 00:26:26,960 you know, 264 00:26:26,960 --> 00:26:36,350 harping on and um talking again and again about vegetables may not be the battle that they want to have for this person. 265 00:26:37,140 --> 00:26:37,450 So, 266 00:26:37,450 --> 00:26:43,390 there can be both this increased environmental demand in the sense of medical issues. 267 00:26:43,400 --> 00:26:48,270 Doctors waiting rooms calling people asking questions. 268 00:26:48,940 --> 00:26:49,590 Um, 269 00:26:49,600 --> 00:26:57,870 but there's also this decreased environmental structure that previously may have been supportive, 270 00:26:57,880 --> 00:26:58,250 like, 271 00:26:58,250 --> 00:26:58,370 oh, 272 00:26:58,370 --> 00:27:00,020 I know what I do next. 273 00:27:00,030 --> 00:27:01,950 This helps me get out of the house, 274 00:27:01,960 --> 00:27:09,450 I don't have to effort to get up and take a shower because that's just what I do every morning before I go to work. 275 00:27:10,340 --> 00:27:11,280 As you can see, 276 00:27:11,280 --> 00:27:29,370 the aging season of life presents similar challenges in the sense of changes in the physical person and the environment when we compare this to other seasons of life and these shifts can lead to shifts in the way that the autistic characteristics feel, 277 00:27:29,380 --> 00:27:35,390 how they're experienced by the individual and also how they are expressed. 278 00:27:35,390 --> 00:27:41,990 So how other people see that this person is doing A spouse may say, 279 00:27:41,990 --> 00:27:54,960 I don't understand because my husband would get up and do this whole routine every day for 40 years at his job and now he can't get going with anything. 280 00:27:55,440 --> 00:27:57,030 So is this a dementia, 281 00:27:57,030 --> 00:27:58,010 what's happening? 282 00:27:58,020 --> 00:28:03,600 And sometimes it's just the total lack of structure that's, 283 00:28:03,610 --> 00:28:04,050 you know, 284 00:28:04,050 --> 00:28:14,850 all these this momentum has been taken and we can see that the autistic characteristics that have always been there are expressed differently. 285 00:28:15,940 --> 00:28:31,950 It's nice to have an increased understanding that this is common and we can also have a context for what we might be seeing as well as more intentionality about how we might want to enter this season. 286 00:28:32,340 --> 00:28:35,450 So how else can I get sensory inputs? 287 00:28:35,450 --> 00:28:39,260 How else can I create structure and momentum? 288 00:28:39,270 --> 00:28:42,340 How can I communicate with my doctors? 289 00:28:42,340 --> 00:28:44,510 That a lot of change is really, 290 00:28:44,510 --> 00:28:47,160 really impossible for me. 291 00:28:47,170 --> 00:28:49,450 It's just I just, 292 00:28:49,460 --> 00:28:54,560 I have a limit on how much I can change and maintain over time. 293 00:28:55,640 --> 00:29:03,670 Let's be intentional about how we enter certain life seasons and also support each other during their life seasons. 294 00:29:04,640 --> 00:29:11,620 Thank you so much for joining me for this series and how autistic characteristics can shift over life seasons. 295 00:29:12,240 --> 00:29:26,960 I hope you join me again soon and please remember to write down questions that you want covered in future podcast episodes too, adultandgeriatricautism@gmail.com      

Join Dr. Regan for the third episode in this series about how autistic characteristics may shift across the lifespan. This episode focuses on the life seasons of women, including monthly cycles, pregnancy, and menopause. Tune in next time for the final episode in the series which will focus on autism and aging.  You may also enjoy the episode: Autism in Women Published Articles for Additional Reading: “Life is Much More Difficult to Manage During Periods”: Autistic Experiences of Menstruation Prevalence of premenstrual syndrome in autism: a prospective observer-rated study Sensory challenges experienced by autistic women during pregnancy and childbirth: a systematic review Exploratory Study of Childbearing Experiences of Women with Asperger Syndrome ‘When my autism broke': A qualitative study spotlighting autistic voices on menopause   Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the episode content: 1 00:00:04,740 --> 00:00:06,280 Hi and welcome back. 2 00:00:06,290 --> 00:00:08,130 This is Dr Theresa Regan, 3 00:00:08,140 --> 00:00:10,070 a neuropsychologist, 4 00:00:10,080 --> 00:00:13,210 mother of a teen on the spectrum author, 5 00:00:13,210 --> 00:00:17,250 speaker and your podcast host for autism in the adult. 6 00:00:17,740 --> 00:00:27,800 You are joining us for the 3rd episode in a four part series on variations in the characteristics of autism across the lifespan. 7 00:00:29,140 --> 00:00:46,260 Our first episode focused on just foundational knowledge about neurology and why we can expect neurologic characteristics to feel and be expressed with some variation across time and also across context. 8 00:00:47,640 --> 00:00:56,760 The second episode focused on adolescents as a season of the lifespan during which some of these variations can become really noticeable. 9 00:00:57,440 --> 00:00:59,470 There's chemical changes going on, 10 00:00:59,470 --> 00:01:00,730 physical development. 11 00:01:00,740 --> 00:01:09,260 A lot of increase in independence is requested of the person and also just the demands of social interaction, 12 00:01:09,270 --> 00:01:11,010 academic demands, 13 00:01:11,020 --> 00:01:15,560 all these things converging to sometimes make that perfect storm. 14 00:01:17,140 --> 00:01:32,790 This third episode is going to focus on women because there are really some pretty market hormone shifts that females experience across their lifespan and these can be accompanied by shifts in the experience of autism. 15 00:01:32,800 --> 00:01:37,000 So we want to focus specifically on that topic today. 16 00:01:37,000 --> 00:01:38,450 For the episode, 17 00:01:40,740 --> 00:01:49,760 we're going to review issues related to a woman's monthly cycle to pregnancy and post pregnancy issues and also to menopause. 18 00:01:50,940 --> 00:02:04,160 I'm going to include links to some articles in the show notes for those who want to read more and I'll let you know that many of the articles really focus on solely identifying that this area needs more study. 19 00:02:04,170 --> 00:02:08,570 So you may start to read thinking that it's going to tell you something. 20 00:02:08,570 --> 00:02:10,420 We don't know when really, 21 00:02:10,420 --> 00:02:11,260 it's just saying, 22 00:02:11,260 --> 00:02:11,580 gosh, 23 00:02:11,580 --> 00:02:13,110 there's not much out there. 24 00:02:13,120 --> 00:02:27,920 We really should be looking at this more in particular and then other studies focus on gathering comments and taking surveys of women on the spectrum and really listening to the experiences of autistic women, 25 00:02:27,930 --> 00:02:30,830 which I think is really informative and helpful. 26 00:02:30,830 --> 00:02:37,310 So we are going to kind of focus on that side of things for the majority of this episode. 27 00:02:39,540 --> 00:02:42,960 So we focused on adolescents in the second episode. 28 00:02:43,340 --> 00:02:52,270 But here we're going to focus specifically on the seasons and a female's lifespan beyond adolescence. 29 00:02:52,270 --> 00:02:57,050 So we are going to start with the topic of monthly cycles in particular. 30 00:02:57,740 --> 00:02:59,850 So these begin during adolescence, 31 00:02:59,850 --> 00:03:06,690 but they continue across much of the female's lifespan and they can impact individuals differently. 32 00:03:06,700 --> 00:03:07,280 So, 33 00:03:07,280 --> 00:03:09,560 across all human females, 34 00:03:09,560 --> 00:03:18,830 there is a lot of variation on how that cycle impacts them how much um consistency they experience in that area, 35 00:03:18,840 --> 00:03:22,500 what kinds of changes in their physical state, 36 00:03:22,500 --> 00:03:24,950 their emotional state they might experience. 37 00:03:25,830 --> 00:03:28,860 And this is really true for the autistic female as well. 38 00:03:29,540 --> 00:03:45,260 One overall theme in the comments of women who are on the spectrum is that many of the issues that can be a challenge for them on a day to day basis can really feel like more of a challenge just before and also during their cycle. 39 00:03:45,940 --> 00:03:50,240 Many of the characteristics specifically mentioned by women on the spectrum. 40 00:03:50,240 --> 00:03:56,260 Focus around sensory sensitivities emotional regulation. 41 00:03:56,570 --> 00:04:02,550 So that ability to feel calm and centered social communication. 42 00:04:02,940 --> 00:04:05,760 So figuring out what am I feeling, 43 00:04:06,240 --> 00:04:08,230 Finding words to express, 44 00:04:08,230 --> 00:04:17,450 that communicating with others in a social exchange and also feeling flexible in everyday situations. 45 00:04:17,460 --> 00:04:18,430 So, 46 00:04:18,440 --> 00:04:33,460 um I really prefer routine and now this unexpected barrier has happened and I also happened to be in that time of my cycle where dealing with these unexpected things feel so much harder. 47 00:04:34,640 --> 00:04:45,460 One woman said it can become much more overwhelming and harder to maintain control of the things that already take a lot of effort for us to keep on top of during our period. 48 00:04:46,740 --> 00:04:52,460 One woman said I have more meltdowns and worse meltdowns just before my period. 49 00:04:52,840 --> 00:05:02,970 And she also noted that understanding that this is what happens in her life makes those episodes in those periods of time more manageable. 50 00:05:02,970 --> 00:05:04,130 So they don't feel, 51 00:05:04,140 --> 00:05:09,650 she doesn't feel quite so thrown off now that she understands what to expect, 52 00:05:10,040 --> 00:05:11,660 although it is challenging. 53 00:05:12,940 --> 00:05:20,260 Some women on the spectrum reported that self injury behavior was more common before periods as well. 54 00:05:20,640 --> 00:05:28,970 Uh for some women's self injury includes um cutting or biting themselves, 55 00:05:28,980 --> 00:05:30,740 hitting their head on something, 56 00:05:30,740 --> 00:05:31,860 hitting their body. 57 00:05:32,440 --> 00:05:36,360 And there was a 2008 study which, 58 00:05:36,370 --> 00:05:36,870 you know, 59 00:05:36,870 --> 00:05:43,150 that's been a while ago and it used some diagnostic criteria that are out of date. 60 00:05:43,540 --> 00:05:47,700 And there weren't a lot of follow up studies in this regard, 61 00:05:47,700 --> 00:05:49,650 but I will link it in the show notes, 62 00:05:49,910 --> 00:06:08,350 but they found that if they looked at women who experienced Um greater than or equal to 30 difficulty with emotions and other things just prior to their periods and during their periods, 63 00:06:08,740 --> 00:06:24,950 that the prevalence of this significant shift And their ability to stay centered was 92% in the autism group and 11% in the control group, 64 00:06:25,340 --> 00:06:28,110 meaning that in their study again, 65 00:06:28,110 --> 00:06:31,090 this has not been replicated that I can see, 66 00:06:31,090 --> 00:06:38,090 but it does really um hold true as far as what we typically see in women, 67 00:06:38,090 --> 00:06:44,260 that this significantly more difficult experience of emotions. 68 00:06:44,540 --> 00:06:52,700 Um that's really much higher in the autism female group than in the neuro typical group who are experiencing monthly shifts. 69 00:06:55,240 --> 00:07:05,650 The hormone shift themselves can really heighten sensory experiences and they can make emotions more intense or even just come out easier. 70 00:07:05,650 --> 00:07:10,580 Like um I might be able to think or feel something inside typically, 71 00:07:10,580 --> 00:07:13,230 but now during this period of my cycle, 72 00:07:13,230 --> 00:07:32,860 it just really easily comes out and I feel like I don't have as much control over that gate of what I let out and what I keep in another layer seems to be that monthly cycles really increase the amount of sensory experiences and also often involve pain or discomfort. 73 00:07:33,340 --> 00:07:40,200 So the women on the spectrum is processing quite a bit more experience and discomfort than typical. 74 00:07:40,210 --> 00:07:47,630 So it's not only that hormones make the common things more disruptive, 75 00:07:47,640 --> 00:07:52,450 but also you're experiencing even more sensation than typical. 76 00:07:53,140 --> 00:07:59,120 This can increase the difficulty that women have during their periods with focusing, 77 00:07:59,130 --> 00:08:00,640 communicating, 78 00:08:00,650 --> 00:08:03,360 staying centered in their experiences. 79 00:08:03,740 --> 00:08:06,860 And one female on the spectrum said, 80 00:08:06,860 --> 00:08:07,330 you know, 81 00:08:07,340 --> 00:08:12,330 there's so much more coming at me and life is intense enough as it is, 82 00:08:12,330 --> 00:08:20,360 but every month I go through this time of even more intensity and that's really challenging for me to sort through. 83 00:08:21,540 --> 00:08:35,090 In addition to descriptions of the shifts and experience a subgroup of autistic females also expressed that they really wish they had more preparation for what the experience would be like. 84 00:08:35,100 --> 00:08:39,630 So for many on the spectrum who love routine or repetition, 85 00:08:39,630 --> 00:08:41,200 preparation detail, 86 00:08:41,200 --> 00:08:43,260 knowing what's going to happen ahead of time, 87 00:08:44,140 --> 00:08:44,580 you know, 88 00:08:44,580 --> 00:08:52,260 having as much information as possible related to monthly cycles would have felt more grounding to them. 89 00:08:52,640 --> 00:08:52,850 Mhm. 90 00:08:54,040 --> 00:09:00,170 The information they wanted more of included practical things like where do I get these supplies? 91 00:09:00,170 --> 00:09:03,280 What kinds of things do I need to buy also? 92 00:09:03,280 --> 00:09:06,150 How long is this expected to last every month? 93 00:09:06,640 --> 00:09:12,460 How to communicate their needs if they're at school and they need to leave to go to the restroom, 94 00:09:12,940 --> 00:09:13,360 you know, 95 00:09:13,360 --> 00:09:19,750 having some preparation as to what kinds of things they could do in different situations. 96 00:09:20,340 --> 00:09:20,550 Mhm. 97 00:09:21,240 --> 00:09:30,000 They also said that they wished they had understood that women experience variation um across time and also between women, 98 00:09:30,010 --> 00:09:37,150 you know that their best friend may have quite a different experience than they do and that's common. 99 00:09:38,040 --> 00:09:48,520 Um So their experience is likely to be somewhat different than their peers experience and that doesn't mean that something is wrong or that they need to feel anxious about that. 100 00:09:48,530 --> 00:10:03,050 The important thing is for them to notice what is typical for them and to communicate with family or doctors if they're typical experience shifts or it's disrupted steps in some way or changes. 101 00:10:04,440 --> 00:10:09,440 They also voiced that they wish they had understood that pain and discomfort was really normal. 102 00:10:09,450 --> 00:10:14,780 Sometimes they felt like it meant something that was really dangerous to them. 103 00:10:14,790 --> 00:10:19,200 Like maybe this was not supposed to be true, 104 00:10:19,200 --> 00:10:21,260 Maybe it meant that something was wrong, 105 00:10:21,260 --> 00:10:22,260 that they were dying, 106 00:10:22,260 --> 00:10:28,980 that they had a medical problem and also that emotional intensity and shifts were very common. 107 00:10:28,990 --> 00:10:32,490 So sometimes they had the basic physical information, 108 00:10:32,500 --> 00:10:40,260 but they really didn't understand that they can expect emotions to feel different during this period of time. 109 00:10:42,240 --> 00:10:55,560 Some individuals on the spectrum really struggle with health anxiety anyway and may quickly feel nervous if they think that they might be sick or if they don't know what to expect in their physical experience. 110 00:10:56,440 --> 00:11:02,360 Other women said it was quite a struggle because there was variation for a month to month. 111 00:11:02,360 --> 00:11:06,440 And so they didn't really know exactly what day they're cycle would start, 112 00:11:06,450 --> 00:11:07,860 how it would feel, 113 00:11:07,860 --> 00:11:09,190 how long it would last. 114 00:11:09,200 --> 00:11:13,360 And even though they had a sense of their typical rhythm, 115 00:11:13,740 --> 00:11:14,750 there's always, 116 00:11:14,760 --> 00:11:15,070 you know, 117 00:11:15,070 --> 00:11:18,620 some variation is this going to start today or tomorrow, 118 00:11:18,630 --> 00:11:20,690 How heavy is it going to be? 119 00:11:20,700 --> 00:11:28,230 Uh and so that may not feel like a big variation to neuro typical females, 120 00:11:28,230 --> 00:11:34,640 but for the autistic female that relies on repetition and detail and knowing what's going to happen. 121 00:11:34,650 --> 00:11:35,280 You know, 122 00:11:35,280 --> 00:11:43,960 sometimes that anxiety about when is this going to happen and what's it going to be like can be kind of a real struggle. 123 00:11:45,640 --> 00:11:50,460 The next season we'll touch on is the season of pregnancy and post pregnancy. 124 00:11:50,840 --> 00:11:52,900 And this could include breastfeeding. 125 00:11:53,540 --> 00:11:55,960 For women who experience this season, 126 00:11:55,970 --> 00:12:08,260 there are many significant hormone changes of course and a lot of physical changes and some women really struggle with feeling like this isn't my body anymore. 127 00:12:08,540 --> 00:12:11,550 And I have all this increased discomfort, 128 00:12:11,560 --> 00:12:13,110 I have sleep problems, 129 00:12:13,110 --> 00:12:13,980 fatigue, 130 00:12:13,980 --> 00:12:15,350 I'm nauseated, 131 00:12:15,350 --> 00:12:17,560 my appetite is different. 132 00:12:17,560 --> 00:12:21,950 I don't fit in my favorite comfortable clothes anymore. 133 00:12:22,340 --> 00:12:27,860 And so having so much different about their own physical experience. 134 00:12:28,240 --> 00:12:32,460 In addition to all the shifting hormones can really be impactful. 135 00:12:33,940 --> 00:12:38,350 Many neuro typical women experience sensory symptoms when they're pregnant. 136 00:12:38,740 --> 00:12:43,260 So a lot of times that involves increased smell sensitivity, 137 00:12:43,270 --> 00:12:52,450 like I cannot stand the smell of food or cologne or the pets have such a strong scent to them now. 138 00:12:53,240 --> 00:13:03,060 And sometimes that's most noticeable in the early months of pregnancy and then just kind of peters out for the neuro typical female, 139 00:13:03,440 --> 00:13:07,420 but for the autistic female who has sensory characteristics. 140 00:13:07,430 --> 00:13:07,960 Anyway, 141 00:13:07,960 --> 00:13:21,200 this can really be a time of heightened difficulty with a variety of census rather than just smell Some women report needing more deep pressure during pregnancy. 142 00:13:21,210 --> 00:13:21,850 Um, 143 00:13:21,850 --> 00:13:31,730 we've talked about deep pressure and other episodes that this is something that can be calming and grounding and centering for the person on the spectrum. 144 00:13:31,730 --> 00:13:40,430 And that is why some will use weighted blankets and other methods to get really some deep pressure that's calming. 145 00:13:40,450 --> 00:13:44,280 And so the women who report this feel like during their pregnancy, 146 00:13:44,280 --> 00:13:48,850 they noticed they needed more in order to feel calm and centered. 147 00:13:51,440 --> 00:13:54,820 Some talked about using things like massage. 148 00:13:54,830 --> 00:14:00,000 Other women talked about wrapping things around like their fingers, 149 00:14:00,000 --> 00:14:00,820 for example, 150 00:14:00,820 --> 00:14:02,180 or their hands. 151 00:14:02,230 --> 00:14:05,010 Some would have their pets lay on top of them. 152 00:14:05,020 --> 00:14:19,290 So whatever way they could get some extra pressure really helped them feel more grounded and calm nausea and sensitivity to food textures and sent maybe heightened. 153 00:14:19,300 --> 00:14:26,280 And many of the individuals on the spectrum already have some repetition and how they eat. 154 00:14:26,290 --> 00:14:30,690 So they may go on what I call food jags where, 155 00:14:30,700 --> 00:14:31,380 oh, 156 00:14:31,380 --> 00:14:37,550 I'm so into yogurt and salami and they'll eat that for a couple of months and then switch. 157 00:14:37,840 --> 00:14:39,740 And that's without pregnancy. 158 00:14:39,740 --> 00:14:43,610 And so when you add the pregnancy and there can be cravings, 159 00:14:43,620 --> 00:14:48,160 there can be nausea texture sensitivities that are even more significant. 160 00:14:48,640 --> 00:14:55,530 Sometimes you'll get this reliance on a few foods for nutrition and that's not necessarily a problem, 161 00:14:55,530 --> 00:15:03,060 but it may be something that they want to monitor and make sure they're getting enough nutrition during their pregnancy, 162 00:15:03,940 --> 00:15:06,960 emotions can be extra challenging to manage. 163 00:15:07,340 --> 00:15:10,550 Similar to what we discussed about monthly cycles. 164 00:15:11,150 --> 00:15:16,350 The impact of hormone changes on emotions during pregnancy may be really noticeable. 165 00:15:16,740 --> 00:15:23,060 And many individuals on the spectrum also experience sleep disturbance at the best of times. 166 00:15:23,540 --> 00:15:29,360 And the extra physical changes during pregnancy can increase problems resting and sleeping. 167 00:15:30,240 --> 00:15:35,890 So this decreased sleep may reduce resilience even more for things like staying centered, 168 00:15:35,900 --> 00:15:36,960 staying calm, 169 00:15:36,960 --> 00:15:38,080 paying attention, 170 00:15:38,090 --> 00:15:43,150 handling unexpected changes and socially communicating. 171 00:15:43,480 --> 00:15:45,010 This is what I'm experiencing. 172 00:15:45,010 --> 00:15:46,250 This is what I need, 173 00:15:46,640 --> 00:15:51,510 what do you need And also similar to monthly cycles, 174 00:15:51,510 --> 00:16:00,000 having to process so much more sensation for such a long period of time can also be noticeable to the autistic woman. 175 00:16:00,440 --> 00:16:11,380 So once the baby is born there are hormonal shifts again and this can be impacted by whether or not the mother chooses to breastfeed or use formula. 176 00:16:11,560 --> 00:16:35,860 And so awareness of how hormone shifts can impact this experience and the expression of autistic characteristics that can help the mother and her partner and her friends and her family at least have this context for what she is experiencing and then they can think um kind of intentionally about what she needs and how to be supportive. 177 00:16:36,240 --> 00:16:37,980 So they can think about Heywood, 178 00:16:37,980 --> 00:16:39,150 deep pressure help. 179 00:16:39,740 --> 00:16:54,210 Um and thinking in that way may really help this season go more smoothly so that she feels more resilient as we talked about in the previous episodes, 180 00:16:54,210 --> 00:17:03,670 Physical changes are often occurring at the same time of life that a lot of just life complexities land on our doorstep. 181 00:17:03,680 --> 00:17:05,590 And when we talk about pregnancy, 182 00:17:05,600 --> 00:17:09,360 we're of course talking about all the life changes that go with it, 183 00:17:09,640 --> 00:17:12,300 so changes in the physical environment, 184 00:17:12,300 --> 00:17:13,010 for example, 185 00:17:13,010 --> 00:17:13,890 of the house, 186 00:17:14,240 --> 00:17:16,610 there's extra furniture in your space, 187 00:17:16,610 --> 00:17:18,630 people are moving things around, 188 00:17:18,830 --> 00:17:23,060 you might have to get rid of things that actually you feel kind of attached to. 189 00:17:23,540 --> 00:17:28,910 Uh and sometimes we just have to get used to having more clutter around and this, 190 00:17:29,340 --> 00:17:29,560 you know, 191 00:17:29,560 --> 00:17:35,270 maybe stressful for the person that likes their physical environment to be a certain way. 192 00:17:36,940 --> 00:17:43,140 Some autistics really depend on their physical environment to help them feel grounded and calm. 193 00:17:43,150 --> 00:17:46,670 Um there's a subset of people on the spectrum, 194 00:17:46,670 --> 00:17:47,410 for example, 195 00:17:47,410 --> 00:17:51,270 that really love a visually simple space. 196 00:17:51,730 --> 00:17:57,670 Other people really love to have objects in certain places or facing a certain way. 197 00:17:58,040 --> 00:18:05,450 So having a shift in the environment can impact this sense of grounded Nous. 198 00:18:08,440 --> 00:18:27,790 Women may report feeling like they have less control over the environment and therefore they may need to rely more on other strategies to find that peaceful place in their own spirit preparing for baby often involves more social contact. 199 00:18:27,800 --> 00:18:35,890 And so people may come up to her and want to touch her or talk to her about their own birth experiences. 200 00:18:35,900 --> 00:18:39,010 They might ask questions about her pregnancy. 201 00:18:39,020 --> 00:18:54,380 So there can be less personal space in a social context and this can feel demanding and draining to the autistic woman who's already really managing a lot of physical and environmental changes. 202 00:18:55,040 --> 00:19:00,460 So this woman may want to decide ahead of time how much social context she wants, 203 00:19:01,040 --> 00:19:03,070 Does she want a baby shower? 204 00:19:03,080 --> 00:19:07,670 Does she want family to visit and stay over when the baby's born? 205 00:19:09,040 --> 00:19:29,000 She may want to practice comments that she can make when strangers want to ask her about the pregnancy in order to just kind of create a safe space for herself without feeling like people are kind of coming into her space more often than she can really handle and and balance. 206 00:19:31,840 --> 00:19:42,240 Some women on the spectrum realize that they have really high standards for themselves and they don't want to take risks or fail or make mistakes. 207 00:19:42,460 --> 00:19:47,440 Inattention to detail may be very important to them and getting this right. 208 00:19:47,450 --> 00:19:48,730 And in that sense, 209 00:19:48,730 --> 00:20:01,770 pregnancy and childbirth and parenting may feel really daunting because it's really difficult to get through that process without realizing that you don't have as much control as you wish you did. 210 00:20:01,780 --> 00:20:05,390 And it feels like a big risk in some ways, 211 00:20:05,400 --> 00:20:08,030 like I can influence the situation, 212 00:20:08,030 --> 00:20:11,170 but I don't have all the answers and nobody else does either. 213 00:20:11,440 --> 00:20:14,400 And that can kind of increase anxiety. 214 00:20:14,840 --> 00:20:21,100 And so having this self awareness if this is your um kind of rhythm, 215 00:20:21,100 --> 00:20:28,860 your internal rhythm that you try to stay on top of so many details and facts so you can get everything right. 216 00:20:29,440 --> 00:20:41,760 Um you may need to process how can you manage that during this really complex life change of pregnancy and becoming apparent. 217 00:20:43,240 --> 00:20:48,970 Some described feeling guilty when there were problems during their pregnancy. 218 00:20:48,980 --> 00:20:57,960 So if they went to the doctor in their blood pressure was high or their sugars were high or there was something that the doctor wanted to monitor more. 219 00:20:58,840 --> 00:21:03,720 They kind of felt like they had failed their doctor's appointment and you know, 220 00:21:03,730 --> 00:21:19,270 having this awareness of what the struggle is about and how to process that can really help um adjust to not having all the answers and not being able to get everything right and avoid risk. 221 00:21:19,740 --> 00:21:31,310 Many women describe to that pregnancy birth plans and breastfeeding and also parenting issues became their special interest and this isn't necessarily a bad thing at all. 222 00:21:31,310 --> 00:21:33,060 They become very informed, 223 00:21:33,440 --> 00:21:41,260 they have strong opinions and things they would like to choose in their parenting um in a really intentional way, 224 00:21:41,270 --> 00:21:58,050 but some also say they wish they had been more aware that this is what was happening so that when they hit obstacles or rough spots and they felt out of control um they could also focus on balance. 225 00:21:58,440 --> 00:22:01,320 Like I have some other interests. 226 00:22:01,330 --> 00:22:05,280 I have um ways of restoring myself, 227 00:22:05,280 --> 00:22:10,780 I have ways of grounding myself and this is a special interest that's okay, 228 00:22:10,780 --> 00:22:17,580 but I also want to seek balance and um and what I'm doing so that when these difficult, 229 00:22:17,580 --> 00:22:19,050 unexpected things happen, 230 00:22:19,050 --> 00:22:21,360 I can still hold the course and be okay. 231 00:22:23,740 --> 00:22:28,260 Also the increased chaos in the home after baby is born, 232 00:22:28,270 --> 00:22:30,190 that really needs no explanation. 233 00:22:30,190 --> 00:22:33,670 There are so many more demands on the parent. 234 00:22:33,680 --> 00:22:35,790 They have less rest time, 235 00:22:35,810 --> 00:22:38,240 there's a lot more sensory input. 236 00:22:38,250 --> 00:22:46,090 So really close attention to having strategies ahead of time and as you go along, 237 00:22:46,090 --> 00:22:51,170 adjusting strategies so that you know what you need, 238 00:22:51,930 --> 00:23:11,820 whether that's pressure or quiet time or um rest breaks and all of these things to really do this marathon of mothering rather than trying to sprint through doing everything perfectly all the time again, 239 00:23:11,820 --> 00:23:38,770 this is really a common experience for any woman who's gone through that season and it just maybe more so for the autistic female that they really want to figure out how to add balance and restorative kinds of activities in their life as we move on to menopause. 240 00:23:39,140 --> 00:23:40,020 Um, 241 00:23:40,280 --> 00:23:41,210 this again, 242 00:23:41,220 --> 00:23:50,020 is a season of a lot of hormonal shifting and some women report that they really did well, 243 00:23:50,020 --> 00:23:52,880 understanding their autistic characteristics, 244 00:23:52,890 --> 00:23:58,360 using their strengths to get ahead at work to get promoted to accomplish life goals. 245 00:23:58,840 --> 00:24:05,270 And they found compatible partners and they really got into this nice groove with um, 246 00:24:05,270 --> 00:24:15,660 a life that fit them and it fit their nervous system and all of a sudden menopause happens and there just was a lot of shift that they didn't expect. 247 00:24:16,040 --> 00:24:22,020 Um one woman described that she felt that her autism broke during menopause, 248 00:24:22,020 --> 00:24:23,790 that it kind of broke through, 249 00:24:23,800 --> 00:24:29,860 whereas she didn't really have to think about it a lot during other Seasons of Life, 250 00:24:31,040 --> 00:24:34,420 A quote from a woman in menopause said during menopause, 251 00:24:34,420 --> 00:24:42,070 I was on three meltdowns a week at times and my meltdowns were of the nature that people would call a basket case, 252 00:24:42,640 --> 00:24:46,660 I'd strip down to my underwear sometimes during a meltdown at work, 253 00:24:47,440 --> 00:24:50,750 so that feeling that my body, 254 00:24:50,750 --> 00:24:51,820 my nervous system, 255 00:24:51,820 --> 00:24:57,730 my my whole system is so overwhelmed that I need to just strip down. 256 00:24:57,730 --> 00:25:00,780 So I'm not getting so much sensory input, 257 00:25:00,780 --> 00:25:10,050 I'm not getting input that feels like it just takes me over the edge of feeling upset. 258 00:25:10,060 --> 00:25:17,770 Um and so I love these quotes because I feel like it really helps us here, 259 00:25:17,770 --> 00:25:19,370 the humanity of that, 260 00:25:19,380 --> 00:25:33,450 and we can probably all relate in certain areas or certain times of our life where we have felt um just overwhelmed by change or by things that hit us harder than we thought. 261 00:25:33,940 --> 00:25:35,360 Um So here again, 262 00:25:35,360 --> 00:25:40,020 we're talking about similarities with the report of many women during menopause, 263 00:25:40,020 --> 00:25:50,670 but it's really crossed with these common autistic characteristics that I feel more anxiety that I feel more sensory difficulty that I have more meltdowns. 264 00:25:50,940 --> 00:25:55,290 An autistic woman may feel that her attention to detail in getting things right, 265 00:25:55,290 --> 00:25:58,050 worked for her and so many aspects of life, 266 00:25:58,440 --> 00:25:59,820 but that during menopause, 267 00:25:59,820 --> 00:26:04,400 her hormone shifts have really led to this increased anxiety. 268 00:26:04,410 --> 00:26:08,060 This feeling of being overwhelmed by the demands of the environment. 269 00:26:09,440 --> 00:26:16,500 And she may feel like she's now getting stuck on detail rather than using that as a real gift. 270 00:26:16,500 --> 00:26:19,280 That helps her move forward with projects. 271 00:26:19,280 --> 00:26:25,850 So getting stuck to the point that it really makes it hard to move on with things to make decisions to feel calm. 272 00:26:26,640 --> 00:26:30,700 Women also report that changes in their physical form again, 273 00:26:30,700 --> 00:26:43,070 that our body really changes without our permission and there are weight changes and wrinkles and sometimes the ways that we use to exercise or have fun and do our leisure time. 274 00:26:43,070 --> 00:26:46,900 Sometimes we just can't physically engage in the same things. 275 00:26:47,340 --> 00:26:54,650 Sleep disturbance is common in menopause and of course for the autistic who already had sleep disturbance. 276 00:26:54,650 --> 00:26:56,760 That can be really challenging. 277 00:26:57,220 --> 00:27:10,350 And the emotional symptoms can all impact how this season feels the physical and hormonal changes impact many aspects of the autistic experience itself. 278 00:27:10,740 --> 00:27:14,380 And similar to other portions of our episodes, 279 00:27:14,380 --> 00:27:18,720 we need to look also at the life season changes as well. 280 00:27:18,720 --> 00:27:20,780 So life complexity, 281 00:27:20,790 --> 00:27:22,670 environmental changes. 282 00:27:23,510 --> 00:27:26,490 Some women are facing the need to downsize, 283 00:27:26,490 --> 00:27:27,560 for example, 284 00:27:27,590 --> 00:27:29,140 during menopause, 285 00:27:29,140 --> 00:27:31,060 maybe they're empty nesters, 286 00:27:31,440 --> 00:27:34,670 maybe they've gone through the loss of a partner, 287 00:27:34,670 --> 00:27:47,300 a divorce or the death of a spouse and they may be thinking about getting rid of their um possessions enough that they're downsizing into a new space. 288 00:27:47,310 --> 00:27:49,500 How will this new space feel? 289 00:27:49,500 --> 00:27:50,960 That can be really hard. 290 00:27:51,640 --> 00:28:00,380 Some women on the spectrum are going to be very attached to things in the environment in a way that feels stronger than a neuro typical may feel. 291 00:28:00,410 --> 00:28:05,260 And doing all this in the midst of physical changes can be really difficult. 292 00:28:06,640 --> 00:28:15,460 They may also be caring for ill or aging parents or have experienced loss in other aspects of their life. 293 00:28:16,340 --> 00:28:17,420 So as we said, 294 00:28:17,420 --> 00:28:31,160 these physical changes that occur in menopause also coincide with shifts and life experience and all of these things together can lead to some pretty big changes and how autism is experienced and expressed, 295 00:28:31,740 --> 00:28:38,040 A woman may feel like she needs to figure out how her system works again from the beginning. 296 00:28:38,050 --> 00:28:40,780 Like I used to have this figured out, 297 00:28:40,790 --> 00:28:43,800 I had come to understand myself and what I need, 298 00:28:43,800 --> 00:28:48,450 but now things have changed and I really have to figure this out again. 299 00:28:50,940 --> 00:28:51,550 Finally, 300 00:28:51,550 --> 00:28:55,850 it is important to recall that these are generalizations. 301 00:28:55,850 --> 00:28:59,810 So I I really want to emphasize that, 302 00:28:59,810 --> 00:29:07,400 I'm not saying that everything falls apart in certain seasons of hormonal shift, 303 00:29:07,410 --> 00:29:09,930 there's so much generalization, 304 00:29:09,940 --> 00:29:22,370 but I think that when the autistic woman goes through a season of life and the things that she thought she understood about herself really seemed to shift, 305 00:29:22,380 --> 00:29:29,520 I think it is helpful to know the context for that that has a context within the nervous system, 306 00:29:29,530 --> 00:29:31,730 within the autistic experience, 307 00:29:31,730 --> 00:29:36,960 within all these life changes and that in itself can be really helpful. 308 00:29:37,540 --> 00:29:38,290 And also, 309 00:29:38,290 --> 00:29:43,070 I think it allows us to be intentional about what do I need now? 310 00:29:43,080 --> 00:29:44,730 I didn't used to need this, 311 00:29:44,730 --> 00:29:45,870 but I need this now. 312 00:29:45,870 --> 00:29:48,500 And so I'm prepared to shift. 313 00:29:48,510 --> 00:29:58,170 I understand that it's not that I figure myself out for a lifetime and I need the same things all the time. 314 00:29:58,540 --> 00:30:04,480 It's that I figure things out for a season and I am prepared to shift when that changes. 315 00:30:05,440 --> 00:30:14,170 I hope this gives a nice overview of some of the physical and life season changes that impact autistic women. 316 00:30:14,840 --> 00:30:17,870 And in our final episode of the series, 317 00:30:17,870 --> 00:30:19,130 coming up next time, 318 00:30:19,130 --> 00:30:23,050 we're going to talk about shifts that have to do with aging. 319 00:30:23,060 --> 00:30:25,430 So we're going to talk about the aging, 320 00:30:25,430 --> 00:30:26,890 brain and body. 321 00:30:26,900 --> 00:30:34,550 We're going to talk about retirement and other aspects of just aging within the context of autism. 322 00:30:34,840 --> 00:30:42,270 I hope you join us for that next episode as we round out this series.      

