Autism in the Adult

Autism and Intentional Living: Using Sensory Inputs to Improve Regulation

Want to live with more intention in order to achieve your goals? You may wish to start with steps to improve your core resilience so you can challenge yourself in other life areas. In this third episode in a series on intentional living, Dr. Regan identifies ways to improve resilience by using physical inputs to calm and center the nervous system. 
 
As referenced in the current episode: 
Dr. Regan's Zur Institute courses for clinicians
Autism in the Adult regulation series- episode one
The Alert Program
The Alert Program: Your Best Self Online Course
 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
 
Read the transcript here:
100:00:05,710 --> 00:00:06,119Hi,
200:00:06,130 --> 00:00:06,800everyone.
300:00:06,809 --> 00:00:11,319This is Dr Regan, host of the podcast Autism in the Adult.
400:00:11,539 --> 00:00:13,239I'm a neuropsychologist,
500:00:13,250 --> 00:00:17,729a certified autism specialist and mom to a teen on the spectrum.
600:00:18,149 --> 00:00:25,360It's my great pleasure to direct an autism diagnostic clinic in Central Illinois for adolescents,
700:00:25,370 --> 00:00:27,360adults and aging adults.
800:00:27,790 --> 00:00:32,139If you are a clinician wanting to increase your knowledge of autism,
900:00:32,150 --> 00:00:34,259in order to better serve your clients,
1000:00:34,490 --> 00:00:38,250you may want to check out my courses at Zur Institute,
1100:00:38,349 --> 00:00:40,409Z U R Institute.
1200:00:40,759 --> 00:00:44,880The links will be in the show notes for this podcast episode.
1300:00:45,520 --> 00:00:48,130If you're a regular follower of the podcast,
1400:00:48,139 --> 00:00:54,569you will know that we are in the third episode in a series about living with intention on the spectrum.
1500:00:55,400 --> 00:01:00,009I would encourage you to listen to the first two episodes to get the most information.
1600:01:00,139 --> 00:01:03,849Although this episode can be stand alone as well.
1700:01:04,300 --> 00:01:04,750Today,
1800:01:04,760 --> 00:01:10,569we'll be talking about a goal within the area of health and wellness and specifically,
1900:01:10,580 --> 00:01:16,230we're going to focus on improving regulation using sensory inputs.
2000:01:16,389 --> 00:01:16,699Now,
2100:01:16,709 --> 00:01:21,449I have several other episodes about regulation and I'll link them in the show notes,
2200:01:21,900 --> 00:01:33,330but in short regulation refers to the ability to stay centered balanced to get that just right state to be both calm and attentive.
2300:01:33,339 --> 00:01:34,349At the same time,
2400:01:35,419 --> 00:01:38,050this regulation can look like a meltdown,
2500:01:38,059 --> 00:01:39,209a panic attack,
2600:01:39,220 --> 00:01:44,309an outburst or it could look like withdrawal from a place or activity.
2700:01:44,319 --> 00:01:45,230For example,
2800:01:45,239 --> 00:01:50,510I need to quit this conversation or I need to go to my room off by myself.
2900:01:50,519 --> 00:01:52,180I can't attend work today.
3000:01:52,190 --> 00:01:53,519I can't go to school.
3100:01:54,300 --> 00:01:56,809It can also look like freeze,
3200:01:57,209 --> 00:02:01,470like shutting down feeling offline or dissociating.
3300:02:02,309 --> 00:02:03,080And finally,
3400:02:03,089 --> 00:02:13,020disregulation can look like the experience of physical symptoms that are not rooted or at least not completely caused by a physical condition,
3500:02:13,250 --> 00:02:15,520injury or disease process.
3600:02:16,020 --> 00:02:21,479Individuals on the spectrum are more likely to struggle with dysregulation in some form.
3700:02:21,789 --> 00:02:30,639Although what the dysregulation looks like can be different from one person to the next and can also change over the lifespan of the individual.
3800:02:30,649 --> 00:02:52,699So we can see how important the wellness topic of regulation is and why we're talking about regulation as a goal first because for some people on the spectrum regulation needs to improve before they can experience enough resiliency to get out of their comfort zone in other areas of life,
3900:02:52,710 --> 00:02:58,130like relationships or working or other areas that we've discussed in the series.
4000:02:58,139 --> 00:02:58,860So far,
4100:02:59,470 --> 00:03:08,910the tricky thing is that there are often more limitations to the success of regulation strategies on the spectrum than for the neurotypical.
4200:03:09,089 --> 00:03:17,360And the go to strategies are often some combination of counseling or talking through the difficulty,
4300:03:17,369 --> 00:03:20,089maybe reasoning through problems,
4400:03:20,339 --> 00:03:27,479we might add medication for the support of regulation or use punishment and reward programs.
4500:03:28,350 --> 00:03:38,270It's not that there's anything wrong with these approaches and they can be helpful as part of a layer in an overall program to help with regulation.
4600:03:38,279 --> 00:03:39,470However,
4700:03:39,750 --> 00:03:42,919if these are the only approaches we're relying on,
4800:03:42,970 --> 00:03:46,100there are likely to be some pretty big limitations.
4900:03:47,050 --> 00:03:49,550So let's think about how the nervous system works.
5000:03:49,559 --> 00:03:52,699If an infant is screaming,
5100:03:52,710 --> 00:03:54,500relentlessly crying,
5200:03:54,509 --> 00:03:55,500very upset,
5300:03:55,509 --> 00:03:57,029can't calm down.
5400:03:57,320 --> 00:03:58,039In other words,
5500:03:58,050 --> 00:03:59,660they can't regulate.
5600:04:00,460 --> 00:04:05,610We don't try to reason with them about how they're completely safe.
5700:04:05,619 --> 00:04:07,509They've just been fed,
5800:04:07,520 --> 00:04:12,589they're not in any danger or that their crying is really too loud.
5900:04:12,600 --> 00:04:13,869It's bedtime.
6000:04:14,690 --> 00:04:17,260We don't go reasoning through all that.
6100:04:17,998 --> 00:04:23,368We don't give them medication for depression or for anxiety.
6200:04:23,959 --> 00:04:28,348We don't use rewards or punishments in the traditional sense.
6300:04:28,799 --> 00:04:29,239Again,
6400:04:29,248 --> 00:04:31,928it's not that I don't recommend these approaches.
6500:04:31,938 --> 00:04:34,588I think they can be very helpful at times.
6600:04:34,598 --> 00:04:40,098But I'm pointing out that there is another way for humans to regulate their nervous system.
6700:04:40,378 --> 00:04:43,428And if you picture what we do for the infant,
6800:04:44,070 --> 00:04:46,149we hold them.
6900:04:46,359 --> 00:05:02,649Sometimes we swaddle the infant in a blanket and the holding or swaddling gives them pressure inputs that gives them this snug hug and then what do we do?
7000:05:02,660 --> 00:05:02,920Well,
7100:05:02,929 --> 00:05:09,059typically we rack them and this gives their brain some movement to input.
7200:05:10,410 --> 00:05:13,260This isn't always a magic way of calming an infant.
7300:05:13,269 --> 00:05:18,619But it often helps quite a bit as an approach to help the infant regulate,
7400:05:18,630 --> 00:05:19,820to center,
7500:05:19,920 --> 00:05:21,470to feel calm.
7600:05:21,630 --> 00:05:26,179Because the infant relies on the adult for regulation.
7700:05:26,730 --> 00:05:29,140This approach of using pressure,
7800:05:29,420 --> 00:05:34,540which we call proprioceptive inputs and movement.
7900:05:34,579 --> 00:05:35,579In this case,
8000:05:35,589 --> 00:05:38,799I'm talking about vestibular inputs.
8100:05:39,170 --> 00:05:48,589This approach of getting these inputs into the nervous system helps people of all ages and with all variations of nervous connections,
8200:05:48,600 --> 00:05:49,859nervous systems,
8300:05:50,410 --> 00:05:53,359uh whether you are neurotypical,
8400:05:53,369 --> 00:05:55,850whether you are neuro diverse,
8500:05:55,859 --> 00:05:57,380it doesn't matter we do.
8600:05:57,390 --> 00:05:59,890This is how our nervous system works.
8700:06:00,049 --> 00:06:08,470That's why therapists working with little kids on regulation may have them do heavy work like carrying or pushing something heavy.
8800:06:08,690 --> 00:06:10,679That's for the pressure input.
8900:06:11,630 --> 00:06:15,489It's why some individuals like weighted blankets for calming,
9000:06:15,750 --> 00:06:17,679that's pressure as well.
9100:06:18,480 --> 00:06:22,820Other individuals like to ride their bike after work or go jogging.
9200:06:22,970 --> 00:06:23,279Well,
9300:06:23,290 --> 00:06:25,179that's movement input.
9400:06:25,290 --> 00:06:34,579So we all tap into some of these inputs without really realizing why we like them or what role they have in helping us feel centered.
9500:06:34,790 --> 00:06:35,309Today,
9600:06:35,320 --> 00:06:47,570we'll focus on increasing your awareness of what your nervous system may need as far as physical inputs to help with regulation as well as how and when to use them.
9700:06:48,450 --> 00:06:58,929One place to start can be to think about what you have historically been drawn to perhaps as a child or in school or most recently,
9800:06:59,600 --> 00:07:03,250you can get pressure in the muscles or the joints,
9900:07:03,260 --> 00:07:11,390proprioceptive inputs into the brain pressure in the muscles could be from a massage or laying in a hammock.
10000:07:11,399 --> 00:07:13,579You get that squeeze input,
10100:07:14,049 --> 00:07:16,429laying under a weighted blanket,
10200:07:16,779 --> 00:07:20,070draping over an exercise ball,
10300:07:20,679 --> 00:07:22,609curling up in a chair.
10400:07:22,619 --> 00:07:25,950When we say I just want to curl up and read a good book.
10500:07:26,320 --> 00:07:28,140That's when we're giving ourselves,
10600:07:28,149 --> 00:07:43,269that kind of squeeze input being in the fetal position helps us have that squeeze hugs or bear hugs can give us that input laying on the ground or flapping on the ground.
10700:07:43,869 --> 00:07:48,160Pressure into the joints could be from things like pushing,
10800:07:48,190 --> 00:07:49,000pulling,
10900:07:49,010 --> 00:07:49,950hanging,
11000:07:50,329 --> 00:07:54,200anything that offers resistance through the joints,
11100:07:54,829 --> 00:07:56,970hanging from a pull up bar,
11200:07:56,980 --> 00:07:58,559shoveling snow,
11300:07:58,709 --> 00:07:59,750swimming,
11400:08:00,019 --> 00:08:03,670stretching a Farrah band or resistance band,
11500:08:04,079 --> 00:08:08,959riding a bike pressure through the jaw by chewing,
11600:08:08,970 --> 00:08:14,140resistive foods can also be pressure input for the nervous system.
11700:08:14,459 --> 00:08:29,549Maybe somebody loves to attack some beef jerky or crunchy food or chew gum pressure through the hands or feet by using a stress ball or rolling your foot over a tennis ball.
11800:08:30,959 --> 00:08:34,729You'll get the most input for the nervous system.
11900:08:34,770 --> 00:08:37,530When you're doing whole body activities,
12000:08:37,539 --> 00:08:40,890then when you're using the jaw or hands and feet,
12100:08:41,119 --> 00:08:44,390but we can't always do whole body activities.
12200:08:44,789 --> 00:08:56,200Maybe we're in a classroom and all we can do is have some gum that we're gonna chew on and maybe squeeze a stress ball under the desk movement.
12300:08:56,210 --> 00:09:02,099Input like the rocking baby gives vestibular input into the brain,
12400:09:02,789 --> 00:09:08,140the brain does not get vestibular input when we move our arms and legs,
12500:09:08,150 --> 00:09:10,619but we stand or sit still.
12600:09:11,049 --> 00:09:13,049There's no vestibular input.
12700:09:13,059 --> 00:09:14,479When we're on a treadmill,
12800:09:14,489 --> 00:09:15,590for example,
12900:09:15,880 --> 00:09:18,700or we're using a stationary bike,
13000:09:19,299 --> 00:09:22,369the fluid in our ears has to be moving.
13100:09:22,559 --> 00:09:24,739So when we're moving through space,
13200:09:24,750 --> 00:09:26,719like running through the neighborhood,
13300:09:26,729 --> 00:09:29,450swinging or riding a bike outside,
13400:09:29,530 --> 00:09:32,059then we're getting vestibular input.
13500:09:32,849 --> 00:09:34,700So those who say,
13600:09:34,710 --> 00:09:34,900oh,
13700:09:34,909 --> 00:09:36,539I love riding my bike,
13800:09:36,549 --> 00:09:39,349but I will not ride a stationary bike.
13900:09:39,520 --> 00:09:44,690What they may be saying is that their nervous system really needs that movement,
14000:09:44,700 --> 00:09:47,890that vestibular input through space.
14100:09:48,950 --> 00:09:53,469There are three types of vestibular input linear.
14200:09:54,030 --> 00:09:57,369So going in a relatively straight line,
14300:09:57,380 --> 00:10:00,690like if you're jumping up and down on a trampoline,
14400:10:00,840 --> 00:10:06,750swinging front and back or rocking left and right or front to back,
14500:10:07,650 --> 00:10:10,919rotary is spinning or twirling.
14600:10:10,929 --> 00:10:14,020That's the second kind of vestibular input.
14700:10:14,710 --> 00:10:19,919And the third kind are inversions which involves being upside down,
14800:10:19,929 --> 00:10:21,840like hanging upside down,
14900:10:21,849 --> 00:10:26,429doing a forward bend or doing a down dog position.
15000:10:26,440 --> 00:10:27,080In yoga.
15100:10:27,900 --> 00:10:31,719The movement inputs can be alerting or calming,
