Autism in the Adult Shifting Autistic Characteristics Across The Lifespan: The Impact of Aging
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
Dr. Regan's Resources
New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
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Hi everyone,
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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.
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Many of you know,
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already that I am a neuropsychologist,
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I'm a certified autism specialist,
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an author podcast host here at autism in the adult and the founder and director of a diagnostic autism clinic for adolescents,
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adults and aging adults in central Illinois.
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We're going to get into this final episode of our series.
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But before we do that,
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I want to talk to you about our next episode.
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I do have some ideas for topics for more episodes and another series,
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but I'm thinking that what I'd really like to do is to make space for an episode,
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answering your questions or talking about um maybe a particular statement or question or term that you would like some feedback about.
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So I'm either going to do that for the next episode or sometime soon.
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If you do have a question you would like me to cover or something to comment on.
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You can email that to me at my professional email which is adultandgeriatricautism@gmail.com.
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adultandgeriatricautism@gmail.com.
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And I cannot comment on any particular personal issue.
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Like I can't give you personal advice.
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But if you have a general question about what something looks like in autism or an approach people take for a certain situation,
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you can certainly email those questions in.
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I will try to get as many as I can and respond to those in an episode.
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I may not get to all of the questions,
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but I can save them for future episodes.
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If there are questions that really should be a whole episode or series,
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I'll go ahead and save those as well.
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But I hope you will participate and will have kind of a question and answer session for those things that are on your mind.
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So as we round out the final episode in our series,
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those of you who have followed the other episodes,
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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.
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And then I talk about things related to changing life circumstances that as we live life across seasons,
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the things that we are in charge of doing or striving to do these kinds of things shift.
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And we also just talk about the interchange of both the physical shifting and the changes in life circumstances.
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So during adolescence,
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we talked about how we have a lot going on in the physical body.
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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,
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independence and the social environment during pregnancy or menopause for example,
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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,
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more noise,
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more visitors,
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etcetera.
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Today we're going to focus on the life season that has to do with aging.
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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,
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circumstances,
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environments,
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etcetera when it comes to physical changes in the body and in the brain.
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One of the ways that the aging of the body can impact the autistic is with regard to regulation.
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So as we've talked about on other episodes about regulation,
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which is the centering of the individual with alertness with attention and with an emotionally calm and resilient state,
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the autistic often has to be more intentional about how to get sensory inputs to help them feel centered.
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For some people,
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these inputs are involving physical activity.
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So some may have realized that hey,
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I feel the best when I am able to get regular bike rides,
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I get that movement input into the brain,
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that vestibular input.
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And maybe this has even turned into a special interest with owning several bikes,
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with going on bike trips with bicycle enthusiasts and entering biking events like races well,
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when the body ages,
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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,
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which can be a big deal because,
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you know,
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perhaps life has revolved a lot around this hobby,
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but also I'm not able to get the appropriate receptive input,
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that pressure in the joints when you're pedaling the bike and the vestibular input into the brain.
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That's that movement input.
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And the combination of those two things really helped someone.
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Let's say that these are the things that their nervous system needed.
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These pressure and movement inputs have helped the person get momentum for daily activities.
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If you haven't listened to this series yet on daily activities and getting momentum,
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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.
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So for the individual who experiences this real benefit from bike riding,
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aging can present this dilemma of how can I fill this void.
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And a lot of people experience this kind of need to shift with aging where oh,
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I can't do the same physical things that I have always done and enjoyed.
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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,
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you know,
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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,
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for example,
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and that there's a void that the person may need to get creative to fill.
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So the ideal situation would be that the person has the self awareness.
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That hey,
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the reason that I love this in part is because my system really benefits from movement or it really benefits from pressure,
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input,
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pressure through my joints,
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pressure into the muscles.
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If the person is self aware about the role that bike riding plays for them,
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but they can't bike bike ride anymore,
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then they can start to think how else can I get pressure input,
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How else can I get movement input?
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So they may need to think about more forgiving ways to get their system,
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this type of thing that they need.
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Someone could get pressure and movement input by laying in a hammock.