Join Dr. Regan for the second episode in this series about how autistic characteristics may shift across the lifespan. This episode focuses on the life season of adolescence. Stay tuned for the next episodes in the series to hear about hormonal shifts in women and autism in the aging adult (50's and beyond).  Recognizing Dysregulation on the Autism Spectrum: Fight, Flight, Freeze   Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the Transcript:   1 00:00:03,340 --> 00:00:08,560 Hello and welcome to this episode of Autism in the Adult podcast, 2 00:00:08,940 --> 00:00:10,030 I am your host, 3 00:00:10,040 --> 00:00:11,550 Dr Theresa Regan. 4 00:00:11,560 --> 00:00:13,980 I am a neuropsychologist. 5 00:00:13,990 --> 00:00:23,750 The director of an adult diagnostic autism clinic in central Illinois, and I'm the mother of a teen on the autism spectrum. 6 00:00:25,140 --> 00:00:45,660 We are starting the second episode of a four part series today and the series is about characteristics of autism that fluctuate or shift across the lifespan according to different seasons in life of the individual or changes in the environment. 7 00:00:46,340 --> 00:00:53,960 And our first episode in this series was that foundational information about shifting characteristics, 8 00:00:53,970 --> 00:01:06,460 shifts in how the individual experiences the characteristics and how those around them experience or are impacted by these autistic characteristics. 9 00:01:07,840 --> 00:01:08,500 Today, 10 00:01:08,500 --> 00:01:09,700 in the second episode, 11 00:01:09,700 --> 00:01:26,360 we're going to focus on the time period of adolescence in the lifespan and talk about why that can be such a huge shift and why there can be so many changes for the individual at that time. 12 00:01:27,540 --> 00:01:47,860 one of the things we covered last time is that the changes in how we experience ourselves and express ourselves are often impacted by characteristics of the person that would include their physical development, 13 00:01:47,860 --> 00:01:49,540 the development of the brain, 14 00:01:49,550 --> 00:01:56,220 the biochemistry of the body and the brain also... things like the environment. 15 00:01:56,230 --> 00:01:59,770 So what kinds of demands are in the environment, 16 00:01:59,770 --> 00:02:05,860 what kind of assistance and structure are within that environment at the time. 17 00:02:07,340 --> 00:02:18,860 Things that may shift may also include coping strategies that we've learned certain things we've learned to mask something or to cope with something and regulate ourselves better. 18 00:02:20,040 --> 00:02:24,360 Let's start with the physical person during adolescence. 19 00:02:25,240 --> 00:02:37,980 So one thing that happens of course is that the physical body has been developing and changing and during adolescence there's just a lot of acceleration in that we've got a lot more muscle mass, 20 00:02:37,980 --> 00:02:39,510 you've got a lot of height, 21 00:02:39,520 --> 00:02:41,560 the voice changes etcetera. 22 00:02:42,140 --> 00:02:48,110 And the person at the end of that whole cycle has a different body in many respects. 23 00:02:48,740 --> 00:03:09,660 And one of the things that clients on the spectrum have discussed with me is that for people who like consistency and predictability and who they are and what's happening sometimes this season of having a different body can really be frustrating and upsetting. 24 00:03:10,140 --> 00:03:13,100 And I've had clients say, 25 00:03:13,110 --> 00:03:14,240 you know, 26 00:03:14,250 --> 00:03:16,420 this is not my body. 27 00:03:16,430 --> 00:03:20,920 I really want my 10 year old body back because that was me. 28 00:03:20,930 --> 00:03:37,320 It felt like my internal person was connected to that physical person and to have so many things change without my permission so that I'm a different height and weight and I just don't feel like this is my body anymore. 29 00:03:37,320 --> 00:03:39,430 I just don't like it. 30 00:03:39,440 --> 00:03:44,090 I want to go back in time and to have my original body, 31 00:03:44,090 --> 00:03:46,650 the body that fits my personhood. 32 00:03:50,140 --> 00:03:55,270 Sometimes this will come out where people say I as an adult, 33 00:03:55,280 --> 00:04:04,660 focused a lot on staying at the weight of 118 because that's what my weight was when I stopped getting taller. 34 00:04:04,660 --> 00:04:07,190 So when I graduated from high school, 35 00:04:07,190 --> 00:04:13,440 I was 118 And I really can't tolerate being 120. 36 00:04:13,450 --> 00:04:16,770 I can't tolerate being 100 and 10. 37 00:04:16,780 --> 00:04:34,080 I need to be kind of that same foundational number that I associate with my body and I don't want it to change as you can predict by thinking about the lifespan of the individual. 38 00:04:34,740 --> 00:04:42,370 This stress related to unexpected or unplanned changes in the body, 39 00:04:42,380 --> 00:04:45,460 can really happen across lots of life seasons. 40 00:04:45,940 --> 00:04:49,750 So adolescence is certainly a big one, 41 00:04:49,760 --> 00:04:51,790 pregnancy is a big one, 42 00:04:51,800 --> 00:04:53,270 aging is a big one. 44 00:04:54,060 --> 00:05:00,960 we can all relate to wanting our younger body back and for the individual on the spectrum, 45 00:05:01,340 --> 00:05:14,160 the angst of feeling disconnected with their personhood when their body changes may maybe even more acute that this really has happened without my permission and I do not like it. 46 00:05:15,440 --> 00:05:20,340 The brain also has been doing a lot of development during this period of time. 47 00:05:20,350 --> 00:05:22,800 And as we talked about in the first episode, 48 00:05:22,800 --> 00:05:30,110 the brain itself does not stop developing as a part of the body until about 20, 21, 49 00:05:30,480 --> 00:05:33,010 that early adulthood phase. 50 00:05:33,020 --> 00:05:36,310 So the brain is not grown, 51 00:05:36,310 --> 00:05:44,260 is not fully developed until the person is really out of high school and starting that young adulthood phase, 52 00:05:45,640 --> 00:05:51,760 This development of the brain includes things like thinking at a different level, 53 00:05:51,770 --> 00:05:55,260 challenging what you've always been told, 54 00:05:55,640 --> 00:06:01,250 trying to graduate into more abstract ways of thinking conceptualized thinking. 55 00:06:01,740 --> 00:06:14,260 So there's a lot of changes in the brain itself and the anatomy and the connections and that can impact how autism feels or is expressed during that time. 56 00:06:15,440 --> 00:06:19,070 The chemistry of the body and the brain also shifts. 57 00:06:19,080 --> 00:06:21,300 And so we talked about this before, 58 00:06:21,300 --> 00:06:31,990 that hormones are meant to change the body and the brain and they do and the impact can really feel quite dramatic, 59 00:06:31,990 --> 00:06:33,850 especially during adolescence, 60 00:06:34,440 --> 00:06:44,320 where sometimes that's just this period of the perfect storm for the most centered individual. 61 00:06:44,330 --> 00:06:44,720 You know, 62 00:06:44,730 --> 00:06:56,240 every person probably has stories about adolescents when they were tearful or yelling or or stomping off, 63 00:06:56,250 --> 00:06:57,620 jumping on their bike, 64 00:06:57,620 --> 00:07:03,530 riding away whatever the drama of that period of time may have been for you, 65 00:07:03,540 --> 00:07:17,120 you can relate to that feeling that this hormonal storm for someone that already has some dysregulation difficulty can also be pretty profound. 66 00:07:17,130 --> 00:07:21,260 So it's even harder for me to stay centered. 67 00:07:21,270 --> 00:07:41,150 It's even harder for me to keep my emotions in check or to um focus or get rid of that anxiety or sleep well that this regulation and you can go ahead and listen to the series on regulation that was not too long ago, 68 00:07:41,150 --> 00:07:44,640 a four part series if you want to know more about that. 69 00:07:44,640 --> 00:07:53,760 But the ability to stay centered and even it's just more difficult once those hormones kick in. 70 00:07:54,140 --> 00:07:58,660 And even more so for the person who struggled to begin with, 71 00:07:59,440 --> 00:08:05,040 it's also true that the body and the brain become sexualized during that time. 72 00:08:05,050 --> 00:08:17,850 And so there are even these additional layers of emotion and physical response related to the sexualization of the body that the person has to navigate. 73 00:08:18,540 --> 00:08:19,290 You know, 74 00:08:19,300 --> 00:08:20,960 it's just not. 75 00:08:21,440 --> 00:08:25,960 this is the time of life anymore when please, thank you, and sorry 76 00:08:25,960 --> 00:08:29,610 was going to help you connect with people around you. 77 00:08:29,620 --> 00:08:39,860 There's this really complicated social environment now and that also includes this sexualization of some relationships, 78 00:08:42,440 --> 00:08:44,470 a psychological task. 79 00:08:44,470 --> 00:08:48,150 So we're still talking about the individual at this moment, 80 00:08:48,150 --> 00:08:56,400 but I want to stop and talk about not the physical piece but the psychological task of much of adolescence. 81 00:08:56,590 --> 00:09:05,180 If you're familiar with Erik Erickson and his work with the tasks that we all have at different seasons of life. 82 00:09:05,190 --> 00:09:12,560 He would say that the adolescent's job is to navigate this journey of identity. 83 00:09:12,940 --> 00:09:14,260 Who am I? 84 00:09:14,640 --> 00:09:21,410 Who am I as separate from my parents or from my family history and I'm my own person. 85 00:09:21,410 --> 00:09:21,930 If so, 86 00:09:21,930 --> 00:09:26,360 what does that look like and how can I connect with my tribe? 87 00:09:26,370 --> 00:09:27,310 Where is my, 88 00:09:27,320 --> 00:09:28,160 my people, 89 00:09:28,160 --> 00:09:42,090 my tribe... peer relationships really are an important piece of the connection at that time where I switch from not so much having my best friend be mom or dad anymore or Joey down the street, 90 00:09:42,090 --> 00:09:49,260 but I really switched toward a lot more peer companionship that I'm going to connect with... 91 00:09:49,640 --> 00:09:51,170 A romantic peer... 92 00:09:51,170 --> 00:09:57,440 I'm going to connect with peer groups at my school or in my neighborhood or at my part time job. 93 00:09:57,450 --> 00:10:01,220 And these people may have different values than my parents had. 94 00:10:01,230 --> 00:10:05,960 And I may explore all these different ways of being and thinking. 95 00:10:06,240 --> 00:10:10,860 And my parents no longer seemed to have all the rules, 96 00:10:11,040 --> 00:10:11,380 uh, 97 00:10:11,380 --> 00:10:13,240 and all the keys to life. 98 00:10:13,250 --> 00:10:17,940 And so this process of navigating life, 99 00:10:17,950 --> 00:10:20,640 navigating the social environment, 100 00:10:20,650 --> 00:10:23,060 navigating all of the um, 101 00:10:23,940 --> 00:10:32,360 the reasoning and facts and cognitive pieces that a person might think throw as far as what do I believe? 102 00:10:32,740 --> 00:10:39,380 Do I believe the same thing my parents do and where can I connect? 103 00:10:39,390 --> 00:10:43,460 Where can I belong and find connection with other people? 104 00:10:45,540 --> 00:11:00,550 What we see in the autism community is that there can be a lot of gender diversity that overlaps here and part of it can be this feeling that this is not my body. 105 00:11:00,940 --> 00:11:01,370 Um, 106 00:11:01,380 --> 00:11:09,510 I don't feel connected to the community of people who were born female or born male, 107 00:11:09,510 --> 00:11:11,060 whatever the case may be. 108 00:11:11,070 --> 00:11:13,360 I don't identify as that. 109 00:11:13,360 --> 00:11:14,730 It's not my identity. 110 00:11:14,730 --> 00:11:16,310 I don't feel connected to that. 111 00:11:16,310 --> 00:11:19,060 I can't connect with the peer group in that way. 112 00:11:19,740 --> 00:11:23,510 And in the case of this emerging sexuality as well, 113 00:11:23,510 --> 00:11:26,300 that I'm looking for my identity, 114 00:11:26,300 --> 00:11:27,760 I'm looking for my group. 115 00:11:28,140 --> 00:11:33,660 And there's this gender diversity journey for some people on the spectrum. 116 00:11:34,440 --> 00:11:41,200 So a lot of the research shows that although we would expect to see two um, 117 00:11:41,210 --> 00:11:45,430 autism within any group throughout the world, 118 00:11:45,430 --> 00:11:47,980 whether it's a um, 119 00:11:47,990 --> 00:12:02,160 type of nation that we're looking at or whether it's a city or That about 2% of people in any particular area would be on the spectrum and within the gender diverse community that's higher. 120 00:12:02,640 --> 00:12:11,870 So the research says about 5-8 % of the gender diverse community maybe on the spectrum, 121 00:12:11,870 --> 00:12:14,560 I suspect it's somewhat higher than that. 122 00:12:15,140 --> 00:12:15,490 Um, 123 00:12:15,490 --> 00:12:21,180 but certainly there's that process of understanding the physical body, 124 00:12:21,180 --> 00:12:23,510 understanding the peer group connection, 125 00:12:23,510 --> 00:12:36,190 seeking that out and this who am I kind of journey in addition to changes in the person that can make, 126 00:12:36,200 --> 00:12:36,630 um, 127 00:12:36,630 --> 00:12:40,060 some added stress during a life season. 128 00:12:40,840 --> 00:12:51,020 There are also a lot of changes to the environment of the individual who's in that adolescent period within autism. 129 00:12:51,020 --> 00:13:03,450 What we see is that the autistic individual has more difficulty than their peers with things like independent daily activities and behavior. 130 00:13:04,040 --> 00:13:11,590 What that means is that this person may have this brilliant sense of math or music or art. 131 00:13:11,600 --> 00:13:15,460 Their head may be filled with facts and ideas. 132 00:13:15,470 --> 00:13:16,190 Um, 133 00:13:16,200 --> 00:13:20,990 but their ability to just kind of flow through the day and get things done. 134 00:13:20,990 --> 00:13:23,200 Like I'm going to take my shower, 135 00:13:23,200 --> 00:13:26,550 I'm going to throw my laundry in as a high school student, 136 00:13:26,550 --> 00:13:27,790 I'm going to learn to drive, 137 00:13:27,790 --> 00:13:30,140 I'm going to learn how to save money, 138 00:13:30,140 --> 00:13:31,530 I'm going to learn to cook. 139 00:13:31,540 --> 00:13:31,960 You know, 140 00:13:31,960 --> 00:13:34,280 that kind of stuff is just harder. 141 00:13:34,280 --> 00:13:37,690 Like I can name all these physics equations, 142 00:13:37,690 --> 00:13:44,400 but I just can't catch up with my peers in this area of being independent and, 143 00:13:44,410 --> 00:13:59,840 and this um kind of emerging into adulthood and this disconnect between the neuro typical peer and the individuals on the spectrum who's going through adolescent that gets bigger, 144 00:13:59,850 --> 00:14:00,660 wider, 145 00:14:00,660 --> 00:14:03,780 The gap gets wider with age. 146 00:14:03,790 --> 00:14:05,590 So as you know, 147 00:14:05,590 --> 00:14:07,190 a five year old, 148 00:14:07,200 --> 00:14:15,050 there's some gap there where neuro typical peers are doing more independently typically than the autistic individual, 149 00:14:15,440 --> 00:14:16,600 but you know, 150 00:14:16,600 --> 00:14:22,360 there's not a whole lot of independent things that a five year old is being asked to do. 151 00:14:22,840 --> 00:14:26,560 But when you get to middle school high school young adulthood, 152 00:14:26,570 --> 00:14:27,210 whoa, 153 00:14:27,210 --> 00:14:33,460 the independent demand just skyrockets and this gap becomes more and more visible. 154 00:14:33,840 --> 00:14:34,300 Um, 155 00:14:34,300 --> 00:14:39,150 and although the person may really be ahead with academic knowledge, 156 00:14:39,540 --> 00:14:44,670 this person may be really feeling the gap of cash, 157 00:14:44,670 --> 00:14:47,680 how do my peers get through life this way? 158 00:14:47,680 --> 00:14:49,170 This is really overwhelming. 159 00:14:49,170 --> 00:14:50,740 I have a lot of anxiety, 160 00:14:50,740 --> 00:14:54,250 I feel like I don't know how to navigate all these things. 161 00:14:55,840 --> 00:15:14,950 So the environment begins to demand more independence and the autistic individual going through this adolescent period starts to fall behind more and more with what's expected as far as independent daily behavior. 162 00:15:15,440 --> 00:15:24,460 So can you approach a teacher and ask a question or talk to your teacher about, 163 00:15:24,840 --> 00:15:25,090 hey, 164 00:15:25,090 --> 00:15:31,150 I think the reason I am falling behind in math is that I don't understand this core concept. 165 00:15:31,160 --> 00:15:36,790 Can you help me understand this or can they approach their peer and say, 166 00:15:36,790 --> 00:15:37,190 hey, 167 00:15:37,190 --> 00:15:41,230 do you want to go to the dance with me or hey, 168 00:15:41,240 --> 00:15:44,540 I think we had kind of a rough interaction back there. 169 00:15:44,540 --> 00:15:46,360 I really didn't mean to, 170 00:15:46,740 --> 00:15:47,540 um, 171 00:15:47,550 --> 00:15:48,010 you know, 172 00:15:48,010 --> 00:15:49,440 criticize you, 173 00:15:49,450 --> 00:15:51,860 I think it was a misunderstanding. 174 00:15:52,640 --> 00:16:05,850 So this increased demand for communication from the individual that mom is going to be calling the school less and the students going to be doing the talking more often than before. 175 00:16:09,330 --> 00:16:20,250 There are demands for independence in self care that all of this hygiene and grooming and eating independently and making sure you drink water and wear deodorant. 176 00:16:20,740 --> 00:16:27,820 These things start to become the person's responsibility instead of the parents' responsibility. 177 00:16:27,820 --> 00:16:34,790 And they're just can be a gap there where the expectation for independence is growing, 178 00:16:34,800 --> 00:16:38,950 but the person is struggling to keep up. 179 00:16:40,240 --> 00:16:45,170 There are increased demands with independence within what we call executive function. 180 00:16:45,200 --> 00:16:51,320 So that ability to plan and organize and multitask time management, 181 00:16:51,320 --> 00:16:57,850 These things that the person becomes more and more in charge of... these become harder and harder. 182 00:16:58,240 --> 00:17:14,450 These are things that are always difficult on the spectrum to some extent and the gap again becomes larger as the demand becomes larger. chores are things that the person is supposed to start doing. 183 00:17:14,450 --> 00:17:14,850 You know, 184 00:17:14,850 --> 00:17:23,770 can I start to do my laundry or I'm in charge of um caring for this pet that the family has or doing the dishes. 185 00:17:24,540 --> 00:17:32,350 Can I message my doctor through the electronic medical record and ask a question and then driving? 186 00:17:33,340 --> 00:17:33,700 You know, 187 00:17:33,700 --> 00:17:39,160 driving can be a milestone that feels overwhelming for the individual on the spectrum. 188 00:17:39,640 --> 00:17:47,830 And I looked this past year at the clinic patients I've seen across several years. 189 00:17:47,840 --> 00:17:55,800 I took ages 16 through 20 who individuals who had uh, 190 00:17:55,810 --> 00:17:57,860 no intellectual disability. 191 00:17:58,440 --> 00:18:16,270 And I saw that 80% of the clients I have seen in the clinic either did not do any driving by the age of 20 or they were significantly anxious about driving where I only drive to this one place and that's it. 192 00:18:17,340 --> 00:18:23,750 So there can be this kind of overwhelming sense that things happen too fast on the road. 193 00:18:23,750 --> 00:18:25,070 Things are overwhelming. 194 00:18:25,070 --> 00:18:27,650 Or what if I make the wrong choice? 195 00:18:27,660 --> 00:18:28,750 What if I crash? 196 00:18:28,750 --> 00:18:37,370 What if I hurt someone in the midst of this increasing demand for independence? 197 00:18:37,380 --> 00:18:43,350 There's also this reduction in structure or helpful support, 198 00:18:44,540 --> 00:18:46,470 as we said before, 199 00:18:46,480 --> 00:18:51,940 the person starts to be encouraged to be their own self advocate. 200 00:18:51,950 --> 00:18:54,690 And I don't know about where you live, 201 00:18:54,700 --> 00:19:05,170 but self advocacy is a word that's used more and more once you get into middle school and high school and college and even in the workplace, 202 00:19:05,840 --> 00:19:12,260 it means that the individual is in charge of doing their own talking to people. 203 00:19:12,840 --> 00:19:16,760 Self advocacy means that you can um, 204 00:19:16,770 --> 00:19:18,610 look at your situation, 205 00:19:19,840 --> 00:19:30,760 think about why it is that you're struggling and what you need to make a plan for improvement and approach someone in your situation and talk to them about it. 206 00:19:31,240 --> 00:19:33,800 So I approach my guidance counselor, 207 00:19:33,800 --> 00:19:35,440 I approach my professor, 208 00:19:35,450 --> 00:19:44,080 I approach my boss and I initiate this discussion and we come to an agreement about what a good plan would be for. 209 00:19:44,090 --> 00:19:48,540 Let's say for me to arrive on time for me to get my work in on time, 210 00:19:48,540 --> 00:19:49,270 et cetera. 211 00:19:49,540 --> 00:19:54,680 So parents start to play less of a role and the, 212 00:19:54,690 --> 00:20:05,070 so the structure and the support starts to be pared back while the demand is increased socially, 213 00:20:05,070 --> 00:20:07,960 things are more complex as well. 214 00:20:08,440 --> 00:20:19,010 So gone are the days where running around and chasing each other and playing tag and hiding things is really a great social interaction. 215 00:20:20,240 --> 00:20:32,660 I remember talking to some parents who were saying what great socialization their child had as a youngster and that when they would go to the park, 216 00:20:33,140 --> 00:20:37,030 the child would play with other kids for example. 217 00:20:37,740 --> 00:20:54,870 But when I asked what kind of play it typically was it was that the child would chase other kids and other kids would chase the child and they would laugh and play and fall and which is good for that age group. 218 00:20:54,870 --> 00:20:55,770 That's fine. 219 00:20:56,340 --> 00:21:07,180 But it's also this kind of instinctual physical play that puppy dogs can play and little kids know how to play that and it's a fun game, 220 00:21:07,200 --> 00:21:23,160 but it doesn't really require the social skills and the social navigation that middle school relationships require right when you get from physical to play to this more relational connection, 221 00:21:23,180 --> 00:21:32,670 that's where you can see some of the social things really begin to be much more difficult and the person really can't navigate that? 222 00:21:33,140 --> 00:21:35,770 How do I start a relationship? 223 00:21:36,340 --> 00:21:38,580 How do I maintain this relationship? 224 00:21:38,580 --> 00:21:42,520 How do I understand this relationship? 225 00:21:42,520 --> 00:21:43,770 What just happened? 226 00:21:44,740 --> 00:21:46,960 Why did this relationship end? 227 00:21:47,540 --> 00:21:49,920 Why did they misinterpret me? 228 00:21:49,920 --> 00:21:51,770 Because that's not what I meant. 229 00:21:52,740 --> 00:22:07,160 So there there becomes a lot more at stake and a lot more complexity when you're navigating not physical play and not play dates that your mom organized, 230 00:22:08,140 --> 00:22:13,770 but you're really navigating your own emerging adult relationships. 231 00:22:14,840 --> 00:22:24,160 Another thing that happens is that life becomes less predictable. 232 00:22:24,940 --> 00:22:27,590 It's not your life in a box anymore. 233 00:22:27,620 --> 00:22:30,320 You know when you're in first grade, 234 00:22:30,320 --> 00:22:35,500 you know that next year you go to second grade and the next year you go to third grade, 235 00:22:35,500 --> 00:22:43,530 fourth grade and life has this very predictable rhythm where you know where you go next. 236 00:22:43,540 --> 00:22:47,910 Now you don't know what classes will be like or what your teacher will be like, 237 00:22:47,920 --> 00:22:52,240 but you're going to the same school or you're switching schools, 238 00:22:52,250 --> 00:22:55,560 but you have the structure ahead of you. 239 00:22:55,940 --> 00:23:00,430 There's still something that propels you along and when you get to the next place, 240 00:23:00,430 --> 00:23:07,960 there's a structure in place for you and someone will tell you where you're going to be next. 241 00:23:10,040 --> 00:23:12,260 When you get to the end of high school, 242 00:23:12,640 --> 00:23:14,580 at least in the United States? 243 00:23:14,590 --> 00:23:17,440 What happens is that people start to say to you, 244 00:23:17,440 --> 00:23:19,060 what are you going to do next? 245 00:23:20,640 --> 00:23:23,530 What are you going to be when you quote grow up, 246 00:23:23,540 --> 00:23:24,860 what do you want to be? 247 00:23:25,340 --> 00:23:39,850 And they'll say things like you can be anything you want to be the whole world is your oyster and you start to see that your peers are no longer following the same path as every other peer, 248 00:23:39,850 --> 00:23:43,460 that everyone is kind of making their own path. 249 00:23:44,240 --> 00:23:46,970 And the person on the spectrum can feel like, 250 00:23:46,970 --> 00:23:47,450 well, 251 00:23:48,140 --> 00:23:49,710 what am I supposed to do? 252 00:23:49,710 --> 00:23:49,910 What, 253 00:23:49,920 --> 00:23:52,060 what is my life supposed to look like? 254 00:23:53,240 --> 00:23:54,600 Where is the path? 255 00:23:54,610 --> 00:23:56,870 Show me the path and I'll follow the path. 256 00:23:56,880 --> 00:24:00,200 But to forge my own path, 257 00:24:00,200 --> 00:24:04,360 may not actually feel that empowering or exciting. 258 00:24:04,940 --> 00:24:08,770 I kind of like to know that I'm on the correct path. 259 00:24:08,780 --> 00:24:11,800 I like to know how to meet people's expectations. 260 00:24:12,240 --> 00:24:14,910 I like to know that I'm not getting lost. 261 00:24:15,180 --> 00:24:18,860 I like to know that I'm not taking a risk that it's not unsafe. 262 00:24:20,140 --> 00:24:24,060 So the future becomes more self propelled. 263 00:24:25,340 --> 00:24:35,680 And this can also be a task of young adulthood that is daunting to the person with neurology that likes to know, 264 00:24:35,680 --> 00:24:36,060 like, 265 00:24:36,840 --> 00:24:38,570 did I get an A on that, 266 00:24:38,670 --> 00:24:39,000 you know, 267 00:24:39,000 --> 00:24:40,230 did I do it right. 268 00:24:40,370 --> 00:24:42,060 Is this where I'm supposed to be? 269 00:24:43,140 --> 00:24:49,260 So here we have the picture during adolescence that the internal self, 270 00:24:49,740 --> 00:24:52,400 the psychological biochemical, 271 00:24:52,400 --> 00:24:56,050 physical self and the external life, 272 00:24:56,540 --> 00:24:58,570 the supportive structure, 273 00:24:58,630 --> 00:25:06,170 the demands on the individual are creating this sense of just a lot less stability. 274 00:25:07,140 --> 00:25:07,550 You know, 275 00:25:07,550 --> 00:25:09,730 my internal self is less stable. 276 00:25:09,730 --> 00:25:11,680 I feel all over the place. 277 00:25:11,690 --> 00:25:14,080 I'm crying one minute I'm laughing. 278 00:25:14,080 --> 00:25:15,700 One minute I'm throwing something. 279 00:25:15,700 --> 00:25:19,710 One minute I have all these demands on me. 280 00:25:19,720 --> 00:25:21,920 People seem to be figuring this out, 281 00:25:21,920 --> 00:25:23,820 but I can't figure it out. 282 00:25:23,830 --> 00:25:25,020 I can't sleep, 283 00:25:25,020 --> 00:25:26,050 I'm anxious. 284 00:25:27,040 --> 00:25:35,560 Um And there's all this stuff that goes along with this less stable season. 285 00:25:37,140 --> 00:25:38,950 The person on the spectrum, 286 00:25:38,950 --> 00:25:40,820 as we said earlier, 287 00:25:40,830 --> 00:25:43,400 with relationship to regulation, 288 00:25:43,400 --> 00:25:48,450 they're more likely to get dis regulated just from a neurological perspective. 289 00:25:48,940 --> 00:25:57,860 And dis regulation looks like fight where it's any externalized expression of being unsent erred, 290 00:25:57,880 --> 00:25:59,410 I'm crying, 291 00:25:59,410 --> 00:26:00,730 I'm melting down. 292 00:26:00,730 --> 00:26:01,920 I'm screaming, 293 00:26:01,920 --> 00:26:03,080 I'm throwing something, 294 00:26:03,080 --> 00:26:06,460 I'm shouting and arguing at you and I'm slamming doors. 295 00:26:07,440 --> 00:26:09,060 You get flight. 296 00:26:09,740 --> 00:26:11,850 I can't go to school anymore. 297 00:26:11,920 --> 00:26:12,970 My stomach hurts. 298 00:26:12,970 --> 00:26:14,270 I need to come home. 299 00:26:14,840 --> 00:26:16,830 I'm staying in my room. 300 00:26:16,840 --> 00:26:18,810 I'm not going to eat at the table. 301 00:26:18,820 --> 00:26:19,950 I have homework to do. 302 00:26:19,950 --> 00:26:21,170 I'm not coming out. 303 00:26:21,940 --> 00:26:33,360 You get this social withdrawal and freeze is also part of this regulation that if you force me to I will sit sit here physically. 304 00:26:34,040 --> 00:26:36,640 But psychologically I'm offline. 305 00:26:36,650 --> 00:26:39,400 I can't process what's happening anymore. 306 00:26:39,410 --> 00:26:41,000 I'm checked out. 307 00:26:41,010 --> 00:26:42,820 I'm staring at the wall, 308 00:26:42,830 --> 00:26:46,470 I might be having a seizure that's not electrical. 309 00:26:46,480 --> 00:27:01,360 I might lose my memory for parts of the day and all of that is this dis regulation and the dis regulation of adolescents can be quite a bit more noticeable that there's this real crisis of regulation. 310 00:27:02,140 --> 00:27:09,760 But also what I see in the clients that I serve is that the regulation difficulty can all of a sudden look different. 311 00:27:10,140 --> 00:27:12,770 So that would not be unusual either. 312 00:27:13,140 --> 00:27:20,460 So what I see is that sometimes if little kiddos were under reactive to their environment, 313 00:27:20,470 --> 00:27:24,360 they were less reactive to what's going on around them, 314 00:27:25,740 --> 00:27:33,170 they may look really um compliant and passive and go with the flow. 315 00:27:33,640 --> 00:27:39,060 But what that really is is that they should have some response to what's going on in the environment. 316 00:27:39,060 --> 00:27:41,760 But instead they just lack a response. 317 00:27:41,770 --> 00:27:44,130 And if someone tells them to sit up, 318 00:27:44,130 --> 00:27:44,750 they set up. 319 00:27:44,750 --> 00:27:47,330 If someone tells them to go here or there, 320 00:27:47,330 --> 00:27:47,970 they do it. 321 00:27:47,980 --> 00:27:52,170 But they don't have a lot of reactivity to what's going on. 322 00:27:53,340 --> 00:27:54,440 And adolescence. 323 00:27:54,440 --> 00:28:03,820 This may be a person that flips into an over reactive state or an elevated reactive profile where oh my gosh, 324 00:28:03,820 --> 00:28:07,340 the littlest thing happens and I react to it now. 325 00:28:07,350 --> 00:28:17,230 So I have like this flip from passive to so elevated in my response or you can have vice versa. 326 00:28:17,240 --> 00:28:19,310 Where as a little kid, 327 00:28:19,310 --> 00:28:25,910 this person was melting down and rolling on the ground and biting people and now as an adolescent, 328 00:28:25,920 --> 00:28:33,030 they can't get out of bed and they're sluggish and they don't eat and they don't have momentum for activities. 329 00:28:34,040 --> 00:28:38,790 That could also be something that you see where there's this dis regulated state, 330 00:28:38,800 --> 00:28:40,410 but it looks different, 331 00:28:40,420 --> 00:28:49,170 but it's still dysregulation and it's still uh kind of falls within what we talked about in that past series. 332 00:28:52,540 --> 00:28:57,740 Some people feel like with biochemical and hormonal changes, 333 00:28:57,740 --> 00:29:00,960 that their anxiety really is elevated. 334 00:29:01,390 --> 00:29:09,260 Sometimes there are self harm behaviors that may look like cutting or um hitting yourself, 335 00:29:09,270 --> 00:29:10,460 biting yourself, 336 00:29:10,840 --> 00:29:12,850 banging your head on the wall. 337 00:29:14,340 --> 00:29:18,450 Sometimes there are elevated sensory concerns where, 338 00:29:19,040 --> 00:29:19,560 you know, 339 00:29:19,560 --> 00:29:24,290 this food never bothered me before or noise or whatever, 340 00:29:24,290 --> 00:29:29,110 but all of a sudden I just really can't tolerate the sensory environment, 341 00:29:29,110 --> 00:29:38,050 It's too much and that can be part of this physical and environmental season of dis regulation. 342 00:29:40,040 --> 00:29:57,310 Now I do wanna um say that this I think is a really good summary of what I tend to see during adolescence as far as shifts in the qualities of autism and people I do want to say however, 343 00:29:57,310 --> 00:30:00,570 that I work in a clinic. 344 00:30:00,580 --> 00:30:17,160 So people come to me during adolescence when they are struggling and so I really don't get to see folks that have improved through adolescence and are doing better and not needing to come through. 345 00:30:17,640 --> 00:30:36,360 So I'm fully aware of that piece as well and I have seen people in my community and in my personal life and in my friendships that have had a bit of a smoother course as well where the sensory issues have really come down by adolescents, 346 00:30:36,740 --> 00:30:39,490 there's a bit better social connection. 347 00:30:39,500 --> 00:30:40,570 Um, 348 00:30:40,580 --> 00:30:43,760 executive functions not that much of a problem. 349 00:30:44,440 --> 00:30:58,770 So you can certainly see this variety of individualized um kind of seasons and my purpose and talking about this isn't to say, 350 00:30:58,780 --> 00:30:59,880 oh gosh, 351 00:30:59,880 --> 00:31:01,350 when people get to adolescence, 352 00:31:01,350 --> 00:31:02,450 that's going to be rough. 353 00:31:02,840 --> 00:31:03,180 No, 354 00:31:03,180 --> 00:31:20,360 it's just to point out that it is an individualized season of life and that just because autism is neurologic in its base doesn't mean that there there aren't shifting seasons and how that feels or how that looks. 355 00:31:20,840 --> 00:31:25,990 And I think whenever that happens in your life or the life of those, 356 00:31:25,990 --> 00:31:26,860 you love that, 357 00:31:27,340 --> 00:31:27,880 um, 358 00:31:27,890 --> 00:31:28,330 you know, 359 00:31:28,330 --> 00:31:31,090 certainly it's likely to happen for you. 360 00:31:31,090 --> 00:31:34,180 It may be adolescents for someone else. 361 00:31:34,190 --> 00:31:34,580 Uh, 362 00:31:34,590 --> 00:31:34,950 you know, 363 00:31:34,950 --> 00:31:40,550 maybe pregnancy or menopause or even just life seasons that aren't physical, 364 00:31:40,550 --> 00:31:41,540 that oh, 365 00:31:41,540 --> 00:31:47,360 my parent dies and that's a season where my body is really responding differently. 366 00:31:49,240 --> 00:32:09,790 I hope this information gives you a context for recognizing when you're going through those ups and downs of season and normalizing that these kinds of things can shift If you would like to review strategies for regulation. 367 00:32:09,800 --> 00:32:22,560 I encourage you to go back to our regulation series not too long ago to look at strategies for centering and feeling better in your own skin. 368 00:32:23,640 --> 00:32:26,810 And I'm looking forward to the third episode. 369 00:32:26,810 --> 00:32:32,270 We're going to focus on next time and this is going to have to do with hormonal shifts. 370 00:32:32,740 --> 00:32:39,170 A lot of that will talk about the experience of females on the spectrum, 371 00:32:39,170 --> 00:32:41,540 just because they're tend to be, 372 00:32:41,540 --> 00:32:46,870 of course more discreet hormonal shifts in the lives of women. 373 00:32:47,540 --> 00:32:50,560 This will include menstrual cycles, 374 00:32:51,040 --> 00:32:51,980 pregnancy, 375 00:32:51,980 --> 00:32:52,920 breastfeeding, 376 00:32:52,920 --> 00:32:53,950 menopause. 377 00:32:54,340 --> 00:32:54,840 Um, 378 00:32:54,840 --> 00:33:03,360 so some of these hormonal shifts will also impact males on the spectrum and some will be more specific to females. 379 00:33:03,740 --> 00:33:14,360 But I really hope you can join us next time as we start rounding out this series on shifting characteristics in autism.  