15200:10:31,859 --> 00:10:35,929intense or gentle as an individual.
15300:10:35,940 --> 00:10:40,390You can see what helps your nervous system at any given time.
15400:10:40,799 --> 00:10:45,210Someone who wants to feel calm or may want to rock in a rocking chair,
15500:10:45,940 --> 00:10:57,330sometimes people like to ride in the car and that just helps them feel centered and calm babies or little kids might fall asleep in the car.
15600:10:57,340 --> 00:11:01,530Even when they were so upset when they were actually getting in the car,
15700:11:01,809 --> 00:11:07,580another person may really feel calmer when they've been swinging again.
15800:11:07,590 --> 00:11:15,320We have the swings for infants that they can rock in and get that gentle front and back motion.
15900:11:17,619 --> 00:11:24,390Someone who wants to feel more alert and activated like I need energy,
16000:11:24,400 --> 00:11:26,809I need momentum to get going.
16100:11:27,169 --> 00:11:31,609They may want to ride their bike down a hill or jump on a trampoline.
16200:11:31,940 --> 00:11:35,349That vigorous movement input is often more alerting.
16300:11:35,909 --> 00:11:37,250So someone might say,
16400:11:37,260 --> 00:11:37,630oh,
16500:11:37,640 --> 00:11:38,820now,
16600:11:38,900 --> 00:11:40,669now I'm really awake.
16700:11:41,099 --> 00:11:46,719Every nervous system though responds a bit uniquely to these different kinds of inputs.
16800:11:46,809 --> 00:11:57,619So it's really important to know your own system to try different things safely and to gradually develop your own insight about what you need.
16900:11:57,630 --> 00:12:03,809And when there are some activities that provide both pressure and movement input,
17000:12:04,169 --> 00:12:09,510riding a bike gives pressure through the joints as well as movement through space.
17100:12:10,119 --> 00:12:10,890Climbing,
17200:12:10,900 --> 00:12:18,349a rock wall provides really intense pressure in the joints as well as gentle movement up the wall,
17300:12:19,200 --> 00:12:22,619swimming provides resistance through the joints.
17400:12:22,640 --> 00:12:32,409Some mild pressure on the muscles from the water pressure and some movement which could be mild or more intense depending on the speed of movement.
17500:12:32,419 --> 00:12:35,530Whether the person is going upside down.
17600:12:35,570 --> 00:12:39,450Are they diving off of a height or going down a water slide?
17700:12:39,700 --> 00:12:43,289If you think back to what you have really loved to do,
17800:12:43,869 --> 00:12:47,750you may get clues about what your nervous system prefers.
17900:12:48,280 --> 00:12:54,820One person may have a history of a love for diving and they've been on the swim team during school,
18000:12:55,140 --> 00:12:59,880but maybe they don't have any source of inputs since they graduated.
18100:13:00,510 --> 00:13:05,349They haven't even realized how important these inputs were to their regulation.
18200:13:06,130 --> 00:13:09,520Another person may have a love of roller coasters,
18300:13:09,530 --> 00:13:10,880fast motorcycles,
18400:13:10,890 --> 00:13:11,989skydiving,
18500:13:12,150 --> 00:13:15,780their system loves intense vestibular inputs.
18600:13:16,440 --> 00:13:18,479Another may love weightlifting,
18700:13:18,489 --> 00:13:20,289cracking their knuckles.
18800:13:20,489 --> 00:13:25,159This is another source of joint pressure and heavy work,
18900:13:25,169 --> 00:13:26,219like yard work,
19000:13:26,229 --> 00:13:26,799gardening,
19100:13:26,809 --> 00:13:30,750household projects involving a lot of lifting of supplies.
19200:13:31,570 --> 00:13:34,270If you can pinpoint what your system has liked,
19300:13:34,280 --> 00:13:35,260historically,
19400:13:35,359 --> 00:13:40,359you may have a place to start in experimenting with what your system needs.
19500:13:40,369 --> 00:13:44,599Now also take into account your current health,
19600:13:44,609 --> 00:13:49,640your physical abilities or restrictions and your doctor's advice.
19700:13:49,690 --> 00:13:53,020If you can't pinpoint what you've liked in the past,
19800:13:53,030 --> 00:13:57,380start making a list of things to try a little bit at a time.
19900:13:58,010 --> 00:14:00,520Perhaps some waits on one day,
20000:14:00,530 --> 00:14:03,979a walk through nature the next or swinging at the park.
20100:14:04,760 --> 00:14:09,630Once you identify an area of inputs that your system benefits from.
20200:14:09,859 --> 00:14:10,429And again,
20300:14:10,440 --> 00:14:12,690the benefit is feeling more centered,
20400:14:12,700 --> 00:14:16,710calm and fully present than before the activity,
20500:14:16,849 --> 00:14:18,380then start thinking,
20600:14:18,390 --> 00:14:21,510how else could I get inputs like this?
20700:14:22,090 --> 00:14:23,549If you love bike riding,
20800:14:23,559 --> 00:14:27,130perhaps try swinging for movement and pressure.
20900:14:27,489 --> 00:14:32,530If you love a way to blanket over you while rocking in a rocking chair,
21000:14:32,630 --> 00:14:44,960you may want to investigate a whole body swing that can be hung from the ceiling and just envelops you like a cocoon in the fabric while you move gently or vigorously.
21100:14:45,330 --> 00:14:47,799It can even spin in rotation.
21200:14:48,840 --> 00:14:50,289If you like weights,
21300:14:50,299 --> 00:14:53,820you might wanna try rock climbing for intense joint pressure.
21400:14:54,159 --> 00:15:03,729Some people who like vestibular input like to join aerial fitness gyms that allow them to hang upside down in a safe and controlled environment.
21500:15:04,440 --> 00:15:11,190Be creative and develop some awareness of what your system responds positively toward and again,
21600:15:11,200 --> 00:15:12,010make sure you know,
21700:15:12,020 --> 00:15:13,140your own body,
21800:15:13,150 --> 00:15:17,669your limitations and any recommendations from your own physician.
21900:15:18,309 --> 00:15:19,960So let's regroup.
22000:15:19,969 --> 00:15:20,719So far,
22100:15:20,729 --> 00:15:23,570you've learned about pressure and movement inputs,
22200:15:24,140 --> 00:15:30,710the variations of intensity and exercise versus restorative based inputs.
22300:15:30,979 --> 00:15:34,809So exercise could be something like riding a bike,
22400:15:35,000 --> 00:15:35,919restorative,
22500:15:35,929 --> 00:15:40,580could be something like laying in a hammock swing or a hammock.
22600:15:42,780 --> 00:15:46,979You've considered what you have liked or not liked historically.
22700:15:46,989 --> 00:15:52,630And perhaps you have a list of things to try in order to build up a repertoire of options.
22800:15:53,479 --> 00:16:03,950The next key to growing in the area of regulation is this don't wait to do the activities until you feel like you need it.
22900:16:04,440 --> 00:16:05,950This is crucial.
23000:16:06,200 --> 00:16:06,770Now,
23100:16:06,780 --> 00:16:14,489this doesn't mean that you shouldn't listen to your body if you're ill or injured and not able to do a specific activity that day.
23200:16:14,909 --> 00:16:18,929But what often happens for the autistic is that they feel great,
23300:16:18,940 --> 00:16:19,500great,
23400:16:19,510 --> 00:16:20,330great.
23500:16:20,609 --> 00:16:23,299And then they feel really off center.
23600:16:23,309 --> 00:16:26,880And a lot of times they'll say I just did not see that coming.
23700:16:27,359 --> 00:16:32,650So by the time they use their as needed inputs,
23800:16:32,919 --> 00:16:35,169they're already deregulated.
23900:16:35,489 --> 00:16:37,250So that's not the goal,
24000:16:37,260 --> 00:16:53,179the goal is to do the activities and give regular nervous system inputs that are regulating so that the episodes of disregulation decrease in number and they're easier to recover from.
24100:16:53,919 --> 00:17:01,450So think about ways to give yourself centering inputs multiple times a day and that will be individual to you.
24200:17:02,090 --> 00:17:04,979Some people might do this three times a day,
24300:17:04,989 --> 00:17:06,239maybe at the beginning,
24400:17:06,250 --> 00:17:07,300middle and end,
24500:17:07,660 --> 00:17:16,099they may need some pressure and movement in the morning to wake up to become energized and to also feel calm and attentive,
24600:17:16,780 --> 00:17:20,349they may need inputs over the lunch hour or midday.
24700:17:20,359 --> 00:17:21,689And then again at night,
24800:17:22,069 --> 00:17:26,869perhaps restorative inputs like a rocking chair or a weighted blanket,
24900:17:27,050 --> 00:17:28,910maybe some nighttime yoga.
25000:17:30,459 --> 00:17:34,349Then when you do become deregulated on any given day,
25100:17:34,359 --> 00:17:39,810think ahead of time about what your as needed inputs might be.
25200:17:40,310 --> 00:17:43,000So when you're in the moment of disregulation,
25300:17:43,010 --> 00:17:46,089it's really difficult to figure out what you need.
25400:17:46,760 --> 00:17:50,150So you may be able to think to yourself ahead of time.
25500:17:50,489 --> 00:17:50,829You know,
25600:17:50,839 --> 00:17:52,619when I get dis regulated,
25700:17:52,630 --> 00:17:55,239this is what that looks and feels like.
25800:17:55,459 --> 00:17:59,160And when I start to see myself in that place,
25900:17:59,170 --> 00:18:08,060I can try these handful of things to see if it helps in that moment of crisis or kind of surprise.
26000:18:08,119 --> 00:18:08,260Uh,
26100:18:08,270 --> 00:18:09,579off centering,
26200:18:10,239 --> 00:18:11,290you may say,
26300:18:11,300 --> 00:18:11,729ok,
26400:18:11,739 --> 00:18:14,099I've had a particularly intense day.
26500:18:14,109 --> 00:18:16,609I'm feeling more off center than usual.
26600:18:16,699 --> 00:18:26,630I'm going to walk around my work building three times or I'm going to do forward bends and shake my head back and forth or listen to music with my headphones.
26700:18:26,910 --> 00:18:30,449This can be what as needed inputs look like.
26800:18:30,880 --> 00:18:34,569So you can see that like with the music and headphones,
26900:18:34,579 --> 00:18:41,739sometimes the regulating inputs could be also um a sensory input from another domain.
27000:18:41,770 --> 00:18:43,790What do you like to listen to?
27100:18:43,800 --> 00:18:46,810What scent do you like to smell like?
27200:18:46,819 --> 00:18:48,550Lavender or vanilla?
27300:18:48,920 --> 00:18:54,790But usually the big regulating inputs will involve movement and pressure.
27400:18:56,229 --> 00:18:57,680So today,
27500:18:57,689 --> 00:19:02,069we have chosen a growth area within health and wellness.
27600:19:02,099 --> 00:19:16,849This may be a good place for you to start as you live life with intention because feeling more grounded can help you feel more resilient as you try to stretch your comfort zone in other areas.
27700:19:17,270 --> 00:19:18,060Remember,
27800:19:18,069 --> 00:19:23,439the general approach we discussed in episode two when developing this program.
27900:19:23,900 --> 00:19:28,569So try to set up small reachable steps forward,
28000:19:28,859 --> 00:19:31,849use strategy to find your momentum.
28100:19:32,339 --> 00:19:37,130And once you've integrated the physical inputs into your daily routine,
28200:19:37,469 --> 00:19:41,599that momentum will kick in and it'll help you.
28300:19:41,609 --> 00:19:45,550Um not feel that this whole thing is effortful.
28400:19:45,560 --> 00:19:49,010It'll be just what you do on a regular basis.
28500:19:49,599 --> 00:19:54,290You'll also reap the benefits of having a more regulated nervous system.
28600:19:55,109 --> 00:19:57,050Be sure to check out the show notes,
28700:19:57,060 --> 00:20:01,969I have various links that we've mentioned here in the episode.
28800:20:02,020 --> 00:20:06,089One is a link to the Z Institute courses,
28900:20:06,099 --> 00:20:11,619Z U R for clinicians to learn more about autism in adolescents,
29000:20:11,630 --> 00:20:13,489adults and aging adults.
29100:20:14,020 --> 00:20:21,680I also have links to my podcast episodes about regulation if you'd like to do a deeper dive.
29200:20:22,030 --> 00:20:39,989And I'm also including links to the alert program put together by occupational therapists who have expertise in teaching people about using sensory inputs like movement or pressure to help regulate the nervous system,
29300:20:40,000 --> 00:20:42,310to feel calmer and more attentive.
29400:20:43,599 --> 00:20:51,569There's also a link specifically for their for All Program alert program four.
29500:20:51,579 --> 00:20:52,880That's the number four,
29600:20:52,890 --> 00:20:57,469not the word all dot com alert program for all dot com.
29700:20:57,800 --> 00:20:59,890That is a self guided study.
29800:20:59,900 --> 00:21:05,400You can purchase for a deeper dive into your own nervous system,
29900:21:05,410 --> 00:21:08,469figuring out what kind of inputs help you regulate.
30000:21:08,890 --> 00:21:13,630And I will have all four of those links in the show notes.
30100:21:15,270 --> 00:21:17,359Thank you for joining me today.
30200:21:17,489 --> 00:21:34,439I hope you will be able to enjoy the benefits of a more regulated nervous system and be sure to listen to our next episode as we continue this series on living with intention making goals and leaving our comfort zone.
 

