Autism in the Adult Recovering from Dysregulation on the Autism Spectrum
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
Book: Understanding Autistic Behaviors
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.