Join Dr. Regan for the first episode in her new series about how autistic characteristics may shift across the lifespan. This episode focuses on why this happens (i.e., changes in the individual and the environment). Stay tuned for the next episodes in the series to hear about changes during adolescence, hormonal shifts in women, and aging (50's and beyond).    Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians   Read the Episode Transcript:  1 00:00:05,840 --> 00:00:07,080 Hi everyone, 2 00:00:07,090 --> 00:00:14,860 this is Dr Theresa Regan and thank you for joining me for a new episode of autism in the adult podcast. 3 00:00:14,870 --> 00:00:29,450 We are starting a new series today and it is going to focus on how the characteristics of autism may shift in their expression or in the experience of the individual across the lifespan. 4 00:00:30,340 --> 00:00:35,610 I'm happy to share my experiences about this as a neuropsychologist, 5 00:00:36,040 --> 00:00:41,260 a certified autism specialist and the mother of a teen on the spectrum. 6 00:00:42,940 --> 00:00:59,850 We are starting this new series and I plan to have four episodes that are outlining some of these shifts that we can see in what autism feels like and what it looks like across the lifespan of the individual. 7 00:01:00,940 --> 00:01:14,180 The reason that I want to focus on this topic is that it does feel confusing to many people as to why would there be shifts? if I'm seeing something that changes over time, 8 00:01:14,180 --> 00:01:26,360 doesn't it mean that something new has happened or that it's not related to an underlying kind of neurologic framework that is part of the foundation of the brain itself. 9 00:01:27,740 --> 00:01:28,970 And indeed, 10 00:01:28,980 --> 00:01:30,890 in the diagnostic manual, 11 00:01:30,890 --> 00:02:01,470 many clinicians really focused on an important part of the criteria which is that the characteristics have to be present across multiple contexts in order to make this diagnosis -- and that is to safeguard from having a diagnosis established when in fact there's just something about the environment or the combination of the environment and the person that triggers similar characteristics. 12 00:02:01,470 --> 00:02:01,980 So, 13 00:02:01,990 --> 00:02:03,710 for example, 14 00:02:03,720 --> 00:02:12,950 if somebody is really triggered and has flashbacks in a certain environment related to trauma, 15 00:02:13,740 --> 00:02:21,760 we don't want to call that autism and perhaps we can tell the difference because in other setting, 16 00:02:21,770 --> 00:02:29,360 they really seem to feel centered and to interact easily with others and not show the same pattern. 17 00:02:29,370 --> 00:02:38,350 Or perhaps someone just has a real struggle connecting with a certain person because of past experiences. 18 00:02:38,350 --> 00:02:46,160 But their ability to connect across environments with a large range of people is where we would expect it to be. 19 00:02:47,740 --> 00:02:48,430 So, 20 00:02:48,430 --> 00:02:50,470 there is a reason that, 21 00:02:50,480 --> 00:02:51,200 you know, 22 00:02:51,210 --> 00:03:00,360 the emphasis is placed on the fact that this is something seen across time and across context. 23 00:03:01,240 --> 00:03:03,030 But at the same time, 24 00:03:03,340 --> 00:03:14,460 I think we need to understand that there can be shifts in what the characteristics feel like and how they are expressed or what they look like to other people. 25 00:03:15,740 --> 00:03:21,990 So this first episode is going to be about some foundational things, 26 00:03:22,000 --> 00:03:23,260 how the brain works. 27 00:03:23,260 --> 00:03:28,360 We're going to talk about the criteria and what the text actually says. 28 00:03:28,740 --> 00:03:36,660 and we're going to talk about the trajectory of some of the changes that we can see within autism across the lifespan. 29 00:03:37,340 --> 00:03:49,400 The second episode I'm planning will have to do with that age range of adolescence through young adulthood and changes that we may see during that period of time. 30 00:03:50,240 --> 00:04:01,960 The third episode will have to do with hormonal shifts and the impact of shifting biochemistry on those autistic characteristics. 31 00:04:02,540 --> 00:04:15,550 A good part of this discussion will center around autism and women as we'll be talking about various hormone shifts in adulthood that will include monthly cycles, 32 00:04:15,560 --> 00:04:16,670 pregnancy, 33 00:04:16,680 --> 00:04:18,960 breast feeding and menopause. 34 00:04:18,970 --> 00:04:24,970 And the fourth and final episode will be about aging and autism. 35 00:04:24,970 --> 00:04:30,680 What to expect or what we typically see across the aging period. 36 00:04:30,690 --> 00:04:36,970 And this episode will focus on the fifth decade of life and onwards. 37 00:04:36,970 --> 00:04:38,390 So fifties, 38 00:04:38,390 --> 00:04:38,890 sixties, 39 00:04:38,890 --> 00:04:39,430 seventies, 40 00:04:39,430 --> 00:04:40,130 etcetera. 41 00:04:40,140 --> 00:04:50,950 We're going to capture what the aging brain may shift as far as how those characteristics are experienced. 42 00:04:53,740 --> 00:05:07,860 So today you are joining me just for some foundational discussion about ... why would we expect there to be shifts in how this neurologic behavioral pattern is expressed. 43 00:05:09,340 --> 00:05:10,180 Well, 44 00:05:10,190 --> 00:05:14,110 let's talk about the brain itself. 45 00:05:14,170 --> 00:05:17,560 So as we've talked about in other episodes, 46 00:05:17,940 --> 00:05:26,440 autism is a developmental neurologic condition reflecting how the brain has developed, 47 00:05:26,440 --> 00:05:33,730 how the wiring has been established in this early developmental period. 48 00:05:33,740 --> 00:05:47,680 And the manual does note that the characteristics must be present in the developmental period and that they need to be present across multiple contexts. 49 00:05:47,690 --> 00:05:48,290 Now, 50 00:05:48,300 --> 00:05:50,560 as the brain develops, 51 00:05:50,560 --> 00:05:52,990 because it is a physical part of the body, 52 00:05:53,000 --> 00:06:01,240 you can see shifts in what those characteristics look like over time because the brain is evolving, 53 00:06:01,240 --> 00:06:08,870 it's developing.  And the brain does not stop physically developing until about age 20, 21... 54 00:06:09,540 --> 00:06:11,910 That early adult period. 55 00:06:11,920 --> 00:06:17,160 And so there's a lot of development that's going on all through childhood, 56 00:06:17,170 --> 00:06:24,400 really getting up into the 20's and in the context of the brain, 57 00:06:24,400 --> 00:06:26,620 as a part of the body developing. 58 00:06:26,630 --> 00:06:35,060 You can certainly see shifts in what that feels like and what it looks like in varying individuals. 59 00:06:35,740 --> 00:06:44,150 One person may feel like some of the characteristics that were challenging to them and childhood have calmed down. 60 00:06:44,150 --> 00:06:46,760 Some may feel that they, 61 00:06:46,770 --> 00:06:47,080 you know, 62 00:06:47,080 --> 00:06:55,790 hit a point where things are quite a bit harder for a season and we'll talk about why that might be in these later episodes. 63 00:06:56,040 --> 00:06:59,270 But the development of physical development, 64 00:06:59,370 --> 00:07:09,750 the foundation of the neurology occurring over that long period of time is one of the reasons that the experience and expression can shift. 65 00:07:11,540 --> 00:07:12,540 In addition, 66 00:07:12,540 --> 00:07:17,840 there are changes in the biochemistry of the body, 67 00:07:17,850 --> 00:07:19,390 including hormones. 68 00:07:19,390 --> 00:07:31,590 And we alluded to that when I talked about the episode and hormones are supposed to change body organs and this includes the brain, 69 00:07:31,600 --> 00:07:33,300 so different parts of the body, 70 00:07:33,300 --> 00:07:34,580 the muscles, 71 00:07:34,590 --> 00:07:35,960 the vocal cords, 72 00:07:35,970 --> 00:07:41,560 lots of different parts are impacted by the release of hormones. 73 00:07:41,840 --> 00:07:44,750 And the brain is changed as well. 74 00:07:45,140 --> 00:07:47,880 That's part of the function of hormones. 75 00:07:48,540 --> 00:08:06,260 Adolescence is well known for this period of time where people don't act like themselves in some ways. they seem very intense or just that that that period of time as the brain is kind of bathed in these chemicals, 76 00:08:06,440 --> 00:08:20,550 there can be a shift in emotional expression and behavioral patterns and connecting with others and that is true for every human and certainly for those on the spectrum as well. 77 00:08:20,550 --> 00:08:23,950 So the changes in the biochemistry, 78 00:08:24,440 --> 00:08:33,350 this also can occur during hormonal shifts as we stated within the female autistic individual over her lifespan. 79 00:08:34,240 --> 00:08:38,460 And with aging there will be some biochemical shifts as well. 80 00:08:40,940 --> 00:08:46,060 It's not only the physical part that changes in our life. 81 00:08:46,060 --> 00:08:50,750 So the anatomy and the developmental piece... the biochemistry, 82 00:08:50,750 --> 00:08:53,860 but also our environment changes. 83 00:08:54,340 --> 00:09:00,480 And this happens both with the environmental demand on us. 84 00:09:00,490 --> 00:09:03,330 How much are we being requested to do? 85 00:09:03,340 --> 00:09:05,220 How complicated is it? 86 00:09:05,220 --> 00:09:07,250 How fast is it coming at us? 87 00:09:07,260 --> 00:09:09,780 How much is changing at one time? 88 00:09:09,780 --> 00:09:11,560 How much do I have to adapt to? 89 00:09:12,440 --> 00:09:13,450 But also, 90 00:09:13,450 --> 00:09:17,810 the amount of support we're offered in the environment will also shift. 91 00:09:17,840 --> 00:09:21,960 And sometimes that has to do with just life circumstances. 92 00:09:21,980 --> 00:09:23,320 For example, 93 00:09:23,320 --> 00:09:34,760 someone in our life is no longer there or we change jobs and the demands on us are different or we had no children now all of a sudden we have twins. 94 00:09:35,740 --> 00:09:39,120 But also it will change with life seasons. 95 00:09:39,220 --> 00:10:01,050 So as a youngster becomes older and they're not in kindergarten anymore - they're in the third grade and then they're in the sixth grade and you start to get into this season of life where more and more independence is asked of you and less environmental support is given 96 00:10:01,060 --> 00:10:18,140 while the demands continue to increase. When we see something that has changed that the person's experience of the autism characteristics feels different or the person's expression feels different to others, 97 00:10:18,150 --> 00:10:23,120 we can think about what has been shifting in this person's life. 98 00:10:23,130 --> 00:10:27,560 Is there a new stressor, is more being demanded of them, 99 00:10:27,840 --> 00:10:29,320 Have things changed? 100 00:10:29,320 --> 00:10:31,490 Have supports has been removed. 101 00:10:31,500 --> 00:10:32,550 For example, 102 00:10:32,550 --> 00:10:38,960 the individual that's used to working the same job for 30 years and retires. 103 00:10:39,340 --> 00:10:39,780 Boy. 104 00:10:39,780 --> 00:10:46,360 That's a huge shift in the environmental structure that is offered to this person. 105 00:10:46,740 --> 00:10:50,620 Now there is a reduction in demand in some ways, 106 00:10:50,630 --> 00:10:58,640 although the demand was so repetitious by that time it was something the person was so used to. 107 00:10:58,650 --> 00:11:03,730 And now all of a sudden the demand actually is to structure yourself, 108 00:11:03,740 --> 00:11:06,260 fill your life with meaningful activities. 109 00:11:06,640 --> 00:11:15,120 And that kind of shift in the environment and shift in life season can bring about changes. 110 00:11:15,130 --> 00:11:16,380 And people around 111 00:11:16,380 --> 00:11:20,180 the individual may comment that they seem different. 112 00:11:20,190 --> 00:11:22,440 Things aren't quite going as before. 113 00:11:22,450 --> 00:11:29,950 Or the person themselves may feel that they just can't get in the same rhythm they were and they just feel different. 114 00:11:32,940 --> 00:11:53,660 Let's talk for a moment about why someone who is versed in autism may argue that changes in the characteristics of autism should not be seen or that we wouldn't expect it to or that shifts are evidence that it's really not a neurologic pattern. 115 00:11:54,940 --> 00:12:02,020 So as I said in the diagnostic manual and this manual that I'm referring to is the D. 116 00:12:02,020 --> 00:12:02,300 S. 117 00:12:02,300 --> 00:12:02,580 M. 118 00:12:02,580 --> 00:12:10,750 Five which is the diagnostic manual that clinicians use in the United States. 119 00:12:10,750 --> 00:12:20,750 So it's called the diagnostic and statistical manual 5th edition. therapists and psychologists and clinicians use this. 120 00:12:21,130 --> 00:12:27,450 Sometimes people in other contexts or other geographic areas use the i. 121 00:12:27,450 --> 00:12:27,640 c. 122 00:12:27,640 --> 00:12:27,800 d. 123 00:12:27,800 --> 00:12:28,450 10. 124 00:12:28,740 --> 00:12:40,260 But in general I'm going to review Information from the DSM5 and I'm going to give some page numbers to reference. 125 00:12:41,140 --> 00:13:07,760 So when you look up the criteria for autism on the internet you will get the diagnostic criteria and you will see the sentences there about how the characteristics are supposed to be present in the developmental period and are also supposed to be seen across a variety of contexts so that we have this implication of consistency to some extent. 126 00:13:09,160 --> 00:13:18,860 This does make sense because the neurologic framework would not be expected to just come and go from day to day. 127 00:13:18,860 --> 00:13:22,460 That's kind of the anatomical framework. 128 00:13:23,240 --> 00:13:23,960 However, 129 00:13:23,960 --> 00:13:36,850 if individuals don't read from the actual manual -- because there are I don't know eight or 10 additional pages that explain what the criteria mean-- 130 00:13:37,240 --> 00:13:56,260 This person may be under the assumption that if there's any variation or if people didn't notice some of the characteristics in early life and they seem to emerge in middle school that that negates the possible diagnosis. 131 00:13:57,940 --> 00:14:07,470 So if we read on page 50 and page 53 what the manual says is the symptoms are present from early childhood. 132 00:14:07,470 --> 00:14:26,490 "However the stage at which functional impairment becomes obvious (and I'll just interject here that what they're referring to is the stage at which someone may uh seem to be struggling with some of these things that this is causing them to stress. 133 00:14:26,500 --> 00:14:38,860 It's causing difficulty with age appropriate life skills or they're having to use so much more energy to do something that their peers are doing) 134 00:14:40,040 --> 00:14:40,430 So. 135 00:14:40,430 --> 00:14:40,750 Again, 136 00:14:40,750 --> 00:14:50,330 the stage at which functional impairment becomes obvious will vary according to characteristics of the individual. 137 00:14:50,400 --> 00:14:56,000 So this is what we referred to earlier as far as the person, 138 00:14:56,000 --> 00:14:57,340 the physical person, 139 00:14:57,340 --> 00:15:04,960 the biochemical person and the characteristics of the individual and his or her environment. 140 00:15:05,740 --> 00:15:13,660 So we tapped into this when we talked about the assistance in the environment and the demand of the environment. 141 00:15:15,210 --> 00:15:16,200 It continues. 142 00:15:16,200 --> 00:15:28,400 The symptoms may not be fully manifest until social demands exceed limited capacities or maybe masked by learned strategies. 143 00:15:28,940 --> 00:15:29,270 So, 144 00:15:29,270 --> 00:15:46,570 what this is saying is that it very well can be that little kiddos get along pretty well because not much reciprocity is demanded of them in their early life or in the context in which they are at. 145 00:15:46,580 --> 00:15:59,950 And then the difficulties that were there all along may become manifest when the demands exceed their limited capacity. 146 00:16:01,940 --> 00:16:09,120 Intervention compensation and supports may mask difficulties in at least some context. 147 00:16:09,130 --> 00:16:10,030 So, 148 00:16:10,030 --> 00:16:10,510 again, 149 00:16:10,510 --> 00:16:28,820 we see that the person's way of coping with things or hiding things or masking things can bring about some variation in context and can hide some of the difficulties that have been there all along Again. 150 00:16:28,820 --> 00:16:30,510 On page 53, 151 00:16:30,520 --> 00:16:42,130 the manual states the verbal and nonverbal deficits in social communication have varying manifestations depending on the individual's age, 152 00:16:42,140 --> 00:16:44,970 intellectual level and language ability, 153 00:16:45,000 --> 00:16:50,470 as well as other factors such as treatment history and current supports. 154 00:16:52,740 --> 00:16:54,490 On page 56, 155 00:16:54,500 --> 00:16:58,970 the characteristics are also impacted by compensation strategies. 156 00:16:58,980 --> 00:17:07,430 "for some, social challenges are still a struggle in novel or unsupported situations." 158 00:17:08,790 --> 00:17:09,870 although you know, 159 00:17:09,870 --> 00:17:13,930 the person may cope better with them in other situations. 160 00:17:16,340 --> 00:17:19,770 The manual also states that when you're doing an assessment, 161 00:17:19,780 --> 00:17:23,860 it's important to get multiple sources of information. 162 00:17:23,870 --> 00:17:34,620 So diagnosis should not only be based on one source of information like the school or or one on one observations, 163 00:17:34,630 --> 00:17:47,210 but it should put together this whole constellation of observations across context because the person's behavior and interactions will not look the same 164 00:17:47,210 --> 00:17:50,460 from everyone's perspective or in every context. 165 00:17:54,740 --> 00:17:55,460 Additionally, 166 00:17:55,460 --> 00:17:56,810 on page 51, 167 00:17:56,820 --> 00:18:04,670 it states that quote severity may vary by context and fluctuate over time. 168 00:18:05,910 --> 00:18:06,470 Therefore, 169 00:18:06,470 --> 00:18:07,960 as we can see, 170 00:18:08,790 --> 00:18:22,010 the manual is trying to emphasize a balance between understanding that there is a neurologic foundation in the autistic profile, that is, 171 00:18:22,080 --> 00:18:28,490 a kind of base, but that different things will change this base. 172 00:18:29,240 --> 00:18:31,130 The brain develops, 173 00:18:31,140 --> 00:18:33,850 the brain is shifted by hormones, 174 00:18:33,850 --> 00:18:35,450 the brain ages, 175 00:18:36,440 --> 00:18:38,860 chemistry changes etcetera. 176 00:18:39,940 --> 00:18:42,140 Also the environment changes, 177 00:18:42,140 --> 00:18:43,640 the demands change. 178 00:18:43,650 --> 00:18:43,860 Oh, 179 00:18:43,860 --> 00:18:46,300 I've never been asked to do this before. 180 00:18:46,320 --> 00:18:53,250 Now I'm being asked to do it frequently and the supports that I used to have just aren't even there. 181 00:18:53,280 --> 00:19:05,140 So now there's this manifesting of different things or perhaps someone really was just feeling really centered doing well at work, 182 00:19:05,150 --> 00:19:07,020 had nice relationships. 183 00:19:07,540 --> 00:19:24,550 Uh But then you know something happened where there was a trauma or the death of a loved one and the things that felt really balanced began to feel unbalanced and really difficult to manage during that season. 184 00:19:26,840 --> 00:19:31,910 Even if people are using the severity levels that the D. 185 00:19:31,910 --> 00:19:32,150 S. 186 00:19:32,150 --> 00:19:34,960 M suggests can be used. 187 00:19:35,840 --> 00:19:46,860 The manual emphasizes that those levels can change over time and that is because of what we've discussed that things change. 188 00:19:47,540 --> 00:19:49,250 The person changes, 189 00:19:49,260 --> 00:19:51,010 the environment changes, 190 00:19:51,020 --> 00:20:03,160 seasons change and it is expected that there will be some shifts and how the person is experiencing. 191 00:20:03,170 --> 00:20:28,990 You know the level of anxiety or sleep disturbance or the ability to connect with others or the amount of resilience they have or the sensory processing um how flexible they feel and how other people experience those that other people say wow I'm really noticing the shift in our relationship now and it's confusing to me. 192 00:20:29,000 --> 00:20:37,560 I see that there's a difference in how this person tolerates some of the relational ambiguity that we're having. 193 00:20:38,240 --> 00:20:53,060 What we expect is that there will be this neurologic base that is somewhat steady and there will also be shifts based on seasons of life. 194 00:20:55,030 --> 00:20:57,730 This helps us when we see these shifts, 195 00:20:57,880 --> 00:21:04,740 it helps us to feel less confused and to understand the context that yes, 196 00:21:04,740 --> 00:21:05,770 this happens. 197 00:21:06,140 --> 00:21:09,350 Um and this may be why, 198 00:21:09,360 --> 00:21:09,700 you know, 199 00:21:09,700 --> 00:21:13,450 there have been these shifts in physical function, 200 00:21:13,450 --> 00:21:18,240 there have been these shifts in environmental demand and support, 201 00:21:18,250 --> 00:21:27,350 and now we can try to focus on understanding and coming alongside this individual to feel more centered. 202 00:21:32,040 --> 00:21:34,700 This is our foundational episode. 203 00:21:34,710 --> 00:21:36,610 And as I said, 204 00:21:36,610 --> 00:21:49,790 we'll be reviewing seasons of the lifespan in our next three episodes and this first one coming up will be that emergence from young childhood into this. 205 00:21:49,800 --> 00:21:50,240 You know, 206 00:21:50,240 --> 00:21:52,610 adolescence and young adulthood period. 207 00:21:52,620 --> 00:21:57,750 A lot of shifting goes on during that time and I can't wait to talk to you guys about it. 208 00:21:57,760 --> 00:21:59,270 Please join me next time.        

Join Dr. Regan for the final episode of the series "Talking About Autism." This episode focuses on how talk to others when you see autistic characteristics in them.  New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians   Read the transcript: 00:00:02,540 --> 00:00:06,380 Hello everyone. 3 00:00:06,390 --> 00:00:13,200 This is Dr Theresa Regan and you are joining me for this episode of autism in the adult podcast. 4 00:00:13,210 --> 00:00:15,620 I am a neuropsychologist, 5 00:00:15,630 --> 00:00:23,730 the parent of a teen on the spectrum and I'm the director of a diagnostic autism clinic for adolescents, 6 00:00:23,730 --> 00:00:26,960 adults and aging adults in central Illinois. 7 00:00:27,540 --> 00:00:33,220 And we are in the third uh segment here of the series that we're calling, 8 00:00:33,220 --> 00:00:34,890 talking about autism, 9 00:00:34,900 --> 00:00:43,350 which has been a listener requested series and a really great topic to review together and discuss. 10 00:00:43,930 --> 00:00:54,260 The first episode was about personal journeys towards getting a diagnosis or receiving a diagnosis and how to communicate with others about that. 11 00:00:54,740 --> 00:01:01,570 The second episode was about navigating emotional atmospheres when talking about autism. 12 00:01:01,570 --> 00:01:02,950 For some reason, 13 00:01:02,970 --> 00:01:21,150 the topic can be very emotionally charged and it can be unexpected at times and intense and thinking about how to navigate all those emotions can help if you're wanting to talk more about the topic with other people. 14 00:01:22,040 --> 00:01:30,930 Uh and this episode is about talking about autism to others when its characteristics in them that you identify, 15 00:01:30,930 --> 00:01:41,060 that you wonder if they might be on the spectrum and you're wanting to bring up the topic and just kind of um suggest that to them or see if they've thought about it. 16 00:01:43,640 --> 00:01:55,060 What I'm going to do first is a segment where I'm going to lay the foundation for how I explain autism to other people. 17 00:01:55,540 --> 00:02:02,610 I think this Foundation may at times be something that you need a way of verbalizing. 18 00:02:02,610 --> 00:02:04,960 If you're going to bring up the topic to others. 19 00:02:05,250 --> 00:02:06,650 This may help some of you. 20 00:02:06,650 --> 00:02:09,100 It may be old hat for some of you. 21 00:02:09,540 --> 00:02:16,530 Um But it'll be after we review that foundational kind of information that I talk about. 22 00:02:16,530 --> 00:02:24,360 Some ways to approach people and ways to talk about the topic or introduced the topic. 23 00:02:26,640 --> 00:02:30,060 So when we talk about autism, 24 00:02:30,640 --> 00:02:53,660 you may be talking to someone who has less knowledge than you do about what it is and at some point in the conversation you may be wanting to clarify what it is so that they can consider the information um in a really accurate way. 25 00:02:55,840 --> 00:03:03,850 What autism is is a neuro behavioral developmental condition that's neurologic. 26 00:03:04,340 --> 00:03:09,800 Uh So what it means is that the brain, 27 00:03:09,810 --> 00:03:17,060 because it's in charge of our thinking skills are academic skills are motor coordination, 28 00:03:17,070 --> 00:03:18,980 our emotions, 29 00:03:18,980 --> 00:03:21,110 our personality structure, 30 00:03:21,120 --> 00:03:22,950 our behavioral patterns. 31 00:03:23,340 --> 00:03:40,450 Um Sometimes the brain has kind of an atypical wiring from birth that whereas one individual may be born with some atypical bone structure or an atypical heart valve. 32 00:03:40,460 --> 00:03:48,150 Um Others are born with an unusual pattern of neurological wiring and that's what this is. 33 00:03:48,430 --> 00:03:57,710 So it's a physical state and research at this point shows us that it's largely driven by the genetic code, 34 00:03:57,710 --> 00:04:20,750 which is not surprising in the sense that we now know it's not the result of poor parenting or um other things that decades ago people were talking about but that it's really um kind of this condition of how the code was revealed during development and how the body developed. 35 00:04:22,440 --> 00:04:27,360 Sometimes for the individuals with developmental differences, 36 00:04:27,370 --> 00:04:32,280 They have a few um atypical areas in their body. 37 00:04:32,280 --> 00:04:37,530 So one person might have a heart valve problem from birth. 38 00:04:37,530 --> 00:04:41,610 That's a congenital difference and may have autism. 39 00:04:41,610 --> 00:04:54,890 And in fact That is um true in the research that I think it's about 30% or so of kids with certain cardiac differences that are congenital, 40 00:04:54,890 --> 00:04:58,500 they're born with them are also on the autism spectrum. 41 00:04:58,500 --> 00:05:11,660 And the reason for that is just that this is a reflection of biology of how the person developed and came together before birth, 42 00:05:13,190 --> 00:05:31,090 neuro behavioral refers to the fact that the diagnosis only describes behavioral patterns and in that as a neuropsychologist behavior is interpreted perhaps more widely than than you might interpret it. 43 00:05:31,090 --> 00:05:31,740 So for me, 44 00:05:31,740 --> 00:05:44,530 behavior has to do with communication and the establishment of relationships and repetitious behavioral patterns and um reacting to the sensory environment. 45 00:05:44,530 --> 00:05:48,260 So all of those are neuro behavioral characteristics. 46 00:05:49,640 --> 00:06:04,170 One thing to understand that might make it easier to think about autism or to explain it to other people is that the brain is an organ that is organized. 47 00:06:04,180 --> 00:06:11,330 It's really organized by pattern and pathway and nuclei and location where, 48 00:06:11,340 --> 00:06:11,780 you know, 49 00:06:11,780 --> 00:06:22,620 you probably know that there are some things that the left side of the brain typically does and some things that the right side is in charge of and the same for the inside versus the outside. 50 00:06:22,630 --> 00:06:41,660 And there are some general patterns about how the brain is organized when a neurologist does a checkup for someone in the emergency room because they've had vision changes and they have weakness on part of their body. 51 00:06:41,670 --> 00:06:46,190 They will check all these kinds of things that the brain is in charge of. 52 00:06:46,190 --> 00:06:48,500 So they'll check the person's vision, 53 00:06:48,500 --> 00:06:50,750 they'll check the person's speech, 54 00:06:50,950 --> 00:06:53,630 their ability to find words that they want to say. 55 00:06:53,630 --> 00:06:56,750 They'll check the person's comprehension of speech. 56 00:06:57,140 --> 00:06:59,130 They'll watch the person walk, 57 00:06:59,140 --> 00:07:01,680 they'll check their strength and their reflexes. 58 00:07:01,750 --> 00:07:11,060 And the reason they do this is that it tells them something about what part of the brain might be struggling. 59 00:07:11,440 --> 00:07:13,920 Because we know for example, 60 00:07:14,040 --> 00:07:17,540 that in general the right side of the body is, 61 00:07:17,550 --> 00:07:21,780 is controlled uh in strength, 62 00:07:21,790 --> 00:07:23,410 in that muscle strength, 63 00:07:23,420 --> 00:07:26,010 by the left side of the brain. 64 00:07:26,020 --> 00:07:31,380 And so if the person's presenting with right sided weakness, 65 00:07:31,410 --> 00:07:34,150 there may be a left side of the brain issue, 66 00:07:34,160 --> 00:07:39,860 But it gives you this sense that when we see clinical signs, 67 00:07:40,440 --> 00:07:46,080 we can make conclusions about pathways and locations in the brain. 68 00:07:47,330 --> 00:07:52,420 The same is true when we look at neuro behavioral patterns. 69 00:07:53,110 --> 00:08:00,700 The reason I bring this up is that I think it gives meaning and cohesion to this concept of autism. 70 00:08:00,700 --> 00:08:22,910 That the reason these characteristics hang together in the same person is that they tend to hang together in certain pathways and connections in the brain and that to me gives this a kind of meaningful picture that oh there, 71 00:08:22,920 --> 00:08:36,160 there are particular freeways in the brain and stops along the way that hang out together anatomically and the expression of differences in that wiring hangs together behaviorally. 72 00:08:37,340 --> 00:08:41,450 So that concept of the anatomy, 73 00:08:41,840 --> 00:08:49,600 the wiring being reflected in the cohesion of these behavioral differences. 74 00:08:49,610 --> 00:08:50,220 To me, 75 00:08:50,220 --> 00:08:51,560 that adds meaning to it. 76 00:08:53,440 --> 00:09:19,030 The next part of neurology that I want to explain is that we realized as a scientific community that these kind of characteristics hang together In about 2% of the population and that they're really important to pay attention to like these have implications and there are things we should understand. 77 00:09:19,040 --> 00:09:30,000 So let's have a name for this so that we can communicate in an efficient way about these pathways that seem to be wired differently. 78 00:09:30,640 --> 00:09:47,350 So we currently use the words autism spectrum and that helps us communicate and study something and learn about it and kind of take a snapshot of someone's needs or how they might process the world. 79 00:09:49,630 --> 00:09:55,850 Now this gets to be complex because we then have to say, 80 00:09:55,850 --> 00:09:56,400 well, 81 00:09:56,400 --> 00:09:59,360 when are we going to call it autism? 82 00:10:00,240 --> 00:10:10,330 Because there will be these um characteristics here and there um that are noticeable. 83 00:10:10,340 --> 00:10:13,560 But when do we actually give it that whole name? 84 00:10:14,540 --> 00:10:20,560 So this is the same process that the scientific community goes through with? 85 00:10:20,570 --> 00:10:22,960 When do we call something dyslexia? 86 00:10:23,840 --> 00:10:26,450 Or when do we call something dementia? 87 00:10:27,140 --> 00:10:29,150 When do we call this? 88 00:10:29,160 --> 00:10:32,400 Alzheimer's dementia versus Lewy body dementia. 89 00:10:32,420 --> 00:10:39,380 So there are these distinctions that we're trying to make that are difficult to say, 90 00:10:39,390 --> 00:10:39,700 oh, 91 00:10:39,700 --> 00:10:39,900 well, 92 00:10:39,900 --> 00:10:46,620 let's say there have to be two characteristics in this area and three characteristics in this area. 93 00:10:46,630 --> 00:10:48,460 And then we're gonna call it this. 94 00:10:49,540 --> 00:10:50,160 Well, 95 00:10:50,540 --> 00:10:59,950 that's helpful in the sense that we add definition to the concept of autism or dementia or whatever we're talking about. 96 00:10:59,960 --> 00:11:03,580 But it is somewhat arbitrary. 97 00:11:03,580 --> 00:11:05,760 Like at some point you have to, 98 00:11:06,440 --> 00:11:08,580 if you're going about this process, 99 00:11:08,750 --> 00:11:11,750 you have to make some type of demarcation. 100 00:11:12,240 --> 00:11:12,900 You know, 101 00:11:12,940 --> 00:11:15,330 this is when we're going to call it this. 102 00:11:16,340 --> 00:11:20,360 An analogy might be um you know, 103 00:11:21,340 --> 00:11:22,800 if we're going to say, 104 00:11:22,800 --> 00:11:24,990 when do we call something purple? 105 00:11:25,940 --> 00:11:26,540 Well, 106 00:11:26,540 --> 00:11:30,210 there are colors that we would all agree are purple. 107 00:11:30,220 --> 00:11:31,110 There are colors, 108 00:11:31,110 --> 00:11:33,190 we would all agree aren't purple. 109 00:11:33,200 --> 00:11:35,620 And then there's kind of this, 110 00:11:35,630 --> 00:11:36,210 you know, 111 00:11:36,210 --> 00:11:40,370 middle progression of Hughes where somebody might say, 112 00:11:40,370 --> 00:11:41,050 well, 113 00:11:41,060 --> 00:11:44,360 I'd call that more red than purple and someone else would say. 114 00:11:44,940 --> 00:11:45,690 Uh well, 115 00:11:45,700 --> 00:11:48,060 I I think it's more purple than red. 116 00:11:48,540 --> 00:12:00,550 Um So there is this area of Hugh that is not captured in the way the diagnosis is currently defined. 117 00:12:00,560 --> 00:12:01,650 In addition, 118 00:12:01,660 --> 00:12:09,620 there are many associated characteristics of autism that are not part of the diagnostic criteria, 119 00:12:09,810 --> 00:12:16,010 but research has shown that they they very frequently occur. 120 00:12:16,640 --> 00:12:17,200 So, 121 00:12:17,210 --> 00:12:18,510 for example, 122 00:12:18,520 --> 00:12:26,330 it's very common for people on the autism spectrum to have sleep disturbance that's not part of the diagnostic criteria, 123 00:12:26,340 --> 00:12:35,160 but it is a very common co occurring um brain characteristic because the brain is in charge of sleep. 124 00:12:36,240 --> 00:12:47,010 Um Also there are people that feel like um atypical motor coordination should be part of the diagnosis because many, 125 00:12:47,010 --> 00:12:53,620 many people on the spectrum have a history of having some difficulty with motor coordination, 126 00:12:53,620 --> 00:12:54,850 not everybody. 127 00:12:54,860 --> 00:13:03,460 But it's common enough that some people feel like it should be one of the diagnostic features that can present. 128 00:13:05,640 --> 00:13:07,600 So in talking about this, 129 00:13:07,690 --> 00:13:12,450 I hope you get the picture that neurology is complicated. 130 00:13:12,940 --> 00:13:21,960 And when we're trying to realize that certain things hang together in a person and are valuable enough that we should be talking about them, 131 00:13:22,740 --> 00:13:28,330 we have to go about some process of defining what we call what. 132 00:13:28,390 --> 00:13:30,200 And the same is true as I said, 133 00:13:30,200 --> 00:13:31,120 for dyslexia. 134 00:13:31,120 --> 00:13:34,560 Like what do we call a reading problem? 135 00:13:34,570 --> 00:13:37,060 Is that when there's a phonetic problem, 136 00:13:37,070 --> 00:13:38,760 a sight reading problem, 137 00:13:38,770 --> 00:13:45,830 a reading comprehension for paragraphs problem and then how how big does the problem have to be like, 138 00:13:45,840 --> 00:13:48,090 is it that they're one grade behind? 139 00:13:48,100 --> 00:13:48,470 You know, 140 00:13:48,470 --> 00:13:57,390 So they're just gets to be this um discussion in scientific communities about what do we call it? 141 00:13:57,390 --> 00:13:58,250 And when do we call it? 142 00:13:58,250 --> 00:14:04,260 That that is true for this diagnostic process? 143 00:14:06,160 --> 00:14:27,250 Some people will end up having what we call sub threshold autism characteristics and that can still be good to understand in the sense that there's a point at which understanding that a behavioral pattern or a reaction to the environment has a neurologic base that can still be helpful, 144 00:14:27,640 --> 00:14:31,670 even if there's not the full picture there, 145 00:14:31,680 --> 00:14:43,150 it may help us understand the person or help the person understand themselves to know that there's kind of this neurologic foundation there for that particular characteristic. 146 00:14:45,040 --> 00:14:48,120 And this happens in families as well. 147 00:14:48,120 --> 00:14:56,630 We talked about the genetic contribution and what may happen in families is that certain people have no characteristics, 148 00:14:56,640 --> 00:15:11,060 certain people have some characteristics and perhaps a few people in the family meet threshold for a full diagnosis as we talked about, 149 00:15:11,070 --> 00:15:14,440 because the diagnosis is neuro behavioral, 150 00:15:14,450 --> 00:15:21,960 it's really important that people understand that thinking skills does not come into this picture at all. 151 00:15:22,440 --> 00:15:27,010 There is no diagnostic criteria for autism that has to do with intellect, 152 00:15:27,020 --> 00:15:30,280 which is good because it doesn't have to do with intellect. 153 00:15:30,290 --> 00:15:33,920 It can co occur with intellectual difficulty, 154 00:15:33,920 --> 00:15:41,060 it can co occur with average thinking skills and it can co occur for those who have giftedness. 155 00:15:41,340 --> 00:15:47,100 So there's no implication when we have this diagnosis, 156 00:15:47,940 --> 00:15:48,500 um, 157 00:15:48,510 --> 00:15:54,690 that intellect will look a certain way or that the future of the individual will look a certain way. 158 00:15:54,700 --> 00:15:59,890 We're just talking about an unusual neurologic level of, 159 00:15:59,900 --> 00:16:07,160 of connection within a certain pathway and these kinds of characteristics tend to hang together in certain people. 160 00:16:09,440 --> 00:16:14,080 So let's switch gears now that we have kind of a foundation about neurology, 161 00:16:14,090 --> 00:16:15,280 what it looks like, 162 00:16:15,280 --> 00:16:17,360 how the diagnosis is created. 163 00:16:18,640 --> 00:16:32,760 Let's go to this topic about how might you approach someone if you want to share with them that you think maybe they're on the spectrum or they have some characteristics that are neurologic or autistic. 164 00:16:33,140 --> 00:16:48,270 Um I'm gonna start by just saying at the beginning that as you may um realize I talked to a lot of people about this topic and sometimes I am invited to talk about it and that gives me permission to talk about it. 165 00:16:48,640 --> 00:16:51,560 Um Other times I bring it up out of the blue, 166 00:16:51,560 --> 00:16:53,770 like we're kind of talking about today, 167 00:16:54,140 --> 00:16:57,540 some of that may be out of the blue in a professional context, 168 00:16:57,540 --> 00:17:11,660 some of it may be uh with people in my general environment and I want you to know that I do not talk to everyone about my thoughts, 169 00:17:12,340 --> 00:17:13,170 um, 170 00:17:14,640 --> 00:17:21,870 indiscriminately so I am not of the opinion that if we notice this pattern and someone else, 171 00:17:21,880 --> 00:17:26,560 we automatically are obliged to talk to them. 172 00:17:27,730 --> 00:17:28,450 Now, 173 00:17:29,440 --> 00:17:49,170 that is because there are some people that I can think of in my life and in my experience in my communities that I know that they have autistic characteristics or I suspect that they would be on the spectrum if they had an assessment, 174 00:17:49,540 --> 00:17:59,960 but I do not have the type of relationship with them where it would be okay for me to bring that up, 175 00:18:01,130 --> 00:18:02,740 for example. 176 00:18:02,750 --> 00:18:04,350 Um you know, 177 00:18:04,350 --> 00:18:09,540 this may be a person that I've had really tough interactions within the past, 178 00:18:09,550 --> 00:18:18,060 or we've had a really difficult relationship and we just don't have the kind of relationship where I have permission to speak into their life. 179 00:18:18,740 --> 00:18:19,270 Um, 180 00:18:19,280 --> 00:18:23,450 I may hope that other people get the opportunity to talk to them about it. 181 00:18:24,140 --> 00:18:24,500 Um, 182 00:18:24,510 --> 00:18:37,570 but I may conclude that anything that I say is probably going to be filtered through this tough relationship that we've had and might even make things worse that now. 183 00:18:37,570 --> 00:18:44,660 I'm less inclined to think about it because I really don't like you talking into my life. 184 00:18:46,140 --> 00:18:46,590 Um, 185 00:18:46,600 --> 00:18:55,950 there may also be contexts in which I think it would be inappropriate to raise it at that place and at that time, 186 00:18:56,440 --> 00:19:00,010 so I'm unlikely to raise it at a funeral. 187 00:19:00,010 --> 00:19:01,060 I may not, 188 00:19:01,540 --> 00:19:02,420 you know, 189 00:19:02,430 --> 00:19:03,170 um, 190 00:19:03,180 --> 00:19:10,580 I feel like I'm going to bring that up to a superior of mine at a professional convention or something like that. 191 00:19:10,580 --> 00:19:11,050 So, 192 00:19:11,440 --> 00:19:11,860 um, 193 00:19:11,870 --> 00:19:20,770 I do pick and choose when I think it would be wise to approach someone and say something. 194 00:19:20,960 --> 00:19:23,140 Now there are exceptions to that. 195 00:19:23,140 --> 00:19:32,380 So let's say this person that I've had kind of a tough relationship with in my life is really in a dire spot, 196 00:19:32,390 --> 00:19:36,720 like they are struggling significantly and they can't figure out why. 197 00:19:36,730 --> 00:19:46,960 And really I believe it's related to things that would be eased if they knew this conceptualization of autism. 198 00:19:48,140 --> 00:19:48,530 Um, 199 00:19:48,540 --> 00:19:49,530 in that situation, 200 00:19:49,530 --> 00:19:55,750 I probably would decide to go ahead and approach them because of their high level of need. 201 00:19:55,760 --> 00:19:58,130 So in that situation, 202 00:19:58,140 --> 00:20:04,760 the context would override the relationship concerns that I have. 203 00:20:05,240 --> 00:20:10,850 So I always kind of make that judgment based on the relationship I have with the person, 204 00:20:11,340 --> 00:20:15,060 the context that we're in and and maybe the time, 205 00:20:15,070 --> 00:20:16,950 like is this the time to do it? 206 00:20:18,040 --> 00:20:27,100 And then I would make exceptions based on just what I think would be wise at that time based on their need based on where they're at. 207 00:20:27,110 --> 00:20:27,490 Um, 208 00:20:27,490 --> 00:20:33,470 and based on what I could contribute in cases where we do decide, 209 00:20:33,720 --> 00:20:33,990 you know, 210 00:20:33,990 --> 00:20:36,260 I think I'm going to at least bring it up. 211 00:20:36,740 --> 00:20:57,860 One thing that I find helpful is to think about this image of putting our toe in the water that we don't have to bring up the topic in all its glory and detail and kind of get down to the nitty gritty and convince someone that this is correct. 212 00:20:57,870 --> 00:21:02,290 We can kind of test the waters so to speak. 213 00:21:02,290 --> 00:21:11,230 So we could bring it up something gently or bring up something in a non direct way. 214 00:21:11,240 --> 00:21:11,920 Um, 215 00:21:11,920 --> 00:21:14,330 and kind of test the waters to see, 216 00:21:14,340 --> 00:21:20,040 does this person have a strong negative reaction to the topic, 217 00:21:20,050 --> 00:21:24,040 do they jump on board and seem really interested to talk about it? 218 00:21:24,050 --> 00:21:26,670 Do you think there's an opening to go deeper? 219 00:21:27,040 --> 00:21:31,640 So if there's some opening and you feel like there's some receptiveness, 220 00:21:31,640 --> 00:21:35,430 you can always share more or provide more information. 221 00:21:35,440 --> 00:21:38,150 So that's one thing that I keep in mind too, 222 00:21:38,150 --> 00:21:40,840 like putting feelers out, 223 00:21:40,850 --> 00:21:47,060 how how comfortable is this person with introducing this new topic, 224 00:21:47,070 --> 00:21:57,420 How open might they be when you decide you are going to share something or bring up the topic, 225 00:21:57,430 --> 00:22:00,040 you could do this in a variety of ways. 226 00:22:00,050 --> 00:22:14,730 So one way might be to share a personal story that kind of gives us an in in the sense that um I have a reason for bringing this up because I've experienced it and this is my experience. 