Autism and Intentional Living: How to Make Goals and Achieve Them

You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this second episode in a series on intentional living, Dr. Regan identifies ways to create steps toward a goal, identify strategies, and monitor success. 
 
As referenced in the current episode: 
First Episode in Momentum for Behavior series
 
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
 
Read the transcript below:
 
100:00:01,830 --> 00:00:02,250Hi,
200:00:02,259 --> 00:00:02,960everyone.
300:00:02,970 --> 00:00:04,380This is your host,
400:00:04,389 --> 00:00:04,829Dr.
500:00:04,840 --> 00:00:05,980Theresa Regan,
600:00:06,250 --> 00:00:11,579introducing this next episode of autism in the adult podcast.
700:00:11,939 --> 00:00:13,779I'm a neuropsychologist.
800:00:13,789 --> 00:00:20,729So I specialize in understanding how the health of the brain and the connections of the brain impact,
900:00:20,739 --> 00:00:21,370thinking,
1000:00:21,379 --> 00:00:22,020skills,
1100:00:22,030 --> 00:00:22,700emotions,
1200:00:22,709 --> 00:00:23,319behavior,
1300:00:23,329 --> 00:00:24,569and personality.
1400:00:24,790 --> 00:00:30,540I've worked in hospitals for over 30 years and I'm the mother of a teen on the spectrum.
1500:00:31,649 --> 00:00:39,250And did you know that I have a series of three podcast episodes about momentum for activity.
1600:00:39,619 --> 00:00:43,869One is about exhaustion and finding balance in momentum.
1700:00:44,189 --> 00:00:53,000One of the episodes is about how to gain momentum for activity and the third is how to keep momentum for activity.
1800:00:53,430 --> 00:00:59,430You can find these three episodes as episodes number 21,
1900:00:59,650 --> 00:01:04,489and 23 In September and October of 2021.
2000:01:05,000 --> 00:01:07,410I'll put the link in the show notes.
2100:01:09,010 --> 00:01:09,449Today,
2200:01:09,459 --> 00:01:23,959we have our second episode of a series about finding some intentionality in um areas of our life where we'd like to grow and maybe challenge ourselves.
2300:01:23,970 --> 00:01:42,660Sometimes life is so fast and furious and we get in survival mode or we just get used to living a certain way that we realize we're not really making choices in all the areas of where we put our attention,
2400:01:42,989 --> 00:01:46,269uh whether we wanna grow or shift gears.
2500:01:46,650 --> 00:01:56,300So the previous episode was this introduction of thinking about where are we in our life right now?
2600:01:56,650 --> 00:02:02,059And if you can identify areas where you would like to find more meaning,
2700:02:02,449 --> 00:02:04,260uh a bit more challenge.
2800:02:04,269 --> 00:02:06,160If you'd like to change direction,
2900:02:06,370 --> 00:02:10,770then we're going to focus together on living intentionally.
3000:02:11,520 --> 00:02:23,789The first episode covered a few things and one is that I think the first step toward being intentional is having this increased self-awareness.
3100:02:24,149 --> 00:02:37,429And I feel like that's one of the greatest blessings of understanding our neurology and going through the diagnostic process about autism to see what,
3200:02:37,440 --> 00:02:41,460how am I wired and what does my system need?
3300:02:41,779 --> 00:02:43,649How do I interact with people?
3400:02:43,660 --> 00:02:46,210What do I find uh joy in,
3500:02:46,220 --> 00:02:46,770in life?
3600:02:46,779 --> 00:02:54,289What drains me and we have this elevated understanding of ourselves.
3700:02:54,300 --> 00:02:57,289Um That is part of that process.
3800:02:58,300 --> 00:03:02,229So I think after that process of self awareness,
3900:03:02,699 --> 00:03:09,410if we do identify areas where we would like to grow or expand in some way,
4000:03:09,919 --> 00:03:11,309one way to do that.
4100:03:11,320 --> 00:03:17,339And we covered this in the initial episode is to think of categories in our life.
4200:03:17,380 --> 00:03:24,490And I invited you to do this um to see where you might want to shift.
4300:03:26,479 --> 00:03:32,490One of the categories we talked about was within the area of a special interest.
4400:03:33,270 --> 00:03:37,470The second was within the area of health and wellness.
4500:03:38,250 --> 00:03:40,559The third was regulation,
4600:03:40,889 --> 00:03:46,699that means the ability to stay centered with things like alertness,
4700:03:46,889 --> 00:03:49,880attention and emotions.
4800:03:50,809 --> 00:03:53,380We also talked about 1/4 category,
4900:03:53,389 --> 00:03:54,729relationships.
5000:03:55,169 --> 00:04:04,6991/5 as everyday tasks kind of like staying on top of those chores and daily things that can be hard to get a rhythm for.
5100:04:05,130 --> 00:04:10,600And the sixth would be something like family and household culture.
5200:04:10,880 --> 00:04:14,130So if you're living in a household with other people,
5300:04:14,350 --> 00:04:19,170and these are people who are wired differently than each other.
5400:04:19,179 --> 00:04:26,690Sometimes focusing on the culture of the household can be a rewarding area of growth.
5500:04:29,399 --> 00:04:30,410Today,
5600:04:30,420 --> 00:04:38,470I would like you to bring your thoughts of what areas you would like to find more meaning in and to have more intention for.
5700:04:38,730 --> 00:05:01,500And we're going to talk about some basic um guidelines for making goals that you can stick with and that you can see change um in these areas without feeling overwhelmed and without kind of stopping in the middle and like our um New Year's resolutions.
5800:05:01,510 --> 00:05:01,980We don't want to,
5900:05:02,059 --> 00:05:03,109to be like that,
6000:05:03,440 --> 00:05:12,369but we want you to have this intention towards something and to give you some structure of how big should the goal be and,
6100:05:12,779 --> 00:05:16,399and how quickly should I work toward it and all of these things,
6200:05:16,410 --> 00:05:20,869I just want to give you some framework to see if this framework helps you.
6300:05:21,730 --> 00:05:26,579The first thing I'd like you to do is to take stock of where you are now.
6400:05:27,059 --> 00:05:30,279So if you chose a health and wellness goal,
6500:05:30,290 --> 00:05:33,709if you chose a household culture goal,
6600:05:33,799 --> 00:05:40,970I just want you to think about where you are right now in this area.
6700:05:41,260 --> 00:05:45,100So don't focus on the end goal.
6800:05:45,109 --> 00:05:47,350Let's just focus on where you are.
6900:05:49,690 --> 00:05:53,500Someone may say for health and wellness.
7000:05:53,510 --> 00:05:53,980Well,
7100:05:53,989 --> 00:06:00,299where I'm at is that I probably walk 10 minutes after work twice a week.
7200:06:00,989 --> 00:06:13,000Another person in the area of everyday tasks may want to really stay on top of bill paying and financial management.
7300:06:13,010 --> 00:06:14,989And so they may say,
7400:06:15,000 --> 00:06:15,279well,
7500:06:15,290 --> 00:06:26,760where I'm at right now is that I tend to um go overboard and spend more than I have in my bank account about four times a month.
7600:06:26,989 --> 00:06:38,209So we're just taking stock whatever your category is for growth and meaning maybe take stock of where you are now.
7700:06:39,250 --> 00:06:47,000And um knowing that you would like to be in a different spot at some point in the future.
7800:06:48,059 --> 00:06:55,269The next step is to create a goal where you're just going to take that one step forward.
7900:06:56,130 --> 00:07:02,420Um What we want to do is to make this goal really achievable.
8000:07:02,429 --> 00:07:05,779We want to set ourselves up for success.
8100:07:05,790 --> 00:07:13,829We want to be able to see the end of the goal and we want the goal to be on the lower side of effort.
8200:07:14,720 --> 00:07:23,880One way to create this type of goal is to think about time spent toward your ultimate destination.
8300:07:26,269 --> 00:07:27,730For example,
8400:07:27,739 --> 00:07:32,179in the area of movement and exercise.
8500:07:32,190 --> 00:07:44,149Someone may realize that they're walking a certain amount after work every week and they may add time to that current routine.
8600:07:44,700 --> 00:07:50,730So someone who wants to have more movement in their life or to get outdoors more frequently,
8700:07:50,869 --> 00:07:52,529perhaps they say,
8800:07:52,540 --> 00:07:52,869well,
8900:07:52,880 --> 00:08:04,049I'm going to add 15 minutes a week to my current routine of being outside or of walking in the neighborhood and moving.
9000:08:04,290 --> 00:08:04,570Um,
9100:08:04,579 --> 00:08:06,829just getting that movement in,
9200:08:06,839 --> 00:08:08,549maybe that's their goal.
9300:08:10,040 --> 00:08:16,630Another person who wants to work toward achieving skills in a certain area,
9400:08:16,640 --> 00:08:26,850maybe they're working toward a promotion or they would like to learn a new skill for fun within perhaps within their special interests.
9500:08:27,929 --> 00:08:35,580The goal may be to spend a certain amount of time per week learning this new skill.
9600:08:36,440 --> 00:08:39,690If they're currently not learning anything about it,
9700:08:39,700 --> 00:08:42,750they might want to start with 20 minutes a week.
9800:08:43,030 --> 00:08:45,190If they're already doing 20,
9900:08:45,200 --> 00:08:48,049they might want to increase by 15,
10000:08:48,849 --> 00:08:54,260whatever the stepwise time goal might be for you,
10100:08:54,270 --> 00:08:57,780that would make sense in your area of interest.
10200:08:58,530 --> 00:09:02,979That may be a way that you'd like to construct what your actual goal is.
10300:09:04,049 --> 00:09:13,780You can also think of it as doing a certain fraction or a certain percentage of the work toward the ultimate goal.
10400:09:14,739 --> 00:09:20,969If someone would like to have intentionality in the area of their special interest,
10500:09:21,580 --> 00:09:22,479publishing,
10600:09:22,489 --> 00:09:32,570some of their short stories may be a goal where they're at currently is they have a collection of 50 short stories,
10700:09:33,049 --> 00:09:36,549most of which are within a science fiction genre.
10800:09:37,950 --> 00:09:45,770They've never taken a class on creative writing or on marketing for their own business.
10900:09:46,549 --> 00:09:58,960What they might do is sit down with a friend and talk about all the steps that they might want to take to make this publishing goal most successful.
11000:10:00,289 --> 00:10:02,719They may identify 10,
11100:10:02,729 --> 00:10:03,46015,
11200:10:03,469 --> 00:10:04,76020 steps.
11300:10:05,460 --> 00:10:10,059One might be taking a free online course in creative writing.
11400:10:11,330 --> 00:10:20,020Another might be joining a local writers group in their community to become part of a network for writers.
11500:10:22,270 --> 00:10:29,919Another goal might be learning how to create a website or how to publish their own material online.
11600:10:30,919 --> 00:10:35,179They would want to take one of these multiple steps.
11700:10:35,239 --> 00:10:37,679So if they've identified 20,
11800:10:38,179 --> 00:10:49,909they may just want to take one goal then they'd have to figure out is this goal small enough that I can see the end.
11900:10:50,270 --> 00:11:05,979I know I can have success and it doesn't feel too effortful if they're going to sign up for a free online class in creative writing that may feel super easy or it may feel too big.
12000:11:07,239 --> 00:11:08,880If it's too big,
12100:11:09,049 --> 00:11:13,400you would want to break that task down.
12200:11:13,739 --> 00:11:23,239So the first step might be to investigate some free online options to choose from.
12300:11:25,359 --> 00:11:37,309If someone has a goal to participate in additional community activities or to get out of the house a bit more often,
12400:11:38,000 --> 00:11:57,130they may make a goal to attend one community event per month uh with a friend Or they may make a goal to spend 15 minutes at a community event before they decide whether they want to come home.
12500:11:57,559 --> 00:12:00,200This just gives a bit of structure,
12600:12:00,309 --> 00:12:12,630but the whole process is meant to just help make one step forward and not to have a goal that's too big or too effortful.
12700:12:12,679 --> 00:12:14,849So we should be able to see the end.
12800:12:14,859 --> 00:12:19,989We should know that it takes some effort that it takes us out of our comfort zone,
12900:12:20,000 --> 00:12:23,359but that we also are set up for success.
13000:12:24,559 --> 00:12:27,710The next step would be thinking of a timeline.
13100:12:29,359 --> 00:12:41,849If someone has a goal in the area of regulation and they identify that they would like to be more intentional about their sleep wake cycle.
13200:12:43,400 --> 00:12:50,000They may determine that they'll watch how they do with their goal across two weeks.
13300:12:50,690 --> 00:12:58,320Perhaps their goal is to get up at the same time every day and after two weeks,
13400:12:58,330 --> 00:13:10,919they can evaluate how easy or difficult that goal was to achieve for someone who's wanting to stay on top of the dishes every day.
13500:13:11,250 --> 00:13:24,380They may also pick a week or two weeks as a time frame that they can monitor their success or stop and reevaluate if the stepwise goal feels like it's been too difficult.
13600:13:24,880 --> 00:13:32,059But here comes the most important step we've looked at creating that step forward goal,
13700:13:32,710 --> 00:13:34,520creating a time frame.
13800:13:35,140 --> 00:13:43,190And this third part I would say is the most important this is picking a strategy to have success.
13900:13:44,140 --> 00:13:47,270What does not work is just saying,
14000:13:47,280 --> 00:13:47,630well,
14100:13:47,640 --> 00:13:48,880I'm going to do it.
14200:13:49,159 --> 00:13:50,630I've made the goal,
14300:13:50,640 --> 00:13:54,690I'm intentional about the goal and I have this time frame.
14400:13:54,700 --> 00:13:56,710I'm just going to do it this time,
14500:13:57,039 --> 00:13:59,890even though it's been really hard in the past.
14600:14:00,559 --> 00:14:04,690What happens with that is that we're able to spurt towards some goal,
14700:14:04,700 --> 00:14:05,919success there,
14800:14:05,929 --> 00:14:08,090but it's very difficult to maintain.
14900:14:09,590 --> 00:14:12,719So what I'd like you to do when you have a goal,
15000:14:12,729 --> 00:14:14,099you have a time frame,
15100:14:14,109 --> 00:14:16,359you have a little chunk that you're gonna work on.
15200:14:17,320 --> 00:14:18,630Say to yourself,
15300:14:18,640 --> 00:14:22,549what's my strategy for accomplishing this goal?
15400:14:23,780 --> 00:14:26,390Never move forward without a strategy.
15500:14:26,659 --> 00:14:28,349If you can't think of one,
15600:14:28,359 --> 00:14:30,710ask a friend or a family member,
15700:14:34,210 --> 00:14:42,869one strategy could be in the area of remembering how can I remember to take my supplies to school?
15800:14:42,979 --> 00:14:46,979How can I remember to do the dishes before I go to bed?
15900:14:48,650 --> 00:14:53,409Another strategy may have to do with adding fun to the task.
16000:14:53,770 --> 00:14:56,340How can I make this task less,
16100:14:56,349 --> 00:14:57,260boring,
16200:14:57,270 --> 00:14:58,750less mundane?
16300:14:59,320 --> 00:15:04,469Maybe I could do it while music is playing or an audio book,
16400:15:04,760 --> 00:15:11,419maybe I could make a race out of it to see if I can get it done within a certain amount of time.
16500:15:12,340 --> 00:15:22,229Perhaps there are ways that I could use a strategy to make the task easier learning about how to streamline the task,
16600:15:22,289 --> 00:15:26,640looking at other ways people do the task to make it easier,
16700:15:26,650 --> 00:15:28,140take up less time.
16800:15:30,210 --> 00:15:35,460Another strategy I could use is offering myself a reward for success.
16900:15:36,200 --> 00:15:40,710Maybe I say if I'm successful for eight weeks in a row,
17000:15:40,969 --> 00:15:46,030I get to buy myself this thing that is not too expensive,
17100:15:46,039 --> 00:15:47,179but usually,
17200:15:47,340 --> 00:15:47,630you know,
17300:15:47,640 --> 00:15:49,510that would be off limits for me.
17400:15:49,520 --> 00:15:54,429But I'm gonna reward myself after I reach this time frame.
17500:15:55,450 --> 00:15:57,719After you've chosen a strategy,
17600:15:58,099 --> 00:15:59,659you have a time frame,
17700:15:59,669 --> 00:16:03,179you have a small goal that you're set up for success with.
17800:16:03,190 --> 00:16:08,789Then it's time to put your plan into action after the week or two weeks.
17900:16:08,799 --> 00:16:15,830What you're going to do is to kind of have an evaluation and debriefing with yourself.
18000:16:15,840 --> 00:16:21,020The first part of the evaluation is I achieve my goal.
18100:16:21,190 --> 00:16:36,049Also think about how effortful was it to achieve what I did achieve if you achieve the goal and you were consistent about it across two weeks and it did not feel too hard or effortful.
18200:16:36,229 --> 00:16:42,700You may decide that you're ready to add another step forward goal to your momentum.
18300:16:43,010 --> 00:16:47,739If you did 10% of the small task toward your goal,
18400:16:47,750 --> 00:16:58,530you could add on another 10% goal or you could add on another 15 minutes of the type of task you were doing to meet your goal.
18500:16:58,539 --> 00:17:05,660Remember to keep a strategy if you need to shift based on your new goal,
18600:17:05,670 --> 00:17:07,530your new step forward goal,
18700:17:07,540 --> 00:17:08,949be sure to do that.
18800:17:12,650 --> 00:17:16,459If you achieved your goal,
18900:17:16,699 --> 00:17:23,500but you pulled it off and are really tired and don't know if you could do that again,
19000:17:24,098 --> 00:17:30,218then you probably need to evaluate whether the goal is small enough,
19100:17:30,229 --> 00:17:37,869whether it's easy enough in the sense that we all have areas of our life that we would say,
19200:17:38,509 --> 00:17:39,088you know,
19300:17:39,098 --> 00:17:40,489for whatever reason,
19400:17:40,499 --> 00:17:42,909this area really wipes me out.
19500:17:42,918 --> 00:17:48,759I just have a huge struggle in this category of my life.
19600:17:48,769 --> 00:17:51,568Maybe you need to start in a different category.
19700:17:52,280 --> 00:17:55,569But if you can make the step forward goal easier,
19800:17:55,930 --> 00:17:56,930do that.
19900:17:57,510 --> 00:18:00,780If you can use a strategy that will help you more,
20000:18:00,849 --> 00:18:02,089go ahead and do that,
20100:18:05,170 --> 00:18:18,390you wouldn't want to add on to your plan until you got that goal achieved in a way that starts to feel pretty effortless like I'm doing this because this is what I do.
20200:18:18,560 --> 00:18:19,979I have momentum for it.
20300:18:19,989 --> 00:18:27,150It's built into my routine and then you don't have to effort as much to keep it going.
20400:18:27,479 --> 00:18:30,609That's when you add just a little bit more to it.
20500:18:32,439 --> 00:18:35,170What do you do if you did not meet your goal?
20600:18:35,209 --> 00:18:35,530Well,
20700:18:35,540 --> 00:18:36,859that's fine too.
20800:18:37,020 --> 00:18:42,079You would step back and evaluate why you may ask yourself.
20900:18:42,089 --> 00:18:46,449Did I use the strategy that I created for this goal?
21000:18:46,459 --> 00:18:52,020If you did and you were not successful with the goal,
21100:18:52,089 --> 00:19:00,119you probably have to reevaluate the strategy or you may need to add another strategy on top of that.
21200:19:01,040 --> 00:19:04,150Maybe you used a remembering goal,
21300:19:04,310 --> 00:19:06,969but that wasn't enough to give you the momentum.
21400:19:06,979 --> 00:19:12,750You need to just get that new behavioral set into your repertoire.
21500:19:13,130 --> 00:19:15,849Maybe you also need to make it easier,
21600:19:15,859 --> 00:19:19,030make it fun or give yourself a reward.
21700:19:19,500 --> 00:19:21,829Maybe you need someone to be accountable to,
21800:19:21,839 --> 00:19:23,589maybe that's your strategy.
21900:19:24,430 --> 00:19:26,130You should also ask yourself,
22000:19:26,140 --> 00:19:28,089did I use my strategy?
22100:19:28,859 --> 00:19:30,949If I didn't reach my goals?
22200:19:30,959 --> 00:19:38,089Maybe it was because I had the intention of using reminders or making it fun.
22300:19:38,209 --> 00:19:41,680But I didn't actually follow through with that.
22400:19:43,589 --> 00:19:44,130Well,
22500:19:44,140 --> 00:19:46,849then you would evaluate that as well.
22600:19:47,130 --> 00:19:49,209Is this strategy too hard?
22700:19:49,910 --> 00:19:54,449Is it too complex and involved in energy draining?
22800:19:54,800 --> 00:19:57,290What other strategies could you think of?
22900:19:57,599 --> 00:20:03,280Do you need to layer something in or do you have to scrap the first strategy and try again?
23000:20:04,209 --> 00:20:08,239What strategies do other people use or find successful?
23100:20:08,869 --> 00:20:12,020What ideas can you glean from other people?
23200:20:12,030 --> 00:20:16,920You're always able to say no to someone's suggestion of a strategy,
23300:20:16,949 --> 00:20:19,640but only if you have a counter offer.
23400:20:19,800 --> 00:20:21,000If your boss says,
23500:20:21,010 --> 00:20:21,260hey,
23600:20:21,270 --> 00:20:22,839this still isn't working.
23700:20:22,959 --> 00:20:25,199I'd like you to try this strategy.
23800:20:25,619 --> 00:20:26,540You can say no,
23900:20:26,550 --> 00:20:28,660I'd rather not use that strategy,
24000:20:28,670 --> 00:20:31,339but only if you have a counter offer.
24100:20:32,189 --> 00:20:37,089If you can say I've thought of this other strategy,
24200:20:37,099 --> 00:20:38,729then you can run with that.
24300:20:39,609 --> 00:20:40,020Now,
24400:20:40,030 --> 00:20:49,469the nice thing about this process is you're learning not only perhaps a new skill that is your goal.
24500:20:49,479 --> 00:20:54,829Um learning how to create a family culture that works in your home.
24600:20:55,229 --> 00:20:59,780Uh Learning how to stay regulated in a way that matches you.
24700:21:00,430 --> 00:21:02,199You're not only learning those things,
24800:21:02,209 --> 00:21:06,890but you're learning this process of growth.
24900:21:07,150 --> 00:21:12,650So I wish I were in a different place in this area of my life.
25000:21:13,739 --> 00:21:17,280How can I start that shift?
25100:21:17,290 --> 00:21:22,510How can I think about doing it without feeling overwhelmed or like,
25200:21:22,520 --> 00:21:24,689I just can't get any,
25300:21:25,069 --> 00:21:25,939um,
25400:21:26,219 --> 00:21:30,790I can't get any forward momentum toward change.
25500:21:30,910 --> 00:21:31,410Well,
25600:21:31,420 --> 00:21:38,089this is a way that you can practice a process for living with more intention.
25700:21:38,510 --> 00:21:40,420Where would I like to be?
25800:21:40,430 --> 00:21:42,500Where am I right now?
25900:21:42,819 --> 00:21:47,060How can I make small steps forward to guarantee that?
26000:21:47,069 --> 00:21:48,959I know I can have success.
26100:21:49,459 --> 00:21:56,979How can I create strategy and timelines and then evaluate what needs to be shifted?
26200:21:57,729 --> 00:22:03,819And what you'll notice too is you may get a great momentum for your goal.
26300:22:03,829 --> 00:22:10,810Maybe you are doing the dishes every night or you're moving for 15 minutes after work every day.
26400:22:11,079 --> 00:22:17,500What will happen is you'll have momentum for that for maybe a long period of time.
26500:22:18,290 --> 00:22:19,839Then at some point,
26600:22:19,849 --> 00:22:31,000something in your life will change and you'll realize that now the strategies you were using aren't really gonna work quite as well anymore.
26700:22:31,170 --> 00:22:34,630And that's really part of that normal human process too.
26800:22:34,920 --> 00:22:36,369And because you know,
26900:22:36,380 --> 00:22:49,859the process of creating strategies of evaluating things of making these small steps forward that can be successful when you do need to reevaluate and get back on board with the goal.
27000:22:50,290 --> 00:23:00,040That's something that you can go back to that skill in itself is something you keep with you and you can use in lots of different areas of life.
27100:23:00,050 --> 00:23:03,780We will continue to talk about living with intention,
27200:23:03,790 --> 00:23:09,844meaning growth and having success with all steps forward.
27300:23:09,954 --> 00:23:17,564Next time when we talk more about strategies and goals within these different categories,
27400:23:17,574 --> 00:23:20,025we mentioned special interests,
27500:23:20,035 --> 00:23:22,135health and wellness regulation,
27600:23:22,194 --> 00:23:23,255relationships,
27700:23:23,265 --> 00:23:26,785everyday tasks and family and household culture.
27800:23:27,255 --> 00:23:28,785I hope you'll join me then.
 