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So they have pressure all along their back,
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all from the tips of their toes up to their neck,
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and their shoulders in their head and some movement rocking back and forth.
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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.
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It's not something that we automatically think of,
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but it takes this awareness, this intentionality to it doesn't it?
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Someone else might try yoga to get pressure in their joints.
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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.
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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.
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You may have to have some creativity about how else can I get my system,
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what it needs with regard to sensory inputs to feel just right,
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this is similar to other life seasons for example,
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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)
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Class,
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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,
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that movement and pressure played a role in centering and helping this person get going,
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helping them calm down when they were too elevated.
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You know,
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without that self awareness,
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they won't be able to shift.
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So this is not only something that happens in a later life season,
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but it often is part of that shifting mindset of what do I need and how can I get that now?
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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,
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but the brain is also an organ that's going to be aging.
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Even for people who age really well,
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there will be age related changes in the brain as humans.
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We just all are going to experience that change as related to aging.
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One of the things that happens with the aging of the brain is a slowing of thought process,
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a difficulty with the efficiency of recalling information,
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that's the tip of the tongue phenomenon,
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or I forget the name of this thing or this person or I can't remember why I walked into this room.
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These changes have a lot to do with the center of the brain and its connections with the front of the brain.
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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.
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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,
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they also get smaller and smaller and in the center of the brain they end up being very small.
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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.
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So we can start to have more problems with the thinking skills related to this area.
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And these skills that are related to that area often fall within the domain of executive function skills.
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Well,
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everyone on the spectrum will have some challenge in the area of executive function already more so than the neuro typical individual will.
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I'm planning on doing a series on executive function in the future.
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But if you would like a really good resource to look at now,
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I look the book series called smart but scattered,
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there are also lots of other books and resources out there.
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An executive function and you're welcome to choose one that fits your needs in short,
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executive function includes lots of brain skills like planning ahead,
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understanding what is most and least important.
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Thinking quickly getting started with the task finishing multiple steps of a task handling multiple things coming at you in succession.
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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.
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What we typically see with aging is that these areas of executive function,
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they become more difficult because executive function abilities impact thinking skills like attention,
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mental organization as well as behavior patterns like getting started with the task.
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The individual may show shifts in these areas.
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So the shifts are related to aging alone,
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although it's aging within an area of your ability that was already sensitive or already weak.
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So sometimes what happens is that we do see some increased difficulty with executive function in the autistic,
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more so than for the neurotypical,
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although everyone who's aging will experience more difficulty in that area than they did in their twenties,
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for example,
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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,
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which is only just impacted by age that there's no um separate disease process that we would call a dementia.
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When I'm talking about dementia,
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I'm talking about the presence of changes in the cells that advance.
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So there's a degeneration that's part of a disease process itself.
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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.
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If you look through the literature,
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there really are not good statistics about how frequently dementia occurs in autism,
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particularly.
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The reason for this is that we have not captured autism in adults and aging adults enough to actually look at this.
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Um,
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so I can only tell you what my personal experience has been in my own experience in seeing people from the dementia clinic.
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Seeing people who are aging,
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I don't tend to think that there's any increased risk of a disease process that we would call dementia.
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Um,
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I haven't seen this.
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I have seen people present with concerns that perhaps there is a dementia or disease process.
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And after assessing this,
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it seems to be that this is part of the aging process and not a separate disease process.
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This is not to say that they aren't noticing differences in their home environment.
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Executive function certainly does impact day to day life.
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So someone may be having more difficulty getting started with tasks,
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taking care of themselves,
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really engaging in life being active in what they're needing to get done during the day.
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This may be a feature that the autistic experiences or expresses during the aging process,
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but again,
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we don't even know how typical that is.
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So all the people that I see are patients who are presenting because they're experiencing some difficulty.
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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,
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um,
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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.
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One of the recommendations for the autistic individual is to focus on living a healthy lifestyle.
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So this is a good recommendation for anyone,
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of course,
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but anything that helps the health of the blood vessels will be likely supportive during aging.
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And that's true for all of us.