227 00:22:14,730 --> 00:22:25,540 So if you're a person who's been diagnosed and you found that helpful or if you're a parent of a child or young adult who's been diagnosed, 228 00:22:25,550 --> 00:22:28,670 sometimes that just gives you, 229 00:22:29,340 --> 00:22:36,830 um it creates a context for the person to hear your wisdom based on your experience. 230 00:22:36,840 --> 00:22:37,600 So, 231 00:22:37,610 --> 00:22:38,040 oh, 232 00:22:38,040 --> 00:22:40,400 you've had this personal experience, 233 00:22:40,410 --> 00:22:43,350 I would like to hear what you have to say. 234 00:22:44,140 --> 00:22:52,770 So sometimes approaching it in that way I'm bringing it up because what you're experiencing reminds me of myself. 235 00:22:55,640 --> 00:23:00,900 Sometimes you can bring it up in the context of new learning that you've had. 236 00:23:00,910 --> 00:23:05,430 So maybe you're not a person who has experienced that yourself, 237 00:23:05,440 --> 00:23:19,120 but maybe you have recently heard a lecture or read a book or listen to a podcast and the light bulb just went off about various things maybe about yourself and about, 238 00:23:19,130 --> 00:23:19,720 you know, 239 00:23:19,720 --> 00:23:22,660 how neurology impacts people in general, 240 00:23:22,670 --> 00:23:32,350 like this has opened up a curiosity in you and you've really been thinking about that for yourself and you're thinking about it for this other person. 241 00:23:34,240 --> 00:23:35,600 And in that context, 242 00:23:35,600 --> 00:23:50,260 if you do lead with I learned about this and I've been thinking about it regarding myself and I realized that I tend to do this and this is really neurologically based. 243 00:23:50,260 --> 00:23:51,780 It's so interesting to me, 244 00:23:51,780 --> 00:23:57,460 it's helped me so much when we do lead with a personal experience. 245 00:23:57,470 --> 00:23:59,670 Even if it's not a diagnosis, 246 00:23:59,690 --> 00:24:00,340 you know, 247 00:24:00,340 --> 00:24:13,950 I have this personal experience where I've learned this about myself and then introducing the other person to think about themselves may be just a nice flow to the conversation. 248 00:24:16,940 --> 00:24:17,270 Mm hmm. 249 00:24:17,840 --> 00:24:23,980 Another way to approach it is to have a wondering or a curious tone. 250 00:24:23,990 --> 00:24:38,080 I think what we want to avoid is to have any kind of lecturing tone or that we are going to argue our point and that they must agree with us by the end of the conversation. 251 00:24:38,080 --> 00:24:47,380 I think what's likely to happen in that sense is that they can feel backed into a corner and they can push back really just to have more space. 252 00:24:47,840 --> 00:24:52,010 And so if we approach it more as a wondering, 253 00:24:52,540 --> 00:24:53,110 you know, 254 00:24:53,110 --> 00:24:54,250 I've been wondering, 255 00:24:54,250 --> 00:25:04,400 I've noticed this or that and I've been wondering if autism would be a way to understand what's been happening and kind of open up possibilities. 256 00:25:04,410 --> 00:25:08,360 What do you think or what's your thought about that? 257 00:25:10,050 --> 00:25:17,050 That gives the person's space to react and to think and they don't feel rushed or pushed. 258 00:25:17,640 --> 00:25:18,450 Um, 259 00:25:18,940 --> 00:25:22,360 and that freedom to explore the thought, 260 00:25:22,840 --> 00:25:23,340 um, 261 00:25:23,340 --> 00:25:27,570 with you or on their own can really bring about some fruit, 262 00:25:27,580 --> 00:25:28,270 I think, 263 00:25:28,740 --> 00:25:29,690 um, 264 00:25:29,700 --> 00:25:41,560 that can encourage people to learn more and give people space to get their in their own time now as a professional. 265 00:25:41,740 --> 00:25:57,190 I also have contexts where I am with a patient and I'm talking to them about this kind of based on my own clinical expertise and they've come in as a patient and I use the word patient because I work in a hospital, 266 00:25:57,200 --> 00:26:01,490 but you could say client or whatever kind of fits the situation. 267 00:26:01,490 --> 00:26:03,190 If you work in a school, 268 00:26:03,200 --> 00:26:04,560 there would be students, 269 00:26:04,560 --> 00:26:05,260 et cetera, 270 00:26:05,940 --> 00:26:08,360 and they have come in for some reason. 271 00:26:08,360 --> 00:26:13,900 And sometimes it has to do with an autism diagnosis and sometimes it does not. 272 00:26:13,910 --> 00:26:17,120 I work with patients who have all kinds of different backgrounds, 273 00:26:17,120 --> 00:26:25,670 someone may have had a head injury and be coming in for that or a stroke or an assessment for dementia. 274 00:26:26,040 --> 00:26:29,780 And I just realized in the midst of that, 275 00:26:29,790 --> 00:26:32,860 that there's an undiagnosed autism spectrum. 276 00:26:32,870 --> 00:26:35,800 So sometimes I'm bringing it up cold, 277 00:26:35,810 --> 00:26:36,310 um, 278 00:26:36,310 --> 00:26:38,910 where there's no context and they're not expecting it. 279 00:26:38,920 --> 00:26:42,860 And other times I'm bringing it up or they are expecting it. 280 00:26:44,640 --> 00:26:45,360 Um, 281 00:26:46,140 --> 00:26:48,880 I think it's pretty straightforward when they're expecting it. 282 00:26:48,880 --> 00:26:50,630 So I'm not going to cover that. 283 00:26:50,630 --> 00:26:53,880 I think what I said at the beginning of the episode, 284 00:26:53,890 --> 00:26:58,460 does summarize how I how I explain autism to people, 285 00:26:58,840 --> 00:27:00,800 but if they're not expecting it, 286 00:27:00,810 --> 00:27:08,170 what I find helpful is to summarize to them what they have said to me, 287 00:27:08,640 --> 00:27:12,060 so that I make sure I understood it correctly. 288 00:27:12,940 --> 00:27:15,660 But I'll take that summary and I'll say, 289 00:27:15,780 --> 00:27:16,090 you know, 290 00:27:16,090 --> 00:27:20,050 it sounds like you're a person who uh, 291 00:27:20,060 --> 00:27:23,440 really gets revived by alone time. 292 00:27:23,440 --> 00:27:32,870 And sometimes the drama of female relationships just actually feels overwhelming that you would be more content with your, 293 00:27:32,880 --> 00:27:34,660 your cat in a good book. 294 00:27:34,660 --> 00:27:39,380 And sometimes people at work seem to think you're standoffish or whatever. 295 00:27:39,380 --> 00:27:48,750 And so I go through the social part and then I'll say it also seems like when you're interested in something you are all in, 296 00:27:48,750 --> 00:27:49,100 like, 297 00:27:49,110 --> 00:27:50,950 you love that thing. 298 00:27:51,340 --> 00:27:51,780 Uh, 299 00:27:51,790 --> 00:27:56,770 and so I'll go through each of the criteria just saying that. 300 00:27:57,540 --> 00:28:00,090 So I'm not bringing up the word autism, 301 00:28:00,280 --> 00:28:06,010 I'm just showing them that I've heard their description of themselves. 302 00:28:07,640 --> 00:28:10,400 And I in my own mind, 303 00:28:11,340 --> 00:28:18,360 I'm saying it back because I know that these things represent some of those criteria, 304 00:28:20,940 --> 00:28:22,910 then I will say, 305 00:28:22,920 --> 00:28:23,630 you know, 306 00:28:23,640 --> 00:28:31,010 when these kinds of things happen and they're expressed in the same person. 307 00:28:31,440 --> 00:28:34,000 One of the things I think about is neurology, 308 00:28:34,000 --> 00:28:37,000 because these patterns of neurology, 309 00:28:37,000 --> 00:28:39,500 these freeways or highways in the brain, 310 00:28:40,470 --> 00:28:40,840 you know, 311 00:28:40,840 --> 00:28:46,500 there are patterns that contain these characteristics and when they happen together, 312 00:28:46,500 --> 00:28:49,520 often it's because of a neurologic, 313 00:28:49,530 --> 00:28:50,660 um, 314 00:28:50,670 --> 00:28:59,540 space in there that has some different kinds of wiring that people are noticing and when we see that in the same person, 315 00:28:59,550 --> 00:29:03,850 we have a name for that and what we call that is autism. 316 00:29:05,040 --> 00:29:10,060 And then I'll just kind of let them process or react. 317 00:29:10,640 --> 00:29:12,770 Now I have to say that I am, 318 00:29:13,140 --> 00:29:17,050 I am very surprised um, 319 00:29:17,060 --> 00:29:20,070 at how many times somebody in the room, 320 00:29:20,070 --> 00:29:24,600 whether it's a family member or themselves will say I thought so, 321 00:29:24,610 --> 00:29:29,030 but I didn't want to bring it up and maybe there's a group of three of them, 322 00:29:29,030 --> 00:29:29,360 right? 323 00:29:29,360 --> 00:29:31,360 Like the client and family members, 324 00:29:31,360 --> 00:29:33,970 but they've never talked to each other about it. 325 00:29:33,980 --> 00:29:35,520 They've just been wondering, 326 00:29:35,520 --> 00:29:38,910 but they don't feel like it's okay to bring the topic up. 327 00:29:38,920 --> 00:29:40,960 Kind of like we talked about before. 328 00:29:40,980 --> 00:29:42,990 Like is this okay to mention, 329 00:29:43,000 --> 00:29:44,450 is this okay to think about? 330 00:29:44,840 --> 00:29:46,890 And so we'll go from there. 331 00:29:49,220 --> 00:29:59,080 Sometimes this is something that they have never considered and they are surprised and kind of pause and have to take that in. 332 00:29:59,090 --> 00:30:01,950 And I might kind of ask them, 333 00:30:01,950 --> 00:30:03,560 what are your thoughts about that. 334 00:30:04,340 --> 00:30:05,170 Um, 335 00:30:06,340 --> 00:30:08,110 if there is, 336 00:30:08,120 --> 00:30:09,190 uh, 337 00:30:09,200 --> 00:30:14,790 a misunderstanding or they just don't know much about autism or they're thinking of it in a different way. 338 00:30:14,800 --> 00:30:17,350 I just try to give that education, 339 00:30:18,440 --> 00:30:24,530 if the person seems to be stressed by that or to be upset, 340 00:30:24,540 --> 00:30:27,670 I just try to figure out what the barrier is. 341 00:30:28,140 --> 00:30:33,680 So if it's not an information gap that I fill in with education, 342 00:30:33,680 --> 00:30:38,550 it may be an emotional reaction like we talked about last time, 343 00:30:40,540 --> 00:30:45,640 um I may say it sounds like maybe you feel like this is a criticism, 344 00:30:45,650 --> 00:30:46,090 you know, 345 00:30:46,090 --> 00:30:48,410 this isn't a criticism to me, 346 00:30:48,420 --> 00:31:01,210 it's really just the self revelation that can help you so much understand yourself and what you need and um really just feel better in your own skin. 347 00:31:01,210 --> 00:31:03,360 There are lots of things we can recommend. 348 00:31:05,640 --> 00:31:19,960 One of the things I try to do if the person is not really feeling open to the diagnosis or the discussion at that time is just to try to leave the door open. 349 00:31:20,540 --> 00:31:22,600 So I might say, 350 00:31:22,610 --> 00:31:23,170 well, 351 00:31:23,170 --> 00:31:27,150 if you ever want to talk more about that topic, 352 00:31:27,160 --> 00:31:29,960 let me know because I'd be happy to do that. 353 00:31:30,540 --> 00:31:32,640 Um but in my mind, 354 00:31:32,640 --> 00:31:34,620 I also know that I just, 355 00:31:34,690 --> 00:31:40,210 I may just want to plant the seed and let them go and not push the topic, 356 00:31:40,250 --> 00:31:42,460 but now that I've introduced it, 357 00:31:42,840 --> 00:31:45,440 they may process that over time. 358 00:31:45,460 --> 00:31:48,460 Someone else may bring it up to them in the future. 359 00:31:48,470 --> 00:31:51,180 It may all fall together to them, 360 00:31:51,180 --> 00:31:52,660 but at a different time. 361 00:31:52,670 --> 00:31:55,950 So planting a seed is okay as well. 362 00:31:58,400 --> 00:31:59,590 I may also say, 363 00:31:59,590 --> 00:32:00,060 you know, 364 00:32:00,710 --> 00:32:04,960 at some point it doesn't matter if we call it that, 365 00:32:04,970 --> 00:32:10,190 but I do think there's some neurology behind it and because of that, 366 00:32:10,190 --> 00:32:13,270 I have some things that I think would really be helpful for you. 367 00:32:13,740 --> 00:32:18,920 So sometimes the person may be able to consider that there is some neurology there, 368 00:32:18,940 --> 00:32:21,770 but not wanting to call it a particular thing? 369 00:32:22,140 --> 00:32:23,510 Uh and other times, 370 00:32:23,520 --> 00:32:23,880 you know, 371 00:32:23,880 --> 00:32:31,950 I just try to focus on what I think would be helpful regardless of whether the person wants to call it a specific thing. 372 00:32:34,340 --> 00:32:39,580 Other times I just let it be, 373 00:32:39,580 --> 00:32:46,680 I don't bring up the topic or maybe I have and it's been shut down and I just, 374 00:32:46,740 --> 00:32:53,130 in my own mind think of the person through that lens when it's helpful. 375 00:32:53,130 --> 00:32:59,770 So maybe there is a behavior or a communication that otherwise I would feel a bit perplexed about. 376 00:33:00,440 --> 00:33:11,950 Um but because I can remind myself that there neurology maybe um autistic in nature that that can help me understand. 377 00:33:11,960 --> 00:33:17,310 So it could help me um when I interact with the individual, 378 00:33:17,320 --> 00:33:23,760 even if we're not kind of overtly calling ah the characteristics by any particular name. 379 00:33:25,440 --> 00:33:33,410 Those are a summary of my thoughts when it comes to describing autism and autistic characteristics to others, 380 00:33:33,420 --> 00:33:44,560 introducing that topic kind of feeling out how they think about it and planting a seed for someone to process that information over time. 381 00:33:45,840 --> 00:33:49,760 I'm really glad you joined me for this last episode of the series, 382 00:33:49,760 --> 00:34:02,960 talking about autism and next time we are going to begin a new series that has to do with the experience and expression of autistic characteristics across the lifespan. 383 00:34:03,840 --> 00:34:08,850 I'm going to be talking about topics such as the developing nervous system. 384 00:34:08,850 --> 00:34:13,420 So the brain doesn't fully develop until about 21 years of age. 385 00:34:13,420 --> 00:34:21,260 So how can that impact the evolution of autistic characteristics through childhood and adolescence? 386 00:34:21,440 --> 00:34:27,600 We're going to talk about hormonal shifts and how that can impact these things puberty, 387 00:34:27,600 --> 00:34:28,630 menstrual cycles, 388 00:34:28,630 --> 00:34:29,540 pregnancy, 389 00:34:29,550 --> 00:34:31,100 menopause aging, 390 00:34:31,740 --> 00:34:38,620 and we're also going to talk about other things related to aging on the autism spectrum, 391 00:34:38,630 --> 00:34:46,260 such as the experience of shifts and how the characteristics our felt or expressed. 392 00:34:47,440 --> 00:34:48,460 Until then, 393 00:34:48,570 --> 00:34:51,690 I hope you have good talks about autism with each other.  

Join Dr. Regan for the second episode of the series "Talking About Autism." This episode focuses on how the thoughtful navigation of emotions during conversations about autism can create space and freedom for more discussions. New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians   Read the transcript: 00:00:05,740 --> 00:00:06,480 Hello, 3 00:00:06,490 --> 00:00:12,460 This is Dr Theresa Regan. Thank you for joining me for this episode of Autism in the Adult. 4 00:00:13,140 --> 00:00:19,260 I am happy that you're joining us for this series called Talking about Autism. 5 00:00:19,270 --> 00:00:37,150 This is the second episode, and I had originally predicted it was going to be about talking to others when you see autistic characteristics in them and you wonder if a diagnostic evaluation would be helpful for them? 6 00:00:38,740 --> 00:00:44,170 What happened is that, as I'm mulling around the topics for the series, 7 00:00:44,180 --> 00:00:49,560 I really couldn't get my mind off what was going to be the 3rd episode -- 8 00:00:50,140 --> 00:00:56,260 which I'm going to call "navigating emotional atmospheres"... when we're talking about autism. 9 00:00:57,040 --> 00:01:13,790 And I've come to the conclusion that I'm going to cover that topic here in the second episode because I feel like it's really important to consider before we talk to other people about autistic characteristics. 10 00:01:13,790 --> 00:01:20,860 How would we navigate the emotions that are sometimes present around the topic itself? 11 00:01:21,640 --> 00:01:39,160 Last episode we talked about Talking About Autism when you are on a journey toward evaluation yourself ... when you're considering that, or when you have a new diagnosis and you might want to talk to people about your diagnosis and about autism. 12 00:01:40,640 --> 00:01:40,960 So, 13 00:01:40,960 --> 00:01:50,260 this episode is going to be focused a little bit more on navigating the complexity of people's emotional responses. 14 00:01:50,740 --> 00:01:54,850 And as we talked about in the first episode, 15 00:01:54,850 --> 00:02:03,690 it really is an emotionally charged topic and in some ways that's a bit mystifying to me. 16 00:02:03,700 --> 00:02:12,650 ... the amount of emotion people have about a topic that sometimes they're not even really impacted by on a personal level, 18 00:02:15,840 --> 00:02:22,160 but talking about autism often does involve navigating emotional atmospheres. 19 00:02:22,780 --> 00:02:23,000 Um, 20 00:02:23,000 --> 00:02:27,760 and it's hard to predict what the atmosphere is going to look like or how complex it is. 21 00:02:29,040 --> 00:02:38,010 Sometimes the atmosphere may be charged because we would like to talk to someone about the topic and how it impacts, 22 00:02:38,010 --> 00:02:38,690 let's say, 23 00:02:38,690 --> 00:02:40,110 our own family, 24 00:02:40,120 --> 00:02:44,600 or how it impacts someone in the family or how it impacts you. 25 00:02:44,610 --> 00:02:51,730 And there can just be this unusual response of 26 00:02:51,740 --> 00:02:53,630 a lot of emotional charge. 27 00:02:53,640 --> 00:03:04,360 I spoke with a young woman recently who was saying that she was shocked at how angry people in her family were when she brought the topic up. 28 00:03:04,940 --> 00:03:10,160 And that is not an unusual thing for someone to share, that 29 00:03:10,170 --> 00:03:12,310 it can really charge people up. 30 00:03:12,320 --> 00:03:13,660 And um, 31 00:03:14,350 --> 00:03:17,440 sometimes you're not just bringing up a topic, 32 00:03:17,450 --> 00:03:22,560 you're bringing up all this emotional processing and content. 33 00:03:24,240 --> 00:03:25,270 Other times, 34 00:03:25,270 --> 00:03:30,560 people on this journey toward an autism diagnosis or self awareness, 35 00:03:30,940 --> 00:03:33,150 they may feel other emotions too. 36 00:03:33,150 --> 00:03:39,460 They might feel relief that they finally understand how they're wired. 37 00:03:39,940 --> 00:03:40,330 Um, 38 00:03:40,330 --> 00:03:51,550 they might share that this is such a meaningful and important thing to them that they really have a lot of emotion about the value of the diagnosis. 39 00:03:52,140 --> 00:03:55,130 Other people may really be in a different spot. 40 00:03:55,130 --> 00:03:59,150 They might be in this spot where they're processing. 41 00:03:59,160 --> 00:03:59,740 Um, 42 00:03:59,750 --> 00:04:01,040 just surprise. 43 00:04:01,040 --> 00:04:05,950 Like they were not expecting it, processing maybe grief or fear. 44 00:04:05,960 --> 00:04:06,730 Um, 45 00:04:06,740 --> 00:04:24,830 a lot of emotions can come with this diagnosis or this discussion. And for people who have been in the autistic community for a while and they have this deep passion to advocate for, 46 00:04:24,840 --> 00:04:25,670 um, 47 00:04:25,680 --> 00:04:27,930 anyone who um, 48 00:04:27,940 --> 00:04:37,810 has diversity in their neurology ... and many times that passion comes with a lot of emotional charge as well. 49 00:04:38,080 --> 00:04:55,940 And so we may have people who are so passionate about what language is used or how we should interact with others or support others or whether we should have interventions for autism or not. 50 00:04:55,950 --> 00:05:09,050 So there can also be this passionate approach to what is right or wrong to say or do for the autistic individual or within the community. 51 00:05:11,240 --> 00:05:22,150 What can happen is that the presence of this emotion can shut down the discussion before it's really launched. 52 00:05:22,540 --> 00:05:31,980 So we have something come up and it's responded to with strong emotion and it's very common, 53 00:05:31,980 --> 00:05:39,190 I think for that strong emotion to overtake the topic itself and then people in the room realize, 54 00:05:39,200 --> 00:05:40,000 oh, 55 00:05:40,010 --> 00:05:40,570 okay, 56 00:05:40,570 --> 00:05:42,960 this is not okay to talk about. 57 00:05:42,970 --> 00:05:45,830 This was a really strong, 58 00:05:45,840 --> 00:05:47,050 passionate, 59 00:05:47,580 --> 00:05:54,850 intense reaction and I feel like I'm getting the emotional message that this is not okay. 60 00:05:56,140 --> 00:05:56,830 In fact, 61 00:05:56,840 --> 00:05:58,530 I think to myself, 62 00:05:58,540 --> 00:06:06,830 if I wanted to make sure that it was not okay to talk about some particular topic and that everyone around me knew it, 63 00:06:06,840 --> 00:06:13,160 I probably would be very quick to have emotional responses. 64 00:06:13,170 --> 00:06:20,350 I'd probably be ready with criticism or judgment or correction or logical arguments. 65 00:06:20,740 --> 00:06:21,440 Um, 66 00:06:21,450 --> 00:06:27,850 maybe even just joking at someone's expense or whatever I could do to make 67 00:06:28,740 --> 00:06:35,360 the discussion so intense that people realize that needs to be shut down. 68 00:06:35,740 --> 00:06:43,170 So when I am approaching this topic of how do we say autism is okay to talk about? 69 00:06:43,170 --> 00:06:44,830 Let's bring it to the table. 70 00:06:44,830 --> 00:06:46,160 It's always okay. 71 00:06:46,160 --> 00:06:48,100 How do we create that atmosphere? 72 00:06:48,110 --> 00:06:54,350 I think one of the things we focus on is protecting the emotional atmosphere. 73 00:06:54,840 --> 00:06:55,610 Um, 74 00:06:55,620 --> 00:07:10,600 and being aware that the emotions that we are filtering into the conversation may actually really detract from someone's comfort level of bringing it up. 75 00:07:10,670 --> 00:07:14,860 It may detract from people's ability to process the topic itself. 76 00:07:15,240 --> 00:07:21,230 And so I'm just really conscious of trying to attend to that. 77 00:07:21,240 --> 00:07:24,060 Whenever I speak with someone about the topic, 78 00:07:28,340 --> 00:07:31,780 there's a lot of emotion about what to call things. 79 00:07:31,790 --> 00:07:34,310 So what language are we using? 80 00:07:34,320 --> 00:07:46,700 Some people really strongly want the language of "the autistic individual" or "the autistic" because they really self identify with that neurology. 81 00:07:46,700 --> 00:07:47,620 It's who they are. 82 00:07:47,620 --> 00:07:49,000 It's how they're knit together. 83 00:07:49,340 --> 00:07:51,650 They welcome that identification. 84 00:07:52,040 --> 00:07:57,090 Other people do not want to be known as an autistic individual. 85 00:07:57,090 --> 00:08:07,660 They feel more comfortable saying they are an individual on the spectrum or they have autism, and other people have strong emotions against that. 86 00:08:07,940 --> 00:08:18,120 So we even have this really emotional response to what words are okay to use and that can really um, 87 00:08:18,130 --> 00:08:20,360 come into the discussion as well. 88 00:08:21,740 --> 00:08:29,510 People may have very charged reactions about the, 89 00:08:29,790 --> 00:08:33,420 the peaks and valleys of anyone's journey and by that, 90 00:08:33,420 --> 00:08:37,460 I mean that in our culture, 91 00:08:37,470 --> 00:08:51,060 if someone is struggling with something and oftentimes people on a journey toward diagnosis have come to that journey because they've hit some season of struggle. 92 00:08:51,440 --> 00:08:52,550 Um, 93 00:08:52,940 --> 00:08:54,130 in our culture, 94 00:08:54,130 --> 00:09:07,990 we're very focused on fixing these struggles and sometimes that in itself can shut down discussions about complex things, 95 00:09:07,990 --> 00:09:10,660 about things that are not easily fixed. 96 00:09:12,540 --> 00:09:21,670 People on a journey probably get a lot of advice before they get to this journey of assessment for autism. 97 00:09:21,740 --> 00:09:24,560 They've probably gotten a lot of advice like, 98 00:09:25,040 --> 00:09:25,370 uh, 99 00:09:25,380 --> 00:09:30,900 "that wouldn't happen in my house" or "this is how we did it and it fixed it completely," 100 00:09:30,910 --> 00:09:32,540 or um, 101 00:09:32,550 --> 00:09:38,510 "these are the seven steps to being free from anxiety and if you do these, 102 00:09:38,520 --> 00:09:40,660 then you shouldn't have a problem." 103 00:09:43,040 --> 00:09:43,400 Um, 104 00:09:43,410 --> 00:09:45,270 in my own personal journey, 105 00:09:45,270 --> 00:09:47,540 I really experienced that a lot. 106 00:09:47,550 --> 00:09:48,300 Um, 107 00:09:48,310 --> 00:09:51,940 as a parent, and I know this podcast is about adults, 108 00:09:51,940 --> 00:09:56,750 but the topic of emotional processing um, 109 00:09:56,760 --> 00:10:00,460 is just a very human topic across the lifespan. 110 00:10:01,140 --> 00:10:01,500 Now, 111 00:10:01,500 --> 00:10:05,210 one of the things that my son on the spectrum struggled with, 112 00:10:05,220 --> 00:10:05,750 um, 113 00:10:05,760 --> 00:10:09,090 so much was sleep and also as an infant, 114 00:10:09,090 --> 00:10:12,310 he was just very colicky and upset. 115 00:10:12,310 --> 00:10:12,500 He, 116 00:10:12,500 --> 00:10:14,960 he had a difficulty calming. 117 00:10:15,340 --> 00:10:16,110 Um, 118 00:10:16,120 --> 00:10:18,550 and a lot of things went into that, 119 00:10:18,550 --> 00:10:20,050 but um, 120 00:10:20,050 --> 00:10:23,880 we were really struggling with a sleep issue. 121 00:10:23,880 --> 00:10:30,260 And in fact he didn't End up sleeping through the night on a consistent basis until he was eight years old. 122 00:10:30,740 --> 00:10:34,020 And that was really difficult on him. 123 00:10:34,030 --> 00:10:48,410 It made all the other features more difficult for him to manage and it impacted our resilience to and our ability to um really sustain wellness as a household. 124 00:10:48,410 --> 00:10:50,550 So I remember um, 125 00:10:50,560 --> 00:10:52,260 getting this, 126 00:10:52,270 --> 00:11:07,050 he was in daycare twice a week and I went to pick him up one day when he was 10 months old and the nursery leader who had had him in her, 127 00:11:07,060 --> 00:11:10,360 they call it class in her class for um, 128 00:11:10,370 --> 00:11:13,020 from the beginning of when we started going, 129 00:11:13,530 --> 00:11:21,880 she left me a note and it said "his crying is disruptive to the class. 130 00:11:22,440 --> 00:11:25,050 Please have him better by tomorrow." 131 00:11:26,030 --> 00:11:31,570 And that is kind of an example of this, 132 00:11:33,740 --> 00:11:46,730 this mindset that things can be fixed if only you're good enough parent or if only you're committed enough to be um, 133 00:11:46,740 --> 00:11:52,960 a calm person or if only you're committed enough to be a good spouse, 134 00:11:53,040 --> 00:11:53,410 you know, 135 00:11:53,410 --> 00:11:54,750 whatever that looks like. 136 00:11:55,590 --> 00:12:00,270 And not only was I a struggling mom, 137 00:12:00,290 --> 00:12:05,210 but now I had been told that I should have this fixed. 138 00:12:05,220 --> 00:12:08,260 I should be able to fix it. 139 00:12:09,010 --> 00:12:14,770 And also another example when he was  140 00:12:14,780 --> 00:12:16,200 a couple of years old, 141 00:12:16,200 --> 00:12:17,470 two or three years old. 142 00:12:17,480 --> 00:12:22,840 I was looking into Melatonin to assist with sleep. 143 00:12:22,850 --> 00:12:49,260 And I read the reviews online for different products and a mother on their wrote this scathing comment that um using Melatonin for children is child abuse because um any good parents should know how to get their kids down for bed and that would never happen in her house. 144 00:12:49,640 --> 00:12:52,450 So it was long... long,  145 00:12:52,450 --> 00:12:54,130 that's the gist of it though. 146 00:12:54,140 --> 00:12:55,850 Um and so, 147 00:12:55,860 --> 00:12:56,420 you know, 148 00:12:56,420 --> 00:13:05,290 these messages that are so emotionally intense and not only does it bring about this shame and blame and hopelessness, 149 00:13:05,300 --> 00:13:09,780 but it also creates this atmosphere where it's clear 150 00:13:09,780 --> 00:13:12,310 it is not okay to say that you're struggling. 151 00:13:12,640 --> 00:13:24,460 Um it's not okay to bring up um that you've tried everything and you don't know what's going on um because not only are you struggling, 152 00:13:24,460 --> 00:13:34,460 but apparently it's also something that you could very well fix um, and you should fix and therefore the struggle is also your fault. 153 00:13:34,940 --> 00:13:39,680 So these emotional um... these emotional charges, 154 00:13:39,690 --> 00:13:48,370 I think really dampen our ability to give people the freedom to talk about all the ups and downs of their life, 155 00:13:48,370 --> 00:13:53,590 like life is messy and good and hard and you know, 156 00:13:53,590 --> 00:14:00,860 I feel like I can bring up any topic um and realize that it's okay to share that. 157 00:14:01,340 --> 00:14:02,320 Instead. 158 00:14:02,320 --> 00:14:10,550 I think we have a lot of emotional overtones to what's okay to bring up and what's okay to talk about. 159 00:14:12,640 --> 00:14:19,860 I remember um being struck too uh when my son was about a year old, 160 00:14:20,440 --> 00:14:23,870 one of my colleagues had an infant, 161 00:14:23,870 --> 00:14:25,170 this was her first child, 162 00:14:25,180 --> 00:14:29,840 and after I think five days after she was born, 163 00:14:29,850 --> 00:14:39,100 um my colleague brought her in and she was just this bundle of pink, cute as can be, slept the whole time. 164 00:14:39,600 --> 00:14:41,610 And you know, 165 00:14:41,610 --> 00:14:45,860 that was so different than what was happening in my home. 166 00:14:46,340 --> 00:14:47,890 And she said, 167 00:14:47,890 --> 00:14:48,360 gosh, 168 00:14:48,360 --> 00:14:52,560 I'm really a little um nervous and watchful, 169 00:14:52,560 --> 00:14:56,110 because I have to wake her up in the middle of the night for her to eat. 170 00:14:56,120 --> 00:14:56,660 You know, 171 00:14:56,660 --> 00:15:00,210 she's already sleeping through and I'm a little nervous about, 172 00:15:00,220 --> 00:15:00,550 you know, 173 00:15:00,550 --> 00:15:02,780 her nutrition, and, of course, 174 00:15:02,790 --> 00:15:06,760 here I am not sleeping for a year. 175 00:15:07,240 --> 00:15:11,010 And another colleague said to her, 176 00:15:11,250 --> 00:15:11,690 "oh, 177 00:15:11,690 --> 00:15:13,810 what a good baby you have." 178 00:15:14,440 --> 00:15:21,250 And usually I'm very measured in my speech and I think about what I say ahead of time, 179 00:15:21,250 --> 00:15:33,860 but I felt this surge going from my toes up to my ... my voice and I blurted out, "all babies are good." 180 00:15:35,140 --> 00:15:36,560 And she said, 181 00:15:36,560 --> 00:15:37,340 "well, 182 00:15:37,360 --> 00:15:37,950 yeah, 183 00:15:37,950 --> 00:15:39,360 but you know what I mean?" 184 00:15:39,840 --> 00:15:48,370 And I realized that we attach goodness to a baby, 185 00:15:48,370 --> 00:15:49,860 that's easy. 186 00:15:50,590 --> 00:15:51,130 I said, 187 00:15:51,130 --> 00:15:51,520 "you mean, 188 00:15:51,520 --> 00:15:53,950 she's easy and that's good." 189 00:15:55,040 --> 00:15:57,020 But all babies are good. 190 00:15:57,030 --> 00:16:08,250 So I think we have to watch our emotional tone so that we make sure everyone knows that every infant has value. 191 00:16:08,260 --> 00:16:11,660 Every individual is important. 192 00:16:12,120 --> 00:16:13,060 There aren't, 193 00:16:13,070 --> 00:16:13,960 you know, 194 00:16:14,640 --> 00:16:16,990 good babies and bad babies. 195 00:16:17,440 --> 00:16:26,460 There are struggling babies and babies that are not struggling and so forth across the whole lifespan, 196 00:16:26,840 --> 00:16:35,150 that our emotional charge can sometimes make people feel less than good, less than valued. 197 00:16:36,060 --> 00:17:00,150 And so I think that really became apparent to me and I'm much more aware of protecting the emotional atmosphere when I'm speaking to someone to really protect that they understand that they are important and that we're having this tough discussion because their well being is important. 198 00:17:01,840 --> 00:17:12,020 What I started to think about is that even though I want people to be have the freedom and the space to be where they're at, 199 00:17:12,020 --> 00:17:13,920 whether they're celebrating this, 200 00:17:13,930 --> 00:17:15,600 whether they're relieved, 201 00:17:15,600 --> 00:17:16,960 whether they're struggling, 202 00:17:17,540 --> 00:17:23,120 whether they're upset about the diagnosis or the concept, 203 00:17:23,130 --> 00:17:25,450 I want to give people space, 204 00:17:25,630 --> 00:17:35,460 they don't have to react in a certain way in order to be good or in order to please me just because I'm in a different place. 205 00:17:36,840 --> 00:17:38,220 On the other hand, 206 00:17:38,230 --> 00:17:48,060 I really want to balance that freedom to feel with my own awareness of protecting the emotional atmosphere. 207 00:17:49,140 --> 00:18:09,170 There are some emotions that I really um try to protect people from during our conversations and The Big one I would say that I never feel is helpful in the conversation is shame. 208 00:18:10,240 --> 00:18:15,780 Um I just feel like that is so easy. 209 00:18:16,940 --> 00:18:29,670 Mhm uh emotionally to bring into conversations when someone is struggling that I really try to be very careful to protect what's going on from any shame. 210 00:18:30,140 --> 00:18:36,760 Um and I would also say emotions like hopelessness, 211 00:18:36,760 --> 00:18:37,620 helplessness, 212 00:18:37,620 --> 00:18:42,780 worthlessness, and it's okay for people to feel fear... 213 00:18:42,780 --> 00:18:48,380 But I do try to protect from that just global fear that doesn't leave, 214 00:18:48,390 --> 00:18:48,680 you know, 215 00:18:48,680 --> 00:18:50,360 this is not a season of fear. 216 00:18:50,360 --> 00:18:56,230 This is "I am afraid of a diagnosis in general." 217 00:18:56,640 --> 00:19:01,100 And so I try to have some protection for that. 218 00:19:02,740 --> 00:19:04,010 By protection. 219 00:19:04,020 --> 00:19:07,640 I mean that I try to really monitor my own language. 220 00:19:07,650 --> 00:19:10,300 I try to acknowledge what people are saying, 221 00:19:10,300 --> 00:19:11,770 but I do point out, 222 00:19:12,340 --> 00:19:13,110 um, 223 00:19:13,120 --> 00:19:18,270 when I feel like an emotion is really just working against their wellness, 224 00:19:18,640 --> 00:19:19,080 you know, 225 00:19:19,080 --> 00:19:23,950 it sounds like this is about shame and there is no criticism here. 226 00:19:24,440 --> 00:19:26,460 This is not a criticism. 227 00:19:26,920 --> 00:19:38,230 This is to increase your power to understand yourself to be able to get centered when you're just feeling off center. 228 00:19:39,010 --> 00:19:40,860 This is not a criticism. 229 00:19:41,740 --> 00:19:46,170 So I may say things like that to protect the atmosphere. 230 00:19:51,740 --> 00:20:00,630 I also try to explain to people if they are in a point of struggle about the topic, 231 00:20:00,640 --> 00:20:02,360 let's say I've brought it up. 232 00:20:03,440 --> 00:20:05,360 They're struggling with the topic. 233 00:20:06,950 --> 00:20:22,850 I try to explain why I bring up what feels like a difficult topic to them and my memory goes back to when my son was in preschool. 234 00:20:23,440 --> 00:20:23,770 Uh, 235 00:20:23,780 --> 00:20:33,270 it was an early intervention preschool and he had started showing at the age of three some additional um, 236 00:20:35,340 --> 00:20:37,860 characteristics that, 237 00:20:38,360 --> 00:20:38,660 you know, 238 00:20:38,660 --> 00:20:45,520 we later realized were part of the autism and I in a parent teacher meeting. 239 00:20:45,520 --> 00:20:48,360 There were two teachers in me and I said, 240 00:20:48,360 --> 00:20:51,470 have you started seeing these kinds of things for him? 241 00:20:51,470 --> 00:20:52,860 Because we're seeing that a lot. 242 00:20:53,330 --> 00:20:58,020 And I remember vividly that they both looked at each other, 243 00:20:58,020 --> 00:21:03,700 both teachers and didn't say anything and then looked at me and said, 244 00:21:03,700 --> 00:21:07,050 well we'll just start to work on that... they hadn't seen it. 245 00:21:07,940 --> 00:21:27,030 And I knew darrn well that they knew something that I didn't and that it didn't feel to them like it was okay to bring up and then I felt too afraid to push it because I'm like, 246 00:21:27,040 --> 00:21:27,530 oh, 247 00:21:27,800 --> 00:21:29,810 if this is not okay to talk about, 248 00:21:29,810 --> 00:21:31,350 do I really want to know? 249 00:21:31,840 --> 00:21:33,180 But to be honest, 250 00:21:33,190 --> 00:21:36,850 I needed to know I needed that information. 251 00:21:37,240 --> 00:21:46,050 It didn't help me to be in the dark for two more years about what we could have been really understanding better. 252 00:21:46,940 --> 00:21:51,350 Um So when I'm talking to someone in that position, 253 00:21:52,730 --> 00:21:54,560 I may say something like, 254 00:21:54,940 --> 00:21:55,680 you know, 255 00:21:55,680 --> 00:22:06,460 it's because your well being is so important that I will always bring up topics that impact your well being, 256 00:22:06,460 --> 00:22:20,270 even if they're ... they feel tough because you are important and it's important to talk about these things and I'm a person that will do that with you. 257 00:22:21,540 --> 00:22:30,390 Um So I also try to bring it to the table when it's about to be shut down again, 258 00:22:30,390 --> 00:22:34,360 tying it to their their well being, 259 00:22:34,360 --> 00:22:36,780 their worth and my value for them. 260 00:22:38,350 --> 00:22:41,730 I've also I started to think, 261 00:22:43,340 --> 00:22:44,110 you know, 262 00:22:44,120 --> 00:22:52,020 what do I want people to leave a conversation with me with? 263 00:22:52,020 --> 00:22:53,640 What do I want him to leave with? 264 00:22:53,700 --> 00:22:54,040 Well, 265 00:22:54,050 --> 00:22:57,080 I'd like them of course to leave with some information. 266 00:22:57,080 --> 00:23:09,860 But even more so I realize that what is most impactful is I want them to leave knowing that they are valued. 267 00:23:10,440 --> 00:23:12,990 I want them to leave without fear. 268 00:23:13,540 --> 00:23:18,360 I want them to feel empowered and courageous and supported. 269 00:23:19,540 --> 00:23:24,670 So when I am interacting with them about the topic, 270 00:23:25,240 --> 00:23:28,770 am I providing data and information of course, 271 00:23:30,040 --> 00:23:54,770 but I'm very watchful that ultimately my goal is to have them sit with me in this experience and to be able to leave with a sense of freedom and being supported and for them to leave and say, 272 00:23:55,940 --> 00:24:03,450 I feel like I was seen because that's really important. 273 00:24:05,540 --> 00:24:09,610 I want to share a personal experience, 274 00:24:10,160 --> 00:24:15,950 just two to round out this episode. 275 00:24:17,040 --> 00:24:19,050 And um, 276 00:24:21,540 --> 00:24:35,850 I got to the point where I did want to process this with my son's pediatrician When he was about four. 277 00:24:36,340 --> 00:24:44,050 And I came to that on my own by research and watching him. 278 00:24:44,050 --> 00:24:47,680 And um I decided, 279 00:24:47,830 --> 00:24:48,290 you know, 280 00:24:48,290 --> 00:24:50,250 it's time to talk about this. 281 00:24:50,570 --> 00:25:11,550 And my reluctance to talk about it with him was because I know that even physicians get emotionally charged about the topic and I did not want to get into any kind of push or pull and I did not know his opinion. 282 00:25:11,560 --> 00:25:19,450 He was our third pediatrician to be honest and I just did not know him that well. 283 00:25:20,330 --> 00:25:30,670 And because I knew it might be a topic that might get shut down or there might be an emotional charge. 284 00:25:32,340 --> 00:25:35,220 I practiced what I was going to say ahead of time. 285 00:25:35,230 --> 00:25:36,780 Like a lot. 286 00:25:36,790 --> 00:25:39,510 You know how you feel like I'm going in. 287 00:25:39,520 --> 00:25:41,550 I have this one appointment. 288 00:25:41,560 --> 00:25:43,110 I don't know this person, 289 00:25:43,120 --> 00:25:47,760 but I need to make sure I'm thinking clearly enough to get these things across. 290 00:25:48,640 --> 00:25:54,580 So I practiced and I wrote things down and the appointment got rescheduled three times. 291 00:25:54,590 --> 00:25:57,360 So it's one of those things and you're waiting. 292 00:25:57,740 --> 00:26:02,610 And I went to the appointment. 293 00:26:02,610 --> 00:26:04,760 So I was kind of armed with, 294 00:26:05,540 --> 00:26:08,580 you know what I wanted to say? 295 00:26:08,580 --> 00:26:13,340 But I was very watchful about how this would go. 296 00:26:14,120 --> 00:26:24,600 And I also had received so much advice for so long without really getting assistance. 297 00:26:24,610 --> 00:26:28,540 And I didn't want that to be the case either. 298 00:26:28,790 --> 00:26:32,460 I really wanted to talk. 299 00:26:32,470 --> 00:26:41,860 I wanted someone to talk with me about a difficult thing and a complex thing and I wanted um something substantive to do next. 300 00:26:43,040 --> 00:26:46,370 So we discussed a lot of things. 301 00:26:46,380 --> 00:26:52,850 Um He referred us to the autism diagnostic clinic at our local easter seals. 302 00:26:53,340 --> 00:26:55,990 Uh and then that wait list started of course. 303 00:26:56,540 --> 00:26:59,520 Um So did he give me information? 304 00:26:59,520 --> 00:27:00,310 Yes. 305 00:27:00,320 --> 00:27:01,960 Did he give me a plan? 306 00:27:01,960 --> 00:27:02,940 Absolutely. 307 00:27:02,950 --> 00:27:05,960 But when I left that office, 308 00:27:06,640 --> 00:27:11,210 what was life changing for me ... was mostly something else. 309 00:27:12,440 --> 00:27:20,800 And what it was was that at the end of our talk... and I still get emotional about this. 310 00:27:20,850 --> 00:27:22,390 At the end of our talk, 311 00:27:22,390 --> 00:27:24,110 he looked at me and he said, 312 00:27:24,110 --> 00:27:24,590 "I hope, 313 00:27:24,590 --> 00:27:33,710 you know you're a good mom"... and I had practiced what to say in this session. 314 00:27:33,710 --> 00:27:35,160 But I, 315 00:27:35,300 --> 00:27:36,600 my mouth hung open. 316 00:27:36,600 --> 00:27:57,550 I was literally speechless and I realized in that moment that nobody had ever said that to me and I knew darn well that if I asked my friends or my family, 317 00:27:57,550 --> 00:27:58,800 do you think I'm a good mom? 318 00:27:58,800 --> 00:27:59,320 They would say, 319 00:27:59,320 --> 00:28:01,300 well of course you are. 320 00:28:01,330 --> 00:28:02,860 That goes without saying. 321 00:28:04,440 --> 00:28:06,350 But I realized it doesn't, 322 00:28:06,590 --> 00:28:19,200 it doesn't go without saying because we get all these messages that we're doing something wrong or our struggle would be gone if we knew what we were doing. 323 00:28:21,540 --> 00:28:23,550 Nobody had ever said, 324 00:28:24,740 --> 00:28:25,190 I hope, 325 00:28:25,190 --> 00:28:25,450 you know, 326 00:28:25,450 --> 00:28:36,770 you're a good mom that has never left me. 327 00:28:37,240 --> 00:28:43,700 It took no skill to say he didn't have to be an autism expert and he was not. 328 00:28:44,840 --> 00:28:54,790 But when I left the emotional atmosphere had been protected and I left feeling seen and heard and valued. 329 00:28:55,840 --> 00:29:07,160 And that gave me the courage to keep going to talk about something that is complex and emotionally charged. 330 00:29:07,840 --> 00:29:26,480 And sometimes what we need to make people understand is that we see the heart that they have for their kids or we see all the detective work they've done to try to figure themselves out that we see their value. 331 00:29:26,480 --> 00:29:27,560 We see them. 332 00:29:28,640 --> 00:29:29,660 We honor them. 333 00:29:29,660 --> 00:29:31,060 We respect them. 334 00:29:32,440 --> 00:29:32,970 Um, 335 00:29:32,980 --> 00:29:35,600 and that's something we think goes without saying, 336 00:29:35,600 --> 00:29:36,890 but it really doesn't. 337 00:29:36,900 --> 00:29:45,910 And so that's what I mean by navigating emotional atmospheres and protecting emotional atmospheres. 338 00:29:46,600 --> 00:30:00,420 That sometimes the one thing we can do to open up a discussion where people feel free and safe enough to talk about something complex is to say, 339 00:30:00,420 --> 00:30:05,270 I see you and you're important and I'm glad you're here. 340 00:30:05,460 --> 00:30:06,560 And let's talk about it. 341 00:30:10,240 --> 00:30:15,330 I hope you'll join me next time for our final episode in the series, 342 00:30:15,340 --> 00:30:22,510 which is about talking about autism to others when you see autistic characteristics in them. 343 00:30:22,510 --> 00:30:25,240 But but they're not expecting this discussion. 344 00:30:25,240 --> 00:30:25,860 This is, 345 00:30:26,040 --> 00:30:26,380 you know, 346 00:30:26,380 --> 00:30:27,720 something you want to bring up. 347 00:30:27,730 --> 00:30:30,660 But should I bring it up and how could I bring it up? 348 00:30:30,940 --> 00:30:40,860 Um That will be our next discussion and I will see you then.