 

Autism and Intentional Living: Goals and Growth

You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this first episode in a series on intentional living, Dr. Regan identifies ways to plan the foundation of change so that you experience growth without becoming overwhelmed. 
As referenced in the current episode: 
adultandgeriatricautism.com
Autism and Regulation podcast episode #1
 
Dr. Regan's online presentations with Zur Institute March, 2023:
Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses
Autism Assessment: The Seven Diagnostic Criteria Brought to Life
 
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
 
Read the transcript: 
100:00:06,040 --> 00:00:08,590Hello and welcome to the podcast,
200:00:08,600 --> 00:00:10,190autism in the adult.
300:00:10,200 --> 00:00:11,540I am your host,
400:00:11,550 --> 00:00:13,160Dr Theresa Regan.
500:00:13,170 --> 00:00:15,630I am a neuropsychologist,
600:00:15,640 --> 00:00:25,930the mom of a teen on the spectrum and I'm a certified autism specialist. For more information about my offerings and background,
700:00:25,940 --> 00:00:31,020please see my website at adultandgeriatricautism.com.
800:00:31,030 --> 00:00:32,830You can see the link below in the show notes.
900:00:33,450 --> 00:00:33,920Today,
1000:00:33,920 --> 00:00:41,420we are starting a new series that I am calling autism and intentional living.
1100:00:41,430 --> 00:00:54,410So living with intention rather than feeling that were just plodding along day to day or that there's a tidal wave of things happening and we are along for the ride.
1200:00:55,700 --> 00:01:03,000I think every human has seasons of life where we just try to recenter... regroup,
1300:01:03,010 --> 00:01:16,430figure out if we're really living with intention and meaning. We're going to focus on the intersection of that kind of season with autistic neurology.
1400:01:16,960 --> 00:01:35,810Today we're going to have just a foundational and introductory session on this topic and we're going to start with the question of why would someone on the spectrum really need to consider living with intention.
1500:01:35,820 --> 00:01:48,350A lot of living in this with this mindset has to do with setting goals and thinking about shifts in your life if you want to change direction,
1600:01:48,350 --> 00:01:51,460if you want to grow in any particular area.
1700:01:51,470 --> 00:01:53,570And some might feel like,
1800:01:53,570 --> 00:01:54,230well,
1900:01:55,320 --> 00:02:08,380a really nonjudgmental approach is just to support people where they are at and I completely agree... if the person is doing well,
2000:02:08,390 --> 00:02:15,000if they're happy and healthy and they don't have goals to shift gears or adjust.
2100:02:15,010 --> 00:02:16,970That is completely fine.
2200:02:17,340 --> 00:02:26,160But many of us really do best when we have some type of momentum toward a goal,
2300:02:26,170 --> 00:02:31,680a momentum toward growing in a particular area...
2400:02:31,690 --> 00:02:40,360but sometimes it's hard to figure out ...what should these goals be and how do I make a goal that's going to stick?
2500:02:40,370 --> 00:02:44,500How do I make a goal that is challenging and I can grow,
2600:02:44,500 --> 00:02:46,190but it's not overwhelming...
2700:02:46,360 --> 00:02:49,810I'm not going to be in this kind of never ending,
2800:02:49,820 --> 00:02:57,030trying to crawl out of this huge weight on my shoulders that I've taken on with this goal.
2900:02:57,040 --> 00:03:14,710So this series is for people who would like to be mindful of ways in which they might like to stretch themselves or go out of their comfort zone and would like to have a topic about how to do that,
3000:03:14,710 --> 00:03:16,000how to think through it,
3100:03:16,190 --> 00:03:20,400and some of the plans and supports that might help along the way.
3200:03:21,230 --> 00:03:36,380Let's talk about a first step to thinking with this intentionality and to be to become more aware of ways in which you might like to grow.
3300:03:36,390 --> 00:03:37,400Um,
3400:03:37,410 --> 00:03:50,430one of the best things I think about a correct diagnosis of autism is the increased self awareness that ... should come from this diagnosis.
3500:03:50,430 --> 00:03:50,620So,
3600:03:50,620 --> 00:03:53,900if you've ever had that aha moment,
3700:03:53,910 --> 00:03:55,710that's what I'm talking about,
3800:03:55,710 --> 00:04:00,460because things fall into place and you say,
3900:04:00,470 --> 00:04:02,780oh my goodness,
4000:04:02,780 --> 00:04:05,250this makes more sense.
4100:04:05,260 --> 00:04:07,350This has come together.
4200:04:07,360 --> 00:04:24,430It really has made a lot of things feel unified and meaningful and like I have a way to understand and express what makes me tick. And this self awareness,
4300:04:24,430 --> 00:04:43,920this increase in self awareness, is often the first step to thinking about... in what ways do I want to just stay centered where I am and in what areas of my life might I like to shift or grow or again kind of go out of that comfort zone.
4400:04:44,810 --> 00:04:47,920So when you have the self awareness,
4500:04:47,930 --> 00:05:01,510that is often the first step toward making some goals and being mindful of where you're at and where you'd like to be after self awareness.
4600:05:01,520 --> 00:05:08,500One thing that can be helpful in goal setting is to think in categories of your life,
4700:05:08,510 --> 00:05:13,130you may already know what your goal is or what you'd like to shift,
4800:05:13,140 --> 00:05:16,650but there may be people who are saying,
4900:05:16,660 --> 00:05:21,800I guess I should probably have a goal to be a better person or to...
5100:05:22,850 --> 00:05:23,930you know,
5200:05:23,940 --> 00:05:26,320become better in some way,
5300:05:26,320 --> 00:05:26,820but I don't...
5400:05:26,830 --> 00:05:30,110I just really don't know where to start.
5500:05:30,120 --> 00:05:31,620It could be everything.
5600:05:31,620 --> 00:05:33,430Maybe it could be nothing.
5700:05:33,440 --> 00:05:35,040So here,
5800:05:35,050 --> 00:05:36,700here's a way to start.
5900:05:36,710 --> 00:05:39,050We're going to think about categories.
6000:05:40,790 --> 00:05:48,960One thing that some people that I work with who are on the autism spectrum,
6200:05:49,760 --> 00:05:53,340one thing they think about as a category in their life,
6300:05:53,350 --> 00:05:57,150could be their special interest. Their... 
6400:05:57,150 --> 00:05:58,790the things they love.
6500:05:58,800 --> 00:06:03,400Sometimes people will take that as a category and they will,
6600:06:03,410 --> 00:06:04,720will say,
6800:06:05,890 --> 00:06:07,730how...
6900:06:07,740 --> 00:06:11,750what kind of place does this have in my life right now,
7000:06:11,760 --> 00:06:15,730and am I satisfied with that?
7100:06:15,740 --> 00:06:21,310Or do I have this special interest,
7200:06:21,310 --> 00:06:29,320but I'd like to grow in a way that makes it more functional or meaningful for a broader audience.
7300:06:29,330 --> 00:06:30,140So,
7400:06:30,140 --> 00:06:32,660one way to think about it is,
7500:06:32,670 --> 00:06:33,850oh,
7600:06:33,850 --> 00:06:35,880I love, for example,
7700:06:35,880 --> 00:06:41,100if the special interest is creative writing and I have these characters,
7800:06:41,110 --> 00:06:47,030I have these narratives and plots in my head,
7900:06:47,030 --> 00:06:51,450and I think about what this character would say to that character,
8000:06:52,420 --> 00:06:55,390or I love history,
8100:06:55,400 --> 00:07:01,860and I combine these characters with historical timelines or science fiction themes.
8200:07:02,460 --> 00:07:02,930You know,
8300:07:02,930 --> 00:07:05,070this person may say,
8400:07:05,670 --> 00:07:08,200I have loved this for a long time,
8500:07:08,200 --> 00:07:19,880and I've gotten to the point where I've developed characters and themes perhaps a way to stretch myself in this area of strength is to say,
8600:07:20,420 --> 00:07:29,870do I want to have a goal to publish something perhaps to share it with other people who might enjoy it,
8700:07:29,880 --> 00:07:37,390perhaps to make some additional income from my writing,
8800:07:37,400 --> 00:07:40,140perhaps to grow as a writer.
8900:07:40,150 --> 00:07:40,770You know,
9000:07:40,770 --> 00:07:44,780this person may have this love of creative writing,
9100:07:44,790 --> 00:07:47,270but they may not have a degree in writing.
9200:07:47,270 --> 00:07:49,780They may not have taken classes.
9300:07:50,300 --> 00:07:51,620So,
9400:07:51,630 --> 00:07:56,320one category to think about is your interest.
9500:07:56,330 --> 00:08:01,150And in what ways might you want to grow in that area,
9600:08:01,160 --> 00:08:03,140you may take a course,
9700:08:03,150 --> 00:08:05,440You may create a product,
9800:08:05,450 --> 00:08:07,400you may create a website.
9900:08:07,410 --> 00:08:10,450Perhaps you want to publish fan fiction,
10000:08:10,450 --> 00:08:13,820Perhaps you want to publish an e book.
10100:08:13,830 --> 00:08:14,490Um,
10200:08:14,500 --> 00:08:18,140the publishing options are really broad right now.
10300:08:18,860 --> 00:08:24,250Another individual on the spectrum may love athletic pursuits.
10400:08:24,250 --> 00:08:30,140Perhaps they run and run and they just love that movement.
10500:08:30,140 --> 00:08:31,680They love to be outside.
10600:08:31,690 --> 00:08:33,570It's one of their special interests.
10700:08:33,570 --> 00:08:37,160They read a lot of running magazines,
10800:08:37,170 --> 00:08:40,780they read about nutrition for the runner and stretching.
10900:08:41,660 --> 00:08:46,950And this has been really a love that they've had for several years.
11000:08:46,960 --> 00:08:55,720This person may wish to think about whether they would like to broaden what they're doing with running.
11100:08:55,730 --> 00:09:06,770So their goal or their intention for growth might be that they'd like to train for a specific race or marathon.
11200:09:07,540 --> 00:09:09,730Another person may say,
11300:09:09,730 --> 00:09:10,230oh,
11400:09:10,240 --> 00:09:10,860you know,
11500:09:10,860 --> 00:09:15,070I don't know if I want to do that or maybe I've already done it,
11600:09:15,080 --> 00:09:23,930but they may say I would like to meet some new people to connect with the community and to give back uh,
11700:09:23,930 --> 00:09:25,210and bless other people.
11800:09:25,210 --> 00:09:38,790So I think I'm going to see if I could coach some track or cross country in the community and teach other people what I love and what I'm good at.
11900:09:39,470 --> 00:09:49,610So you can see that one category for growth and intention and momentum can be a special interest and something that you love,
12000:09:49,620 --> 00:09:51,170you've researched,
12100:09:51,170 --> 00:10:02,450you've done it and you'd like to expand that. 
Another category I'd like you to consider is health and wellness.
12200:10:03,370 --> 00:10:11,920There are so many different areas... that this part of life can feel overwhelming. For the autistic though.
12300:10:11,920 --> 00:10:14,300If you want to think about health and wellness,
12400:10:14,310 --> 00:10:22,690you might think about areas that are particularly easy or particularly difficult for you.
12500:10:23,590 --> 00:10:38,610One person on the spectrum may have a love of nutrition and cooking and again that can be combined with the last category where they're gonna start to teach other people about that.
12600:10:39,250 --> 00:10:39,940However,
12700:10:39,940 --> 00:10:46,900another person on the spectrum may really find it difficult to expand
12800:10:46,910 --> 00:10:49,500the range of what they eat.
12900:10:49,510 --> 00:10:51,980They might say to themselves.
13200:10:54,130 --> 00:10:59,130I would like to expand my palate.
13300:10:59,550 --> 00:11:04,750This is not to say that they must eat every food.
13400:11:04,760 --> 00:11:05,200No,
13500:11:05,200 --> 00:11:09,260it's just saying if I go out of my comfort zone,
13600:11:09,270 --> 00:11:10,590how could I do that?
13700:11:10,600 --> 00:11:12,650Or maybe the individual says,
13800:11:12,650 --> 00:11:13,180you know what,
13900:11:13,190 --> 00:11:21,170I don't think I'm going to expand my palate but I do want to focus on... within the foods I can eat comfortably...
14000:11:21,180 --> 00:11:25,020How could I get better nutrition.
14100:11:25,420 --> 00:11:52,120So this person might say I'm going to try adding a protein powder to my smoothie that I have every day or I'm going to try some supplements because I really can do pretty well with swallowing pills or capsules, and I want to make sure I'm getting all the vitamins that I need... or all the minerals.
14200:11:52,800 --> 00:12:03,600Another person in the area of health and wellness may realize that they spend a lot of their time doing seated work.
14300:12:03,610 --> 00:12:11,150Maybe they love to do video games or they have a youtube channel that they keep up and they really enjoy that.
14400:12:11,520 --> 00:12:18,890Perhaps the part of health and wellness that they choose to move forward with might be movement.
14500:12:18,900 --> 00:12:19,790You know,
14600:12:19,790 --> 00:12:22,700a lot of times the nervous system,
14800:12:32,250 --> 00:12:43,450particularly for those on the spectrum might need close attention to... how much movement and pressure does their nervous system need.  Pressure,
14900:12:43,450 --> 00:12:46,740meaning pressure in the muscles,
15000:12:46,750 --> 00:12:50,930like a weighted blanket OR pressure in the joints.
15100:12:50,930 --> 00:12:52,530Like lifting weights,
15200:12:52,540 --> 00:12:53,640yoga.
15300:12:54,020 --> 00:13:02,670A lot of times these sensory inputs are regulating and calming for well always for any human,
15400:13:02,670 --> 00:13:08,380but the person on the spectrum may really need that need that intentionality,
15500:13:08,390 --> 00:13:16,090that purposefulness where they really increase that during their daily routine.
15600:13:17,080 --> 00:13:23,250This person may start with saying I really need more movement.
15700:13:23,260 --> 00:13:30,610Therefore I'm going to walk the dog in the morning or I'm going to get a rocking chair and rock.
15800:13:30,620 --> 00:13:35,830Uh it's not exercise but it gives the nervous system movement input.
15900:13:35,840 --> 00:13:42,130And that can be for some people regulating where they feel more centered if they get to rock,
16000:13:42,560 --> 00:13:44,540another person may feel like,
16100:13:44,550 --> 00:13:47,440gosh I need more pressure input.
16200:13:47,450 --> 00:13:52,680Um I'm going to get a hammock so I can lay in the hammock,
16300:13:52,690 --> 00:13:54,860I'm going to get a weighted blanket.
