Regulation for Autism in the Adult

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

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Welcome to autism in the adult podcast.

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I'm your host,

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Dr Theresa Regan,

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an adult neuropsychologist.

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I specialize in brain behavior relationships for those 14 and older.

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I'm the parent of an amazing teen on the autism spectrum and a certified autism specialist.

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I am deeply grateful to bring validation,

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hope and purpose to individuals and their families living on the autism spectrum.

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With this mission at its core,

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I founded and currently direct the OsF healthcare adult diagnostic autism center in central Illinois.

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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.

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Please join me in helping individuals,

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couples and families thrive while living life on the autism spectrum.

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Hello and welcome to this episode of Autism in the Adult.

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And I'm glad you joined me for this first episode of 2022.

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I just want to highlight a few things that have gone on recently.

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I was happy to be named in the episode Best Of for 2021 that The Testing Psychologist produces.

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This is a podcast by Dr.

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Jeremy Sharp

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talking about issues related to assessment in psychology, and my episode in august Identifying Adult Autism was the second downloaded episode of the season.

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So,

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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.

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So,

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I was happy about that.

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I'll put the link below if you or someone you know

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would like to learn more about assessment.

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This episode of the testing psychologist was produced for clinicians.

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So people who are trying to understand how to assess and evaluate autistic characteristics in their clients.

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I also have an exciting opportunity for clinicians coming up in February on the 26th of 2022.

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This is a two hour live interactive webinar with Zur Institute.

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And again,

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I'll put the link below.

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This is entitled Autism Spectrum Disorder: Interventions Across the Lifespan.

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So not everyone on the spectrum will need support or intervention at all seasons of life.

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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.

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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.

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So that's February 26,

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2022.

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And I'll go ahead and put that link below.

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Today's topic is dysregulation.

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I envision this to be the first episode in a four part series.

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And so today we're going to talk about what this regulation is and

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how to recognize it.

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In the next episode of the series,

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we're going to talk about how to reduce the amount of dysregulation that someone experiences.

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The third episode will be how to recover from dysregulation.

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The fourth will be how can you recognize when someone is trying to regulate.

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So someone around us maybe trying to regulate,

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and we may criticize them or ask them to stop it,

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but there would be other,

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more impactful ways to get a good outcome.

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You'll understand more about what I mean

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when we start to talk about this thing called regulation and dysregulation,

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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.

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Can we wake up in the morning?

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Can we calm down and fall asleep at night?

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That's kind of our ... the tone of our alertness,

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our brain helps us with that.

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We also have this attention regulation.

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So our brain is supposed to help us focus on what's most important and just release and let go

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things that are no longer important or uh you know... if the information in our environment has changed.

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So we need to switch gears and attend to something else... so our brain helps us regulate alertness and attention.

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So when we talk about these two aspects of regulation (alertness and attention),

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there is an analogy that is commonly used with the occupational therapists that often try to help people learn how to regulate better.

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And that analogy is "how is your motor running today?"

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So if your motor is running sluggish,

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you are tired,

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you may describe yourself as feeling lazy,

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unmotivated.

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I can't get going,

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I feel sleepy.

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I'm just a bump on a log ... that is when your motor is running too low.

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Your motor can also sometimes run too high.

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It's revved up and it's not in that just right state.

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And a motor that's too high will be someone who is hyper, restless,

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angry,

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agitated,

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anxious,

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that extra alertness that we just don't need all the time.

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This high level of alertness.

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Um that is the motor that is running too high, and we would like our motor to be running just right.

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The Alert Program is one program you might want to investigate.

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It's run by occupational therapists who are very experienced in regulation strategies.

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And I have a link to the alert program below.

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Now,

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they train occupational therapists in strategies to help others.

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But they also have a new online program called Your Best Self that people can investigate to figure out regulation strategies for themselves.

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Now,

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we've talked about alertness and attention.

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There's also this area of emotional regulation.

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So when we have a strong emotion,

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our brain should help us make sense of it.

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Our brain should help us center it and help it be present in our mind that we're aware of it,

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but it's not overwhelming,

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it doesn't hijack us,

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it doesn't take control of us,

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It doesn't hurt other people.

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And that would be regulation or dysregulation of emotional experiences.

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When we talk about a dysregulated state in the area of emotions,

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we can talk about a fight reaction,

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flight reactions or freeze reactions.

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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.

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And what I mean by that is I would include meltdowns in this category.

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I would include outbursts,

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crying spells.

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I even include, even though it's not fight,

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but I'd like to capture all the externalized reactions in this category.

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That I am going to argue with you.

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I am going to explode.

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And you can picture this volcano,

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right?

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that is just to the point of being uncontained and out comes

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this spewing of tears or yelling or throwing things... so that is the externalized sign of a dysregulated state.