Join Dr. Regan for this first episode of the new series "Talking About Autism." This episode focuses on talking about autism when you are on a journey toward diagnosis and after you have received a diagnosis.  New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians Read the transcript:  1 00:00:03,540 --> 00:00:07,840 Hello and welcome to this episode of Autism in the Adult. 2 00:00:07,880 --> 00:00:09,020 I am your host, 3 00:00:09,020 --> 00:00:10,510 Dr Theresa Regan. 4 00:00:10,520 --> 00:00:12,600 I'm a neuropsychologist. 5 00:00:12,620 --> 00:00:15,060 I am a certified autism specialist, 6 00:00:15,440 --> 00:00:23,750 the director of an autism diagnostic clinic for adults in central Illinois, and the mother of a teen and the spectrum. 7 00:00:24,550 --> 00:00:27,630 I am starting a new series of episodes today. 8 00:00:28,040 --> 00:00:33,040 I think this may end up being a 3-4 part series. 9 00:00:33,040 --> 00:00:34,330 We'll see how it goes. 10 00:00:34,340 --> 00:00:40,060 Um and basically the series is going to be called "Talking About Autism." 11 00:00:40,440 --> 00:00:50,490 And this was a listener request... from multiple listeners that have emailed about "How do I talk about this to other people, 12 00:00:50,490 --> 00:00:52,570 whether that's my own diagnosis, 13 00:00:52,570 --> 00:00:56,720 whether that's talking to people that I think may be on the spectrum, 14 00:00:56,720 --> 00:01:07,320 but they haven't been thinking in that direction... and how do I navigate all the emotion that sometimes comes with these kinds of discussions?" 15 00:01:07,320 --> 00:01:12,460 So we're going to take some time to sort through some of those topics. 16 00:01:13,340 --> 00:01:22,680 I believe that this topic is really important, and that's why I have set aside to do a series of episodes about the topic. 17 00:01:22,690 --> 00:01:31,780 I also feel like this is probably one of the most challenging episodes that I've put my mind to here. 18 00:01:31,790 --> 00:01:59,210 And that is because in some ways it's a lot easier to present some research and a list of facts and definitions of terms than to talk about these concepts and experiences and to wrap words around things that are perhaps more personal or experiential is a little more challenging, but worth it I think... 19 00:01:59,210 --> 00:02:00,260 but challenging. 20 00:02:00,270 --> 00:02:05,960 And one of the challenges is probably to make some organization of it. 22 00:02:06,750 --> 00:02:11,650 ... So there's some cohesion in what we're talking about in each episode. 23 00:02:12,140 --> 00:02:13,810 So in this first episode, 24 00:02:13,810 --> 00:02:22,700 I'm going to cover the topic of talking about your own autism diagnosis to other people, 25 00:02:22,700 --> 00:02:25,060 and I'm going to cover two things. 26 00:02:25,060 --> 00:02:37,560 One is if you're an individual who's thinking about starting a journey toward evaluation, and you're talking to people about your desire to do this, 27 00:02:37,940 --> 00:02:38,340 um, 28 00:02:38,340 --> 00:02:45,270 some of what we review will have to do with this kind of process ... this starting of that journey. 29 00:02:45,280 --> 00:02:46,590 And also, 30 00:02:46,590 --> 00:02:50,800 then we'll finish by talking about once you have a diagnosis, 31 00:02:50,810 --> 00:02:51,930 um, 32 00:02:51,940 --> 00:02:54,270 who do you talk to about it? 33 00:02:54,280 --> 00:02:55,960 How do you bring it up? 34 00:02:56,340 --> 00:02:56,890 Um, 35 00:02:56,900 --> 00:03:00,750 how does that go after you have a diagnosis? 36 00:03:01,140 --> 00:03:01,660 Um, 37 00:03:01,660 --> 00:03:13,960 so we're going to jump in first with that process that perhaps you're someone who's been thinking about yourself or been thinking about, 38 00:03:13,970 --> 00:03:14,870 um, 39 00:03:14,880 --> 00:03:16,890 perhaps your loved one, 40 00:03:16,890 --> 00:03:28,020 Maybe your partner has been thinking about this and wants you to join them in this journey or you have a child or adolescent that you think may be on the spectrum. 41 00:03:28,020 --> 00:03:28,360 And, 42 00:03:28,370 --> 00:03:35,550 and this is just the beginning of a quest to figure out more information. 43 00:03:36,840 --> 00:03:43,910 One of the really unusual things I think about autism as a diagnosis is that for some reason, 44 00:03:43,910 --> 00:04:00,060 and I don't really understand why, everyone really seems to have an opinion about this topic as far as whether you actually are or are not on the spectrum. 45 00:04:01,140 --> 00:04:03,120 And it's, 46 00:04:03,130 --> 00:04:03,780 again, 47 00:04:03,780 --> 00:04:09,280 mystifying to me because it doesn't seem to be based on any professional qualifications. 48 00:04:09,740 --> 00:04:10,330 Um, 49 00:04:10,340 --> 00:04:10,770 you know, 50 00:04:10,770 --> 00:04:17,750 I think someone that you see at the grocery store seems just as adamant about that as your grandmother, 51 00:04:17,750 --> 00:04:19,390 who's just as adamant, 52 00:04:19,400 --> 00:04:21,860 um as your therapist and so forth. 53 00:04:22,540 --> 00:04:33,460 Um it's mystifying in the sense that if someone told me they had a cardiac uh difference that was causing some arrhythmia or whatever, 54 00:04:33,840 --> 00:04:36,020 I would never think to say no, 55 00:04:36,020 --> 00:04:37,180 you don't. 56 00:04:37,320 --> 00:04:39,490 I'm not a cardiologist. 57 00:04:39,500 --> 00:04:42,360 I don't know if you do or not, 58 00:04:42,940 --> 00:04:44,640 and um, 59 00:04:44,650 --> 00:04:50,840 that just doesn't carry over to this neuro behavioral developmental condition. 60 00:04:50,840 --> 00:04:51,260 So, 61 00:04:52,340 --> 00:05:06,610 autism is a physical, neurologic state where the genetic code and the process of development of the brain has produced this less than typical neurology. 62 00:05:06,610 --> 00:05:10,610 So 2% of people  63 00:05:10,620 --> 00:05:17,250 in our population, and that is a percentage that's pretty stable across age groups, 64 00:05:17,250 --> 00:05:18,250 across country, 65 00:05:18,250 --> 00:05:24,220 across research study ... that 2% of people will present with this neurology. 66 00:05:24,220 --> 00:05:26,650 And so it's not very common. 67 00:05:27,340 --> 00:05:28,230 Um, 68 00:05:28,240 --> 00:05:34,130 and yet everyone seems to feel like they could recognize it... and I'm not, 69 00:05:34,140 --> 00:05:35,770 I'm not sure where that comes from, 70 00:05:35,770 --> 00:05:48,970 but that will probably be something you encounter if you say "I've been wondering if I'm on the autism spectrum" or "I've been wondering if my child is on the autism spectrum." 71 00:05:48,970 --> 00:05:55,830 And you'll probably get some immediate responses from people that that is not the case. 72 00:05:55,830 --> 00:05:57,950 And that could range from, 73 00:05:58,340 --> 00:05:58,790 you know, 74 00:05:58,790 --> 00:06:00,860 the physician that you see. 75 00:06:00,860 --> 00:06:02,910 It could be a therapist. 76 00:06:02,910 --> 00:06:07,250 It could be any range of people. 77 00:06:09,040 --> 00:06:20,860 The reason that I bring up this type of encounter is that I think it's often not very helpful because it's non specific. 78 00:06:21,440 --> 00:06:27,290 Um there's often not a reason given and it's not really based in data, 79 00:06:27,290 --> 00:06:38,160 it's kind of based on this general gut feeling or what people expect autism to look like in their neighborhood or their family or their classroom or whatever. 80 00:06:38,640 --> 00:06:39,110 Um, 81 00:06:39,120 --> 00:06:42,260 but it's not really based on substance. 82 00:06:42,840 --> 00:06:54,860 And one of the ways that I have found to kind of defuse that or at least ask for some substance is to say in response to that, 83 00:06:55,440 --> 00:06:55,860 "Oh, 84 00:06:55,860 --> 00:06:56,390 okay. 85 00:06:56,390 --> 00:06:59,410 What criteria don't you think I meet?" 86 00:07:01,040 --> 00:07:04,320 And whenever I've said that, 87 00:07:04,320 --> 00:07:13,660 I've never had anyone who knew the criteria that actually were responding to that or giving this input that autism is incorrect. 88 00:07:14,140 --> 00:07:15,760 Um so again, 89 00:07:16,440 --> 00:07:20,790 unusual that people feel that strongly about it, 90 00:07:21,240 --> 00:07:22,160 um, 91 00:07:22,540 --> 00:07:25,140 and will produce that, 92 00:07:25,150 --> 00:07:25,800 um, 93 00:07:26,040 --> 00:07:27,360 that opinion. 94 00:07:27,740 --> 00:07:33,900 But you can kind of diffuse that if you ask them for more specific data, 95 00:07:33,910 --> 00:07:35,770 more specific information, 96 00:07:35,780 --> 00:07:36,500 um, 97 00:07:36,500 --> 00:07:39,680 you can kind of point out ... and sometimes it's been interesting. 98 00:07:39,680 --> 00:07:40,290 So, 99 00:07:40,300 --> 00:07:41,150 you know, 100 00:07:41,150 --> 00:07:45,240 one person might say to me well I'm a counselor and I'll say, 101 00:07:45,240 --> 00:07:45,480 yeah, 102 00:07:45,480 --> 00:07:47,940 I know... a lot of people don't know the criteria though. 103 00:07:47,940 --> 00:07:51,190 So what criteria don't you think this person meets? 104 00:07:51,640 --> 00:07:52,920 And then she said, 105 00:07:52,920 --> 00:07:53,070 well, 106 00:07:53,070 --> 00:07:55,060 I guess I don't really know the criteria. 107 00:07:55,840 --> 00:07:58,060 So it just helps diffuse that. 108 00:07:58,070 --> 00:07:59,760 And I wouldn't recommend, 109 00:08:00,340 --> 00:08:00,820 you know, 110 00:08:00,820 --> 00:08:03,580 going in guns blazing or anything, 111 00:08:03,660 --> 00:08:05,680 but just in a very matter of fact, 112 00:08:05,690 --> 00:08:10,990 calm way that you'd like their input if it's based in the data, 113 00:08:10,990 --> 00:08:15,550 what kind of observations are they using to say that, 114 00:08:17,440 --> 00:08:17,880 you know, 115 00:08:17,880 --> 00:08:31,410 Another comment that I find non specific and I find this comment to be kind of dismissing 116 00:08:31,410 --> 00:08:44,410 I guess of someone's journey that they're taking toward an evaluation and what can happen unfortunately is the person will say, 117 00:08:44,410 --> 00:08:44,630 "Well, 118 00:08:44,630 --> 00:08:46,120 why do you think that?" 119 00:08:46,130 --> 00:08:55,960 And you'll start to share some of your thoughts and experiences and then you're a bit trapped because they may say, 120 00:08:56,340 --> 00:08:56,780 "Oh yeah, 121 00:08:56,780 --> 00:08:57,760 but I do that too. 122 00:08:57,760 --> 00:08:59,170 And I'm not autistic, 123 00:08:59,180 --> 00:09:00,560 everybody does that." 124 00:09:01,240 --> 00:09:10,350 Um and it just doesn't leave you in any better place than you were. 125 00:09:10,360 --> 00:09:10,680 Again, 126 00:09:10,680 --> 00:09:12,760 it doesn't add anything of substance. 127 00:09:12,760 --> 00:09:14,350 It doesn't clear anything up. 128 00:09:14,840 --> 00:09:23,260 Um And so one thing I find helpful to mention in this kind of dynamic would be to say, 129 00:09:23,840 --> 00:09:24,610 "Well, 130 00:09:24,620 --> 00:09:42,960 that would be like saying that because we all forget things that Alzheimer's dementia isn't really impactful to people, and something may be impactful to an individual because of how frequently it happens or how much distress it causes. 131 00:09:43,340 --> 00:09:44,370 Um So, 132 00:09:44,380 --> 00:09:52,200 so that's the thought process I'm using about my own experiences in the end. 133 00:09:52,200 --> 00:09:56,560 I would never have your goal be ah, 134 00:09:56,940 --> 00:10:00,390 to convince everyone that you come in contact with, 135 00:10:00,390 --> 00:10:02,690 that the journey is relevant. 136 00:10:02,700 --> 00:10:18,650 I think that autism is just such a misunderstood concept that you're going to have people who just are not in the same place that you are, and to go back and forth feeling like your role is to convince people, 137 00:10:18,660 --> 00:10:19,460 um, 138 00:10:19,460 --> 00:10:21,060 is probably not, 139 00:10:21,640 --> 00:10:22,270 um, 140 00:10:22,280 --> 00:10:24,660 not a role that really brings fruit. 141 00:10:25,220 --> 00:10:33,800 And so I would consider letting go that agenda if that's your goal, 142 00:10:33,860 --> 00:10:36,260 that you'll be able to convince everybody. 143 00:10:39,440 --> 00:10:40,950 And interestingly, 144 00:10:40,950 --> 00:10:44,680 as with other complex life situations, 145 00:10:44,680 --> 00:10:53,100 what I find personally is that sometimes the people I expect to be there for me in this situation, 146 00:10:53,110 --> 00:10:57,740 whether that's a celebration or whether I'm grieving about something, 147 00:10:57,750 --> 00:10:58,690 um, 148 00:10:58,700 --> 00:10:59,770 a wedding, 149 00:10:59,770 --> 00:11:00,900 a funeral, 150 00:11:00,910 --> 00:11:01,640 uh, 151 00:11:01,650 --> 00:11:02,630 a promotion, 152 00:11:02,630 --> 00:11:06,240 a move ... sometimes I expect, 153 00:11:06,250 --> 00:11:06,930 you know, 154 00:11:06,930 --> 00:11:17,150 these closest people to be really with me and a lot of times that's not necessarily the case and we may like it to be that way, 155 00:11:17,540 --> 00:11:23,440 but in life I just find that there will always be people that step up that surprise you. 156 00:11:23,450 --> 00:11:23,690 Like, 157 00:11:23,690 --> 00:11:24,150 wow, 158 00:11:24,150 --> 00:11:26,500 I wouldn't have expected you to be the one, 159 00:11:26,510 --> 00:11:27,320 you know, 160 00:11:27,320 --> 00:11:30,190 to kind of step up and meet me in this place. 161 00:11:30,200 --> 00:11:36,860 But I did expect this other person to be able to support me and they're really not able to do that. 162 00:11:37,140 --> 00:11:47,570 So sometimes the journey does involve letting go of some expectations and giving other people the freedom to be in a different place, 163 00:11:47,580 --> 00:11:56,350 allowing yourself to grieve that you're not on the same journey that everyone else is ... that other people don't appreciate that part of your journey. 164 00:11:57,040 --> 00:12:05,960 Um but not getting into the trap of trying to convince people who just aren't really there. 165 00:12:08,640 --> 00:12:23,850 Another comment that I feel is dismissive and very general and non substantive is a comment people make ... I suppose to be um supportive, 166 00:12:24,340 --> 00:12:29,330 but it dismisses some of the complexity of the journey, 167 00:12:29,340 --> 00:12:30,250 I think. 168 00:12:30,260 --> 00:12:32,400 And that is the comment I hear a lot, 169 00:12:32,400 --> 00:12:32,980 which is, 170 00:12:32,980 --> 00:12:33,410 "Well, 171 00:12:33,420 --> 00:12:36,160 I guess everyone's a little autistic these days. 172 00:12:37,040 --> 00:12:39,250 Apparently we're all autistic." 173 00:12:39,260 --> 00:12:39,580 You know, 174 00:12:39,580 --> 00:12:41,260 that kind of comment. 175 00:12:41,940 --> 00:12:49,050 Um actually 2% of individuals meet full criteria for the autism spectrum. 176 00:12:49,440 --> 00:12:50,100 Um, 177 00:12:50,110 --> 00:12:57,360 so it's not this popular fad that everyone's getting diagnosed with. 178 00:12:57,840 --> 00:13:06,360 Um I think there's a lot of emphasis on diagnosis now because we're realizing how many people have been missed or misdiagnosed. 179 00:13:06,840 --> 00:13:07,280 Um, 180 00:13:07,290 --> 00:13:09,490 but everyone's not autistic. 181 00:13:09,500 --> 00:13:13,130 Uh this is an unusual neurologic pattern. 182 00:13:13,140 --> 00:13:14,490 It's unique. 183 00:13:14,500 --> 00:13:21,230 Uh it's not that common and it's really worth paying attention to and realizing, 184 00:13:21,240 --> 00:13:21,770 you know, 185 00:13:21,770 --> 00:13:23,250 when that's present. 186 00:13:26,000 --> 00:13:38,960 Some people will advise that you don't pursue the journey of evaluation based on their premise that the diagnosis won't make a difference anyway. 187 00:13:39,440 --> 00:13:42,810 And I've heard that from physicians, 188 00:13:42,810 --> 00:13:45,760 from psychologists. psychiatrists, teachers, 189 00:13:46,240 --> 00:13:46,770 um, 190 00:13:46,780 --> 00:13:49,930 all kinds of people. 191 00:13:49,930 --> 00:13:56,050 So I don't think it's really specific to any group of people or generation, 192 00:13:56,050 --> 00:14:11,160 but I think it's just a revelation that in our culture... in our communities... we're really not to the point where people understand what a difference it does make and what a difference it should make. 193 00:14:11,540 --> 00:14:15,350 So um if someone says that ... that probably, 194 00:14:15,740 --> 00:14:26,030 well I would say it does reveal that they don't understand the neurology of autism well enough that they can really comment on your situation. 195 00:14:26,040 --> 00:14:35,960 And again it may be your psychiatrist who doesn't or ... and it's not um a criticism of any one person. 196 00:14:36,040 --> 00:14:44,630 I'm just commenting I think on the state of our community as far as our awareness of what the neurology looks like, 197 00:14:44,630 --> 00:14:54,150 what impact it has on you or people around you and all the things that do make a difference about knowing that. 198 00:14:54,640 --> 00:14:59,080 Um So it should direct our expectations, 199 00:14:59,080 --> 00:14:59,860 our goals, 200 00:14:59,860 --> 00:15:03,100 our understanding of the why of behavioral patterns, 201 00:15:03,110 --> 00:15:05,020 how to get the best outcomes, 202 00:15:05,020 --> 00:15:06,600 how to support each other. 203 00:15:06,610 --> 00:15:16,310 Um because at a very basic level when you're going on a journey to um have an evaluation for autism,   204 00:15:16,310 --> 00:15:29,450 you're trying to figure out if your behavioral patterns in certain areas reflect neurology or whether they reflect more traditional mental health issues. 205 00:15:29,450 --> 00:15:39,460 And I know that those two categories are not clean cut categories but for the purpose of this basic discussion, 206 00:15:39,470 --> 00:15:44,340 I'm going to point out those 2 categories. 207 00:15:44,340 --> 00:15:55,380 So I'm going to give an analogy that I hope will demonstrate why it does make a difference to understand if parts of a behavioral pattern have a neurologic base. 208 00:15:55,390 --> 00:16:03,410 So let's consider that a psychologist has two clients coming in that day and they both have the same concern. 209 00:16:03,440 --> 00:16:08,830 They both have a memory concern, and the psychologist could think, 210 00:16:08,830 --> 00:16:11,040 "Well it's the same concern. 211 00:16:11,040 --> 00:16:22,460 So I'm just going to use the same treatment for both patients since we're really just wanting to improve memory regardless of the reason for the memory difficulty." 212 00:16:23,340 --> 00:16:23,980 Well, 213 00:16:23,990 --> 00:16:24,480 let's say, 214 00:16:24,480 --> 00:16:27,400 another psychologist has the same thing. 215 00:16:27,400 --> 00:16:29,920 They have to people coming in but they decide, 216 00:16:29,930 --> 00:16:30,470 you know, 217 00:16:30,480 --> 00:16:33,700 it really does matter what the reason is. 218 00:16:33,710 --> 00:16:39,640 And so I'm going to do an assessment to see -- why are these people having memory difficulties? 219 00:16:39,650 --> 00:16:42,010 And the first client of the day, 220 00:16:42,010 --> 00:16:50,570 the psychologist does the assessment and they see a cognitive pattern that's very classic for an alzheimer's dementia, 221 00:16:51,140 --> 00:16:54,390 which means that the hippocampus is not functioning well, 222 00:16:54,400 --> 00:16:56,670 there's a disease process here. 223 00:16:56,680 --> 00:17:03,650 It really looks like it's going to be degenerative, and the memory loss is very based in neurology. 224 00:17:05,340 --> 00:17:07,900 And the second client who comes in, 225 00:17:07,910 --> 00:17:22,860 the psychologist does the assessment and realizes after the evaluation that their memory loss is due to traumatic experiences... that they've had so much trauma in their life that they're dissociating, 226 00:17:23,140 --> 00:17:41,960 that they are shutting down their awareness in order to just go on autopilot and that's why they're losing chunks of their day and they forget parts of their childhood and their mind is just not online all of the time because it's trying to protect itself from all these strong emotions. 227 00:17:44,240 --> 00:18:03,720 So at a basic level the treatment needs to be different ... the conceptualization needs to be different, and the support that we offer people needs to be different - based on whether there's been this more mental health path to these symptoms or whether there is some neurologic base. 228 00:18:04,140 --> 00:18:17,040 So I'm not going to recommend that the Alzheimer's patient come into psychodynamic therapy every day to work on trauma work so that their memory will improve. 229 00:18:17,050 --> 00:18:21,970 I need to understand what the base of the concern is. 230 00:18:21,970 --> 00:18:25,160 So I understand what's likely to be helpful, 231 00:18:25,540 --> 00:18:31,620 but I very well may recommend that the second client engage in trauma work, 232 00:18:31,620 --> 00:18:32,860 whatever that looks like. 233 00:18:33,340 --> 00:18:48,390 Uh and that should help this pattern of dissociating and help her be more aware and present psychologically in the moment and cut down on that loss of memory. Now, 234 00:18:48,390 --> 00:18:51,240 certainly Alzheimer's and autism are not the same, 235 00:18:51,240 --> 00:18:51,710 right? 236 00:18:51,720 --> 00:18:57,160 Autism is developmental and Alzheimer's is acquired. 237 00:18:57,840 --> 00:19:00,080 Alzheimer's is degenerative, 238 00:19:00,090 --> 00:19:01,220 it gets worse. 239 00:19:01,230 --> 00:19:07,370 Um and autism is based on how the brain was wired during development. 240 00:19:07,370 --> 00:19:10,770 It's not a degenerative process, 241 00:19:11,640 --> 00:19:35,460 but you can see this general concept of figuring out if there's a part of something going on that's neurologic versus more traditional mental health issue, and so I feel ... I feel like that in itself can be a really important part of the journey toward figuring out if autism is present. 242 00:19:35,940 --> 00:19:41,840 So let me offer one additional example in this ... , 243 00:19:41,840 --> 00:20:04,170 I'm going to take little Johnny who's in kindergarten, and mother comes to talk with the teacher and gets to hear that "Unfortunately, Johnny is really struggling with his color recognition, and all of his peers are really taking off on recognizing colors and naming them and organizing them into hues and patterns. 244 00:20:04,170 --> 00:20:09,200 And boy, little Johnny is not up to speed in that area. 245 00:20:09,210 --> 00:20:15,720 And so what the teacher recommends is that she's going to repeat, for Johnny, 246 00:20:15,720 --> 00:20:24,760 why it's important to work hard to learn his colors because it does impact various parts of his life. 247 00:20:25,140 --> 00:20:29,990 So explaining ... a lot of explanation of why this is important. 248 00:20:30,000 --> 00:20:31,950 She's gonna ask Johnny if ... 249 00:20:31,960 --> 00:20:42,450 if he agrees that this is an important thing, and he says yes. And so she's going to add extra homework, extra tutoring about color recognition. 250 00:20:42,540 --> 00:20:54,290 She's going to ask the parents to give extra work and help him at home and maybe set up um a prize versus consequences kind of thing. 251 00:20:54,290 --> 00:20:59,370 Like if you can advance in this area up to your peers, 252 00:20:59,380 --> 00:21:01,600 you can get this extra present. 253 00:21:01,600 --> 00:21:08,060 But if you can't, then you can't go on the trip at the end of the year with your class. 254 00:21:08,740 --> 00:21:12,060 So they've set this whole thing up, and every year, 255 00:21:12,060 --> 00:21:13,590 the same thing is repeated. 256 00:21:13,590 --> 00:21:19,670 Boy, Johnny needs to work harder on his color recognition. By middle school, 257 00:21:19,670 --> 00:21:23,120 Johnny has this learned hopelessness... 258 00:21:23,120 --> 00:21:25,980 That no matter how hard he tries, 259 00:21:25,990 --> 00:21:30,890 he's always falling short of people's expectations in this area. 260 00:21:30,890 --> 00:21:36,260 And instead of being shamed and embarrassed about it anymore, 261 00:21:36,260 --> 00:21:37,330 he starts to say, 262 00:21:37,330 --> 00:21:38,110 "You know what? 263 00:21:38,120 --> 00:21:40,400 It's because I don't even care about colors, 264 00:21:40,480 --> 00:21:42,170 I don't care about this." 265 00:21:42,540 --> 00:21:50,720 And there starts to be this really difficult dynamic now between Johnny and his parents and his teachers, 266 00:21:50,730 --> 00:21:52,050 a lot of strain, 267 00:21:52,050 --> 00:21:56,290 some acting out. And all of a sudden, in middle school, 268 00:21:56,290 --> 00:22:02,030 someone thinks to see if Johnny is colorblind. Lo and behold, 269 00:22:02,040 --> 00:22:08,760 he has color blindness, and all this time we've been telling him to work harder. 270 00:22:10,440 --> 00:22:15,030 We've been lecturing him about why it's important to do better. 271 00:22:15,140 --> 00:22:18,060 We've been asking him if he agrees that it's important. 272 00:22:18,740 --> 00:22:19,240 Um, 273 00:22:19,240 --> 00:22:31,960 We've been tutoring him, all to no avail, and here we were asking him to do something he's not capable of doing at the same level as his peers. 274 00:22:32,540 --> 00:22:37,930 And that is a difficulty because we've really uh, 275 00:22:37,940 --> 00:22:39,870 set up this expectation. 276 00:22:39,870 --> 00:22:44,950 He has this learned hopelessness that he just can't meet people's expectations. 277 00:22:44,960 --> 00:23:01,570 The relationship between him and the teachers and the parents has become very strained and it could have been avoided if we understood that there's really a physical limitation that his eyes just can't process that information. 278 00:23:01,570 --> 00:23:07,190 So asking him to work harder is not going to be something that is helpful. 279 00:23:07,190 --> 00:23:09,350 It's not going to bring about a better outcome. 280 00:23:09,620 --> 00:23:11,800 In fact it's making things worse. 281 00:23:12,640 --> 00:23:18,700 So now let's say you have gone on this journey and you do have a diagnosis. 282 00:23:19,740 --> 00:23:23,360 Um One of the questions that people then ask is well, 283 00:23:25,140 --> 00:23:25,740 you know, 284 00:23:25,740 --> 00:23:29,150 I don't ... I don't know who I want to talk to about this. 285 00:23:29,150 --> 00:23:30,860 Do I have to tell everybody? 286 00:23:31,240 --> 00:23:40,670 Um In fact some people may say I don't even want to go on that journey toward evaluation ... because my partner wouldn't understand that diagnosis. 287 00:23:40,680 --> 00:23:48,190 And in reality... this is part of your medical record, 288 00:23:48,190 --> 00:23:59,370 part of your um diagnostic history that you do not have to share with people outside of your medical care. 289 00:23:59,370 --> 00:24:02,350 So if you have a partner, 290 00:24:02,740 --> 00:24:05,770 you do not have to reveal that to them. 291 00:24:06,340 --> 00:24:09,400 If you don't want to tell your family, 292 00:24:09,400 --> 00:24:12,100 if you don't want to tell your teachers, 293 00:24:12,110 --> 00:24:17,690 you have discretion about who you reveal too. 294 00:24:17,700 --> 00:24:23,560 And I am speaking to you about the interpersonal aspects of revealing. 295 00:24:24,040 --> 00:24:34,810 Um I'm not giving any legal or policy advice on anything about revealing in certain situations. 296 00:24:34,820 --> 00:24:36,990 But interpersonally, 297 00:24:37,000 --> 00:24:43,060 you don't have to reveal everything about yourself to every person in your life. 298 00:24:44,640 --> 00:24:52,460 There may be reasons that you may decide to discuss your diagnosis with someone or some group of people. 299 00:24:52,940 --> 00:25:07,260 And one of the reasons may be that you may want to explain who you are and how you're wired and what your needs are to other people and that may make life just easier with them. 300 00:25:08,280 --> 00:25:15,540 And you can make the explanation nonspecific or specific. 301 00:25:15,540 --> 00:25:20,390 And what I mean by that is you can use the word autism or not use the word autism, 302 00:25:20,940 --> 00:25:23,620 but in some instances you might want to say, 303 00:25:23,620 --> 00:25:23,920 you know, 304 00:25:23,920 --> 00:25:27,390 I've really learned that my system needs X, 305 00:25:27,390 --> 00:25:29,900 y and Z to feel calm. 306 00:25:29,900 --> 00:25:32,720 So I'm gonna go take a break now, 307 00:25:32,720 --> 00:25:34,060 if that's okay with you, 308 00:25:34,540 --> 00:25:36,660 or you might want to say, 309 00:25:36,670 --> 00:25:37,380 you know, 310 00:25:37,380 --> 00:25:41,770 I've learned that I kind of miss sometimes what my friends need. 311 00:25:41,770 --> 00:25:42,730 And so, 312 00:25:42,740 --> 00:25:43,250 you know, 313 00:25:43,250 --> 00:25:45,700 if you said something and it's just gone over my head, 314 00:25:45,700 --> 00:25:47,370 please tell me again, 315 00:25:47,370 --> 00:25:50,170 I really don't want to miss what your needs are. 316 00:25:50,540 --> 00:25:51,020 Um, 317 00:25:51,030 --> 00:25:58,070 so that's kind of a nonspecific way without using the word autism, 318 00:25:58,070 --> 00:26:05,760 that you can share what you've learned about yourself in that context and that could make your relationships, 319 00:26:06,340 --> 00:26:07,120 um, 320 00:26:07,130 --> 00:26:08,860 really run more smoothly. 321 00:26:10,640 --> 00:26:21,380 Another reason that someone may want to discuss their diagnosis may be that they might want to be someone that advocates for people on the spectrum, 322 00:26:21,380 --> 00:26:32,310 that they might want to be part of creating an atmosphere that normalizes discussions about autism and that supports autistic individuals. 323 00:26:32,320 --> 00:26:37,670 So they may decide that part of their own journey as personal to them, 324 00:26:38,540 --> 00:26:41,840 that that may be part of how they approach things, 325 00:26:41,840 --> 00:26:43,960 at least during a season of their life. 326 00:26:44,640 --> 00:26:45,160 Um, 327 00:26:45,160 --> 00:26:45,640 so, 328 00:26:45,640 --> 00:26:52,670 in an effort to create an atmosphere of discussion and inviting discussion and advocating, 329 00:26:53,040 --> 00:26:57,290 they may give this personal kind of, 330 00:26:57,300 --> 00:26:57,860 um, 331 00:26:58,240 --> 00:27:01,180 revelation to people about their own experience, 332 00:27:01,190 --> 00:27:02,480 what they've learned, 333 00:27:02,480 --> 00:27:05,560 how they can help support individuals on the spectrum. 334 00:27:07,440 --> 00:27:11,550 I had a situation come up like that in my own life, 335 00:27:12,340 --> 00:27:23,950 after my son had been diagnosed at the age of five at our local easter seals and I was at a Children's event and my son was out there, 336 00:27:23,960 --> 00:27:24,650 um, 337 00:27:24,660 --> 00:27:36,860 taking a certain kind of lesson in a group and another mother was sitting next to me and I had seen her son there a few times before and in watching his behavior 338 00:27:36,860 --> 00:27:38,770 I did think to myself, 339 00:27:38,780 --> 00:27:42,310 I wonder if his parents know he's on the spectrum. 340 00:27:42,310 --> 00:27:44,980 It was pretty clear to me, 341 00:27:45,540 --> 00:27:46,030 um, 342 00:27:46,030 --> 00:27:51,720 for a variety of reasons... and one day she just happened to be sitting next to me. 343 00:27:51,720 --> 00:27:56,290 We hadn't sat next to each other before and she, 344 00:27:56,300 --> 00:27:58,450 I actually just said to her, 345 00:27:58,450 --> 00:27:58,830 how, 346 00:27:58,840 --> 00:28:01,060 how's your son enjoying this? 347 00:28:01,540 --> 00:28:07,720 I asked about how he likes school and my intention was not to bring up the, 348 00:28:07,730 --> 00:28:09,350 the diagnostic issue. 349 00:28:09,360 --> 00:28:11,700 My intention was just to be polite. 350 00:28:11,710 --> 00:28:13,880 So how does your son like school? 351 00:28:13,880 --> 00:28:14,980 What is he like best? 352 00:28:14,980 --> 00:28:16,080 How you know? 353 00:28:16,090 --> 00:28:16,880 Um, 354 00:28:16,890 --> 00:28:18,930 and in that process, 355 00:28:18,930 --> 00:28:19,650 she said, 356 00:28:19,660 --> 00:28:20,060 oh, 357 00:28:20,060 --> 00:28:21,550 he's doing really well, 358 00:28:21,640 --> 00:28:24,340 he's a little behind with some social things, 359 00:28:24,340 --> 00:28:26,970 but I'm sure that will mature quickly. 360 00:28:27,540 --> 00:28:28,010 Um, 361 00:28:28,010 --> 00:28:31,470 and then she said a really, 362 00:28:31,480 --> 00:28:37,890 there was a really pivotal moment for me and I was caught off guard and she said, 363 00:28:38,440 --> 00:28:39,160 actually, 364 00:28:39,160 --> 00:28:45,260 his teachers had the gall to suggest he's on the autism spectrum. 365 00:28:46,340 --> 00:28:54,110 And I had that kind of moment where you feel like everything sits still and things are moving in slow motion. 366 00:28:54,110 --> 00:28:54,740 But you know, 367 00:28:54,740 --> 00:28:56,670 you have to respond or, 368 00:28:56,680 --> 00:28:59,360 or your mind is trying to think of something to say. 369 00:29:00,740 --> 00:29:02,930 And I thought to myself, 370 00:29:02,940 --> 00:29:14,860 I know I don't have to talk about our experience with her, and I'm not feeling very generous in this moment, 371 00:29:15,440 --> 00:29:17,300 but I said, 372 00:29:17,300 --> 00:29:17,610 you know, 373 00:29:17,610 --> 00:29:19,280 if I don't say anything, 374 00:29:20,430 --> 00:29:25,350 I feel like I'm going to be agreeing that this is not something we can talk about. 375 00:29:26,340 --> 00:29:29,440 And that's not what I believe and that's not the atmosphere 376 00:29:29,440 --> 00:29:35,280 I want to create ... that if I don't reveal our experience, 377 00:29:36,140 --> 00:29:40,760 I am agreeing that it takes gall to suggest that. 378 00:29:41,940 --> 00:29:44,160 And I also didn't want to shame her. 379 00:29:44,740 --> 00:29:47,430 I know what it's like to be a struggling mom. 380 00:29:48,140 --> 00:29:48,770 I don't, 381 00:29:49,540 --> 00:29:50,110 I'm not, 382 00:29:50,120 --> 00:29:52,990 I wasn't in the same place that she is, 383 00:29:53,540 --> 00:29:57,100 but I did not want to wound her or shame her. 384 00:29:57,330 --> 00:30:03,060 And so I ended up saying in a very matter of fact tone, 385 00:30:03,070 --> 00:30:03,390 "Oh, 386 00:30:03,390 --> 00:30:05,120 my son's on the spectrum. 387 00:30:05,130 --> 00:30:08,580 We got diagnosed at easter seals and you know, 388 00:30:08,580 --> 00:30:10,670 that was one of the best things we ever did. 389 00:30:10,680 --> 00:30:14,650 His therapies were so helpful and you know, 390 00:30:14,650 --> 00:30:17,800 that was really something that was good for us." 391 00:30:19,040 --> 00:30:21,120 And then I just said to her, 392 00:30:21,130 --> 00:30:21,640 "You know, 393 00:30:21,640 --> 00:30:26,910 whatever your son needs to be doing well and uh, 394 00:30:26,920 --> 00:30:28,660 feeling good and connecting with people, 395 00:30:28,660 --> 00:30:31,060 I just hope he gets that ... whatever that is." 396 00:30:33,540 --> 00:30:39,960 So sometimes we make decisions about revelation based on what kind of atmosphere we want to promote. 397 00:30:43,690 --> 00:30:49,760 Sometimes we might want to discuss our diagnosis to formalize something in a record, 398 00:30:50,140 --> 00:30:58,650 like a medical record or a school or work record where we're asking for specific accommodations or we're asking, 399 00:30:58,660 --> 00:30:59,350 um, 400 00:30:59,740 --> 00:31:00,530 for, 401 00:31:00,540 --> 00:31:01,390 uh, 402 00:31:01,400 --> 00:31:03,000 an intervention like, 403 00:31:03,010 --> 00:31:03,580 um, 404 00:31:03,590 --> 00:31:08,250 occupational therapy or something that's going to be directed towards that need. 405 00:31:08,250 --> 00:31:10,420 So sometimes we'll um, 406 00:31:10,430 --> 00:31:17,170 discuss that with a team of people working on giving us specific interventions or accommodations. 407 00:31:19,140 --> 00:31:23,410 And we also may wish to help someone specific. 408 00:31:23,420 --> 00:31:25,470 So maybe we've, 409 00:31:25,480 --> 00:31:26,070 you know, 410 00:31:26,080 --> 00:31:29,990 we've revealed the diagnosis to some people close to us, 411 00:31:29,990 --> 00:31:38,270 but most people don't know, and you run across someone that's really struggling, and you really think you get it. 412 00:31:38,340 --> 00:31:39,020 You know, 413 00:31:39,030 --> 00:31:47,170 you think I know what that is and I was so helped by this that maybe my experience might help them. 414 00:31:47,540 --> 00:31:57,850 So you may choose in that moment or with that person to kind of talk about your own experience of diagnosis and why that made a difference for you. 415 00:31:57,850 --> 00:32:00,800 And you might say something like, 416 00:32:00,810 --> 00:32:01,220 you know, 417 00:32:01,220 --> 00:32:03,330 "I don't know if that's anything you've considered, 418 00:32:03,330 --> 00:32:05,160 but it may be something to think about." 419 00:32:08,140 --> 00:32:17,360 And the last reason I'm going to put out there is just that sometimes when you are in an increasingly close relationship, 420 00:32:17,370 --> 00:32:20,450 whether it's a friendship or um, 421 00:32:20,460 --> 00:32:22,040 a partnership, 422 00:32:22,050 --> 00:32:23,560 a romantic partnership, 423 00:32:24,540 --> 00:32:26,100 part of growing closer, 424 00:32:26,100 --> 00:32:27,180 over time, 425 00:32:28,140 --> 00:32:28,670 you know, 426 00:32:28,670 --> 00:32:31,400 maybe you've connected over favorite interests, 427 00:32:31,400 --> 00:32:33,470 maybe you've connected in a group, 428 00:32:33,480 --> 00:32:39,260 maybe it's been a year and you're getting closer and (the time frame isn't important, 429 00:32:39,260 --> 00:32:53,170 I'm just trying to emphasize that there's been this growth together) ... And part of encouraging even more intimacy and closeness is self revelation. 430 00:32:53,640 --> 00:33:03,440 So you start to reveal over time things that have really impacted you or things that you've been through and what your journey has been like. 431 00:33:03,450 --> 00:33:09,350 So someone might share with their increasingly close friend what it was like when their mom died. 432 00:33:09,840 --> 00:33:15,060 Or someone might share their diagnostic journey towards an autism diagnosis. 433 00:33:15,440 --> 00:33:23,280 So sometimes it's part of this growing intimacy that self revelation brings whatever that revelation is. 434 00:33:23,290 --> 00:33:27,770 And in this case it could have to do with the diagnosis of autism. 435 00:33:30,140 --> 00:33:34,760 Those are my scattered thoughts um, 436 00:33:34,770 --> 00:33:42,800 about talking about a journey toward diagnosis or an existing diagnosis with other people. 437 00:33:42,810 --> 00:33:48,300 And I hope that these have provided some food for thought. 438 00:33:48,310 --> 00:33:48,930 Um, 439 00:33:48,930 --> 00:34:07,440 some examples of things that you might say or might avoid or might consider. The next episode is going to focus on bringing up the conversation or the topic with people that you think may be on the spectrum that you'd like to help, 440 00:34:07,450 --> 00:34:10,520 but they really don't see this coming. 441 00:34:10,530 --> 00:34:12,660 You don't ... you're not sure how they're gonna react, 442 00:34:12,660 --> 00:34:13,850 You don't know what to say. 443 00:34:14,240 --> 00:34:19,260 So that will be this next episode and the final episode, 444 00:34:19,270 --> 00:34:25,260 I envision being about dealing with strong emotions um, 445 00:34:25,270 --> 00:34:28,280 in conversation about autism. 446 00:34:28,280 --> 00:34:34,110 So one of the things I've really experienced and learned is that people have strong, 447 00:34:34,110 --> 00:34:39,540 strong emotions for a variety of very legitimate reasons. 448 00:34:39,550 --> 00:34:42,310 And sometimes dealing with the emotions 449 00:34:42,310 --> 00:34:48,550 in the conversation can be even more difficult than figuring out the words to say. 450 00:34:48,940 --> 00:34:49,560 Um, 451 00:34:49,560 --> 00:34:54,410 and sometimes you never know what kind of emotion is going to come on the scene. 452 00:34:54,420 --> 00:34:55,260 Um, 453 00:34:55,270 --> 00:35:03,890 and so I'm going to kind of focus on this emotional exchange during the third episode of this series, 454 00:35:03,890 --> 00:35:05,860 Talking About Autism.