16400:13:54,870 --> 00:14:02,510There's lots of ways to think about health and wellness as a category.
16500:14:03,260 --> 00:14:07,130Speaking of sensory regulation techniques,
16600:14:07,130 --> 00:14:10,180let's talk about regulation as a category,
16700:14:10,190 --> 00:14:17,930you can see past series that talk through a lot of detail about regulation.
16800:14:18,700 --> 00:14:24,990Every individual on the spectrum will find some challenges in the area of regulation.
16900:14:25,000 --> 00:14:32,420And here let's talk about regulation of emotions and of the internal motor,
17000:14:32,420 --> 00:14:37,670how activated someone feels or how sluggish.
17100:14:37,680 --> 00:14:46,060So for the autistic individual they may have difficulty staying centered,
17200:14:46,070 --> 00:14:47,350calm,
17300:14:47,660 --> 00:14:48,960attentive,
17400:14:48,970 --> 00:14:55,330and that they find that just right spot where they don't feel anxious,
17500:14:55,340 --> 00:14:56,450angry,
17600:14:56,450 --> 00:14:58,600overwhelmed or frozen,
17700:14:59,150 --> 00:15:12,650where they're aware and they're centered. There are strategies for regulation and I will put the link to that regulation series in the show notes.
17800:15:12,660 --> 00:15:17,580Someone may think of this category of regulation and say,
17900:15:18,120 --> 00:15:19,020you know,
18000:15:19,030 --> 00:15:32,710I would like to stay more even, I would like to feel more steady in my own person ...that I can feel resilient toward the day.
18100:15:32,710 --> 00:15:44,070And so my area for growth that I choose is to live with some intention about how to regulate myself
18200:15:44,520 --> 00:15:48,330the best that I can across time every day.
18300:15:49,250 --> 00:15:55,490Another great area for consideration would be relationships and communication.
18400:15:57,870 --> 00:16:00,880Not everyone needs a goal in this area,
18500:16:00,890 --> 00:16:07,400but the self awareness of the categories can help us think through again with intention.
18600:16:07,410 --> 00:16:13,180Like is this the place I'd like to be in my relationships and if you're in that place,
18700:16:13,190 --> 00:16:14,390super.
18800:16:14,400 --> 00:16:17,610If you would like to improve some area,
18900:16:17,610 --> 00:16:23,540you might consider whether you want to be intentional about some goals in that area.
19000:16:24,620 --> 00:16:53,320One individual may feel like they really have relationships that work well for them and they have this already established way of communicating this rhythm together and they just want to keep and maintain that -- another person may want to figure out how to get some extra social time and and kind of add to their relationships in a way that feels really satisfying to them.
19100:16:53,330 --> 00:17:07,520Like what type of person would I like to connect with and what kind of activities do I actually like to do with people... again in a way that feels really satisfying and filling to that individual.
19200:17:08,030 --> 00:17:11,680Another person may have a communication goal,
19300:17:11,750 --> 00:17:13,240they might say,
19400:17:13,250 --> 00:17:13,630you know,
19500:17:13,630 --> 00:17:18,650I'm super good at presenting facts and details at work,
19600:17:18,660 --> 00:17:21,090I like going on conference calls,
19700:17:21,090 --> 00:17:24,040I know what to say when it's my turn to talk,
19800:17:24,050 --> 00:17:31,610but I really get overwhelmed with conflict and I can shut down,
19900:17:31,610 --> 00:17:40,640I can freeze and at some point I might just kind of blow up and go too far trying to get my point across,
20000:17:40,650 --> 00:18:02,220I might want there to be justice in this situation and it's really difficult for me to know how to have effective communication without shutting down or blowing up in a case where there's a lot at stake ... where there's high emotion. That might be your area of growth this season,
20100:18:03,660 --> 00:18:05,490An additional category,
20200:18:05,500 --> 00:18:08,050may be everyday life tasks.
20300:18:08,060 --> 00:18:11,840We all have these kind of mundane,
20400:18:11,850 --> 00:18:13,770repetitive,
20500:18:13,780 --> 00:18:20,000really uninspiring things that have to get done in our everyday life.
20600:18:20,010 --> 00:18:25,380We have to pay bills... we need to take the car to get an oil change.
20700:18:26,060 --> 00:18:31,060We're really due to go to the dentist,
20800:18:31,060 --> 00:18:31,480you know,
20900:18:31,480 --> 00:18:35,970appointments and tasks and chores... these kinds of things.
21000:18:35,980 --> 00:18:46,780This may be an area where someone wants to push themselves this season and kind of get in a better rhythm. For one person.
21100:18:46,780 --> 00:18:51,200It may be tackling how to really clean their environment.
21200:18:51,210 --> 00:18:55,160... more frequently or ...or less frequently.
21300:18:55,170 --> 00:19:05,870How to declutter. For people on the spectrum who have great collections and love different objects perhaps related to their interest,
21400:19:05,880 --> 00:19:18,070they may feel they've gotten to the point where there's just not enough space... or they've spent too much money and they want to figure out how to balance out how many collections they have.
21500:19:19,110 --> 00:19:24,660Another person may feel like they want to figure out a better rhythm for budgeting.
21600:19:25,340 --> 00:19:29,730It's really tough to balance.
21700:19:29,740 --> 00:19:31,420you know...
21800:19:31,420 --> 00:19:33,400I've got to pay these bills first.
21900:19:33,400 --> 00:19:46,240But then this unexpected bill came and also I have these things related to my interests that I would really really love to invest my money in as well.
22000:19:46,250 --> 00:19:51,140There's also this executive function piece to money management of,
22100:19:51,390 --> 00:19:54,710have I set up all these automatic accounts?
22200:19:54,720 --> 00:19:57,130Have I forgotten to pay something.
22300:19:57,130 --> 00:20:03,980Have I not realized that my check didn't land in my account properly.
22400:20:03,990 --> 00:20:14,150So organization, planning, details and being able to wait to perhaps get something that you really love.
22500:20:14,160 --> 00:20:22,650Those things might be this category for you of tackling daily tasks a little differently.
22600:20:23,800 --> 00:20:29,060And someone else may want to work on how to get out there in the community,
22700:20:29,070 --> 00:20:30,830navigate their community,
22800:20:30,830 --> 00:20:33,890Perhaps they have a license to drive,
22900:20:33,890 --> 00:20:34,630they have a car,
23000:20:34,630 --> 00:20:37,310but it is not their favorite thing to do.
23100:20:37,320 --> 00:20:41,710Perhaps strategies related to...
23300:20:43,310 --> 00:20:52,340how do I maintain getting out of the house and connecting with people when driving is really kind of draining for me.
23400:20:53,500 --> 00:20:58,370A final category you might want to think about is the family culture.
23500:20:58,370 --> 00:21:01,980So if you live in a household with other people,
23600:21:01,990 --> 00:21:06,990you might want to think about how the culture works.
23700:21:07,000 --> 00:21:10,180This is part of self awareness and intentionality.
23800:21:10,180 --> 00:21:20,430Because what happens in any household is that we get into this just rhythm of what needs to be done.
23900:21:20,430 --> 00:21:21,010Who said
24000:21:21,010 --> 00:21:21,430what?
24100:21:21,430 --> 00:21:21,840Who did
24200:21:21,840 --> 00:21:22,360what,
24300:21:22,630 --> 00:21:25,990Who's irritating which person?
24400:21:26,000 --> 00:21:30,720Um and the culture can very easily drift into,
24500:21:30,730 --> 00:21:34,550hey don't do that or why didn't you do this?
24600:21:34,560 --> 00:21:44,960A lot of telling people how they're falling short ...having them know what our expectation is that they behave differently,
24700:21:44,960 --> 00:21:51,760that they do different tasks... and that can be a very draining kind of culture when we drift into that.
24800:21:52,000 --> 00:22:00,140So a different culture might be again focusing on this intentionality and awareness...
24900:22:00,150 --> 00:22:08,350To introduce the culture where our thought process is "this is what I need today."
25100:22:09,380 --> 00:22:17,450Maybe you're working on regulation and you need to take certain things into account to get better centered or more centered,
25200:22:17,460 --> 00:22:26,340but you have this culture emerging at home where you realize that other people may have a different need.
25300:22:26,340 --> 00:22:29,960So we say "this is what I need today,
25400:22:29,970 --> 00:22:31,850what is it that you need?"
25500:22:33,090 --> 00:22:34,600And then we say,
25600:22:34,610 --> 00:22:37,110how can we both get our needs met?
25700:22:37,780 --> 00:22:41,530And there are times when yeah,
25800:22:41,540 --> 00:22:43,910everybody can't get all their needs met.
25900:22:43,920 --> 00:22:57,240But this culture of trying to protect other people's needs and bring them out into the open and negotiate about those is really nice,
26000:22:57,250 --> 00:22:58,360it's really fun,
26100:22:58,380 --> 00:22:59,270freeing,
26200:22:59,280 --> 00:23:03,580It changes us from adversaries to partners.
26300:23:03,590 --> 00:23:28,360So if a dad is super sound sensitive and just had a rough day on a zoom call with his boss and he comes in and his five year old daughter is in her ballerina costume and she's singing and twirling and jumping and she jumps into his arms.
26400:23:28,860 --> 00:23:29,890You know,
26500:23:29,900 --> 00:23:33,030he may have this strong reaction like,
26600:23:33,040 --> 00:23:34,990oh my gosh,
26700:23:35,000 --> 00:23:36,370this house is a mess,
26800:23:36,370 --> 00:23:41,430this child is spinning all around and it's so loud,
26900:23:41,440 --> 00:23:42,590so loud,
27000:23:42,590 --> 00:23:44,210I'm so sound sensitive,
27100:23:44,220 --> 00:23:46,080I need my own space.
27200:23:46,090 --> 00:23:48,260I mean my own quiet.
27300:23:48,270 --> 00:23:57,350Um and he could very easily react to this and say stop,
27400:23:57,360 --> 00:23:58,770go to your room.
27500:23:59,280 --> 00:24:05,740Um but a shift in culture may look like look at you,
27600:24:05,750 --> 00:24:07,450you are all dressed up.
27700:24:07,460 --> 00:24:08,950Does that feel good?
27800:24:08,960 --> 00:24:13,920It looks like you'd really love to spin and sing today.
27900:24:13,930 --> 00:24:16,390I really need quiet.
28000:24:16,390 --> 00:24:17,680My ears are hurting.
28100:24:17,680 --> 00:24:19,940They're kind of sensitive today.
28200:24:20,980 --> 00:24:27,320If you're wanting to sing and dance and I need quiet and rest,
28300:24:27,330 --> 00:24:29,740how could we both get our needs met?
28400:24:31,520 --> 00:24:33,140And then dad could say,
28500:24:33,150 --> 00:24:33,660hey,
28600:24:33,660 --> 00:24:53,030I wonder if you could sing and dance in the basement, and I could have some rest and quiet time in the backyard ...and then we could meet back here and you can tell me more about your dancing that would represent a shift in culture.
28700:24:53,040 --> 00:24:59,780How does this household handle the needs of others when they conflict?
28800:24:59,790 --> 00:25:00,990Um,
28900:25:01,000 --> 00:25:08,800so that maybe this area of growth that you might want to focus on for a season today,
29000:25:08,800 --> 00:25:20,090we've talked about the way that an autism diagnosis creates some freedom and openness by increasing self awareness.
29100:25:20,100 --> 00:25:21,710This is how I work.
29200:25:21,710 --> 00:25:23,500This is what makes me tick.
29300:25:23,510 --> 00:25:36,090This is what I need and that in itself is an expanding out of the smaller place that you might have felt you existed in before.
29400:25:36,100 --> 00:25:39,060So with this expansion of self awareness,
29500:25:39,070 --> 00:26:06,450we can either kind of go back to life as usual or we can ride the tidal wave of all our daily activities and things that we're used to doing or we can pause and kind of restock and think about if I want to live intentionally and perhaps I want to grow,
29600:26:06,460 --> 00:26:08,880I want to go out of my comfort zone,
29700:26:08,880 --> 00:26:13,570I want to have goals and momentum toward those goals,
29800:26:13,570 --> 00:26:15,780but I don't want to be overwhelmed.
29900:26:16,870 --> 00:26:17,320You know,
30000:26:17,320 --> 00:26:20,230this is a way to approach that.
30100:26:20,240 --> 00:26:25,220If you would like to take some journey with me during the series,
30200:26:25,230 --> 00:26:42,050take some time this month to say which of these categories might fit where I'm at and where I'd like to have some growth now I do not want you to make goals in every category.
30300:26:42,060 --> 00:26:42,890No,
30400:26:42,900 --> 00:26:51,220this is about being intentional without um kind of running ourselves into the ground.
30500:26:51,230 --> 00:27:02,010We don't want to make so many goals that we just um can't keep up the momentum because we're weighted down.
30600:27:02,020 --> 00:27:07,860So just pick a category and pick one little goal,
30700:27:07,870 --> 00:27:46,540one area of growth within that category to start and then in the future you can redo other categories but be mindful think about intention and what you would like to think through as an area of growth and then join me back next time because what we're going to talk about in the second session of the series is how to take an area within a category and think about it in more specific ways in order to make a goal.
30800:27:46,550 --> 00:27:52,190Many clients that I have come in and say I'd like to grow in this area,
30900:27:52,190 --> 00:28:04,490but I have no idea how what kind of goal I can have success with or what kind of goal is reasonable for me at this time of my life,
31000:28:04,500 --> 00:28:07,310I feel lost about how to make a goal,
31100:28:07,310 --> 00:28:08,490how to choose a goal,
31200:28:08,500 --> 00:28:10,120how to choose an area of....
31300:28:10,490 --> 00:28:31,410So next episode will be about that topic and then in the future will have additional episodes of this series that takes some of these categories and break them down even more with some strategies that might help you create more growth and wellness in any of these categories of life.
31400:28:32,270 --> 00:28:32,860So,
31500:28:32,860 --> 00:28:34,590food for thought for this month,
31600:28:34,600 --> 00:28:44,950I'm so glad you joined me and I hope that you come back again with some thoughts about where you would like to have more intention in your living.
 