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In the area of emotions,

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flight is another reaction that someone could have when they are dysregulated.

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This could look like ... I'm going to walk away from you and quit this conversation.

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I'm going to spend all day in my room doing things I enjoy but not interacting with you.

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I'm going to quit school and do home schooling.

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I'm going to quit this job.

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I'm going to quit this relationship because it's so up and down.

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It's like a roller coaster.

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It's just too intense for me.

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It's too unpredictable.

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I have to quit this,

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I have to escape,

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I have to withdraw. Then there are freeze reactions.

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So this is the time when you're physically present,

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but you're not psychologically present,

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that your brain shuts down,

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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,

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someone may say,

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you know,

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I hear what you're saying,

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but my mind is blank and I don't know what to respond.

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That's a freeze reaction.

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So it signals that the person is dysregulated.

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They're having difficulty being fully present in the midst of the strong emotion.

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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.

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And so the body says,

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hey,

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I will help you escape from this really difficult emotion.

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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.

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I'll just process that stress right through the physical system in these cases,

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the symptom which could be a staring spell.

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It could be something that looks like an electrical seizure,

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but it's really not.

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It could be something like a loss of memory for chunks of time or days or weeks,

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it could be a weakness where the person feels like their limbs are weak or paralyzed.

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So it could be a variety of things like that.

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Physical systems also could include issues of pain,

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issues of stomach distress,

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headaches,

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so lots of different things.

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Lots of different physical systems can process stress for us.

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And these symptoms,

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these physical expressions are real.

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They are not produced by the individual,

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They're not feigned,

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they're not exaggerated,

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they're not used to manipulate,

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they are really experienced and they are distressing in themselves.

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But they do help the individual ... kind of shield the individual from having to process in their awareness

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such strong emotion.

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And it can also include what we call dissociation.

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So I feel like I'm not even in my own body right now,

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I don't feel like I even know who I am or what's reality and what's not reality.

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I don't remember parts of the day,

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I feel disconnected from myself.

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So this dissociation can also be this form of a freeze state,

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a dysregulated state.

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So in summary,

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I'm talking about regulation as being that centered state that the brain should help us maintain,

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its that state where you're just right with alertness, with attention, and with emotional centeredness,

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you're not too low and sluggish and out of it,

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you're not too high,

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being overwhelmed,

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restless or agitated,

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You're not in a fight, flight, or freeze mode,

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you're psychologically present,

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You're physically present and you can maintain some sense of centeredness,

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you're not overwhelmed.

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Now,

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every human who lives life has periods with where they are dysregulated.

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It's a very human thing,

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right?

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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.

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And that's just a very human thing. For individuals on the spectrum,

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that nervous system pathway through the center and the front of the brain is particularly involved for them

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and it also is particularly in charge of regulation.

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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,

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but seasons where... if anything gives them trouble,

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it very well may be the issue of regulation.

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That is why we talk about regulation on this program for Autism in the Adult.

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Because oftentimes when people are seeking assistance or they are in pain or there's something that they're struggling with...

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Uh,

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it very well may be in the area of getting to a regulated state.

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Now,

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one thing to understand is that the type of dysregulation that the individual shows can be somewhat specific to them.

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We kind of have our,

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our general ways of handling things.

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Um,

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and so one thing I recommend is knowing what you as an individual, or this person that you love,

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what they lean toward when they're dysregulated, because one thing we want to do is recognize what dysregulation looks like in this person.

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So for example,

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the person who is exploding and ranting because their usual parking space at work is being used by someone else,

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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

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they couldn't get the gas that they typically like to get...

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So they're feeling very uncentered,

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They're feeling off, and for this particular person when they're uncentered,

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they tend to get elevated.

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Um and tend to externalize that stress.

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So for this person,

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this outburst that they may have,

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maybe they come in and they have an outburst toward their colleague or something.

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Well that is often nothing to do with the colleague in particular.

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It just may be that,

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wow,

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this is a sign,

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this is a clue.

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This person is really off center.

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They're struggling to feel in that just right state.

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And for this person,

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when they struggle to feel that way,

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it happens to be that it comes out as irritability.

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Another person may lean toward quieter reactions.

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So this person,

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let's say we have another individual who experiences the very same thing,

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but this person comes in quietly, walks to their office and shuts the door, and doesn't open their office door as typical.

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Uh maybe they're in there for three hours without opening it, when typically they would go get some coffee,

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maybe say good morning to their coworkers.

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So wow,

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they've really retreated and become quiet.

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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,

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wow,

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stay away from Joe today because he got up on the wrong side of the bed.

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He's really,

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he's really irritable.

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Um Now they may misunderstand the reason for that and they may not like the fact that he is loud and irritable.