Join Dr. Regan for the final episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on recognizing when an individual is attempting to regulate and using this information to partner toward the best outcome. New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians Transcript of Episode 1 00:00:00,340 --> 00:00:03,370 This is Dr Theresa Regan. 2 00:00:03,380 --> 00:00:10,830 I'm a neuropsychologist and I specialize in understanding the way that the brain is related to emotions, 3 00:00:10,830 --> 00:00:13,000 behavior, cognition -- 4 00:00:13,000 --> 00:00:16,430 thinking skills -- and also personality. 5 00:00:16,440 --> 00:00:18,910 I'm a certified autism specialist. 6 00:00:18,920 --> 00:00:24,060 I'm the director of an autism diagnostic clinic for adults in Illinois. 7 00:00:24,070 --> 00:00:26,650 And I'm the mother of a teen on the spectrum. 8 00:00:27,740 --> 00:00:35,960 This is our final episode of a four point series on regulation and dysegulation on the autism spectrum. 9 00:00:36,440 --> 00:00:37,640 In the first episode, 10 00:00:37,640 --> 00:00:39,800 we talked about what those words mean. 11 00:00:39,800 --> 00:00:49,130 So regulation has to do with the nervous system's ability to help us stay centered with alertness... 12 00:00:49,140 --> 00:01:02,480 whether we are able to wake up quickly and efficiently in the morning and are able to wind down to sleep in the evening ... that has to do with regulation of our alertness, 13 00:01:02,490 --> 00:01:04,900 Also regulation of attention... 14 00:01:04,900 --> 00:01:14,000 so sometimes we may feel spacey and inattentive and other times we may have too much hyper focus, 15 00:01:14,000 --> 00:01:19,350 too attentive to details that aren't really helping our situation. 16 00:01:19,360 --> 00:01:21,530 And also third, 17 00:01:21,530 --> 00:01:24,370 the regulation of emotions and behavior. 18 00:01:24,370 --> 00:01:35,970 And so this would be what we typically call fight, flight, or freeze modes when someone's overwhelmed and they may revert to an outburst or a meltdown, 19 00:01:35,980 --> 00:01:39,230 they may be an individual who has quieter struggle... 20 00:01:39,230 --> 00:01:41,930 So they may have flight reactions -- 21 00:01:41,930 --> 00:01:43,590 like I'm leaving school, 22 00:01:43,590 --> 00:01:46,580 I can't come out of my room, 23 00:01:46,580 --> 00:01:48,340 I'm withdrawing. 24 00:01:48,350 --> 00:01:52,880 I'm hiding ... psychologically or physically. 25 00:01:53,740 --> 00:01:57,440 And some people have freeze reactions that ... I'm physically present, 26 00:01:57,440 --> 00:01:59,430 but I'm really shut down. 27 00:01:59,430 --> 00:02:07,660 I'm not psychologically present ... and it may even take the form of a dissociative episode like this person is shut down... 28 00:02:07,670 --> 00:02:10,520 They don't remember this conversation later. 29 00:02:10,520 --> 00:02:14,360 They're really just not able to be fully present. 30 00:02:15,440 --> 00:02:18,590 Another form of freeze reaction 31 00:02:18,590 --> 00:02:25,130 could be this expression of psychological stress through the physical body. 32 00:02:25,140 --> 00:02:29,330 So a person who's having what we call nonepileptic seizures. 33 00:02:29,340 --> 00:02:39,150 Those are seizures that are expressions of psychological struggle rather than based in electrical changes in the brain. 34 00:02:39,160 --> 00:02:42,420 That would be in this category. 35 00:02:42,420 --> 00:02:49,150 People who have feelings of physical pain in the context of emotional pain. 36 00:02:49,540 --> 00:02:52,750 People who have headaches or stomachaches etcetera. 37 00:02:55,540 --> 00:03:02,510 So we talked about ways to prevent dysregulation in the second episode. 38 00:03:02,510 --> 00:03:06,960 How to reduce those episodes of feeling uncentered. 39 00:03:08,240 --> 00:03:09,490 In the third episode, 40 00:03:09,490 --> 00:03:26,260 we talked about how to recover once dysregulation occurs, because it will ... it does for every human and there are just times in our life when we have more difficulties slipping into these dysregulated states. 41 00:03:26,270 --> 00:03:27,850 And then once that happens, 42 00:03:27,850 --> 00:03:30,760 we need to have strategies to recover. 43 00:03:30,770 --> 00:03:33,360 And that was our third topic. 44 00:03:34,040 --> 00:03:52,950 This is our fourth and final topic, and it's about how to recognize when the person you are with ... or how to recognize in yourself ... when you are attempting to regulate, because a lot of what we do as humans is say to ourselves, 45 00:03:52,950 --> 00:03:53,310 "Gosh, 46 00:03:53,310 --> 00:03:55,540 why is this person behaving that way? 47 00:03:55,550 --> 00:03:57,150 What does it mean? 48 00:03:57,640 --> 00:03:59,980 Why is my kid doing this? 49 00:04:00,050 --> 00:04:01,770 What's their intention? 50 00:04:01,770 --> 00:04:02,820 What does that mean? 51 00:04:02,830 --> 00:04:06,790 Or why did my spouse say this or didn't say this? 52 00:04:06,790 --> 00:04:08,460 What is the meaning behind that?" 53 00:04:09,040 --> 00:04:15,620 And it's really important if someone has a behavior and an attempt to regulate, that 54 00:04:15,620 --> 00:04:19,740 we understand that's what this behavior means. 55 00:04:19,740 --> 00:04:24,760 It's stemming, not from any personal issue between me and this person, 56 00:04:24,770 --> 00:04:48,260 It's stemming from an attempt to regulate and it's a sign ...it's revelation to the person and to those around him or her, that this is a person who's not feeling centered, and they're trying to get there and we all really want to support each individual's attempt to get to the center. 57 00:04:48,740 --> 00:05:04,560 And the first step is recognizing when someone is trying to do that and not interfering with their attempt to regulate unless we can offer them a better option for regulation and we'll talk about that in a little bit. 58 00:05:06,140 --> 00:05:18,160 One of the strategies that we talked about in previous episodes for regulating, whether that is alertness or attention or emotional calm, 59 00:05:19,240 --> 00:05:34,590 can have to do with the sensory system. The sensory inputs that people often use for adjusting that regulation state often has to do with pressure... 60 00:05:34,600 --> 00:05:40,460 So getting sensations of pressure, and that can be in the muscles or the joints. 61 00:05:40,940 --> 00:05:44,560 That's when we get what we call proprioceptive input. 62 00:05:44,940 --> 00:06:02,550 And that is why weighted blankets are calming for some people, that you have this pressure in the muscles and the nervous system gets these signals that it can kind of recenter, refocus, and get grounded. 63 00:06:02,840 --> 00:06:09,760 That's why yoga often is something that people gravitate toward for calming and centering, 64 00:06:09,940 --> 00:06:19,520 you often have these poses that you hold for a significant amount of time... enough that that pressure in the joint really gets settled in there. 65 00:06:19,530 --> 00:06:35,590 But there are a lot of other ways that people get pressure as well and we'll talk more about how to recognize that ... A lot of times the things people gravitate toward without really realizing why do I do this... 66 00:06:35,600 --> 00:06:42,930 There could be some sensory input part to it besides pressure... 67 00:06:42,930 --> 00:06:45,740 we're also going to be looking at movement. 68 00:06:45,750 --> 00:06:50,360 So that's when our brain receives vestibular input. 69 00:06:50,840 --> 00:07:00,690 So if person is riding their bike down through hills and down through neighborhoods, 70 00:07:00,700 --> 00:07:04,950 that person is getting vestibular input into their brain. 71 00:07:05,340 --> 00:07:18,240 And this kind of input is only present if the person is moving through space in the sense that they were in position one and now they're in position two... like they're down the street, 72 00:07:18,250 --> 00:07:23,660 that means the fluid in their ears starts to move and the brain gets this type of input... 73 00:07:24,440 --> 00:07:32,360 What doesn't give the brain vestibular movement input would be if the person is riding a stationary bike, 74 00:07:32,740 --> 00:07:37,920 they're moving their arms and legs and guess what ... they are getting proprioceptive input.... 75 00:07:37,920 --> 00:07:40,980 that pressure in their muscles and their joints... 76 00:07:41,020 --> 00:07:45,670 but they're not moving through the neighborhood, down the hill, 77 00:07:45,720 --> 00:07:53,560 they're not getting that sense of movement into the brain, and that can be why a lot of people -- and you know who you are -- 78 00:07:53,640 --> 00:07:56,650 will say, "I love running through the neighborhood, 79 00:07:56,650 --> 00:07:58,590 but I'm not going to run on a treadmill." 80 00:07:58,600 --> 00:07:59,580 You know, 81 00:07:59,590 --> 00:08:04,670 that is a clue that you are someone that needs that vestibular component, 82 00:08:04,680 --> 00:08:07,950 otherwise it just doesn't meet your sensory needs. 83 00:08:09,740 --> 00:08:25,450 Let me give some more examples of sensory strategies so that we recognize when someone around us may be using a sensory strategy. When kids or adults chew on things... 84 00:08:25,840 --> 00:08:27,110 pencils, 85 00:08:27,120 --> 00:08:28,170 shirts, 86 00:08:28,180 --> 00:08:29,910 chewing on gum, 87 00:08:29,920 --> 00:08:34,280 chewing on the tops or tabs of things. 88 00:08:34,280 --> 00:08:39,010 People put all kinds of things... like straws or tabs in their mouth. 89 00:08:39,020 --> 00:08:42,710 So our approach to correcting that is to say, 90 00:08:42,710 --> 00:08:42,900 "Hey, 91 00:08:42,900 --> 00:08:44,330 don't chew on your shirt, 92 00:08:44,330 --> 00:08:45,460 that's disgusting"... 93 00:08:45,740 --> 00:08:48,410 or don't chew on the pencil, 94 00:08:48,410 --> 00:08:49,850 it's not for chewing. 95 00:08:50,140 --> 00:08:54,580 Um but that kind of instruction doesn't really help. 96 00:08:54,590 --> 00:09:06,710 And the reason that in the long term the person kind of reverts back to that is it's probable that they actually are needing some pressure input through their jaw, 97 00:09:06,720 --> 00:09:09,680 through their uh the teeth into the jaw. 98 00:09:09,690 --> 00:09:19,950 And when you chew you get a lot of oral input and a lot of pressure input and that kind of input may be centering for that person. 99 00:09:20,440 --> 00:09:30,240 We even now ...at least in the United States, when there's an individualized educational plan for a student with attention problems or other difficulties in school, 100 00:09:30,250 --> 00:09:47,750 it may be written in their program that they're allowed to chew gum during class because it can help with focus and concentration and centering to have some pressure through the jaw and through the the teeth into the jaw. 101 00:09:49,240 --> 00:10:09,850 Another way that you might see people trying to get proprioceptive input would be that kid that is rolling on the ground, is crashing into people or things, and seems to like that.... um impact of hitting something or tackling in football, 102 00:10:10,240 --> 00:10:16,260 that kind of thing is going to give them pressure in their muscles and joints. 103 00:10:16,940 --> 00:10:34,400 Kds who like to run and jump into someone's lap or jump into a bear hug might really be wanting to get that pressure input ... for people who like to work on a laptop or on a project while they're laying on their stomach, 104 00:10:34,400 --> 00:10:38,360 you're getting a lot of pressure throughout your... 105 00:10:38,740 --> 00:10:56,460 the length of your body. When people are sitting and they're um kind of swinging their legs and they're hitting their ankles onto the the leg of the chair. 106 00:10:56,940 --> 00:11:00,960 Uh that gives pressure into the ankle joint there. 107 00:11:01,440 --> 00:11:04,360 People who like to go barefoot, 108 00:11:04,370 --> 00:11:22,550 you get a lot more proprioceptive input from the floor that way... by going barefoot rather than having a shoe on. Other people shuffle or drag their feet and they might be corrected by a parent and saying pick up your feet... 109 00:11:23,440 --> 00:11:34,020 the individual who sleeps with a ton of blankets or stuffed animals or really likes to be swaddled into something to sleep 110 00:11:34,030 --> 00:11:39,250 might be seeking pressure input. For people seeking vestibular input, 111 00:11:39,640 --> 00:11:45,970 you get that movement input ... and it may be riding the bike as I had talked about, 112 00:11:45,980 --> 00:11:54,330 It could be jumping on a trampoline (that also gives you pressure in your joints or when you flop on the bed of the trampoline). 113 00:11:54,340 --> 00:11:55,010 So you, 114 00:11:55,020 --> 00:12:00,260 you might be seeing that the person is getting both of those ... 115 00:12:02,240 --> 00:12:06,720 people who love roller coasters, who like to ride a motorcycle, 116 00:12:07,140 --> 00:12:07,910 Um, 117 00:12:07,920 --> 00:12:20,790 even just we can see that some people like to go for a ride in the car, and that clears their mind and it may be that there's some component of quiet that they find there, 118 00:12:20,790 --> 00:12:27,260 but they're also maybe just this predictable linear movement that might be calming. 119 00:12:28,440 --> 00:12:30,980 I want to tell you a story in particular. 120 00:12:30,990 --> 00:12:35,480 I saw a mother and her... 121 00:12:35,490 --> 00:12:52,510 I would say the son was probably about 10 years old, and it was one of those situations where unfortunately we were all in line to sign up for something that was related to a kids activity. 122 00:12:52,520 --> 00:12:57,890 And so there were parents in this long line and um, 123 00:12:57,900 --> 00:13:01,930 some parents had their kids with them and the line, 124 00:13:01,940 --> 00:13:07,550 I think it was raining outside and the interior of the office... 125 00:13:07,740 --> 00:13:23,220 it was just very winding and it was like you could fit one person in this little hallway and then it it just um meandered like a snake around this whole building and so you didn't see any windows and you were kind of... 126 00:13:23,230 --> 00:13:25,900 it really was loud and claustrophobic, 127 00:13:25,900 --> 00:13:29,460 it was very difficult for me to wait in that line. 128 00:13:30,340 --> 00:13:33,720 And the boy who was next to me, 129 00:13:33,730 --> 00:14:07,460 I could hear his mom talking to another mom in line ...and she was talking about how her boys loved to ride down this a really, really steep hill by their house, and she she just worries about them a bit because it's so steep and they do things like you know riding on their handlebars and ...they just are so driven to go down this hill that she hasn't been able to figure out a way to keep them from doing that. 130 00:14:08,540 --> 00:14:14,270 And in my mind I'm thinking "oh those are kids that need a lot of vestibular input, 131 00:14:14,270 --> 00:14:20,750 they need that ... they're trying to regulate and that's the way that they found that really serves that purpose. 132 00:14:21,340 --> 00:14:35,820 And interestingly, the next thing that happened was the boy next to me started shaking his head back, back, back, back, back, back, back and forth... vigorously and then he'd stop and then he'd shake, 133 00:14:35,820 --> 00:14:36,060 shake, 134 00:14:36,060 --> 00:14:36,290 shake, 135 00:14:36,290 --> 00:14:36,510 shake, 136 00:14:36,510 --> 00:14:36,780 shake, 137 00:14:36,780 --> 00:14:37,010 shake, 138 00:14:37,010 --> 00:14:50,930 shake his head and then he'd stop... and in my head, I thought "oh that's a great way for this kid to try to regulate in a hallway, because there's no way he's riding his bike down this hallway," 139 00:14:50,940 --> 00:14:52,730 but by shaking his head, 140 00:14:52,730 --> 00:14:54,150 he's standing still, 141 00:14:54,150 --> 00:15:02,300 he's not making any noise and he's getting vestibular input because his head is shaking and that fluid in the ears is moving. 142 00:15:02,540 --> 00:15:03,230 And I thought, 143 00:15:03,230 --> 00:15:03,490 wow, 144 00:15:03,490 --> 00:15:05,660 that's a really great strategy for him. 145 00:15:06,240 --> 00:15:08,180 And the mom though, 146 00:15:08,190 --> 00:15:17,060 didn't realize what was happening, and she saw that as bad behavior and she said "stop that." 147 00:15:18,240 --> 00:15:23,480 And that's really the purpose of this episode... that if we don't understand, 148 00:15:23,520 --> 00:15:24,180 you know, 149 00:15:24,180 --> 00:15:32,630 here is someone who is struggling to stand still in a winding hallway, 150 00:15:32,630 --> 00:15:34,040 that's not moving, 151 00:15:34,050 --> 00:15:35,740 the line's not moving, 152 00:15:35,750 --> 00:15:37,290 people are talking, 153 00:15:37,290 --> 00:15:39,160 it's a very close space. 154 00:15:39,640 --> 00:15:42,360 Um and he's not able to move at all. 155 00:15:43,040 --> 00:15:47,060 So here he comes up with this great strategy, 156 00:15:47,060 --> 00:15:48,570 I'm sure unconsciously, 157 00:15:48,570 --> 00:15:49,550 it's not like he thought, 158 00:15:49,550 --> 00:15:51,060 how can I get movement input? 159 00:15:51,070 --> 00:15:54,120 But his body helped him out by saying, 160 00:15:54,120 --> 00:15:54,350 hey, 161 00:15:54,350 --> 00:15:55,210 do this. 162 00:15:55,740 --> 00:15:57,670 And mom said no, 163 00:15:57,680 --> 00:16:02,770 and so what we can really do, if we recognize what is this behavior... 164 00:16:02,770 --> 00:16:03,920 we could say, 165 00:16:03,930 --> 00:16:06,450 "oh that's a great strategy, 166 00:16:07,030 --> 00:16:15,000 Does that feel good to move your head like that" -- and we can help the person identifying themselves, 167 00:16:15,000 --> 00:16:17,160 what feels calming and what they need. 168 00:16:17,840 --> 00:16:18,470 Now, 169 00:16:18,480 --> 00:16:25,930 if she felt like that was too disruptive or if he were somehow banging his head into people, 170 00:16:25,940 --> 00:16:28,400 she very well could say something like, 171 00:16:28,410 --> 00:16:31,510 oh I really see that your body has that itch 172 00:16:31,520 --> 00:16:32,250 to move, 173 00:16:32,250 --> 00:16:33,940 it really needs to move, 174 00:16:33,950 --> 00:16:36,190 That's kind of hard to do in here. 175 00:16:36,190 --> 00:16:42,160 But would you like to go to the indoor pool after we're done? 176 00:16:42,160 --> 00:16:53,240 So you can get some of that movement that you really need... so that she's offering an alternative, and she's acknowledging that that actually serves a very important need for him, 177 00:16:53,250 --> 00:17:08,950 that he needs a lot of movement throughout the day and offering him more opportunity to do that again in a way that is safe and healthy and doesn't disrupt other people is a much better strategy than saying "don't do that." 178 00:17:09,140 --> 00:17:11,620 So once she understands that, 179 00:17:11,630 --> 00:17:18,080 they'll get along well with it, once we have a detective's hat on and we can say, 180 00:17:18,080 --> 00:17:18,520 wow, 181 00:17:18,520 --> 00:17:21,240 I wonder if X, 182 00:17:21,240 --> 00:17:22,480 y and Z. 183 00:17:22,490 --> 00:17:22,890 You know, 184 00:17:22,890 --> 00:17:28,960 I wonder if this behavior that you're showing really serves a function for you that's important. 185 00:17:29,440 --> 00:17:40,060 Then our solution can be to help the person realize what's happening, to support their attempts to regulate, and to create more opportunities for good regulation. 186 00:17:42,540 --> 00:17:50,170 It also breaks up this adversarial stance between people where if I'm correcting this person and saying, 187 00:17:50,180 --> 00:17:50,960 um, 188 00:17:50,970 --> 00:17:51,440 you know, 189 00:17:51,440 --> 00:17:52,380 pick your feet up, 190 00:17:52,380 --> 00:17:55,740 don't drag your feet, and don't shake your head, and don't talk. 191 00:17:55,750 --> 00:18:18,890 It gets into this very constant kind of adversarial situation where I've established a relationship with the person where I'm making sure they fit into a very small space, and they feel like their needs aren't getting met ... and she's asking, let's take the son who likes to move or needs movement, 192 00:18:18,900 --> 00:18:22,030 She's asking him to be still and be quiet. 193 00:18:22,030 --> 00:18:25,830 So she's asking him to regulate in the hallway. 194 00:18:25,840 --> 00:18:29,560 But she's asking him not to use regulation strategies. 195 00:18:29,570 --> 00:18:31,560 So that's where the problem is. 196 00:18:31,560 --> 00:18:43,910 He can either stay in the line and tolerate it by moving his head -- or he might then become more disruptive. 197 00:18:43,910 --> 00:18:48,450 Like then "I just can't stay in the line if I can't use the movement." 198 00:18:50,640 --> 00:19:11,790 I want to give you another example I witnessed of someone who is using vestibular input to regulate, and that was a preschooler who I observed the class was walking in their single file line behind the teacher. One of the students that had a lot of difficulty regulating  199 00:19:11,790 --> 00:19:15,480 -- I already knew from past observations -- 200 00:19:15,490 --> 00:19:21,740 He was spinning while walking down in line. 201 00:19:21,750 --> 00:19:23,940 This kind of took a lot of coordination, 202 00:19:23,940 --> 00:19:27,150 but he was spinning in his own personal space, 203 00:19:27,150 --> 00:19:31,260 but while moving in a single file... line and again, 204 00:19:31,260 --> 00:19:34,520 that was something that he got reprimanded for. 205 00:19:34,530 --> 00:19:36,050 But it's a big revelation. 206 00:19:36,050 --> 00:19:37,050 It's a big clue. 207 00:19:37,340 --> 00:19:38,410 And if we can say, 208 00:19:38,410 --> 00:19:38,890 wow, 209 00:19:38,890 --> 00:19:40,350 that's a clue, 210 00:19:40,360 --> 00:19:46,240 maybe I should put this kid on a swing and and let him go before we go back into the classroom, 211 00:19:46,250 --> 00:19:48,770 then we can use that information. 212 00:19:51,140 --> 00:19:54,130 The person who wants to chew on everything. 213 00:19:54,140 --> 00:19:59,030 Maybe they can chew gum instead of chewing on pencils or ruining their shirts. 214 00:19:59,040 --> 00:20:06,770 Um maybe they can chew on a pencil topper ... so they make different things you can chew on that you could put on top of a pencil. 215 00:20:07,040 --> 00:20:17,890 Another strategy that sometimes works for kids to kind of give them another source of regulation is to have them do their homework or um you know, 216 00:20:17,890 --> 00:20:23,940 for an adult to do their projects, while sitting on an exercise ball because when you're doing that, 217 00:20:23,940 --> 00:20:30,350 you're getting more pressure into your seat and you have the opportunity to move and get that vestibular input as well. 218 00:20:30,350 --> 00:20:39,660 And sometimes that reduces the need for chewing because you're actually getting some pressure and movement and feel more centered. 219 00:20:43,840 --> 00:20:48,020 Another way that people tend to seek regulations... 220 00:20:48,020 --> 00:20:58,150 so we've talked about sensory inputs... and another way that people seek regulation is when they want to engage in their pleasurable activities. 221 00:20:58,160 --> 00:21:00,640 So for the individual on the spectrum, 222 00:21:00,640 --> 00:21:07,010 this might include something like sorting or patterning objects in their collections. 223 00:21:07,340 --> 00:21:11,590 So they may take time to sort and organize their colored pencils, 224 00:21:11,590 --> 00:21:13,060 they're playing cards, 225 00:21:13,070 --> 00:21:16,140 they may take out items to look at that 226 00:21:16,150 --> 00:21:24,350 ... they have that are figurines that are ornaments, that are books in a collection with special covers signed by the author. 227 00:21:25,940 --> 00:21:31,930 It may be that this person is wanting to read their favorite book, 228 00:21:31,930 --> 00:21:33,830 watch their favorite tv show, 229 00:21:33,840 --> 00:21:38,970 eat their favorite meal ... and this is their attempt to regulate. 230 00:21:38,970 --> 00:21:42,500 So they're gonna like ... their pleasurable, 231 00:21:42,500 --> 00:22:02,420 go-to activities ... and they're also going to tend to like things that are familiar. And one of the biggest problems I encounter for families is when they misinterpret why the person is trying to grasp at these familiar and pleasurable things. 232 00:22:02,430 --> 00:22:12,260 So let's take the example of a teenage girl who comes home from school and she is exhausted, 233 00:22:12,640 --> 00:22:14,910 it's loud at school, 234 00:22:14,920 --> 00:22:17,520 she was previously homeschooled, 235 00:22:17,520 --> 00:22:21,340 so the high school environment is a big difference. 236 00:22:21,350 --> 00:22:24,860 And after school she gets off the bus, 237 00:22:24,860 --> 00:22:34,600 she comes in and she breaks the family rule about using mom's iPad. 238 00:22:34,600 --> 00:22:41,910 So she is allowed to use mom's ipad for a certain number of minutes a day, 239 00:22:42,440 --> 00:22:47,770 and it is not until she has done her homework that she's able to start with it. 240 00:22:48,240 --> 00:23:05,170 But she goes right in to get the iPad, and she goes to her closet and she sits in the dark with the iPad, um with the closet door closed and mom finds her in there and ... really, 241 00:23:05,170 --> 00:23:08,550 really gets upset! Like this... 242 00:23:08,560 --> 00:23:10,870 these kind of things have happened before. 243 00:23:10,880 --> 00:23:16,900 And mom really views her as being very defiant, 244 00:23:16,910 --> 00:23:29,670 even though she intellectually knows the rules. She interprets her sitting in the closet in the dark with the ipad as "I know I'm not supposed to be doing this and I'm doing it anyway" 245 00:23:29,670 --> 00:23:36,200 and that feels very, very intentionally willful and defiant to mom. 246 00:23:36,200 --> 00:23:40,450 And so she um takes a very hard stance about it... 247 00:23:40,450 --> 00:23:43,960 she starts to yell and get upset, 248 00:23:43,960 --> 00:23:50,320 she grabs the ipad and physically takes it out of her daughter's hands. 249 00:23:50,840 --> 00:23:53,110 the daughter loses it, 250 00:23:53,190 --> 00:23:55,160 she starts screaming, 251 00:23:55,540 --> 00:23:58,540 she slams doors, 252 00:23:58,540 --> 00:24:03,560 she takes one of the doors ... not completely off the hinge, 253 00:24:03,560 --> 00:24:19,380 but kind of breaks and bends one of the hinges, and it just turned into a very loud screaming and property breaking kind of episode. 254 00:24:19,380 --> 00:24:29,700 And so this was unfortunate because I think mom's interpretation of what was going on was inaccurate. 255 00:24:29,720 --> 00:24:34,060 In my working with this teen, 256 00:24:34,540 --> 00:24:38,460 this is a teen with straight A's in school, 257 00:24:38,840 --> 00:24:43,760 she is very rule-oriented in school, 258 00:24:43,760 --> 00:24:47,860 which makes her mom feel very upset that she breaks the rules at home ... 259 00:24:48,640 --> 00:24:52,390 but she's just exhausted by the time she gets home, 260 00:24:52,400 --> 00:24:59,970 it's a complex academic, sensory, and social environment ...and she has not been used to it, 261 00:24:59,980 --> 00:25:05,320 she's back in a public school environment, and even the bus drive there and the bus drive home, 262 00:25:05,320 --> 00:25:06,570 that adds another, 263 00:25:06,580 --> 00:25:07,340 you know, 264 00:25:07,340 --> 00:25:15,330 hour to the day of being around all these people ...and it's very overwhelming to her. When she gets overwhelmed, 265 00:25:17,840 --> 00:25:32,000 what she wants to do is look at pictures of animals, and she wants to look up animal facts and topics and charts, and she wants to learn about a new animal and see pictures of the animal. 266 00:25:32,010 --> 00:25:54,060 And so all she's doing on the ipad is looking up animal facts and pictures and this is soothing to her. I do get where mom's coming from, that there are some households where the rule is you get to do fun things after you do your homework, 267 00:25:54,940 --> 00:26:04,740 but this person's nervous system really needs the opportunity to regroup before doing something again. 268 00:26:04,750 --> 00:26:05,550 That's hard. 269 00:26:06,340 --> 00:26:18,300 So she is at a breaking point when she comes home and it's actually her attempt to regulate that has her take this thing ... and I know she's hiding with it. 270 00:26:18,300 --> 00:26:26,360 But I also think that being in a dark, quiet space is also something she's trying to do to regulate as well. 271 00:26:29,140 --> 00:26:41,150 I think the misunderstanding is that mom feels that the daughter on the spectrum could easily comply and behave in a different way. 272 00:26:41,160 --> 00:26:51,480 And my view is that she's leaning toward trying to get her neurologic needs met and it breaks the household rule 273 00:26:51,480 --> 00:26:54,540 which puts everybody in a very tough position. 274 00:26:54,550 --> 00:27:00,810 So mom is essentially saying "I want you to regulate without doing your pleasant activities." 275 00:27:00,820 --> 00:27:06,970 And she is saying "I can't regulate if that's taken away from me." 276 00:27:06,980 --> 00:27:14,580 So mom's um kind of coming in and barging into the the bedroom area and the closet area, 277 00:27:14,580 --> 00:27:17,860 turning the lights on, physically taking away the 278 00:27:18,540 --> 00:27:30,270 ipad and raising her voice ... really added to this very overwhelming situation for her ... and then when she couldn't use flight...  279 00:27:31,040 --> 00:27:33,760 here she had come home and used flight right?... 280 00:27:33,760 --> 00:27:35,560 I'm going to go to the closet. 281 00:27:36,240 --> 00:27:36,440 Um, 282 00:27:36,440 --> 00:27:41,860 and her favorite activity to prevent a meltdown. 283 00:27:42,240 --> 00:27:44,310 Once that was taken away from her, 284 00:27:44,310 --> 00:27:48,350 then she did have a meltdown, and it wasn't in defiance... 285 00:27:48,360 --> 00:27:52,050 it was just that what she was using to regulate was taken away. 286 00:27:53,040 --> 00:27:58,300 I think there would have been a much better outcome if the parent had seen her in the closet and thought, 287 00:27:58,300 --> 00:27:58,720 wow, 288 00:27:58,730 --> 00:28:01,170 it looks like you had a really rough day. 289 00:28:01,740 --> 00:28:07,260 Does it feel good to be in a dark cozy space and looking at your animals? 290 00:28:07,740 --> 00:28:14,850 And this could have started a real dialogue about what her system needs and what she notices. 291 00:28:15,330 --> 00:28:23,200 And it can introduce this concept that we can partner together to make sure that you're safe and healthy, 292 00:28:23,200 --> 00:28:29,960 but that your needs also get met because you are important and how you're doing is important. 293 00:28:30,640 --> 00:28:30,990 Um, 294 00:28:30,990 --> 00:28:34,060 and it sets up this collaboration and this partnership. 295 00:28:35,740 --> 00:28:46,070 Maybe there could be flexibility in the iPad rule and maybe they discussed that mom really does want her to feel centered after a hard day at work. 296 00:28:46,080 --> 00:28:55,060 And one option might be that mom and daughter could sit in a dark room together after school and look at animal facts for 30 minutes. 297 00:28:55,540 --> 00:29:10,140 If the reason that mom is restricting the ipad is that she thinks that she must be in the closet because she's looking at unapproved sites ... or maybe they could decide that having animal books from the library 298 00:29:10,150 --> 00:29:10,880 299 00:29:10,880 --> 00:29:19,170 and the daughter could choose those books and go into an enclosed dark space and look at the books... 300 00:29:19,180 --> 00:29:25,270 if the reason for the rule is that mom doesn't want electronics all day in front of the daughter. 301 00:29:26,540 --> 00:29:34,310 Perhaps they could even have a tradition where after her alone time looking at animal facts and books, 302 00:29:34,310 --> 00:29:37,810 she could come out and tell mom some animal information. 303 00:29:37,920 --> 00:29:42,660 What was the most interesting that she learned... and this could also bring them together. 304 00:29:43,140 --> 00:29:43,710 305 00:29:43,710 --> 00:29:44,930 once they have this, 306 00:29:44,940 --> 00:29:49,510 this better partnership and a tradition like 'this is how you unwind, 307 00:29:49,520 --> 00:29:51,060 this is how we connect'... 308 00:29:53,350 --> 00:29:56,450 And then once they figure out that that's helpful, 309 00:29:56,940 --> 00:30:03,780 they can talk about what else could we set up for you and give you access to that would help your system. 310 00:30:03,790 --> 00:30:04,330 You know, 311 00:30:04,330 --> 00:30:22,270 maybe this person needs a weighted blanket or a hammock or maybe laying in a bubble bath after school feels grounding, and they could come up with more ideas so that she has more access rather than less access to regulating activities. 312 00:30:24,140 --> 00:30:28,080 Consider an example of a husband who comes home from work 313 00:30:28,090 --> 00:30:34,350 to his wife and two preschool kids, and he walks straight to his home office, 314 00:30:34,350 --> 00:30:35,570 he shuts the door, 315 00:30:35,580 --> 00:30:47,870 he watches tv, plays games on his phone... and his kids had just thrown themselves at him when he came in the door only to be uh rejected and feel rejected. 316 00:30:47,880 --> 00:30:54,320 His wife is feeling like she's the one who needs to recharge because she's been with the kids all day. 317 00:30:54,320 --> 00:30:59,760 She hasn't seen another adult and she also feels ignored and rejected in her marriage. 318 00:31:00,940 --> 00:31:03,360 This again is a case of, 319 00:31:03,940 --> 00:31:04,300 um, 320 00:31:04,300 --> 00:31:13,160 an autistic adult who has given everything at work and comes in and actually does need some recentering time. 321 00:31:13,640 --> 00:31:19,670 And a discussion of this would probably be more fruitful 322 00:31:20,100 --> 00:31:27,860 than people talking about discontent with it, or telling him to do something different. 323 00:31:28,440 --> 00:31:28,840 Uh, 324 00:31:28,850 --> 00:31:42,760 it may be much more strategic to say "what do you need for these 30 or 40 minutes when you get home and then I'll tell you what I need and how can we get these things that we all need in the evening." 325 00:31:45,040 --> 00:31:55,720 Another strategy would be maybe he could start doing things at his office that would help him regulate during the day and then when he gets home, 326 00:31:55,730 --> 00:31:58,800 maybe he'd have a little bit more left. 327 00:31:58,800 --> 00:32:00,880 So maybe over a lunch break, 328 00:32:00,890 --> 00:32:04,450 he could eat his sandwich while he's walking around the block, 329 00:32:04,830 --> 00:32:08,300 Maybe he could listen to music when he's not in meetings. 330 00:32:08,740 --> 00:32:18,850 So this conscious working towards strategy helps us with the regulation piece. 331 00:32:19,850 --> 00:32:21,320 Then when he gets home, 332 00:32:21,720 --> 00:32:26,330 maybe he could go into his office and do some alone things for 30 minutes. 333 00:32:26,740 --> 00:32:31,770 And if wife needs alone time then or needs together time with him, 334 00:32:32,140 --> 00:32:38,390 they could pick maybe a restorative activity for the family... one that the kids never get to do. 335 00:32:38,400 --> 00:32:53,170 But they're going to pull this out in the evening because they really need something that's restorative and calm and so maybe they don't let let the kids watch movies or eat popcorn or eat anything in the living room. 336 00:32:53,440 --> 00:33:05,000 So maybe they could have a popcorn picnic or a pancake picnic in the living room while they put on a cartoon and they can turn off the lights. 337 00:33:05,060 --> 00:33:07,540 The kids might settle down in there, 338 00:33:07,540 --> 00:33:15,490 they can turn the volume down and then the parents could just cuddle on the couch and that level of activity 339 00:33:15,490 --> 00:33:22,450 may be something that he can regulate through and that actually is also restorative for them as a family. 340 00:33:23,740 --> 00:33:35,700 So once we recognize that the behavior is not intentionally defiant or manipulative at its core... and it doesn't represent a rejection of other people, 341 00:33:35,700 --> 00:33:38,860 we can problem solve and establish a partnership. 342 00:33:39,240 --> 00:33:42,550 And if you're the individual learning about yourself, 343 00:33:42,550 --> 00:33:48,500 you can say to the other person ... it looks like you have had a crazy day, 344 00:33:48,510 --> 00:33:50,390 I want to know what you need. 345 00:33:50,400 --> 00:33:58,060 Let me tell you what I think I need ... and so we can all grow in this self awareness and in these discussions about partnering. 346 00:33:59,940 --> 00:34:07,230 It's also important to note that flight can sometimes be an attempt to save regulation as well. 347 00:34:07,240 --> 00:34:09,320 And we talked about this a little bit. 348 00:34:09,320 --> 00:34:31,190 I just want to emphasize it before we end today ... that if someone leaves the room or if they shut down or if they stop the conversation and they are just going to leave ... one danger to chasing after them physically or psychologically, 349 00:34:32,040 --> 00:34:36,180 is that that flight may be the only thing 350 00:34:36,180 --> 00:34:39,720 saving them from melting down, 351 00:34:39,730 --> 00:34:41,350 that might be their strategy... 352 00:34:41,350 --> 00:34:43,160 flight might be their strategy. 353 00:34:43,170 --> 00:34:45,360 And so if it is, 354 00:34:46,440 --> 00:34:53,540 it often doesn't help to chase after the person and prevent them from flight. 355 00:34:53,550 --> 00:35:00,900 That's not to say that we don't want to work toward a more sustained level of communication. 356 00:35:01,340 --> 00:35:09,630 It's just that what doesn't seem to work -- and even though it's understandable ---is to go kind of in chase mode, 357 00:35:09,630 --> 00:35:11,770 like "I'm not going to let this go, 358 00:35:11,770 --> 00:35:12,600 this is important, 359 00:35:12,600 --> 00:35:13,860 we need to do this." 360 00:35:14,840 --> 00:35:16,080 Again, 361 00:35:16,080 --> 00:35:18,600 there are lots of caveats to all these, 362 00:35:18,600 --> 00:35:24,740 these are kind of general principles that I found helpful, 363 00:35:24,750 --> 00:35:30,960 but there may be times that you do block an activity or escape because of safety reasons. 364 00:35:31,340 --> 00:35:35,100 Um but most of the time when I see it happening, 365 00:35:35,100 --> 00:35:36,970 it's in frustration. 366 00:35:37,340 --> 00:35:42,170 Uh that ... I'm not gonna let you leave or I'm not gonna let you be defiant. 367 00:35:43,140 --> 00:35:48,360 Another approach that may work better in the flight mode issue is saying, 368 00:35:48,370 --> 00:35:51,750 I know that having this conversation is really tough for you, 369 00:35:52,240 --> 00:35:56,340 but it's also really important to me to communicate about this. 370 00:35:56,340 --> 00:36:01,250 And what would help you feel more centered and still be able to communicate. 371 00:36:02,130 --> 00:36:14,160 So some people may do better communicating about a sensitive topic when you're sitting in the dark so that they don't have to be face to face with you and they don't have to have eye contact. 372 00:36:14,630 --> 00:36:26,540 Another person may want to email about things for the same reason... that anything you can do to reduce the intensity of the conversation might make it more successful. 373 00:36:26,550 --> 00:36:29,390 So if they're overwhelmed enough that they want to leave, 374 00:36:29,400 --> 00:36:35,950 how can you reduce the intensity without reducing the core of what you want to accomplish? 375 00:36:36,230 --> 00:36:39,710 So maybe you can reduce the eye contact. 376 00:36:39,720 --> 00:36:49,960 Maybe you can reduce um you know turn down the lights or go in a quieter spot or schedule a time instead of having it spontaneous. 377 00:36:50,930 --> 00:37:05,450 So the bottom line summary of today's episode on recognizing when someone is attempting to regulate is that the way that we interpret someone's behavior ... 378 00:37:06,140 --> 00:37:07,850 you know, "what does this mean?" 379 00:37:08,430 --> 00:37:17,490 ... it ends up impacting a lot, and if we think the behavior means someone's being disrespectful, 380 00:37:17,490 --> 00:37:36,300 manipulative, defiant, rejecting us ... then we are often going to respond in a way that's less effective than if we recognize that "oh this is a person who is dysregulated and trying to regulate. 381 00:37:36,300 --> 00:37:37,950 They're trying to get back. 382 00:37:37,960 --> 00:37:47,010 ... this is a person who's overwhelmed ... then we can make better choices about how to respond in that situation to get the better outcome, 383 00:37:47,020 --> 00:37:55,580 the best outcome ... and that may include "wow it looks like you've had a rough day" or "it's really noisy in here isn't it?" 384 00:37:55,590 --> 00:38:01,670 Or "it seems like your system might need to move"... and really problem solving together. 385 00:38:03,130 --> 00:38:07,440 I hope this four part series on regulation has been helpful to you. 386 00:38:08,330 --> 00:38:15,550 It's certainly a topic that people often contact our clinic for ... for advice and education. 387 00:38:17,430 --> 00:38:22,840 Next time you join me it will be for the beginning of our next series, and I'm going to call it, 388 00:38:22,840 --> 00:38:24,450 Talking About Autism. 389 00:38:24,830 --> 00:38:28,140 This is a listener request, and I think it's a great one. 390 00:38:28,140 --> 00:38:30,140 It was sent in by several people, 391 00:38:30,150 --> 00:38:36,950 all wanting to really hear my input about how to talk about autism with each other. 392 00:38:37,630 --> 00:38:39,110 Hope you can join me then.  