 

Neurodiversity: Making Space for Complexity

Join Dr. Regan for this episode on the neurodiversity movement, autism affirming services, and the importance of allowing for complexity in our understanding of autism. 
 
Dr. Regan's online presentations with Zur Institute March, 2023:
Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses
Autism Assessment: The Seven Diagnostic Criteria Brought to Life
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
 
Read the transcript here:
 
100:00:07,050 --> 00:00:10,400Welcome to the podcast Autism in the Adult.
200:00:10,540 --> 00:00:12,310I'm Dr Theresa Regan,
300:00:12,320 --> 00:00:14,060a neuropsychologist,
400:00:14,100 --> 00:00:16,150the mother of a teen on the spectrum,
500:00:16,160 --> 00:00:22,680and the founder and director of an autism diagnostic clinic in Central Illinois for adolescents,
600:00:22,690 --> 00:00:24,720adults and aging adults.
700:00:26,490 --> 00:00:32,300Sometimes I get emails from people asking if I perform autism assessments for adults.
800:00:32,310 --> 00:00:33,080And indeed,
900:00:33,080 --> 00:00:35,030that's my full time job.
1000:00:35,040 --> 00:00:36,850So I go to work every day.
1100:00:36,850 --> 00:00:42,730I see patients and clients in a medical setting for evaluations and recommendations.
1200:00:44,260 --> 00:00:58,920Then I also have other things that I've chosen to do in the topic area of autism because I'm passionate about the people impacted and the positive things that can happen when we understand more about the autistic neurology.
1300:01:00,000 --> 00:01:12,240I do have a few online presentations coming up through Zur Institute which is a continuing education program for professionals.
1400:01:12,250 --> 00:01:20,970I'll include a link in the podcast show notes to these programs so you can look at the descriptions and registration links.
1500:01:21,340 --> 00:01:26,440And the first one is Tuesday March 7th 2023.
1600:01:26,440 --> 00:01:27,740For one hour.
1700:01:27,760 --> 00:01:34,100The presentation covers information about the basic foundational rules of the autism.
1800:01:34,100 --> 00:01:45,750Diagnostic criteria Will be dispelling myths about the foundations and requirements that may prevent people from being referred for assessment appropriately.
1900:01:45,870 --> 00:01:48,740And the second presentation is on Saturday,
2000:01:48,750 --> 00:01:50,210March 25,
2100:01:50,220 --> 00:02:02,410that's for two hours and this presentation will highlight the seven diagnostic criteria what they mean and also what they look like in a clinical case of a young adult female,
2200:02:02,410 --> 00:02:05,580just to illustrate some of the concepts.
2300:02:05,900 --> 00:02:08,860So if you are a clinician or you know,
2400:02:08,870 --> 00:02:13,420of professionals in your area who are wanting to learn more about autism,
2500:02:13,430 --> 00:02:16,420this may be a good resource opportunity.
2600:02:16,940 --> 00:02:22,020The topic of the podcast today is actually not the topic that I had been working on.
2700:02:22,030 --> 00:02:23,860Uh to record,
2800:02:23,870 --> 00:02:29,120I've had multiple interactions about a different topic over the last few weeks.
2900:02:29,120 --> 00:02:35,460And it really struck me as perhaps something that would be timely to talk about or helpful to process.
3000:02:35,470 --> 00:02:37,090And so in this episode,
3100:02:37,090 --> 00:02:47,760I wanted to talk about neurodiversity and autism affirming approaches to serving those on the spectrum.
3200:02:47,770 --> 00:02:54,790I'm gonna talk about three things within the context of this episode.
3300:02:54,790 --> 00:02:57,480One is just what are we talking about?
3400:02:57,480 --> 00:03:01,050What's the definition when we talk about neuro diversity?
3500:03:01,060 --> 00:03:11,630The second is what kinds of conditions or characteristics might we want to include under the umbrella of neuro diversity?
3600:03:11,640 --> 00:03:30,220And the third has to do with a viewpoint that some put forward that says that only individuals who have diagnoses of neuro divergence should be offering services to those on the spectrum.
3700:03:30,230 --> 00:03:32,820When we talk about neuro diversity,
3800:03:32,830 --> 00:03:40,800we're basically talking about the idea that people experience and interact with the world around them in many different ways.
3900:03:40,810 --> 00:03:44,570And this concept of course,
4000:03:44,570 --> 00:03:47,450neuro being neurology and diversity,
4100:03:47,460 --> 00:03:48,760meaning diversity.
4200:03:48,760 --> 00:03:58,080So we all have variations in our neurologic wiring and there's no one quote right way of thinking,
4300:03:58,090 --> 00:04:05,700learning and behaving and that all neurologic differences should be appreciated as part of natural variation.
4400:04:06,370 --> 00:04:10,350And I explain those concepts,
4500:04:10,360 --> 00:04:16,990knowing and wanting to communicate that people will defined neuro diversity differently.
4600:04:16,990 --> 00:04:23,630And so I'm trying to use phrases that are commonly used um in describing what that means,
4700:04:23,640 --> 00:04:25,750one person can say that,
4800:04:25,760 --> 00:04:26,230you know,
4900:04:26,230 --> 00:04:31,060that isn't really what it means to me and that's completely fine.
5000:04:31,070 --> 00:04:39,020It's such a complex topic that getting it right as everyone would define it is difficult.
5100:04:39,020 --> 00:04:40,260But basically,
5200:04:40,270 --> 00:05:06,220it is this understanding that there's variations on our wiring and there's this emphasis that there's not one right way to be connected neurologically um at its best when we're talking about neuro diversity as a concept and autism affirmation as a concept.
5300:05:06,230 --> 00:05:29,960It really helps ward against an approach to intervention that may focus on correcting or fixing behaviors in the neuro diverse individual only because the behaviors are unusual or atypical. When a therapist is neuro diversity affirming or autism affirming,
5400:05:29,970 --> 00:05:44,310this is often used to emphasize that they understand that neuro divergence itself is not a flaw or an illness that needs to be fixed or corrected.
5500:05:44,640 --> 00:05:47,820And we're gonna talk about this a little bit more later.
5600:05:47,820 --> 00:05:52,640But neuro divergence often refers to autism,
5700:05:52,640 --> 00:05:56,030but it is a much larger umbrella right now.
5800:05:56,030 --> 00:05:58,020And so we'll talk about that as well.
5900:05:58,800 --> 00:06:02,940However,
6000:06:04,180 --> 00:06:05,410at the same time,
6100:06:05,410 --> 00:06:23,080we hope that the autism affirming therapist can also acknowledge some parts of autism that really may create a lot of difficulty or pain for the person that's presenting for care.
6200:06:23,090 --> 00:06:25,230So at its best,
6300:06:25,230 --> 00:06:39,420we really hope there's this balance of understanding of the gifts and strengths in the autistic experience in the struggles and difficulties that someone may really inherently experience,
6400:06:39,430 --> 00:06:43,960not because of the attitudes of society or,
6500:06:43,970 --> 00:06:44,690or anything,
6600:06:44,690 --> 00:06:51,640but because this neurologic piece is really giving them difficulty. At it's extreme,
6700:06:52,260 --> 00:07:24,600there may be some in the autism affirming community or the neuro divergence community that really emphasize that the autistic experience is very positive in its essence that the diverse experience should always be emphasized as strength and the variation doesn't involve any inherent struggle.
6800:07:25,560 --> 00:07:28,740I think that when
6900:07:28,740 --> 00:07:32,970we get to that categorical kind of description,
7000:07:32,980 --> 00:07:39,740whether someone is talking about the autistic experience is all bad... or all good,
7100:07:40,010 --> 00:07:40,430you know,
7200:07:40,430 --> 00:07:49,340I think we're missing the complexity of the human experience and specifically here,
7300:07:49,340 --> 00:07:51,210the autistic experience.
7400:07:51,220 --> 00:08:05,430So what I would say about the movement and the concept of neuro diversity is it's really best when we're able to stay centered in the complexity... in the center,
7500:08:05,430 --> 00:08:07,550not those two extreme categories,
7600:08:07,550 --> 00:08:18,990but in the center of this mix of good and difficult where most often the truth lies in that center in that complexity.
7700:08:19,990 --> 00:08:24,140Let me explain what the DSM 5,
7800:08:24,140 --> 00:08:32,620that's the diagnostic manual for many of the conditions that people refer to as neurodivergent...
7900:08:32,630 --> 00:08:39,240I want to talk about the criteria they use for when something is called a diagnosis.
8000:08:39,240 --> 00:08:41,880So this is not specific to autism.
8100:08:41,890 --> 00:08:46,040This could include learning disability,
8200:08:46,050 --> 00:08:47,250autism,
8300:08:47,260 --> 00:08:48,360psychosis,
8400:08:48,360 --> 00:08:49,400depression,
8500:08:49,410 --> 00:08:50,960lots of different things.
8600:08:50,960 --> 00:09:01,810And there are two things that they really focus on as being present in order for a diagnosis to be relevant.
8700:09:01,810 --> 00:09:04,760And so one is that the condition,
8800:09:04,770 --> 00:09:19,440the constellation of characteristics, is statistically atypical ... that it's not the most common constellation that we see in the daily human experience.
8900:09:19,450 --> 00:09:23,410It's not the most common state.
9000:09:24,060 --> 00:09:24,340Now,
9100:09:24,340 --> 00:09:33,970the second thing though is that the atypical constellation of characteristics must cause some form of difficulty for the individual,
9200:09:33,980 --> 00:09:34,490you know,
9300:09:34,490 --> 00:09:36,500does it work against their physical health?
9400:09:36,500 --> 00:09:39,580Does it reduce their safety in some situations?
9500:09:39,590 --> 00:09:43,320Is it associated with internal distress,
9600:09:43,320 --> 00:09:46,810does it prevent the person from reaching goals for daily living,
9700:09:46,810 --> 00:09:48,290like maintaining work?
9800:09:48,550 --> 00:09:51,660Is it associated with pain and relationships?
9900:09:51,660 --> 00:10:01,860So it has to have some functional impact that has worked against the well being of this individual.
10000:10:01,870 --> 00:10:02,490So,
10100:10:02,490 --> 00:10:08,070both things according to the diagnostic manual must be present for a diagnosis.
10200:10:08,080 --> 00:10:11,530There has to be this atypical constellation,
10300:10:11,530 --> 00:10:20,590but there also has to be ... that this atypical constellation has been the root of some functional struggle.
10400:10:21,450 --> 00:10:31,440So if there are individuals who have the autistic neurology and it has never been a source of functional difficulty,
10500:10:31,450 --> 00:10:36,950they actually don't meet the criteria for a diagnosis as defined in the in the manual.
10600:10:36,960 --> 00:10:40,710So when we're talking about having an official diagnosis,
10700:10:40,720 --> 00:10:42,010that would be part of it,
10800:10:42,010 --> 00:10:43,540that in some season,
10900:10:43,540 --> 00:10:44,700in some way,
11000:10:44,710 --> 00:10:50,130there's really been a struggle associated with those neurologic characteristics.
11100:10:50,790 --> 00:10:51,680And this is why,
11200:10:51,680 --> 00:10:52,560for example,
11300:10:52,560 --> 00:10:57,680depression is a diagnosis as well. It's not rare,
11400:10:57,690 --> 00:11:00,650but ... it's not the most typical mood state.
11500:11:00,650 --> 00:11:04,600And when people get stuck in that atypical mood state,
11600:11:04,610 --> 00:11:08,230it causes these functional areas of difficulty.
11700:11:08,230 --> 00:11:09,330It's hard to get up,
11800:11:09,330 --> 00:11:10,470it's hard to go to work,
11900:11:10,470 --> 00:11:12,660it's hard to maintain relationships.
12000:11:12,850 --> 00:11:22,610And so that's where we shift from saying something is diverse to something that
12100:11:22,620 --> 00:11:29,740we're calling a diagnosis... that rather than just being mood-diversity where gosh,
12200:11:29,740 --> 00:11:31,410I've had a bad day,
12300:11:31,930 --> 00:11:37,590but it's really not impacted functionally how I'm doing across time...
12400:11:37,600 --> 00:11:48,460but when I get stuck in this mood state and it's really interfering with wellness in my daily life,
12500:11:48,460 --> 00:11:50,440that's when it's a diagnosis.
12600:11:51,270 --> 00:11:51,660Now,
12700:11:51,660 --> 00:12:01,130autism as a diagnosis does require that difficulty at some point in your life that you've really had the autistic neurology,
12800:12:01,140 --> 00:12:07,590making it hard to function in a way that's comfortable where you're achieving your goals.
12900:12:08,030 --> 00:12:08,440Now,
13000:12:08,440 --> 00:12:13,360autism as a diagnosis occurs in 2% of individuals,
13100:12:13,370 --> 00:12:15,290they would meet the full criteria.
13200:12:15,300 --> 00:12:27,890The neurologic characteristics hang together in those individuals because they hang together anatomically and they have also impacted the individual's well being their goals,
13300:12:27,890 --> 00:12:29,390their functional life.
13400:12:29,910 --> 00:12:30,170Now,
13500:12:30,170 --> 00:12:36,400does this mean that the neurology of autism causes pain or distress in every way?
13600:12:36,410 --> 00:12:37,870Absolutely not.
13700:12:37,880 --> 00:12:43,160Does it mean that the difficulty is constant throughout the whole lifespan?
13800:12:43,580 --> 00:12:44,440No.
13900:12:44,450 --> 00:12:46,100So in my viewpoint,
14000:12:46,110 --> 00:12:52,160all humans have characteristics that work for them in some ways and against them in some ways.
14100:12:52,170 --> 00:12:54,870And this is true in autism as well.
14200:12:54,880 --> 00:12:55,870For example,
14300:12:55,870 --> 00:13:00,570the attention to detail can be a great strength in some work projects.
14400:13:00,570 --> 00:13:08,360Whereas it can really create difficulty when the ultimate goal is speed and generalization rather than detail.
14500:13:09,070 --> 00:13:22,980So much of the benefit for the autistic individual and those who love them is this increased awareness of how their characteristics may work for them or against them in different contexts or across life seasons?
14600:13:23,510 --> 00:13:23,790Now,
14700:13:23,790 --> 00:13:25,180having said that again,
14800:13:25,180 --> 00:13:40,460remember that individuals who meet that full criteria by definition have had a level of neurologic difference that really increases the risk of difficulty and a lot of these functional areas compared with someone with a different neurology,
14900:13:41,100 --> 00:13:45,930we know that every human will have this mix of gifts and weaknesses,
15000:13:45,930 --> 00:13:47,270strengths and struggles,
15100:13:47,280 --> 00:13:49,510abilities and limitations.
15200:13:49,520 --> 00:13:51,510And for one person,
15300:13:51,520 --> 00:13:52,070you know,
15400:13:52,070 --> 00:13:57,780he may excel in athletics but struggle to read at functional levels.
15500:13:57,790 --> 00:14:05,040So he can't read a contract or release or a medical form without struggling and getting taken advantage of,