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So they may not say,

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oh he's really in a dysregulated state,

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that poor guy.

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Um but they do notice it.

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They notice he's off center. On the other hand,

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for the person who reacts with flight to being dysregulated,

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they are often missed,

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right?

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So they may spend all morning in their office and either nobody will notice or they might misinterpret it and say,

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you know,

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she's kind of stuck up.

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She's just in her own little world.

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She doesn't socialize ... when really both the first person and the second person are in a state of dysregulation,

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which means that they are struggling.

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They're not doing well,

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But the quieter one may not be noticed and the louder one may be misunderstood.

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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...

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and someone asked them a question about a recent project.

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They can't think of the details.

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They're really feeling shut down and kind of out of their own system.

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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.

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Uh they just really don't physically feel well.

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Um Now this may be their state of dysregulation... that I'm feeling disconnected.

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It's hard to think through things and they may even say it's probably because of my headache.

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I can't think clearly because of my headache or my stomach ache and then they may go home for the day.

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Again,

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this is actually... in this scenario I'm describing...

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this is the same thing.

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It's dysregulation.

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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.

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And so all three of these people may look very different,

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but they're all struggling with dysregulation.

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Now one of the interesting things can be... if these people were sent to get help for their dysregulation.

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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...

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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

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she really needs to speak up more,

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be a leader,

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be more engaged in the social milieu of the office.

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And so she's being coached on getting out there and maybe she,

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she gets a diagnosis,

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if she goes to a clinician,

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maybe she gets a diagnosis of anxiety,

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generalized anxiety or social anxiety.
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The third person goes to get help because they often leave work feeling cloudy in there thinking they have some staring spells,

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they feel disconnected,

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they feel physically ill.

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So they go to the doctor and they get diagnosed with chronic headaches,

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maybe fibromyalgia,

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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...

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What I'm saying though is that for this hypothetical individual,

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it's just not that simple.

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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,

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you know,

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that trigger,

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we could help much more efficiently without adding medications that may make things worse or extra doctor's appointments or extra stress.

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Um,

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we could say,

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hey,

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you know what,

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when you are are off center,

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when you are stressed and things have gone wrong.

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I feel like your system responds in this way,

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you know that your stress is expressed through your system and that you feel disconnected.

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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.

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And I bring this up for a couple of reasons.

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One is ... dysregulation is common on the spectrum.

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Two is,

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it can be misunderstood and depending on the type of dysregulation,

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it can add diagnoses to a person's list that aren't the most helpful diagnosis.

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Um,

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often autism isn't on there.

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Um,

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but there may be this gathering of diagnoses that fit the symptoms in the moment.

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Like they fit some characteristic in the moment,

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but they missed the big picture of why this person is dysregulated.

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You know,

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they're dysregulated because the rhythm of their day,

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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.

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And so the topic of this podcast then is to introduce you to this concept of regulation.

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And when you see yourself or someone you love in a dysregulated state.

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And instead of telling them to get it together,

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calm down,

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get out there,

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get over it.

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Um,

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you can say to yourself,

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wow,

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this is dysregulation.

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I know what this is.

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For example,

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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,

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lays on the couch and puts a cover over his whole body... over his head.

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I could say,

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Hey,

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you didn't say hi to me.

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You threw your stuff on the ground,

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which you know,

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it doesn't go there!

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Come out here and make this

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right.

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This isn't a hotel for you.

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I'm not your maid.

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But, if I really wanted to get the best outcome,

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I would say,

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oh,

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I know what this is.

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This is a clue to me.

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This is data.

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This is information.

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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.

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He's already overwhelmed.

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What would really help is if I said,

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wow,

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this is a flight reaction,

353
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right?

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He's hiding.

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He's withdrawing.

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He must have had a bad day.

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So then I can go in and say,

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hey,

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it looks like you had a rough day.

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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.

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So number one,

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I'm recognizing it,

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which is important.

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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
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This is dysregulation.

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This is someone who is overwhelmed and uncentered and it's expressed as flight in this particular person.

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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
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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,

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wow,

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it looks like you've had a hard day and you probably need something to get centered.

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And then we're also introducing this topic that there are strategies that you could use to help yourself get centered.

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Let's figure out what those are and let me partner with you to get centered to get regulated.

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So in the future in this series we're going to talk about not only how to recognize it ... which we did today.

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We're going to talk about how to prevent episodes of dysregulation or you know lessen them as humans.

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We're going to have them but... not to have them so frequent that someone's not functioning well.

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How to recover from a dysregulated state, and how to recognize when someone around you is trying to regulate.

380
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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.

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And I hope you'll check out the links below.

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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.

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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,

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00:30:04,840 --> 00:30:05,390
um,

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across the lifespan.

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So I will see you for next episode on how to prevent dysregulation.