Join Dr. Regan for the third episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on strategies for recovering from dysregulated states.    As referenced in the podcast:  Exhaustion in Autism: Balancing Momentum for Daily Activities Gaining Momentum for Activities: Shifting from Sluggish to Active Keeping Momentum for Activities on the Autism Spectrum   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians   Transcript of Episode 1 00:00:03,540 --> 00:00:07,840 Hello everyone and welcome to this episode of the podcast, 2 00:00:07,850 --> 00:00:09,680 autism in the adult, 3 00:00:09,690 --> 00:00:10,910 I am your host, 4 00:00:10,910 --> 00:00:12,450 Dr Theresa Regan. 5 00:00:13,040 --> 00:00:14,870 I am a neuropsychologist, 6 00:00:14,870 --> 00:00:20,640 which means that I specialize in understanding how the brain impacts things like thinking, 7 00:00:20,640 --> 00:00:21,320 skills, 8 00:00:21,330 --> 00:00:22,410 emotions, 9 00:00:22,420 --> 00:00:24,560 behavior and personality. 10 00:00:25,160 --> 00:00:30,460 I'm the founder and director of an adult diagnostic autism clinic in central Illinois. 11 00:00:30,840 --> 00:00:40,560 And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum. 12 00:00:41,440 --> 00:00:42,960 In the first episode, 13 00:00:42,960 --> 00:00:51,080 we defined these terms where regulation is feeling just right in the area of alertness, 14 00:00:51,090 --> 00:01:03,630 attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions, 15 00:01:03,630 --> 00:01:11,960 they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down, 16 00:01:12,410 --> 00:01:19,850 they might include physical expressions of stress, or what we call dissociation. 17 00:01:20,540 --> 00:01:31,760 Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real. 18 00:01:33,640 --> 00:01:34,800 In the first episode, 19 00:01:34,800 --> 00:01:38,030 we also reviewed that within the autism spectrum, 20 00:01:38,030 --> 00:01:43,360 dysregulation is more common than for those with different neurology. 21 00:01:44,540 --> 00:01:46,760 In the second episode of this series, 22 00:01:46,760 --> 00:02:08,760 we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into. 23 00:02:10,520 --> 00:02:12,120 For our third episode, 24 00:02:12,120 --> 00:02:16,460 our focus will be on what to do when dysregulation hits. 25 00:02:16,940 --> 00:02:21,650 We all have dysregulated states... for the person on the spectrum, 26 00:02:21,650 --> 00:02:28,970 they may be more likely to have these and, even when we do all that we can do to support the nervous system, 27 00:02:29,440 --> 00:02:38,260 we're going to have periods where we're really not just right with regard to alertness or attention or emotional status. 28 00:02:38,840 --> 00:02:40,860 So when someone is dysregulated, 29 00:02:40,860 --> 00:02:47,170 they might appear to be sluggish or have difficulty getting going or unmotivated. 30 00:02:47,180 --> 00:02:53,360 That would be when their motor is running too low in the area of alertness and activation. 31 00:02:54,040 --> 00:03:04,330 This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism. 32 00:03:04,330 --> 00:03:10,290 And I will post the links to these episodes below today, 33 00:03:10,290 --> 00:03:15,530 We're going to focus on the dysregulation that looks like anxiety, 34 00:03:15,540 --> 00:03:17,310 upset, anger, 35 00:03:17,310 --> 00:03:18,360 restlessness. 36 00:03:18,930 --> 00:03:24,570 These things that may manifest in fight, flight, or freeze reactions. 37 00:03:28,540 --> 00:03:37,480 So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing. 38 00:03:37,480 --> 00:03:41,650 So we're gonna start with this category of what not to do. 39 00:03:42,040 --> 00:03:49,540 Many of the things that we have an instinct for when someone is dysregulated actually may make things worse. 40 00:03:49,550 --> 00:03:51,270 So what do we tend to do? 41 00:03:51,270 --> 00:03:51,470 Well, 42 00:03:51,470 --> 00:03:55,010 we might ask the person to talk about how they're feeling, 43 00:03:55,010 --> 00:03:56,760 why they're feeling that way, 44 00:03:56,760 --> 00:04:01,320 what triggered this really strong emotional reaction. 45 00:04:02,240 --> 00:04:08,560 We may reason with them about why they should be feeling or reacting differently. 46 00:04:08,940 --> 00:04:10,390 We might say things like, 47 00:04:10,390 --> 00:04:13,130 "Well they didn't mean it" or "it's not a big deal," 48 00:04:13,130 --> 00:04:28,420 "don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better. 49 00:04:28,440 --> 00:04:31,000 So we may say to them calm down, 50 00:04:31,010 --> 00:04:32,180 don't yell, 51 00:04:32,190 --> 00:04:43,490 look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system. 52 00:04:43,500 --> 00:04:52,360 It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed. 53 00:04:54,040 --> 00:04:56,530 For the person on the spectrum, 54 00:04:56,530 --> 00:05:02,300 it's already going to be effortful for them to figure out what their emotions are, 55 00:05:02,310 --> 00:05:09,250 what triggered them, and to talk about them face to face and eye to eye with another person. 56 00:05:10,040 --> 00:05:18,350 And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves. 57 00:05:18,940 --> 00:05:26,280 Um and so it's probably not only not realistic for them to be able to do that when overwhelmed, 58 00:05:26,840 --> 00:05:33,750 but talking to the individual who's overwhelmed also just adds stimulus, 59 00:05:33,760 --> 00:05:35,150 It adds demand, 60 00:05:35,150 --> 00:05:36,860 it adds noise. 61 00:05:37,740 --> 00:05:45,750 And so to the extent that talking is just adding stimulus to the situation, 62 00:05:46,540 --> 00:05:50,490 I really would recommend being calm, 63 00:05:50,490 --> 00:05:51,840 being quiet. 64 00:05:52,340 --> 00:05:59,360 Not necessarily engaging with the person in the moment that they are overwhelmed. 65 00:06:00,540 --> 00:06:21,560 So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time 66 00:06:24,440 --> 00:06:34,060 Other things that I would recommend not doing would be ... I would not take away possessions from them at this time. 67 00:06:34,540 --> 00:06:37,820 So don't try to take something out of their hands. 68 00:06:37,830 --> 00:06:43,810 Don't try to take something away from their space or their room... 69 00:06:43,820 --> 00:06:51,070 the place where maybe they find comfort. Objects are often very important to the individual on the spectrum. 70 00:06:51,070 --> 00:06:55,530 And when someone's dysregulated and overwhelmed, 71 00:06:55,530 --> 00:07:01,660 it's often not a good time to try to separate them from something that's that important to them. 72 00:07:03,640 --> 00:07:09,120 Likewise touching them or wrestling with them ...kind of getting into their space. 73 00:07:09,130 --> 00:07:16,060 Um It's generally again going to add stimulus to what they're trying to process. 74 00:07:16,070 --> 00:07:26,660 So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state. 75 00:07:27,640 --> 00:07:35,830 Again just kind of thinking how much information is coming at this individual who's already overwhelmed. 76 00:07:35,830 --> 00:07:46,660 So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them... 77 00:07:48,520 --> 00:07:50,970 So during a period of dysregulation, 78 00:07:50,970 --> 00:08:09,650 the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ... 79 00:08:09,660 --> 00:08:12,090 adding your speech, adding... 80 00:08:12,090 --> 00:08:13,990 being in in their space, 81 00:08:14,000 --> 00:08:17,080 taking away things that are comforting to them... 82 00:08:17,080 --> 00:08:20,860 that's likely to increase the dysregulated state. 83 00:08:23,440 --> 00:08:36,660 Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion. 84 00:08:37,440 --> 00:08:45,220 So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum. 85 00:08:45,220 --> 00:09:06,420 And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed. 86 00:09:08,040 --> 00:09:14,760 I would recommend staying very calm and even and predictable. 87 00:09:17,240 --> 00:09:27,650 I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process. 88 00:09:28,240 --> 00:09:31,670 If you do approach the person with high reactivity, 89 00:09:31,680 --> 00:09:43,970 you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own. 90 00:09:43,980 --> 00:09:52,760 And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated. 91 00:09:55,840 --> 00:10:08,350 The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated. 92 00:10:10,040 --> 00:10:26,190 We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual. 93 00:10:26,240 --> 00:10:38,930 The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs. 94 00:10:38,940 --> 00:10:43,950 And we talked about some of the strategies for this during the last episode. 95 00:10:44,440 --> 00:10:53,160 But, for example, an individual on the spectrum may really like pressure inputs or movement inputs. 96 00:10:53,730 --> 00:11:06,880 So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub, 97 00:11:06,890 --> 00:11:09,660 they feel a lot more centered after that. 98 00:11:10,240 --> 00:11:13,360 Some people recenter by lifting weights, 99 00:11:13,360 --> 00:11:14,330 doing yoga, 100 00:11:14,330 --> 00:11:26,460 swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding. 101 00:11:28,340 --> 00:11:30,830 Those experiences may be calming, 102 00:11:30,840 --> 00:11:38,750 they may be centering for the individuals so if you can add calming and centering inputs without talking, 103 00:11:39,440 --> 00:11:43,250 this can really help getting back to a regulated state. 104 00:11:44,140 --> 00:11:55,150 And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them. 105 00:11:55,740 --> 00:11:58,480 So thinking about this individual, 106 00:11:58,480 --> 00:12:01,210 what do they lean towards doing ... that 107 00:12:01,210 --> 00:12:04,050 they seem to find rejuvenating. 108 00:12:05,240 --> 00:12:17,860 Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos, 109 00:12:18,840 --> 00:12:28,460 another person may love sorting through their collections or sorting through images on Pinterest, 110 00:12:28,840 --> 00:12:36,510 looking at various colors that are so ... they're just so compelled by these colors, 111 00:12:36,520 --> 00:12:40,760 they capture their attention and it's almost like they just fill, 112 00:12:40,770 --> 00:12:45,290 fill this person up ... and they feel so rejuvenated. 113 00:12:46,240 --> 00:12:53,980 A third person may love to listen to history podcasts or to watch a favorite movie, 114 00:12:53,990 --> 00:12:57,870 even one that they've watched 100 times, 115 00:12:57,880 --> 00:13:04,560 It may be their go-to movie when they want to regroup and settle back to the center. 116 00:13:05,540 --> 00:13:10,020 In these moments of being uncentered and wanting to recenter, 117 00:13:10,030 --> 00:13:17,640 it's very likely that familiar things will be more calming than new things. 118 00:13:17,640 --> 00:13:24,650 So um a lot of times if people watch what they're drawn to on a difficult day, 119 00:13:24,740 --> 00:13:27,850 it may give them this information. 120 00:13:27,860 --> 00:13:38,590 This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment. 121 00:13:38,600 --> 00:14:05,300 And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far. 122 00:14:05,300 --> 00:14:35,050 We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time 123 00:14:35,640 --> 00:14:37,320 some type of game plan, 124 00:14:37,350 --> 00:14:53,130 a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?" 125 00:14:53,270 --> 00:14:53,690 You know, 126 00:14:53,690 --> 00:14:56,800 what should I do during this episode to feel better? 127 00:14:57,340 --> 00:15:10,650 So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time. 128 00:15:11,240 --> 00:15:13,260 People do it all different ways. 129 00:15:13,260 --> 00:15:23,230 Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered. 130 00:15:23,240 --> 00:15:24,200 Oh yes, 131 00:15:24,210 --> 00:15:24,590 you know, 132 00:15:24,590 --> 00:15:25,940 I wouldn't have thought of this, 133 00:15:25,940 --> 00:15:32,060 but I can take a walk outside of the weather permits and I actually do feel better then. 134 00:15:32,840 --> 00:15:41,890 Sometimes people make a box ahead of time of items in it that are soothing. 135 00:15:41,890 --> 00:15:46,070 They might have a lava lamp in there that they can just watch, 136 00:15:46,070 --> 00:15:47,960 they might have a stress ball. 137 00:15:48,440 --> 00:15:57,350 Uh there might be slime or different scents like lavender or vanilla that are soothing or calming. 138 00:15:59,140 --> 00:16:06,550 So this detective work ahead of time can be really helpful and then adding cues to the person 139 00:16:06,550 --> 00:16:09,000 either from familiar people who can say, 140 00:16:09,000 --> 00:16:09,280 hey, 141 00:16:09,280 --> 00:16:14,900 I wonder if it would feel good for you to do this or to have it in the environment, 142 00:16:14,900 --> 00:16:17,460 like a list or a box of items... 143 00:16:19,840 --> 00:16:27,240 Ideally the individual will have a sense over time of when a dysegulated state is coming on. 144 00:16:27,250 --> 00:16:28,660 So for example, 145 00:16:28,670 --> 00:16:37,060 if they lean toward starting to shut down or disassociate during difficult times or difficult conversations, 146 00:16:37,470 --> 00:16:43,520 they may start to catch themselves when their mind starts to go blank and they're talking to somebody. 147 00:16:44,540 --> 00:16:49,630 They also may have a sense over time of when this happens at home, 148 00:16:49,670 --> 00:16:55,320 it often helps me to do these kinds of things-- and when it happens in public, 149 00:16:55,330 --> 00:16:57,860 I've learned to do these other kinds of things. 150 00:16:59,140 --> 00:17:02,700 Being able to recognize dysregulation, know 151 00:17:02,700 --> 00:17:11,670 what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening... 152 00:17:11,680 --> 00:17:21,090 that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people, 153 00:17:21,100 --> 00:17:25,370 we can really stabilize these situations and these relationships. 154 00:17:25,380 --> 00:17:26,850 So for example, 155 00:17:26,850 --> 00:17:33,770 if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown, 156 00:17:34,140 --> 00:17:40,530 it's generally very acceptable and professional in most work settings to step out... 157 00:17:40,540 --> 00:17:49,670 if you offer some type of explanation...  walking out of the room without explanation would not be considered okay or professional, 158 00:17:50,040 --> 00:17:55,250 but someone may use a very generic explanation and just say, 159 00:17:55,260 --> 00:17:55,870 "You know, 160 00:17:55,880 --> 00:17:58,340 I'm starting to not feel very well, 161 00:17:58,340 --> 00:18:13,360 I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work. 162 00:18:14,940 --> 00:18:17,480 So in that case the person might say, 163 00:18:17,480 --> 00:18:17,840 "You know, 164 00:18:17,840 --> 00:18:21,450 I can see that I'm really feeling passionate about this topic, 165 00:18:21,840 --> 00:18:29,660 but I also want to be able to hear what you have to say and ways in what your opinion is different from mine. 166 00:18:29,670 --> 00:18:34,050 And I think I just need to step out to regroup for a few minutes," 167 00:18:34,740 --> 00:18:45,960 or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate. 168 00:18:46,440 --> 00:18:48,310 They may say to their boss, 169 00:18:48,320 --> 00:18:48,720 "You know, 170 00:18:48,720 --> 00:18:52,890 I can feel myself getting really passionate about my own opinion, 171 00:18:52,890 --> 00:18:55,920 but I know that your perspective is important too, 172 00:18:55,920 --> 00:19:08,140 and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized. 173 00:19:08,260 --> 00:19:11,440 I'd really love for you to hear them, 174 00:19:11,440 --> 00:19:14,320 but I also would like to read your thoughts. 175 00:19:14,320 --> 00:19:15,960 If you could send them to me. 176 00:19:15,970 --> 00:19:32,670 I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps. 177 00:19:33,940 --> 00:19:39,360 Then I would like to come back and talk more about our opinions and talk them through." 178 00:19:40,340 --> 00:19:51,640 Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things. 179 00:19:51,650 --> 00:19:55,330 So this could be a technique that's done in a workplace, 180 00:19:55,340 --> 00:20:06,600 in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on. 181 00:20:06,600 --> 00:20:07,970 But it's very important, 182 00:20:07,970 --> 00:20:08,290 you know, 183 00:20:08,290 --> 00:20:17,670 being able to have time and space to process before you come back together can help stabilize that interaction. 184 00:20:20,940 --> 00:20:35,920 It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you, 185 00:20:35,920 --> 00:20:38,430 even though you disagree with it. 186 00:20:38,440 --> 00:20:46,530 Um that it kind of helps show that you want there to be a good exchange. 187 00:20:46,540 --> 00:20:48,000 If you're walking out, 188 00:20:48,000 --> 00:20:52,110 sometimes people feel like they're not even committed to a good exchange. 189 00:20:52,110 --> 00:20:54,950 So what ... what good is this partnership? 190 00:20:54,960 --> 00:21:09,600 But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now. 191 00:21:09,610 --> 00:21:16,260 Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work. 192 00:21:18,540 --> 00:21:28,670 That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ... 193 00:21:29,440 --> 00:22:07,960 what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time. 194 00:22:08,640 --> 00:22:14,960 So we've talked now about several ways to approach periods of dis regulation. 195 00:22:15,340 --> 00:22:31,060 One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation, 196 00:22:31,140 --> 00:22:38,260 but all I can say certainly is that these are general things I've noticed that do help or don't help. 197 00:22:40,120 --> 00:22:44,630 Focus should also always be on the person's safety in that moment, 198 00:22:44,630 --> 00:22:47,690 if there's something unsafe that needs to be stopped, 199 00:22:47,700 --> 00:22:52,260 that's really something to immediately intervene with. 200 00:22:53,340 --> 00:23:01,460 But in general reducing stimuli and demand and increasing soothing inputs can be really helpful. 201 00:23:03,840 --> 00:23:12,810 I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life. 202 00:23:12,810 --> 00:23:36,960 So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing. 203 00:23:37,440 --> 00:23:48,800 So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial -- 204 00:23:48,800 --> 00:23:54,860 so that goals with some challenge can be added once regulation has improved. 205 00:23:57,640 --> 00:24:05,670 Now our next episode will be the final in our four episode series on regulation and dysregulation. 206 00:24:07,140 --> 00:24:09,360 In the 4th and final episode, 207 00:24:09,360 --> 00:24:19,670 we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations. 208 00:24:20,740 --> 00:24:28,060 So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.    

Join Dr. Regan for the second episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on three strategies to help reduce the frequency and intensity of dysregulation episodes for the autistic individual.    Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians 1 00:00:03,540 --> 00:00:07,840 Hello everyone and welcome to this episode of the podcast, 2 00:00:07,850 --> 00:00:09,680 autism in the adult, 3 00:00:09,690 --> 00:00:10,910 I am your host, 4 00:00:10,910 --> 00:00:12,450 Dr Theresa Regan. 5 00:00:13,040 --> 00:00:14,870 I am a neuropsychologist, 6 00:00:14,870 --> 00:00:20,640 which means that I specialize in understanding how the brain impacts things like thinking, 7 00:00:20,640 --> 00:00:21,320 skills, 8 00:00:21,330 --> 00:00:22,410 emotions, 9 00:00:22,420 --> 00:00:24,560 behavior and personality. 10 00:00:25,160 --> 00:00:30,460 I'm the founder and director of an adult diagnostic autism clinic in central Illinois. 11 00:00:30,840 --> 00:00:40,560 And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum. 12 00:00:41,440 --> 00:00:42,960 In the first episode, 13 00:00:42,960 --> 00:00:51,080 we defined these terms where regulation is feeling just right in the area of alertness, 14 00:00:51,090 --> 00:01:03,630 attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions, 15 00:01:03,630 --> 00:01:11,960 they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down, 16 00:01:12,410 --> 00:01:19,850 they might include physical expressions of stress, or what we call dissociation. 17 00:01:20,540 --> 00:01:31,760 Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real. 18 00:01:33,640 --> 00:01:34,800 In the first episode, 19 00:01:34,800 --> 00:01:38,030 we also reviewed that within the autism spectrum, 20 00:01:38,030 --> 00:01:43,360 dysregulation is more common than for those with different neurology. 21 00:01:44,540 --> 00:01:46,760 In the second episode of this series, 22 00:01:46,760 --> 00:02:08,760 we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into. 23 00:02:10,520 --> 00:02:12,120 For our third episode, 24 00:02:12,120 --> 00:02:16,460 our focus will be on what to do when dysregulation hits. 25 00:02:16,940 --> 00:02:21,650 We all have dysregulated states... for the person on the spectrum, 26 00:02:21,650 --> 00:02:28,970 they may be more likely to have these and, even when we do all that we can do to support the nervous system, 27 00:02:29,440 --> 00:02:38,260 we're going to have periods where we're really not just right with regard to alertness or attention or emotional status. 28 00:02:38,840 --> 00:02:40,860 So when someone is dysregulated, 29 00:02:40,860 --> 00:02:47,170 they might appear to be sluggish or have difficulty getting going or unmotivated. 30 00:02:47,180 --> 00:02:53,360 That would be when their motor is running too low in the area of alertness and activation. 31 00:02:54,040 --> 00:03:04,330 This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism. 32 00:03:04,330 --> 00:03:10,290 And I will post the links to these episodes below today, 33 00:03:10,290 --> 00:03:15,530 We're going to focus on the dysregulation that looks like anxiety, 34 00:03:15,540 --> 00:03:17,310 upset, anger, 35 00:03:17,310 --> 00:03:18,360 restlessness. 36 00:03:18,930 --> 00:03:24,570 These things that may manifest in fight, flight, or freeze reactions. 37 00:03:28,540 --> 00:03:37,480 So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing. 38 00:03:37,480 --> 00:03:41,650 So we're gonna start with this category of what not to do. 39 00:03:42,040 --> 00:03:49,540 Many of the things that we have an instinct for when someone is dysregulated actually may make things worse. 40 00:03:49,550 --> 00:03:51,270 So what do we tend to do? 41 00:03:51,270 --> 00:03:51,470 Well, 42 00:03:51,470 --> 00:03:55,010 we might ask the person to talk about how they're feeling, 43 00:03:55,010 --> 00:03:56,760 why they're feeling that way, 44 00:03:56,760 --> 00:04:01,320 what triggered this really strong emotional reaction. 45 00:04:02,240 --> 00:04:08,560 We may reason with them about why they should be feeling or reacting differently. 46 00:04:08,940 --> 00:04:10,390 We might say things like, 47 00:04:10,390 --> 00:04:13,130 "Well they didn't mean it" or "it's not a big deal," 48 00:04:13,130 --> 00:04:28,420 "don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better. 49 00:04:28,440 --> 00:04:31,000 So we may say to them calm down, 50 00:04:31,010 --> 00:04:32,180 don't yell, 51 00:04:32,190 --> 00:04:43,490 look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system. 52 00:04:43,500 --> 00:04:52,360 It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed. 53 00:04:54,040 --> 00:04:56,530 For the person on the spectrum, 54 00:04:56,530 --> 00:05:02,300 it's already going to be effortful for them to figure out what their emotions are, 55 00:05:02,310 --> 00:05:09,250 what triggered them, and to talk about them face to face and eye to eye with another person. 56 00:05:10,040 --> 00:05:18,350 And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves. 57 00:05:18,940 --> 00:05:26,280 Um and so it's probably not only not realistic for them to be able to do that when overwhelmed, 58 00:05:26,840 --> 00:05:33,750 but talking to the individual who's overwhelmed also just adds stimulus, 59 00:05:33,760 --> 00:05:35,150 It adds demand, 60 00:05:35,150 --> 00:05:36,860 it adds noise. 61 00:05:37,740 --> 00:05:45,750 And so to the extent that talking is just adding stimulus to the situation, 62 00:05:46,540 --> 00:05:50,490 I really would recommend being calm, 63 00:05:50,490 --> 00:05:51,840 being quiet. 64 00:05:52,340 --> 00:05:59,360 Not necessarily engaging with the person in the moment that they are overwhelmed. 65 00:06:00,540 --> 00:06:21,560 So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time 66 00:06:24,440 --> 00:06:34,060 Other things that I would recommend not doing would be ... I would not take away possessions from them at this time. 67 00:06:34,540 --> 00:06:37,820 So don't try to take something out of their hands. 68 00:06:37,830 --> 00:06:43,810 Don't try to take something away from their space or their room... 69 00:06:43,820 --> 00:06:51,070 the place where maybe they find comfort. Objects are often very important to the individual on the spectrum. 70 00:06:51,070 --> 00:06:55,530 And when someone's dysregulated and overwhelmed, 71 00:06:55,530 --> 00:07:01,660 it's often not a good time to try to separate them from something that's that important to them. 72 00:07:03,640 --> 00:07:09,120 Likewise touching them or wrestling with them ...kind of getting into their space. 73 00:07:09,130 --> 00:07:16,060 Um It's generally again going to add stimulus to what they're trying to process. 74 00:07:16,070 --> 00:07:26,660 So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state. 75 00:07:27,640 --> 00:07:35,830 Again just kind of thinking how much information is coming at this individual who's already overwhelmed. 76 00:07:35,830 --> 00:07:46,660 So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them... 77 00:07:48,520 --> 00:07:50,970 So during a period of dysregulation, 78 00:07:50,970 --> 00:08:09,650 the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ... 79 00:08:09,660 --> 00:08:12,090 adding your speech, adding... 80 00:08:12,090 --> 00:08:13,990 being in in their space, 81 00:08:14,000 --> 00:08:17,080 taking away things that are comforting to them... 82 00:08:17,080 --> 00:08:20,860 that's likely to increase the dysregulated state. 83 00:08:23,440 --> 00:08:36,660 Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion. 84 00:08:37,440 --> 00:08:45,220 So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum. 85 00:08:45,220 --> 00:09:06,420 And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed. 86 00:09:08,040 --> 00:09:14,760 I would recommend staying very calm and even and predictable. 87 00:09:17,240 --> 00:09:27,650 I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process. 88 00:09:28,240 --> 00:09:31,670 If you do approach the person with high reactivity, 89 00:09:31,680 --> 00:09:43,970 you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own. 90 00:09:43,980 --> 00:09:52,760 And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated. 91 00:09:55,840 --> 00:10:08,350 The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated. 92 00:10:10,040 --> 00:10:26,190 We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual. 93 00:10:26,240 --> 00:10:38,930 The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs. 94 00:10:38,940 --> 00:10:43,950 And we talked about some of the strategies for this during the last episode. 95 00:10:44,440 --> 00:10:53,160 But, for example, an individual on the spectrum may really like pressure inputs or movement inputs. 96 00:10:53,730 --> 00:11:06,880 So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub, 97 00:11:06,890 --> 00:11:09,660 they feel a lot more centered after that. 98 00:11:10,240 --> 00:11:13,360 Some people recenter by lifting weights, 99 00:11:13,360 --> 00:11:14,330 doing yoga, 100 00:11:14,330 --> 00:11:26,460 swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding. 101 00:11:28,340 --> 00:11:30,830 Those experiences may be calming, 102 00:11:30,840 --> 00:11:38,750 they may be centering for the individuals so if you can add calming and centering inputs without talking, 103 00:11:39,440 --> 00:11:43,250 this can really help getting back to a regulated state. 104 00:11:44,140 --> 00:11:55,150 And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them. 105 00:11:55,740 --> 00:11:58,480 So thinking about this individual, 106 00:11:58,480 --> 00:12:01,210 what do they lean towards doing ... that 107 00:12:01,210 --> 00:12:04,050 they seem to find rejuvenating. 108 00:12:05,240 --> 00:12:17,860 Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos, 109 00:12:18,840 --> 00:12:28,460 another person may love sorting through their collections or sorting through images on Pinterest, 110 00:12:28,840 --> 00:12:36,510 looking at various colors that are so ... they're just so compelled by these colors, 111 00:12:36,520 --> 00:12:40,760 they capture their attention and it's almost like they just fill, 112 00:12:40,770 --> 00:12:45,290 fill this person up ... and they feel so rejuvenated. 113 00:12:46,240 --> 00:12:53,980 A third person may love to listen to history podcasts or to watch a favorite movie, 114 00:12:53,990 --> 00:12:57,870 even one that they've watched 100 times, 115 00:12:57,880 --> 00:13:04,560 It may be their go-to movie when they want to regroup and settle back to the center. 116 00:13:05,540 --> 00:13:10,020 In these moments of being uncentered and wanting to recenter, 117 00:13:10,030 --> 00:13:17,640 it's very likely that familiar things will be more calming than new things. 118 00:13:17,640 --> 00:13:24,650 So um a lot of times if people watch what they're drawn to on a difficult day, 119 00:13:24,740 --> 00:13:27,850 it may give them this information. 120 00:13:27,860 --> 00:13:38,590 This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment. 121 00:13:38,600 --> 00:14:05,300 And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far. 122 00:14:05,300 --> 00:14:35,050 We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time 123 00:14:35,640 --> 00:14:37,320 some type of game plan, 124 00:14:37,350 --> 00:14:53,130 a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?" 125 00:14:53,270 --> 00:14:53,690 You know, 126 00:14:53,690 --> 00:14:56,800 what should I do during this episode to feel better? 127 00:14:57,340 --> 00:15:10,650 So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time. 128 00:15:11,240 --> 00:15:13,260 People do it all different ways. 129 00:15:13,260 --> 00:15:23,230 Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered. 130 00:15:23,240 --> 00:15:24,200 Oh yes, 131 00:15:24,210 --> 00:15:24,590 you know, 132 00:15:24,590 --> 00:15:25,940 I wouldn't have thought of this, 133 00:15:25,940 --> 00:15:32,060 but I can take a walk outside of the weather permits and I actually do feel better then. 134 00:15:32,840 --> 00:15:41,890 Sometimes people make a box ahead of time of items in it that are soothing. 135 00:15:41,890 --> 00:15:46,070 They might have a lava lamp in there that they can just watch, 136 00:15:46,070 --> 00:15:47,960 they might have a stress ball. 137 00:15:48,440 --> 00:15:57,350 Uh there might be slime or different scents like lavender or vanilla that are soothing or calming. 138 00:15:59,140 --> 00:16:06,550 So this detective work ahead of time can be really helpful and then adding cues to the person 139 00:16:06,550 --> 00:16:09,000 either from familiar people who can say, 140 00:16:09,000 --> 00:16:09,280 hey, 141 00:16:09,280 --> 00:16:14,900 I wonder if it would feel good for you to do this or to have it in the environment, 142 00:16:14,900 --> 00:16:17,460 like a list or a box of items... 143 00:16:19,840 --> 00:16:27,240 Ideally the individual will have a sense over time of when a dysegulated state is coming on. 144 00:16:27,250 --> 00:16:28,660 So for example, 145 00:16:28,670 --> 00:16:37,060 if they lean toward starting to shut down or disassociate during difficult times or difficult conversations, 146 00:16:37,470 --> 00:16:43,520 they may start to catch themselves when their mind starts to go blank and they're talking to somebody. 147 00:16:44,540 --> 00:16:49,630 They also may have a sense over time of when this happens at home, 148 00:16:49,670 --> 00:16:55,320 it often helps me to do these kinds of things-- and when it happens in public, 149 00:16:55,330 --> 00:16:57,860 I've learned to do these other kinds of things. 150 00:16:59,140 --> 00:17:02,700 Being able to recognize dysregulation, know 151 00:17:02,700 --> 00:17:11,670 what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening... 152 00:17:11,680 --> 00:17:21,090 that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people, 153 00:17:21,100 --> 00:17:25,370 we can really stabilize these situations and these relationships. 154 00:17:25,380 --> 00:17:26,850 So for example, 155 00:17:26,850 --> 00:17:33,770 if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown, 156 00:17:34,140 --> 00:17:40,530 it's generally very acceptable and professional in most work settings to step out... 157 00:17:40,540 --> 00:17:49,670 if you offer some type of explanation...  walking out of the room without explanation would not be considered okay or professional, 158 00:17:50,040 --> 00:17:55,250 but someone may use a very generic explanation and just say, 159 00:17:55,260 --> 00:17:55,870 "You know, 160 00:17:55,880 --> 00:17:58,340 I'm starting to not feel very well, 161 00:17:58,340 --> 00:18:13,360 I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work. 162 00:18:14,940 --> 00:18:17,480 So in that case the person might say, 163 00:18:17,480 --> 00:18:17,840 "You know, 164 00:18:17,840 --> 00:18:21,450 I can see that I'm really feeling passionate about this topic, 165 00:18:21,840 --> 00:18:29,660 but I also want to be able to hear what you have to say and ways in what your opinion is different from mine. 166 00:18:29,670 --> 00:18:34,050 And I think I just need to step out to regroup for a few minutes," 167 00:18:34,740 --> 00:18:45,960 or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate. 168 00:18:46,440 --> 00:18:48,310 They may say to their boss, 169 00:18:48,320 --> 00:18:48,720 "You know, 170 00:18:48,720 --> 00:18:52,890 I can feel myself getting really passionate about my own opinion, 171 00:18:52,890 --> 00:18:55,920 but I know that your perspective is important too, 172 00:18:55,920 --> 00:19:08,140 and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized. 173 00:19:08,260 --> 00:19:11,440 I'd really love for you to hear them, 174 00:19:11,440 --> 00:19:14,320 but I also would like to read your thoughts. 175 00:19:14,320 --> 00:19:15,960 If you could send them to me. 176 00:19:15,970 --> 00:19:32,670 I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps. 177 00:19:33,940 --> 00:19:39,360 Then I would like to come back and talk more about our opinions and talk them through." 178 00:19:40,340 --> 00:19:51,640 Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things. 179 00:19:51,650 --> 00:19:55,330 So this could be a technique that's done in a workplace, 180 00:19:55,340 --> 00:20:06,600 in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on. 181 00:20:06,600 --> 00:20:07,970 But it's very important, 182 00:20:07,970 --> 00:20:08,290 you know, 183 00:20:08,290 --> 00:20:17,670 being able to have time and space to process before you come back together can help stabilize that interaction. 184 00:20:20,940 --> 00:20:35,920 It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you, 185 00:20:35,920 --> 00:20:38,430 even though you disagree with it. 186 00:20:38,440 --> 00:20:46,530 Um that it kind of helps show that you want there to be a good exchange. 187 00:20:46,540 --> 00:20:48,000 If you're walking out, 188 00:20:48,000 --> 00:20:52,110 sometimes people feel like they're not even committed to a good exchange. 189 00:20:52,110 --> 00:20:54,950 So what ... what good is this partnership? 190 00:20:54,960 --> 00:21:09,600 But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now. 191 00:21:09,610 --> 00:21:16,260 Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work. 192 00:21:18,540 --> 00:21:28,670 That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ... 193 00:21:29,440 --> 00:22:07,960 what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time. 194 00:22:08,640 --> 00:22:14,960 So we've talked now about several ways to approach periods of dis regulation. 195 00:22:15,340 --> 00:22:31,060 One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation, 196 00:22:31,140 --> 00:22:38,260 but all I can say certainly is that these are general things I've noticed that do help or don't help. 197 00:22:40,120 --> 00:22:44,630 Focus should also always be on the person's safety in that moment, 198 00:22:44,630 --> 00:22:47,690 if there's something unsafe that needs to be stopped, 199 00:22:47,700 --> 00:22:52,260 that's really something to immediately intervene with. 200 00:22:53,340 --> 00:23:01,460 But in general reducing stimuli and demand and increasing soothing inputs can be really helpful. 201 00:23:03,840 --> 00:23:12,810 I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life. 202 00:23:12,810 --> 00:23:36,960 So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing. 203 00:23:37,440 --> 00:23:48,800 So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial -- 204 00:23:48,800 --> 00:23:54,860 so that goals with some challenge can be added once regulation has improved. 205 00:23:57,640 --> 00:24:05,670 Now our next episode will be the final in our four episode series on regulation and dysregulation. 206 00:24:07,140 --> 00:24:09,360 In the 4th and final episode, 207 00:24:09,360 --> 00:24:19,670 we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations. 208 00:24:20,740 --> 00:24:28,060 So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.    