15600:14:05,040 --> 00:14:09,390that's a neurologic difference in that reading comprehension.
15700:14:09,790 --> 00:14:18,050Another person may be able to produce wonderful needlework that requires really good fine motor skills appreciation of color
15800:14:18,050 --> 00:14:18,770palettes,
15900:14:18,770 --> 00:14:20,660creativity and design.
16000:14:20,670 --> 00:14:21,450However,
16100:14:21,450 --> 00:14:30,420they might struggle to keep blood sugar levels even and their pancreas just isn't helping them with this task as much as we would wish.
16200:14:30,430 --> 00:14:33,810And maybe they take insulin shots because of this.
16300:14:34,400 --> 00:14:39,960I bring these examples up just to say that in our human form,
16400:14:39,970 --> 00:14:48,650we all have gifts and strengths and triumphs and skill sets.
16500:14:48,660 --> 00:14:59,580And we also will have some form of limitation or struggle at some part in our life and my struggle,
16600:14:59,580 --> 00:15:03,850my limitation in my human form may be different than yours.
16700:15:04,100 --> 00:15:12,010But I know that the commonality of the human experience is that you also will have some strength,
16800:15:12,010 --> 00:15:16,520some gift in your human form and some limitation,
16900:15:16,520 --> 00:15:19,500some struggle in that human form.
17000:15:19,510 --> 00:15:27,980And for some their area of gift and struggle may involve aspects of this autistic neurology.
17100:15:29,200 --> 00:15:34,380I think we do best for each other when we appreciate all sides of our humanity,
17200:15:34,420 --> 00:15:36,550that these are my strengths,
17300:15:36,550 --> 00:15:38,030these are my limitations,
17400:15:38,030 --> 00:15:39,710this is my humanity,
17500:15:39,870 --> 00:15:43,840this mix of good and difficult and strong and weak.
17600:15:43,850 --> 00:15:55,770And I'll always have a mix of this and this is what it is to be human and to truly show honor and respect and appreciation to the personhood of each individual.
17700:15:55,780 --> 00:16:00,960We allow all those things in the mix to be viewed and discussed.
17800:16:01,030 --> 00:16:04,340There's no reason to only talk about easy things,
17900:16:04,340 --> 00:16:05,120bright things,
18000:16:05,120 --> 00:16:06,220successful things.
18100:16:06,220 --> 00:16:13,630We can talk about all the messiness of each of our humanity and still affirm that every single person,
18200:16:13,640 --> 00:16:15,420no matter their age,
18300:16:15,430 --> 00:16:16,030culture,
18400:16:16,030 --> 00:16:17,340health abilities,
18500:16:17,340 --> 00:16:18,580spirituality,
18600:16:18,590 --> 00:16:19,340gender,
18700:16:19,340 --> 00:16:20,880any of these things,
18800:16:20,890 --> 00:16:38,020every single person is filled with inherent value and is deserving of honor and respect because that is inherent to their personhood and having a gift does not make them any more valued in having limitations.
18900:16:38,020 --> 00:16:41,120Does not take away any of their value.
19000:16:41,550 --> 00:16:44,140When someone is celebrating and rejoicing,
19100:16:44,140 --> 00:16:47,220we can come alongside and celebrate too.
19200:16:47,420 --> 00:16:49,440And when someone is grieving,
19300:16:49,450 --> 00:16:54,530when someone is struggling with something or coming across their own limitations,
19400:16:54,530 --> 00:16:58,540we also come alongside them in this as well.
19500:16:58,550 --> 00:17:00,860We can acknowledge the struggle,
19600:17:00,870 --> 00:17:03,640we can offer community assistance,
19700:17:03,650 --> 00:17:10,640anything that we can bring to the table in this moment of of humanity and coming together.
19800:17:10,650 --> 00:17:13,890So let's talk about the second topic,
19900:17:13,890 --> 00:17:25,000which is What kinds of diagnoses or characteristics do we want to consider as under that neuro diversity umbrella.
20000:17:25,010 --> 00:17:38,640So the neuro diversity movement began in the 90s as a way of talking about autism and sometimes attention deficit and the real benefit of it was that it,
20100:17:38,650 --> 00:17:56,780it championed the humanity of everyone with neuro diverse characteristics and made sure that they weren't being looked at as less than or somehow not as valued in society.
20200:17:57,410 --> 00:18:07,690Examples of conditions that are currently considered under the neuro diversity umbrella often include in addition to autism and attention deficit,
20300:18:07,700 --> 00:18:10,370things like obsessive compulsive disorder,
20400:18:10,370 --> 00:18:11,680bipolar disorder,
20500:18:11,680 --> 00:18:13,020dyslexia,
20600:18:13,030 --> 00:18:14,800and dyspraxia.
20700:18:15,870 --> 00:18:16,950But now,
20800:18:16,960 --> 00:18:18,640even though in the beginning,
20900:18:18,640 --> 00:18:26,350we often would talk about autism or attention deficit as being a large part of neuro diversity.
21000:18:26,360 --> 00:18:27,010Now,
21100:18:27,010 --> 00:18:43,020there's a much bigger umbrella that people um talk about as involving these kinds of conditions and it's kind of growing all the time and there's not an inherent  difficulty with that,
21200:18:43,020 --> 00:19:02,280but there are some challenges with having the umbrella be very narrow or having it be really um inclusive because neuro diversity at its most inclusive is anything that has diverse neurology as part of its definition.
21300:19:02,290 --> 00:19:03,510So,
21400:19:03,710 --> 00:19:08,910if we're going to expand it beyond autism and attention deficit,
21500:19:08,910 --> 00:19:18,120that we're really going to um be expanding it to include everything with diverse neurology.
21600:19:18,120 --> 00:19:23,850And so that's going to include things like spinal cord injury,
21700:19:23,860 --> 00:19:24,710stroke,
21800:19:24,720 --> 00:19:25,970cerebral palsy,
21900:19:25,970 --> 00:19:28,150parkinson's traumatic brain injury,
22000:19:28,150 --> 00:19:29,230encephalitis,
22100:19:29,240 --> 00:19:30,430brain tumor,
22200:19:30,430 --> 00:19:31,750multiple sclerosis,
22300:19:31,750 --> 00:19:32,820hydrocephalus,
22400:19:32,830 --> 00:19:34,020Alzheimer's disease,
22500:19:34,020 --> 00:19:35,920and all other forms of dementia,
22600:19:35,930 --> 00:19:37,980all learning difficulties,
22700:19:37,990 --> 00:19:40,880intellectual disability and so on.
22800:19:41,500 --> 00:19:46,300If we're going to use the umbrella to be all inclusive of neurologic diversity,
22900:19:46,310 --> 00:19:51,090we are essentially going to be talking about all neurologic conditions.
23000:19:51,340 --> 00:19:52,170In which case,
23100:19:52,170 --> 00:19:56,240we really kind of lost the meaning of the term itself.
23200:19:56,250 --> 00:20:01,010So I'm not sure that it's as powerful a term or meaningful a term.
23300:20:01,800 --> 00:20:04,120But if that's what we prefer,
23400:20:04,120 --> 00:20:05,900we certainly can do this.
23500:20:05,910 --> 00:20:07,620I just think at some point,
23600:20:07,620 --> 00:20:15,560we'll need to decide what meaning do we want the term to include and to be specific,
23700:20:15,560 --> 00:20:28,640knowing that there are a lot of neuro diverse conditions that would have to be under the umbrella if we're going to be all inclusive for neuro diverse conditions.
23800:20:29,480 --> 00:20:29,910So,
23900:20:29,910 --> 00:20:30,620in summary,
24000:20:30,620 --> 00:20:31,600so far,
24100:20:31,610 --> 00:20:38,470I would suggest that we think about what kind of meaning we want the term to have as far as neurology.
24200:20:38,470 --> 00:20:48,170And then also are we able to approach autism in a way that acknowledges all the strengths and the struggles that each individual presents with?
24300:20:48,180 --> 00:20:51,240Always understanding that in all of this mix,
24400:20:51,250 --> 00:21:06,870every person is filled with inherent value and you are important and your importance is never defined by strengths or limitations and you will always have a mix of both because you are human.
24500:21:07,660 --> 00:21:08,000Now,
24600:21:08,000 --> 00:21:23,280in this final section will be addressing an opinion that some have put forth that states that it's really not okay for individuals without an autism diagnosis or some form of neurodivergent diagnosis.
24700:21:23,290 --> 00:21:23,700Again,
24800:21:23,700 --> 00:21:25,270this is ill defined,
24900:21:25,460 --> 00:21:34,370but it's not all right for these individuals to provide services or input to autistic individuals essentially,
25000:21:34,370 --> 00:21:38,750only autistic providers should serve those on the spectrum.
25100:21:38,760 --> 00:21:40,780Uh For example,
25200:21:40,780 --> 00:21:51,550there are some workplaces that serve neurodivergent clients and only hire those with neurodivergent diagnoses.
25300:21:52,110 --> 00:21:57,940I think my response to this is similar to my response to the topics that we've covered so far,
25400:21:57,940 --> 00:22:12,740which is basically that I think the truth and the life and the best outcomes are often found in the center rather than um at either categorical opinion.
25500:22:13,020 --> 00:22:17,950So anytime we're tempted to go for that uh kind of simple,
25600:22:17,950 --> 00:22:18,870straightforward,
25700:22:18,880 --> 00:22:21,550only this and never that kind of thought process,
25800:22:21,550 --> 00:22:28,380we're really limiting the truth and limiting the good that we'll find in the complex middle.
25900:22:29,030 --> 00:22:30,200And in this case,
26000:22:30,200 --> 00:22:44,190I think the wonderful thing about this approach is it does emphasize uh welcoming all kinds of diverse inputs to discussion services and program development as far as they do go,
26100:22:44,200 --> 00:22:51,260which is neuro diversity that we bring together the neuro diverse to serve the neuro diverse.
26200:22:52,500 --> 00:22:53,030Now,
26300:22:53,030 --> 00:22:55,620I love to hear people's stories,
26400:22:55,630 --> 00:22:56,580their opinions,
26500:22:56,580 --> 00:23:01,170their perspectives and whether those are from the autistic individual,
26600:23:01,170 --> 00:23:01,940their friends,
26700:23:01,940 --> 00:23:03,320their family members,
26800:23:03,330 --> 00:23:07,320whether those are from individuals and a helping profession,
26900:23:07,320 --> 00:23:08,550anyone,
27000:23:08,560 --> 00:23:12,350it enriches me over and over and over again.
27100:23:13,700 --> 00:23:14,390However,
27200:23:14,390 --> 00:23:24,700I think saying that only autistic providers should come alongside the autistic to provide input is limiting in a way that would work against the greatest good.
27300:23:24,710 --> 00:23:31,330Not because the autistic providers viewpoint is not valid or in some way less than others viewpoint.
27400:23:31,340 --> 00:23:44,400But because the breadth of specialization and experience that benefits individuals is so huge that no one group of individuals can ever cover all of that information.
27500:23:44,410 --> 00:23:54,020And I think if we tap into our diverse knowledge and experience that we will have the richest information to share.
27600:23:54,030 --> 00:23:59,240So having occupational therapists and neurologists and neuropsychologist,
27700:23:59,250 --> 00:24:02,290experts in academic learning and nutrition,
27800:24:02,300 --> 00:24:05,200all of these things are so beneficial,
27900:24:05,210 --> 00:24:13,150such richness of knowledge and experience that it's the exchange here that brings the blessing.
28000:24:13,160 --> 00:24:18,030It's increasing the diversity of input that brings the blessing.
28100:24:18,490 --> 00:24:27,720And some of these individuals in their specialization will be on the spectrum and some will not in other examples.
28200:24:27,730 --> 00:24:28,200You know,
28300:24:28,200 --> 00:24:36,470if I had multiple sclerosis and I would only receive care from a neurologist who had the same diagnosis.
28400:24:36,480 --> 00:24:41,670I would be limiting some of my um options.
28500:24:41,670 --> 00:24:43,740There may not be someone available.
28600:24:43,750 --> 00:24:47,690Uh This person may not be as experienced as someone else.
28700:24:47,700 --> 00:24:52,030Um I may be limiting where I could have a whole team of people.
28800:24:52,030 --> 00:24:53,090Maybe I'm saying no,
28900:24:53,090 --> 00:24:54,870I just want this one person.
29000:24:55,300 --> 00:24:59,490It would get even more difficult if I had two conditions,
29100:24:59,490 --> 00:24:59,930right?
29200:24:59,930 --> 00:25:04,870That I have multiple sclerosis and congestive heart failure.
29300:25:04,880 --> 00:25:05,390Now,
29400:25:05,390 --> 00:25:12,550do I have to find a provider that has both or I can see a heart provider that also has congestive heart failure?
29500:25:13,230 --> 00:25:22,290It's not that there's not value in getting input from others who share characteristics about your life and have walked in your shoes and get it.
29600:25:22,300 --> 00:25:25,220I think that's really valuable.
29700:25:25,700 --> 00:25:32,230But there's also value in getting input from those who don't share the same characteristics,
29800:25:32,230 --> 00:25:40,150but they have areas of expertise that they can offer some input that you wouldn't get in other places.
29900:25:40,250 --> 00:25:41,190Essentially,
30000:25:41,190 --> 00:25:46,240we're talking about the benefits of diversity and getting diverse input.
30100:25:46,240 --> 00:25:50,810When you have some struggles or limitations in any form of your life,
30200:25:51,140 --> 00:25:57,930then you get to take in the perspectives of all those other people and you decide what's helpful to you.
30300:25:57,940 --> 00:26:03,160But you have a lot of diverse input and rather than limiting the input,
30400:26:03,160 --> 00:26:04,140you're getting,
30500:26:04,150 --> 00:26:11,020you get to take in this information process it and say this has really helped me.
30600:26:11,030 --> 00:26:17,290This is not helpful to me and you get to be the filter for what you take into your own life.
30700:26:17,810 --> 00:26:20,720This is a really complex topic.
30800:26:20,730 --> 00:26:23,220There's a lot of emotions involved.
30900:26:23,230 --> 00:26:24,410I think in the end,
31000:26:24,410 --> 00:26:38,470what I'm saying is just that being able to be in the center of complexity helps me the most to understand the good and the difficult,
31100:26:38,480 --> 00:26:43,220the strength and the struggle of all kinds of human experience.
31200:26:43,230 --> 00:26:54,750And I would emphasize that the inherent value of the person is in their personhood and that never changes.
31300:26:54,760 --> 00:27:02,820So whether we're working with someone on something that they're celebrating or something that they're grieving,
31400:27:02,830 --> 00:27:07,200we can come along either way and say you are important,
31500:27:07,580 --> 00:27:09,110your personhood,
31600:27:09,120 --> 00:27:11,300you have this inherent value.
31700:27:11,310 --> 00:27:13,600I value that you've come,
31800:27:13,610 --> 00:27:21,320I value your story and your input and let me come alongside you and add what I can to your journey.
31900:27:22,070 --> 00:27:31,790I'm glad that you joined me today and that you're part of this podcast community and I hope you join me next time for another great topic.
 