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Um,
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but especially if a person has a weakness and executive function already,
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um,
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they may really want to focus on that even more intentionally.
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So watching things like cholesterol,
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high blood pressure,
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diabetes,
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these are all things that can stress the blood vessel systems.
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And although we can't stop the impact of aging on the blood vessels,
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there are probably choices that we can make to just help support the health of the vessels.
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And of course this does not constitute medical advice for anyone.
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I really encourage you to engage with your doctors about what would be healthy for you.
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But certainly if you want to give your body what it needs to age well,
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um things like healthy diet and movement and exercise and sleep.
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These are all things that may support your body as you age.
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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,
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one of the things I want to talk about is that there's often less built in structure to our life during that season,
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because people often are either cutting down on the number of hours they're working or they've retired,
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their kids aren't living at home anymore,
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they have an empty nest,
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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,
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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,
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can mean that it's harder for them to get momentum for activities.
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The autistic who lean toward anxiety or wanting to know what the day would likely bring benefited from structure because it felt supportive,
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in contrast,
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the autistic who had trouble with momentum,
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like I feel lazy,
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I feel like I just can't get going,
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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,
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this group of people on the spectrum find it really challenging to find an internal source of momentum.
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Um they often struggle to say,
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oh I can plan my day this way or these are things that need to get done.
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Even issues of self care may kind of be put on the back burner,
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like,
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oh,
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I used to take a shower before work every day,
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but now I don't have to work.
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So can they have this internal momentum towards self care?
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Some would say they used to shower and eat breakfast and take medication as part of their morning routine,
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but if they're not even leaving the house,
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the morning routine doesn't get done as consistently,
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so pretty soon doing one activity can really feel demanding,
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like,
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oh,
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I can't get groceries today because I'm also getting a haircut,
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whereas before,
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when our day was so scheduled,
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we had this just internal momentum and we didn't have to get our energy up to do something.
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One thing for the individual to consider then is their need to make an artificial structure during retirement.
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Some people may wish to volunteer or have other reasons to leave the house on a particular schedule.
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They may make a list of life areas that they want to attend to every week.
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So one person may say,
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I really benefit from saying I want to learn something new every week.
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I want to see a friend every week I exercise on the schedule.
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I do chores on this schedule in having a schedule or a structure helps them stay engaged in life,
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helps them have momentum for what needs to get done in order to have really a balanced and healthy lifestyle.
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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,
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even though there's less engagement with the external world.
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In some respects,
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there's increasing demand to engage in self care to visit and communicate with physicians and to change all of a sudden,
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people are telling you to change your lifestyle what you eat or drink what medicines you take,
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instructions to change or shift gears can feel really demanding,
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and sometimes the individual may kind of bow out of the whole process and say,
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I'm just not going to do this.
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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,
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Maybe they're more likely to pick their battles,
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so to speak.
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So,
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understanding how hard it is for the person to engage with people to shift what they're eating.
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For example,
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you know,
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if somebody has lived on pasta because that's all they can tolerate with regard to texture,
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um,
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you know,
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harping on and um talking again and again about vegetables may not be the battle that they want to have for this person.
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So,
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there can be both this increased environmental demand in the sense of medical issues.
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Doctors waiting rooms calling people asking questions.
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Um,
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but there's also this decreased environmental structure that previously may have been supportive,
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like,
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oh,
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I know what I do next.
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This helps me get out of the house,
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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.
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As you can see,
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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,
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how they're experienced by the individual and also how they are expressed.
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So how other people see that this person is doing A spouse may say,
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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.
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So is this a dementia,
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what's happening?
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And sometimes it's just the total lack of structure that's,
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you know,
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all these this momentum has been taken and we can see that the autistic characteristics that have always been there are expressed differently.
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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.
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So how else can I get sensory inputs?
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How else can I create structure and momentum?
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How can I communicate with my doctors?
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That a lot of change is really,
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really impossible for me.
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It's just I just,
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I have a limit on how much I can change and maintain over time.
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Let's be intentional about how we enter certain life seasons and also support each other during their life seasons.
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Thank you so much for joining me for this series and how autistic characteristics can shift over life seasons.
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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