Individuals on the spectrum who are going through a season of struggle often describe episodes of dysregulation (not feeling centered in their alertness, attention, or emotions). Join Dr. Regan for this first episode in a 4 part series on dysregulation to learn how to recognize a dysregulated state and why these states are often misinterpreted or mishandled.    The Alert Program: Your Best Self The Testing Psychologist podcast: Best of 2021 Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians   Episode Transcript 1 00:00:00,340 --> 00:00:17,760 Welcome to autism in the adult podcast. 2 00:00:17,770 --> 00:00:18,750 I'm your host, 3 00:00:18,760 --> 00:00:20,290 Dr Theresa Regan, 4 00:00:20,300 --> 00:00:22,560 an adult neuropsychologist. 5 00:00:22,640 --> 00:00:28,050 I specialize in brain behavior relationships for those 14 and older. 6 00:00:28,540 --> 00:00:35,050 I'm the parent of an amazing teen on the autism spectrum and a certified autism specialist. 7 00:00:35,740 --> 00:00:38,200 I am deeply grateful to bring validation, 8 00:00:38,200 --> 00:00:42,850 hope and purpose to individuals and their families living on the autism spectrum. 9 00:00:43,540 --> 00:00:45,430 With this mission at its core, 10 00:00:45,440 --> 00:00:52,580 I founded and currently direct the OsF healthcare adult diagnostic autism center in central Illinois. 11 00:00:52,590 --> 00:01:10,560 My books include Understanding Autism in Adults and Aging Adults and Understanding Autistic Behaviors. For more information and to join my online community for free visit www.adultandgeriatricautism.com. 12 00:01:11,440 --> 00:01:13,550 Please join me in helping individuals, 13 00:01:13,560 --> 00:01:18,550 couples and families thrive while living life on the autism spectrum. 14 00:01:20,540 --> 00:01:24,460 Hello and welcome to this episode of Autism in the Adult. 15 00:01:25,240 --> 00:01:29,460 And I'm glad you joined me for this first episode of 2022. 16 00:01:30,240 --> 00:01:35,050 I just want to highlight a few things that have gone on recently. 17 00:01:35,050 --> 00:01:44,680 I was happy to be named in the episode Best Of for 2021 that The Testing Psychologist produces. 18 00:01:44,680 --> 00:01:46,520 This is a podcast by Dr. 19 00:01:46,520 --> 00:01:47,550 Jeremy Sharp 20 00:01:47,940 --> 00:02:02,790 talking about issues related to assessment in psychology, and my episode in august Identifying Adult Autism was the second downloaded episode of the season. 21 00:02:02,800 --> 00:02:03,290 So, 22 00:02:03,290 --> 00:02:14,720 I was so honored to be among many very accomplished people talking about important topics and assessment of Autism in the adult was right up there at # two. 23 00:02:14,720 --> 00:02:14,990 So, 24 00:02:14,990 --> 00:02:16,900 I was happy about that. 25 00:02:16,900 --> 00:02:19,920 I'll put the link below if you or someone you know 26 00:02:19,920 --> 00:02:22,800 would like to learn more about assessment. 27 00:02:23,340 --> 00:02:29,160 This episode of the testing psychologist was produced for clinicians. 28 00:02:29,160 --> 00:02:36,450 So people who are trying to understand how to assess and evaluate autistic characteristics in their clients. 29 00:02:37,040 --> 00:02:44,660 I also have an exciting opportunity for clinicians coming up in February on the 26th of 2022. 30 00:02:45,100 --> 00:02:50,030 This is a two hour live interactive webinar with Zur Institute. 31 00:02:50,040 --> 00:02:50,480 And again, 32 00:02:50,480 --> 00:02:52,330 I'll put the link below. 33 00:02:52,840 --> 00:02:58,210 This is entitled Autism Spectrum Disorder: Interventions Across the Lifespan. 34 00:02:58,640 --> 00:03:05,150 So not everyone on the spectrum will need support or intervention at all seasons of life. 35 00:03:05,540 --> 00:03:26,890 But for those who are clinicians, we have people come to us asking for assistance during a tough period or about a difficult thing that they're grappling with and to understand the neurology of the client is so important to drive the strategies that will be most helpful for them. 36 00:03:27,140 --> 00:03:42,770 So I'll be talking specifically about strategies that are likely to help the autistic client and ... things that we typically do in a counseling sessions, will highlight those that wouldn't be likely to be as helpful. 37 00:03:42,770 --> 00:03:45,730 So that's February 26, 38 00:03:45,730 --> 00:03:46,340 2022. 39 00:03:46,350 --> 00:03:48,850 And I'll go ahead and put that link below. 40 00:03:51,540 --> 00:03:55,260 Today's topic is dysregulation. 41 00:03:55,840 --> 00:04:00,240 I envision this to be the first episode in a four part series. 42 00:04:00,250 --> 00:04:04,160 And so today we're going to talk about what this regulation is and 43 00:04:04,170 --> 00:04:06,060 how to recognize it. 44 00:04:06,840 --> 00:04:09,290 In the next episode of the series, 45 00:04:09,290 --> 00:04:15,880 we're going to talk about how to reduce the amount of dysregulation that someone experiences. 46 00:04:15,890 --> 00:04:20,550 The third episode will be how to recover from dysregulation. 47 00:04:21,040 --> 00:04:27,820 The fourth will be how can you recognize when someone is trying to regulate. 48 00:04:27,830 --> 00:04:31,350 So someone around us maybe trying to regulate, 49 00:04:31,360 --> 00:04:35,650 and we may criticize them or ask them to stop it, 50 00:04:35,660 --> 00:04:37,230 but there would be other, 51 00:04:37,230 --> 00:04:41,050 more impactful ways to get a good outcome. 52 00:04:41,940 --> 00:04:44,020 You'll understand more about what I mean 53 00:04:44,020 --> 00:04:48,750 when we start to talk about this thing called regulation and dysregulation, 54 00:04:50,440 --> 00:05:05,650 Everyone's brain and nervous system are in charge of helping us to stay centered with various things and part of what we stay centered with has to do with alertness. 55 00:05:05,660 --> 00:05:08,070 Can we wake up in the morning? 56 00:05:08,070 --> 00:05:11,690 Can we calm down and fall asleep at night? 57 00:05:11,700 --> 00:05:16,830 That's kind of our ... the tone of our alertness, 58 00:05:16,940 --> 00:05:18,760 our brain helps us with that. 59 00:05:19,440 --> 00:05:23,900 We also have this attention regulation. 60 00:05:23,900 --> 00:05:31,520 So our brain is supposed to help us focus on what's most important and just release and let go 61 00:05:31,520 --> 00:05:38,670 things that are no longer important or uh you know... if the information in our environment has changed. 62 00:05:38,680 --> 00:05:46,990 So we need to switch gears and attend to something else... so our brain helps us regulate alertness and attention. 63 00:05:47,740 --> 00:05:53,190 So when we talk about these two aspects of regulation (alertness and attention), 64 00:05:53,740 --> 00:06:05,050 there is an analogy that is commonly used with the occupational therapists that often try to help people learn how to regulate better. 65 00:06:05,540 --> 00:06:09,560 And that analogy is "how is your motor running today?" 66 00:06:10,340 --> 00:06:14,560 So if your motor is running sluggish, 67 00:06:15,340 --> 00:06:17,420 you are tired, 68 00:06:17,470 --> 00:06:20,370 you may describe yourself as feeling lazy, 69 00:06:20,370 --> 00:06:21,540 unmotivated. 70 00:06:21,540 --> 00:06:22,910 I can't get going, 71 00:06:22,910 --> 00:06:24,250 I feel sleepy. 72 00:06:24,730 --> 00:06:31,750 I'm just a bump on a log ... that is when your motor is running too low. 73 00:06:32,640 --> 00:06:35,620 Your motor can also sometimes run too high. 74 00:06:36,140 --> 00:06:41,260 It's revved up and it's not in that just right state. 75 00:06:41,640 --> 00:06:47,250 And a motor that's too high will be someone who is hyper, restless, 76 00:06:47,640 --> 00:06:48,290 angry, 77 00:06:48,300 --> 00:06:49,240 agitated, 78 00:06:49,250 --> 00:06:50,070 anxious, 79 00:06:50,070 --> 00:06:54,700 that extra alertness that we just don't need all the time. 80 00:06:54,800 --> 00:06:56,970 This high level of alertness. 81 00:06:57,440 --> 00:07:07,360 Um that is the motor that is running too high, and we would like our motor to be running just right. 82 00:07:09,240 --> 00:07:13,370 The Alert Program is one program you might want to investigate. 83 00:07:13,380 --> 00:07:19,830 It's run by occupational therapists who are very experienced in regulation strategies. 84 00:07:19,840 --> 00:07:23,160 And I have a link to the alert program below. 85 00:07:23,640 --> 00:07:23,960 Now, 86 00:07:23,960 --> 00:07:28,870 they train occupational therapists in strategies to help others. 87 00:07:28,870 --> 00:07:41,060 But they also have a new online program called Your Best Self that people can investigate to figure out regulation strategies for themselves. 88 00:07:43,040 --> 00:07:43,540 Now, 89 00:07:43,540 --> 00:07:46,450 we've talked about alertness and attention. 90 00:07:46,840 --> 00:07:51,280 There's also this area of emotional regulation. 91 00:07:51,290 --> 00:07:54,160 So when we have a strong emotion, 92 00:07:54,170 --> 00:07:58,700 our brain should help us make sense of it. 93 00:07:58,710 --> 00:08:06,810 Our brain should help us center it and help it be present in our mind that we're aware of it, 94 00:08:06,810 --> 00:08:08,400 but it's not overwhelming, 95 00:08:08,410 --> 00:08:10,070 it doesn't hijack us, 96 00:08:10,080 --> 00:08:11,770 it doesn't take control of us, 97 00:08:11,780 --> 00:08:13,550 It doesn't hurt other people. 98 00:08:13,560 --> 00:08:20,160 And that would be regulation or dysregulation of emotional experiences. 99 00:08:22,440 --> 00:08:28,060 When we talk about a dysregulated state in the area of emotions, 100 00:08:28,120 --> 00:08:31,560 we can talk about a fight reaction, 101 00:08:32,240 --> 00:08:36,950 flight reactions or freeze reactions. 102 00:08:38,040 --> 00:08:56,000 So a fight reaction in the area of emotions is that this very strong emotional experience ... comes in and the person feels so overwhelmed that there is this externalized expression of distress. 103 00:08:56,640 --> 00:09:01,950 And what I mean by that is I would include meltdowns in this category. 104 00:09:01,960 --> 00:09:04,170 I would include outbursts, 105 00:09:04,180 --> 00:09:05,320 crying spells. 106 00:09:05,320 --> 00:09:08,480 I even include, even though it's not fight, 107 00:09:08,490 --> 00:09:14,960 but I'd like to capture all the externalized reactions in this category. 108 00:09:15,440 --> 00:09:18,050 That I am going to argue with you. 109 00:09:18,050 --> 00:09:19,950 I am going to explode. 110 00:09:19,960 --> 00:09:23,230 And you can picture this volcano, 111 00:09:23,240 --> 00:09:23,820 right? 112 00:09:23,830 --> 00:09:29,480 that is just to the point of being uncontained and out comes 113 00:09:29,480 --> 00:09:41,650 this spewing of tears or yelling or throwing things... so that is the externalized sign of a dysregulated state. 114 00:09:41,920 --> 00:09:43,890 In the area of emotions, 115 00:09:46,040 --> 00:09:52,660 flight is another reaction that someone could have when they are dysregulated. 116 00:09:53,340 --> 00:09:58,650 This could look like ... I'm going to walk away from you and quit this conversation. 117 00:09:59,040 --> 00:10:04,460 I'm going to spend all day in my room doing things I enjoy but not interacting with you. 118 00:10:05,140 --> 00:10:08,760 I'm going to quit school and do home schooling. 119 00:10:08,760 --> 00:10:10,450 I'm going to quit this job. 120 00:10:10,940 --> 00:10:15,560 I'm going to quit this relationship because it's so up and down. 121 00:10:15,560 --> 00:10:17,000 It's like a roller coaster. 122 00:10:17,000 --> 00:10:18,650 It's just too intense for me. 123 00:10:18,650 --> 00:10:20,000 It's too unpredictable. 124 00:10:20,040 --> 00:10:21,620 I have to quit this, 125 00:10:21,630 --> 00:10:23,060 I have to escape, 126 00:10:23,440 --> 00:10:28,630 I have to withdraw. Then there are freeze reactions. 127 00:10:28,630 --> 00:10:32,150 So this is the time when you're physically present, 128 00:10:32,160 --> 00:10:34,980 but you're not psychologically present, 129 00:10:34,990 --> 00:10:36,710 that your brain shuts down, 130 00:10:36,720 --> 00:10:46,300 Someone might say the veil just seemed to go over his eyes and I just knew he was there but not processing what was happening during that time, 131 00:10:46,300 --> 00:10:47,720 someone may say, 132 00:10:47,730 --> 00:10:48,200 you know, 133 00:10:48,200 --> 00:10:49,320 I hear what you're saying, 134 00:10:49,320 --> 00:10:52,460 but my mind is blank and I don't know what to respond. 135 00:10:52,470 --> 00:10:54,140 That's a freeze reaction. 136 00:10:54,150 --> 00:10:59,010 So it signals that the person is dysregulated. 137 00:10:59,010 --> 00:11:04,260 They're having difficulty being fully present in the midst of the strong emotion. 138 00:11:05,940 --> 00:11:28,150 Another part of the freeze reaction can be what we call a somatization response to stress and that just means that the stress is not able to come into the person's emotional awareness and kind of sit there and be recognized and felt. 139 00:11:28,740 --> 00:11:30,300 And so the body says, 140 00:11:30,300 --> 00:11:30,910 hey, 141 00:11:30,910 --> 00:11:35,150 I will help you escape from this really difficult emotion. 142 00:11:35,160 --> 00:11:45,140 I will process the stress for you so that you don't have to feel this deep fear or this deep pain or anguish or anger. 143 00:11:45,150 --> 00:11:52,690 I'll just process that stress right through the physical system in these cases, 144 00:11:52,700 --> 00:11:56,390 the symptom which could be a staring spell. 145 00:11:56,400 --> 00:11:59,740 It could be something that looks like an electrical seizure, 146 00:11:59,740 --> 00:12:01,350 but it's really not. 147 00:12:02,040 --> 00:12:08,600 It could be something like a loss of memory for chunks of time or days or weeks, 148 00:12:09,040 --> 00:12:17,000 it could be a weakness where the person feels like their limbs are weak or paralyzed. 149 00:12:17,010 --> 00:12:19,860 So it could be a variety of things like that. 150 00:12:20,240 --> 00:12:24,340 Physical systems also could include issues of pain, 151 00:12:24,350 --> 00:12:27,600 issues of stomach distress, 152 00:12:27,600 --> 00:12:28,470 headaches, 153 00:12:28,480 --> 00:12:30,550 so lots of different things. 154 00:12:30,550 --> 00:12:35,960 Lots of different physical systems can process stress for us. 155 00:12:36,340 --> 00:12:39,570 And these symptoms, 156 00:12:39,570 --> 00:12:42,760 these physical expressions are real. 157 00:12:43,140 --> 00:12:46,580 They are not produced by the individual, 158 00:12:46,580 --> 00:12:47,850 They're not feigned, 159 00:12:47,860 --> 00:12:50,290 they're not exaggerated, 160 00:12:50,290 --> 00:12:51,760 they're not used to manipulate, 161 00:12:51,760 --> 00:12:56,250 they are really experienced and they are distressing in themselves. 162 00:12:56,840 --> 00:13:04,260 But they do help the individual ... kind of shield the individual from having to process in their awareness 163 00:13:04,260 --> 00:13:05,660 such strong emotion. 164 00:13:07,340 --> 00:13:11,560 And it can also include what we call dissociation. 165 00:13:11,940 --> 00:13:17,410 So I feel like I'm not even in my own body right now, 166 00:13:17,420 --> 00:13:22,620 I don't feel like I even know who I am or what's reality and what's not reality. 167 00:13:22,630 --> 00:13:25,550 I don't remember parts of the day, 168 00:13:25,550 --> 00:13:28,090 I feel disconnected from myself. 169 00:13:28,100 --> 00:13:34,790 So this dissociation can also be this form of a freeze state, 170 00:13:34,800 --> 00:13:36,550 a dysregulated state. 171 00:13:38,040 --> 00:13:39,200 So in summary, 172 00:13:39,200 --> 00:13:48,820 I'm talking about regulation as being that centered state that the brain should help us maintain, 173 00:13:48,840 --> 00:13:58,410 its that state where you're just right with alertness, with attention, and with emotional centeredness, 174 00:13:59,040 --> 00:14:03,080 you're not too low and sluggish and out of it, 175 00:14:03,540 --> 00:14:05,090 you're not too high, 176 00:14:05,090 --> 00:14:06,620 being overwhelmed, 177 00:14:06,620 --> 00:14:08,460 restless or agitated, 178 00:14:09,840 --> 00:14:13,420 You're not in a fight, flight, or freeze mode, 179 00:14:13,840 --> 00:14:17,010 you're psychologically present, 180 00:14:17,020 --> 00:14:23,520 You're physically present and you can maintain some sense of centeredness, 181 00:14:23,520 --> 00:14:25,060 you're not overwhelmed. 182 00:14:26,640 --> 00:14:27,040 Now, 183 00:14:27,050 --> 00:14:33,850 every human who lives life has periods with where they are dysregulated. 184 00:14:33,860 --> 00:14:35,750 It's a very human thing, 185 00:14:35,760 --> 00:14:36,320 right? 186 00:14:36,330 --> 00:14:52,450 We're living in a life day to day that is sometimes very difficult to navigate and we'll have periods of times where we lose it or where we go in our room and shut the door or we just freeze. 187 00:14:52,840 --> 00:14:58,170 And that's just a very human thing. For individuals on the spectrum, 188 00:14:58,180 --> 00:15:06,440 that nervous system pathway through the center and the front of the brain is particularly involved for them 189 00:15:06,440 --> 00:15:10,760 and it also is particularly in charge of regulation. 190 00:15:11,240 --> 00:15:26,240 So everyone on the spectrum will have difficulty in some way with getting to a regulated state and they'll probably have seasons of life where that is much more achievable, 191 00:15:26,250 --> 00:15:29,940 but seasons where... if anything gives them trouble, 192 00:15:29,950 --> 00:15:32,550 it very well may be the issue of regulation. 193 00:15:34,840 --> 00:15:40,860 That is why we talk about regulation on this program for Autism in the Adult. 194 00:15:41,240 --> 00:15:49,970 Because oftentimes when people are seeking assistance or they are in pain or there's something that they're struggling with... 195 00:15:49,980 --> 00:15:50,570 Uh, 196 00:15:50,580 --> 00:15:55,960 it very well may be in the area of getting to a regulated state. 197 00:15:58,230 --> 00:15:58,570 Now, 198 00:15:58,570 --> 00:16:06,930 one thing to understand is that the type of dysregulation that the individual shows can be somewhat specific to them. 199 00:16:06,930 --> 00:16:09,470 We kind of have our, 200 00:16:09,480 --> 00:16:12,950 our general ways of handling things. 201 00:16:12,960 --> 00:16:13,480 Um, 202 00:16:13,480 --> 00:16:20,970 and so one thing I recommend is knowing what you as an individual, or this person that you love, 203 00:16:20,980 --> 00:16:30,950 what they lean toward when they're dysregulated, because one thing we want to do is recognize what dysregulation looks like in this person. 204 00:16:32,840 --> 00:16:34,960 So for example, 205 00:16:35,640 --> 00:16:47,590 the person who is exploding and ranting because their usual parking space at work is being used by someone else, 206 00:16:47,600 --> 00:16:56,300 and the person at the entryway to work gave them a hard time because they don't have their badge on, and on the way to work 207 00:16:56,300 --> 00:16:59,660 they couldn't get the gas that they typically like to get... 208 00:17:00,040 --> 00:17:02,690 So they're feeling very uncentered, 209 00:17:02,690 --> 00:17:08,260 They're feeling off, and for this particular person when they're uncentered, 210 00:17:08,260 --> 00:17:11,270 they tend to get elevated. 211 00:17:12,140 --> 00:17:16,490 Um and tend to externalize that stress. 212 00:17:17,940 --> 00:17:19,860 So for this person, 213 00:17:20,240 --> 00:17:22,830 this outburst that they may have, 214 00:17:22,830 --> 00:17:26,560 maybe they come in and they have an outburst toward their colleague or something. 215 00:17:26,940 --> 00:17:32,220 Well that is often nothing to do with the colleague in particular. 216 00:17:32,220 --> 00:17:33,680 It just may be that, 217 00:17:33,690 --> 00:17:34,060 wow, 218 00:17:34,060 --> 00:17:36,050 this is a sign, 219 00:17:36,060 --> 00:17:37,810 this is a clue. 220 00:17:37,820 --> 00:17:40,860 This person is really off center. 221 00:17:40,870 --> 00:17:45,100 They're struggling to feel in that just right state. 222 00:17:45,110 --> 00:17:46,480 And for this person, 223 00:17:46,480 --> 00:17:48,190 when they struggle to feel that way, 224 00:17:48,190 --> 00:17:51,960 it happens to be that it comes out as irritability. 225 00:17:53,740 --> 00:17:58,560 Another person may lean toward quieter reactions. 226 00:17:59,140 --> 00:18:00,930 So this person, 227 00:18:00,940 --> 00:18:06,120 let's say we have another individual who experiences the very same thing, 228 00:18:06,130 --> 00:18:17,590 but this person comes in quietly, walks to their office and shuts the door, and doesn't open their office door as typical. 229 00:18:17,600 --> 00:18:24,080 Uh maybe they're in there for three hours without opening it, when typically they would go get some coffee, 230 00:18:24,080 --> 00:18:26,460 maybe say good morning to their coworkers. 231 00:18:26,840 --> 00:18:27,760 So wow, 232 00:18:27,760 --> 00:18:30,350 they've really retreated and become quiet. 233 00:18:31,840 --> 00:18:45,350 Now the difference between the fight reaction and the flight reaction is that one is very noticeable and everyone around that first person is like, 234 00:18:45,350 --> 00:18:45,780 wow, 235 00:18:45,780 --> 00:18:50,600 stay away from Joe today because he got up on the wrong side of the bed. 236 00:18:50,600 --> 00:18:51,390 He's really, 237 00:18:51,400 --> 00:18:52,860 he's really irritable. 238 00:18:53,540 --> 00:19:03,940 Um Now they may misunderstand the reason for that and they may not like the fact that he is loud and irritable. 239 00:19:03,950 --> 00:19:05,080 So they may not say, 240 00:19:05,090 --> 00:19:07,490 oh he's really in a dysregulated state, 241 00:19:07,490 --> 00:19:08,450 that poor guy. 242 00:19:08,940 --> 00:19:11,940 Um but they do notice it. 243 00:19:11,950 --> 00:19:16,310 They notice he's off center. On the other hand, 244 00:19:16,310 --> 00:19:21,500 for the person who reacts with flight to being dysregulated, 245 00:19:21,510 --> 00:19:23,580 they are often missed, 246 00:19:23,590 --> 00:19:24,250 right? 247 00:19:24,250 --> 00:19:32,550 So they may spend all morning in their office and either nobody will notice or they might misinterpret it and say, 248 00:19:33,420 --> 00:19:33,910 you know, 249 00:19:33,910 --> 00:19:35,350 she's kind of stuck up. 250 00:19:35,360 --> 00:19:37,130 She's just in her own little world. 251 00:19:37,130 --> 00:19:47,160 She doesn't socialize ... when really both the first person and the second person are in a state of dysregulation, 252 00:19:47,160 --> 00:19:49,160 which means that they are struggling. 253 00:19:50,240 --> 00:19:51,460 They're not doing well, 254 00:19:52,840 --> 00:19:58,660 But the quieter one may not be noticed and the louder one may be misunderstood. 255 00:20:02,140 --> 00:20:14,430 Now we also have freeze, of course, and let's say that there's a third individual and they have the exact same thing happen and yet they're walking into work... 256 00:20:14,450 --> 00:20:19,560 and someone asked them a question about a recent project. 257 00:20:19,940 --> 00:20:21,890 They can't think of the details. 258 00:20:21,890 --> 00:20:25,960 They're really feeling shut down and kind of out of their own system. 259 00:20:26,340 --> 00:20:36,770 And they're also realizing that they ... their stomach doesn't feel that well and they are starting to get some chronic pain in their muscles that they're feeling. 260 00:20:37,140 --> 00:20:41,060 Uh they just really don't physically feel well. 261 00:20:41,940 --> 00:20:49,760 Um Now this may be their state of dysregulation... that I'm feeling disconnected. 262 00:20:50,140 --> 00:20:56,160 It's hard to think through things and they may even say it's probably because of my headache. 263 00:20:56,170 --> 00:21:01,860 I can't think clearly because of my headache or my stomach ache and then they may go home for the day. 264 00:21:03,140 --> 00:21:03,760 Again, 265 00:21:03,760 --> 00:21:07,990 this is actually... in this scenario I'm describing... 266 00:21:07,990 --> 00:21:10,890 this is the same thing. 267 00:21:10,890 --> 00:21:12,500 It's dysregulation. 268 00:21:12,760 --> 00:21:24,860 It looks different, but it's the state of having things happen in your day that threw you off center and you're really struggling to know how to get back to center. 269 00:21:25,740 --> 00:21:31,050 And so all three of these people may look very different, 270 00:21:31,320 --> 00:21:33,860 but they're all struggling with dysregulation. 271 00:21:34,210 --> 00:21:43,050 Now one of the interesting things can be... if these people were sent to get help for their dysregulation. 272 00:21:43,740 --> 00:21:57,450 The first one might be sent to anger management training and perhaps he'd be diagnosed with something like bipolar because he has these swings of mood and regulation... 273 00:21:58,140 --> 00:22:13,490 Perhaps the second person goes for help and they coach her on social skills with colleagues and they tell her that as part of her job 274 00:22:13,490 --> 00:22:15,770 she really needs to speak up more, 275 00:22:15,840 --> 00:22:16,750 be a leader, 276 00:22:16,750 --> 00:22:20,340 be more engaged in the social milieu of the office. 277 00:22:20,540 --> 00:22:24,760 And so she's being coached on getting out there and maybe she, 278 00:22:24,770 --> 00:22:26,370 she gets a diagnosis, 279 00:22:26,370 --> 00:22:27,860 if she goes to a clinician, 280 00:22:27,870 --> 00:22:30,280 maybe she gets a diagnosis of anxiety, 281 00:22:30,280 --> 00:22:32,860 generalized anxiety or social anxiety. 282 00:22:34,340 --> 00:22:45,200 The third person goes to get help because they often leave work feeling cloudy in there thinking they have some staring spells, 283 00:22:45,200 --> 00:22:46,320 they feel disconnected, 284 00:22:46,320 --> 00:22:47,770 they feel physically ill. 285 00:22:48,440 --> 00:22:52,860 So they go to the doctor and they get diagnosed with chronic headaches, 286 00:22:52,860 --> 00:22:54,470 maybe fibromyalgia, 287 00:22:54,480 --> 00:23:10,470 maybe um some um digestive sensitivities... and I'm definitely not here to say that nobody has those diagnoses and physical issues and this person may as well... 288 00:23:10,480 --> 00:23:15,270 What I'm saying though is that for this hypothetical individual, 289 00:23:15,280 --> 00:23:16,950 it's just not that simple. 290 00:23:16,960 --> 00:23:32,940 We don't want to miss the internal struggle of it because... if we understood that those physical symptoms in that state of fogginess were at least worsened by some of this dysregulated state, 291 00:23:32,950 --> 00:23:33,240 you know, 292 00:23:33,240 --> 00:23:34,170 that trigger, 293 00:23:34,540 --> 00:23:45,460 we could help much more efficiently without adding medications that may make things worse or extra doctor's appointments or extra stress. 294 00:23:45,940 --> 00:23:46,780 Um, 295 00:23:46,790 --> 00:23:47,600 we could say, 296 00:23:47,600 --> 00:23:47,900 hey, 297 00:23:47,900 --> 00:23:48,590 you know what, 298 00:23:48,590 --> 00:23:51,370 when you are are off center, 299 00:23:51,370 --> 00:23:53,970 when you are stressed and things have gone wrong. 300 00:23:53,980 --> 00:23:58,510 I feel like your system responds in this way, 301 00:23:58,520 --> 00:24:05,590 you know that your stress is expressed through your system and that you feel disconnected. 302 00:24:05,590 --> 00:24:13,860 I'm wondering if we could hypothesize about that and see if there's a more efficient way to get you to feel more centered. 303 00:24:14,840 --> 00:24:18,100 And I bring this up for a couple of reasons. 304 00:24:18,220 --> 00:24:22,160 One is ... dysregulation is common on the spectrum. 305 00:24:23,640 --> 00:24:24,860 Two is, 306 00:24:25,440 --> 00:24:31,870 it can be misunderstood and depending on the type of dysregulation, 307 00:24:31,880 --> 00:24:39,660 it can add diagnoses to a person's list that aren't the most helpful diagnosis. 308 00:24:40,540 --> 00:24:41,090 Um, 309 00:24:41,100 --> 00:24:43,360 often autism isn't on there. 310 00:24:43,940 --> 00:24:44,510 Um, 311 00:24:44,520 --> 00:24:52,080 but there may be this gathering of diagnoses that fit the symptoms in the moment. 312 00:24:52,080 --> 00:24:54,040 Like they fit some characteristic in the moment, 313 00:24:54,040 --> 00:24:58,060 but they missed the big picture of why this person is dysregulated. 314 00:24:58,840 --> 00:24:59,200 You know, 315 00:24:59,200 --> 00:25:03,070 they're dysregulated because the rhythm of their day, 316 00:25:03,070 --> 00:25:18,260 the structure of their day that they depend on as an autistic individual... that that was disrupted and that triggered this dysregulated state and in them it happens to look like fight or flight or freeze. 317 00:25:19,240 --> 00:25:25,660 And so the topic of this podcast then is to introduce you to this concept of regulation. 318 00:25:27,840 --> 00:25:33,620 And when you see yourself or someone you love in a dysregulated state. 319 00:25:33,630 --> 00:25:38,030 And instead of telling them to get it together, 320 00:25:38,040 --> 00:25:39,290 calm down, 321 00:25:39,290 --> 00:25:40,380 get out there, 322 00:25:40,380 --> 00:25:41,360 get over it. 323 00:25:41,740 --> 00:25:42,370 Um, 324 00:25:42,700 --> 00:25:45,060 you can say to yourself, 325 00:25:45,440 --> 00:25:46,110 wow, 326 00:25:46,110 --> 00:25:48,230 this is dysregulation. 327 00:25:48,630 --> 00:25:49,890 I know what this is. 328 00:25:51,040 --> 00:25:52,580 For example, 329 00:25:53,140 --> 00:26:02,730 if my son, who's on the autism spectrum, comes home from school and drops his book bag on the floor and walks past me without saying hello, 330 00:26:02,810 --> 00:26:07,060 lays on the couch and puts a cover over his whole body... over his head. 331 00:26:08,040 --> 00:26:09,220 I could say, 332 00:26:09,230 --> 00:26:10,050 Hey, 333 00:26:10,540 --> 00:26:12,010 you didn't say hi to me. 334 00:26:12,020 --> 00:26:13,630 You threw your stuff on the ground, 335 00:26:13,630 --> 00:26:14,140 which you know, 336 00:26:14,140 --> 00:26:15,300 it doesn't go there! 337 00:26:15,420 --> 00:26:16,740 Come out here and make this 338 00:26:16,740 --> 00:26:17,070 right. 339 00:26:17,080 --> 00:26:18,610 This isn't a hotel for you. 340 00:26:18,610 --> 00:26:20,350 I'm not your maid. 341 00:26:21,340 --> 00:26:24,230 But, if I really wanted to get the best outcome, 342 00:26:24,240 --> 00:26:25,320 I would say, 343 00:26:25,330 --> 00:26:26,110 oh, 344 00:26:26,120 --> 00:26:27,300 I know what this is. 345 00:26:27,300 --> 00:26:29,740 This is a clue to me. 346 00:26:29,750 --> 00:26:30,650 This is data. 347 00:26:30,650 --> 00:26:31,860 This is information. 348 00:26:32,240 --> 00:26:50,200 This is telling me he is dysregulated ... so it's not going to help things for me to punish him for being dysregulated, and it's not going to help me to tell him to get better regulated because he already doesn't know how to do that. 349 00:26:50,200 --> 00:26:51,460 He's already overwhelmed. 350 00:26:52,240 --> 00:26:55,020 What would really help is if I said, 351 00:26:55,640 --> 00:26:56,080 wow, 352 00:26:56,080 --> 00:26:58,500 this is a flight reaction, 353 00:26:58,500 --> 00:26:58,750 right? 354 00:26:58,750 --> 00:26:59,690 He's hiding. 355 00:26:59,700 --> 00:27:00,950 He's withdrawing. 356 00:27:01,340 --> 00:27:02,760 He must have had a bad day. 357 00:27:02,760 --> 00:27:04,590 So then I can go in and say, 358 00:27:04,590 --> 00:27:05,060 hey, 359 00:27:05,540 --> 00:27:07,270 it looks like you had a rough day. 360 00:27:08,040 --> 00:27:16,290 I'm going to give you five minutes, and I'll be back and we can figure out what you need to get more centered. 361 00:27:17,540 --> 00:27:18,800 So number one, 362 00:27:18,810 --> 00:27:20,330 I'm recognizing it, 363 00:27:20,340 --> 00:27:21,460 which is important. 364 00:27:22,240 --> 00:27:22,590 You know, 365 00:27:22,590 --> 00:27:23,850 this isn't bad behavior. 366 00:27:23,850 --> 00:27:25,270 This is dysregulation. 367 00:27:25,840 --> 00:27:33,170 This is someone who is overwhelmed and uncentered and it's expressed as flight in this particular person. 368 00:27:34,640 --> 00:27:43,610 I'm also explaining to him what I see because ... you know when we're overwhelmed, we often don't know what we're feeling, 369 00:27:43,620 --> 00:27:45,510 we're just surviving, 370 00:27:45,510 --> 00:27:46,060 right? 371 00:27:46,540 --> 00:27:48,360 So I'm saying to him, 372 00:27:48,940 --> 00:27:49,550 wow, 373 00:27:49,560 --> 00:27:56,460 it looks like you've had a hard day and you probably need something to get centered. 374 00:27:57,740 --> 00:28:05,150 And then we're also introducing this topic that there are strategies that you could use to help yourself get centered. 375 00:28:05,150 --> 00:28:11,570 Let's figure out what those are and let me partner with you to get centered to get regulated. 376 00:28:12,040 --> 00:28:19,450 So in the future in this series we're going to talk about not only how to recognize it ... which we did today. 377 00:28:20,340 --> 00:28:29,400 We're going to talk about how to prevent episodes of dysregulation or you know lessen them as humans. 378 00:28:29,400 --> 00:28:34,550 We're going to have them but... not to have them so frequent that someone's not functioning well. 379 00:28:35,240 --> 00:28:46,160 How to recover from a dysregulated state, and how to recognize when someone around you is trying to regulate. 380 00:28:46,740 --> 00:28:48,400 Um for example, 381 00:28:48,400 --> 00:28:50,270 my son under the cover, 382 00:28:51,140 --> 00:28:54,300 his being under the cover is him trying to regulate. 383 00:28:55,040 --> 00:28:57,210 So I don't want to punish him for that. 384 00:28:57,220 --> 00:28:59,250 I don't want to chastise him for that. 385 00:28:59,260 --> 00:29:20,330 I want to recognize what that is and then help him have different strategies ...more effective strategies to regulate and to let him know that I come alongside him to do that with him because I also really commit that his well being is important and I'm on his side. 386 00:29:20,490 --> 00:29:21,060 You know, 387 00:29:21,070 --> 00:29:24,360 I want him to feel just right. 388 00:29:26,540 --> 00:29:39,670 I'm glad you joined me for this first episode of 2022 as we dive into this concept of regulation and dysregulation and the role that the nervous system has in helping us be centered. 389 00:29:40,140 --> 00:29:43,900 And I hope you'll check out the links below. 390 00:29:43,900 --> 00:29:46,180 I have the alert program link, 391 00:29:46,190 --> 00:29:52,250 I have the link to the Best Episode of the Testing Psychologist podcast in 2021. 392 00:29:52,260 --> 00:30:04,460 I'm happy, happy to be the number two episode... and I have a link to my upcoming webinar for clinicians about interventions for the autistic client, 393 00:30:04,840 --> 00:30:05,390 um, 394 00:30:05,400 --> 00:30:07,100 across the lifespan. 395 00:30:07,120 --> 00:30:12,460 So I will see you for next episode on how to prevent dysregulation.  

Take a moment to listen again to this holiday episode originally published in 2020. Celebrations may be draining or overwhelming to the individual on the spectrum. A little advanced awareness and planning can make a big difference! Enjoy ~   Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians  

Autism is found at higher than expected rates in those with eating disorders or problematic eating patterns. Join Dr. Regan to hear about this link and why it is important to understand. article: Autism Spectrum Disorders in Eating Disorder Populations. A Systematic Review Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians   article: Autism Spectrum Disorders in Eating Disorder Populations. A Systematic Review

In this episode, hear why repetitive fears about social interactions may chase the autistic individual and learn four strategies for escaping those worries.  Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians

Individuals on the spectrum may have more difficulty than others finding and staying in a "just right" state for activities and tasks. Join Dr. Regan to hear recommendations for keeping momentum without crashing into an exhausted state.  Related Resources Dr. Regan's videos on using sensory input for regulation Dr. Regan's Resources The Understanding Autism book series (paperback, hardback, ebook) Audiobook Autism in the Adult website Resources for Clinicians