Autism in the Adult

In this podcast, Dr. Regan discusses the misdiagnosis of bipolar disorder and depression in autistic individuals. She explores the overlapping symptoms between mania and autism, as well as the similarities and differences between autism and bipolar disorder. Dr. Regan also highlights the challenges of accurately diagnosing autism and not misattributing symptoms to depression.

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

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

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

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

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

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

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

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

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