Autism and ”Just Right”: The Quest for Balance

Join Dr. Regan for this episode on the quest for balance on the autism spectrum. Whether it's emotional regulation, attention, sleep, social interactions, task initiation, finances and more, finding the "just right" state is difficult for many on the spectrum.
Book: The Science of Making Friends
 
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the Transcript Here: 
 
100:00:07,240 --> 00:00:11,610Hello and welcome back to the podcast Autism in the Adult.
200:00:11,620 --> 00:00:12,730I am your host,
300:00:12,730 --> 00:00:14,390Dr Theresa Regan,
400:00:14,400 --> 00:00:16,120a neuropsychologist,
500:00:16,130 --> 00:00:18,470a certified autism specialist.
600:00:18,480 --> 00:00:23,930The director of an autism diagnostic clinic for adolescents,
700:00:23,940 --> 00:00:29,590adults and aging adults in central Illinois and the mother of a teen on the spectrum.
800:00:30,660 --> 00:00:48,140I'm glad you're joining me today for this episode that I'm going to call autism and "just right."  This is actually a great topic that was suggested by a listener from Finland and I hope that I am pronouncing the name correctly.
900:00:48,140 --> 00:01:07,680I think it's Maya ... Maya wrote about questions and struggles within the topic of balance in life when you have that autistic neurology,
1000:01:07,690 --> 00:01:09,270Maya wrote this.
1100:01:09,670 --> 00:01:23,030I would so much love to hear what you have to say about autistic people and the struggle we have with striking a balance in situations where we have to create an appropriate view on or understanding of things?
1200:01:23,040 --> 00:01:29,350I am convinced that this is the major autistic difficulty that I personally struggle with.
1300:01:30,110 --> 00:01:34,570It shows up in different forms for me and on many levels.
1400:01:35,700 --> 00:01:39,890I could take a few examples so that you understand what I mean?
1500:01:39,900 --> 00:01:44,520Because most often this is not linked to intelligence,
1600:01:44,530 --> 00:01:46,350for example,
1700:01:46,350 --> 00:01:47,490is this person,
1800:01:47,500 --> 00:01:50,100a friend who respects me or not,
1900:01:50,740 --> 00:01:53,230am I too skinny or even to fat?
2000:01:53,240 --> 00:01:58,050Should I contact a doctor because of this thing that I'm feeling right now.
2100:01:58,570 --> 00:02:01,470How far should I stand by this person's side?
2200:02:01,660 --> 00:02:04,500How much should I help him or her?
2300:02:05,210 --> 00:02:10,820Exactly how well should I perform in this university course in order to pass.
2400:02:11,910 --> 00:02:15,030I want to thank Maya for writing about that.
2500:02:15,040 --> 00:02:29,300Um this is something I've thought about as well and I think it's one of those really great ways to conceptualize autism aside from specific details.
2600:02:29,310 --> 00:02:34,510So sometimes to get the most meaning out of what you're feeling,
2700:02:34,510 --> 00:02:47,890it can help to step back and say how is it that all these little pieces of the autistic experience hang together in some ways it can feel so granular,
2800:02:47,900 --> 00:02:51,500like so many things are impacted.
2900:02:51,510 --> 00:02:59,120Why do these things happen at the same time and when we have ways of conceptualizing it?
3000:02:59,480 --> 00:03:02,450Um I think it brings meaning.
3100:03:02,460 --> 00:03:10,290It helps these little pieces come together as why do I have trouble with these 12 things?
3200:03:10,300 --> 00:03:11,380Well,
3300:03:11,390 --> 00:03:19,090these 12 things have a thread that go through and when we can step back and see that thread that joins things,
3400:03:19,100 --> 00:03:23,020I think it really makes things more meaningful.
3500:03:23,030 --> 00:03:26,210Um and so that's what I want to do with this topic.
3600:03:26,210 --> 00:03:32,870Today I call this the just right state.
3700:03:32,880 --> 00:03:35,570So she was talking about balance.
3800:03:35,570 --> 00:03:38,230That's another great way to term it.
3900:03:38,240 --> 00:03:43,950Um A lot of times with the neurology that we're talking about,
4000:03:43,950 --> 00:03:55,770somebody will have difficulty finding that just right spot of balance where whatever they're attempting is not too much or too little.
4100:03:56,130 --> 00:04:24,560And ideally our neurology should help us flow in these areas that we can flow and adjust and we have this innate sense of where we should land to be just right for this context for this person for this topic and we can shift because just right will look different in one setting that it will in another setting or across time.
4200:04:25,100 --> 00:04:30,320So there's a lot of innit nous and flow in this ability to find just right.
4300:04:31,650 --> 00:04:35,920We've talked about difficulty with regulation in a very broad sense.
4400:04:35,920 --> 00:04:47,530We did a series on regulation issues having to do with alertness and attention and emotions and getting to that just rate state in those areas.
4500:04:47,540 --> 00:04:59,270But I think what Maya is pointing out is that regulation and balance and just right is a thread that goes through a lot of other areas with autism as well.
4600:04:59,280 --> 00:05:04,170So let's take a few areas and see how this just right.
4700:05:04,400 --> 00:05:08,330Uh this quest for just right is difficult.
4800:05:08,950 --> 00:05:10,990Let's take the social area.
4900:05:11,590 --> 00:05:19,020So some things that were struggling with that would capture this difficulty with just right would be,
5000:05:19,030 --> 00:05:22,400how much should I be speaking right now to this person?
5100:05:22,410 --> 00:05:24,690How much detail should I be giving?
5200:05:24,700 --> 00:05:27,830How much personal information should I share?
5300:05:27,840 --> 00:05:34,660What is the just right intensity and level of excitement for this context or person?
5400:05:35,020 --> 00:05:41,240What is just right as I'm interacting with a boss versus an acquaintance?
5500:05:41,250 --> 00:05:43,090How much eye contact?
5600:05:43,100 --> 00:05:44,700Too much or too little?
5700:05:44,710 --> 00:05:55,420How much emotional expression should I be using without looking false or like I'm putting on a show or that I don't care at all.
5800:05:56,380 --> 00:05:57,410For example,
5900:05:57,420 --> 00:06:01,380opening gifts without looking just flat or board,
6000:06:01,390 --> 00:06:07,660but without looking like an actor that's pretending to be happy with a gift.
6100:06:08,690 --> 00:06:11,720How much should I give this person?
6200:06:12,830 --> 00:06:15,130How long should I stand by them?
6300:06:15,140 --> 00:06:17,200How much money should I loan them?
6400:06:17,210 --> 00:06:20,490How many times should I give them a ride or a lift?
6500:06:20,500 --> 00:06:24,040How much leeway should I give in a relationship?
6600:06:24,050 --> 00:06:25,270For example,
6700:06:25,280 --> 00:06:31,540I know people are complex and I can be friends with people who do things that I don't agree with.
6800:06:31,550 --> 00:06:34,120But at what point do I say?
6900:06:34,120 --> 00:06:34,420Yeah,
7000:06:34,420 --> 00:06:37,970this is really not a healthy relationship for me.
7100:06:37,970 --> 00:06:40,130I need to end this relationship.
7200:06:41,290 --> 00:06:44,200How close should I make this relationship?
7300:06:44,210 --> 00:06:52,470And how soon what is the just right closeness and the timing of a relationship?
7400:06:52,480 --> 00:07:03,690So some people on the spectrum struggle because they really want some definition to the relationship quickly because this in between state,
7500:07:03,690 --> 00:07:06,770this undefined state feels really uncomfortable.
7600:07:07,600 --> 00:07:08,600So they might say,
7700:07:08,600 --> 00:07:20,770well let's just get married right away because we know we're right for each other and in essence defining and structuring the relationship feels better than this.
7800:07:20,770 --> 00:07:21,300Huh?
7900:07:21,310 --> 00:07:23,600I don't know what's gonna happen with this relationship.
8000:07:23,610 --> 00:07:27,070It feels safer and more defined and more predictable.
8100:07:28,080 --> 00:07:36,130Others will break up a relationship because they don't want to be in that undefined spot that in between place.
8200:07:36,140 --> 00:07:42,420Um So how much is just right as far as closeness in a relationship.
8300:07:43,810 --> 00:07:52,850What is the just right number of times to text or phone someone if they don't call you back or to extend an invitation to someone.
8400:07:52,860 --> 00:07:58,530Now sometimes there are rules of thumb for something like that.
8500:07:58,540 --> 00:08:06,670There's a nice book that I like called the Science of Making Friends that I'll link in the show notes that talks about,
8600:08:06,680 --> 00:08:06,970you know,
8700:08:06,970 --> 00:08:14,120you don't text or call again once you've done so twice without a return text or call.
8800:08:17,250 --> 00:08:28,880I once worked with a couple and we were trying to really increase his ability to bring some nurturance and emotional content to the relationship.
8900:08:28,890 --> 00:08:38,330And I worked with him on being aware that one way to show his wife love is to compliment her.
9000:08:38,340 --> 00:08:40,960So we kind of worked on that as a goal,
9100:08:40,960 --> 00:08:41,780practiced it,
9200:08:41,780 --> 00:08:45,090role played it and he put it into action.
9300:08:45,820 --> 00:08:48,310The problem was then his wife said,
9400:08:48,310 --> 00:08:50,820well now he's complimenting me too much.
9500:08:53,000 --> 00:08:54,570It is the difficulty,
9600:08:54,570 --> 00:08:55,820isn't it?
9700:08:55,870 --> 00:08:58,880Like I can learn a strategy,
9800:08:58,890 --> 00:09:02,390I can apply new knowledge,
9900:09:03,300 --> 00:09:08,690but the getting the just right amount,
10000:09:08,690 --> 00:09:09,880the just right moment,
10100:09:09,880 --> 00:09:11,970the just right compliment boy.
10200:09:11,970 --> 00:09:13,510That's really difficult.
10300:09:13,520 --> 00:09:15,260It's difficult for anyone.
10400:09:15,270 --> 00:09:16,010Uh,
10500:09:16,010 --> 00:09:18,580and even more so on the spectrum,
10600:09:20,830 --> 00:09:24,280let's look at finances for that just right state.
10700:09:25,130 --> 00:09:39,340It seems common for individuals on the spectrum to either lean toward spending too much perhaps on their special interests or other things that cut their eye or to spend too little.
10800:09:40,490 --> 00:09:41,090Um,
10900:09:41,100 --> 00:09:56,050there are people that have lots of money in a savings account or other type of account but they don't want to withdraw anything to fix the roof or to buy an updated phone.
11000:09:57,660 --> 00:10:01,970What is the amount of spending that is just right.
11100:10:02,830 --> 00:10:12,100There are guides for budgeting but it can still feel really elusive to get just right in specific personal situations.
11200:10:12,110 --> 00:10:13,490So yeah,
11300:10:13,490 --> 00:10:14,840this is the principle,
11400:10:14,840 --> 00:10:16,080this is the guideline,
11500:10:16,080 --> 00:10:17,750this is the percentage,
11600:10:17,760 --> 00:10:25,380but it is hard to have to look that framework up and not have a sense,
11700:10:25,380 --> 00:10:29,070an innate sense like yeah,
11800:10:29,070 --> 00:10:33,180I really need to get this roof repaired some will say,
11900:10:33,190 --> 00:10:33,730yeah,
12000:10:33,730 --> 00:10:35,960I know that I can ask for advice,
12100:10:35,960 --> 00:10:41,950I know that I can use this budget but I wish I had this innate sense of yeah,
12200:10:41,950 --> 00:10:46,440I really need to update this in my home or boy,
12300:10:46,440 --> 00:10:51,570I've spent too much on this area and not enough on this other area.
12400:10:53,460 --> 00:10:54,240They'll say,
12500:10:54,240 --> 00:10:54,540you know,
12600:10:54,540 --> 00:11:02,840it's difficult to have a feel for it instead of having to stick to some type of formula and maybe feeling like,
12700:11:02,850 --> 00:11:09,360well what would that rule of thumb look like in this situation and how would it apply to this other case.
12800:11:11,270 --> 00:11:16,490Let's look at just right as it relates to task completion on the spectrum.
12900:11:17,020 --> 00:11:22,400What is the just right amount of completion for some people on the spectrum,
13000:11:22,410 --> 00:11:30,960completion is very important but when is something complete and what is the just right amount of accuracy and detail?
13100:11:30,970 --> 00:11:44,080Some may feel like I need to finish one task before I start another task or I can't go to bed until I read all of these pages assigned from the class of the previous day.
13200:11:45,060 --> 00:11:49,120What is the right amount of detail?
13300:11:49,130 --> 00:11:51,290What is the right amount of speed?
13400:11:53,480 --> 00:11:57,100Have I done enough that this assignment is complete,
13500:11:57,140 --> 00:12:03,440especially when we get to adulthood tasks don't have a clear cut off.
13600:12:04,510 --> 00:12:16,370It's not like there are five math problems and we finish each one and we know the task is complete and maybe that we have a research paper or we have a software project.
13700:12:16,380 --> 00:12:16,830Well,
13800:12:16,840 --> 00:12:18,040when is it complete?
13900:12:18,040 --> 00:12:19,620When is it good enough?
14000:12:23,130 --> 00:12:25,020That difficulty knowing?
14100:12:25,020 --> 00:12:25,480Hey,
14200:12:25,480 --> 00:12:29,120I haven't attended a task B at all,
14300:12:29,120 --> 00:12:33,420but I've overworked on task A and how do I balance that?
14400:12:33,420 --> 00:12:35,030When do I know that?
14500:12:35,030 --> 00:12:36,560That's the difficulty.
14600:12:38,750 --> 00:12:50,450One person I worked with said I've always had the strong feeling that a newspaper needs to be read completely from cover to cover from every page that there,
14700:12:50,460 --> 00:12:53,030there is a completion that's important.
14800:12:53,840 --> 00:12:56,700You can't just read an article here and there.
14900:12:56,750 --> 00:12:58,630That's just not right.
15000:12:59,420 --> 00:13:06,680Another person may feel I have to finish this test completely before I start this other project.
15100:13:07,650 --> 00:13:18,980Even though the first task was something a coworker asked me about and this next one I have to complete is something my boss asked me to work on.
15200:13:22,510 --> 00:13:32,520It's difficult sometimes for the individual with that autistic neurology to understand that all details do not have the same importance.
15300:13:33,110 --> 00:13:38,970Um There are people um on the spectrum who feel like,
15400:13:38,980 --> 00:13:48,350well every detail is going to be important so it has to be included and the neurology there just isn't helping the person know like Yeah,
15500:13:48,350 --> 00:13:54,010but in this instance this part is not as important as this part,
15600:13:56,290 --> 00:14:06,880it can be really hard to get the neurology to shift uh to adjust if a task needs to be done quickly but does not need to be as accurate.
15700:14:07,390 --> 00:14:12,510So meeting deadlines might really be difficult if your boss says to you,
15800:14:12,510 --> 00:14:15,910hey this project needs to be done quickly.
15900:14:15,920 --> 00:14:21,720It doesn't really need to be detailed but I have to have it ready for a meeting tomorrow at noon.
16000:14:21,730 --> 00:14:24,990I just want to give a broad overview.
16100:14:25,000 --> 00:14:29,830Details are not important that can feel actually very stressful.
16200:14:29,840 --> 00:14:32,990Well what does a broad overview look like?
16300:14:33,000 --> 00:14:34,600And will,
16400:14:34,610 --> 00:14:41,230will I feel okay stopping when there are other details available.
16500:14:43,910 --> 00:14:49,200This is also related to the topic that maya brought up about working on a course,
16600:14:49,210 --> 00:14:50,780a university class.
16700:14:50,790 --> 00:14:57,460How much work do I need to do in order to do a good job?
16800:14:57,470 --> 00:15:00,290What if I could have done more?
16900:15:00,300 --> 00:15:01,820Could have done better.
17000:15:03,090 --> 00:15:06,500How many a's do I need to get to be a good student?
17100:15:06,500 --> 00:15:11,730How can I hit the mark of balance with accuracy and speed?
17200:15:12,910 --> 00:15:14,800How can I balance that?
17300:15:14,800 --> 00:15:18,460Everything doesn't have the same importance at the same time,
17400:15:20,530 --> 00:15:26,400something may be able to go undone while something else cannot wait another minute.
17500:15:26,400 --> 00:15:27,490So triaging,
17600:15:27,490 --> 00:15:32,400how do I triage quickly based on importance?
17700:15:33,210 --> 00:15:36,360How thorough do I need to be on this project?
17800:15:36,870 --> 00:15:41,420If the professor said I need to cite 10 sources,
17900:15:42,200 --> 00:15:44,070Can my brain let go?
18000:15:44,070 --> 00:15:52,440The other 25 sources I might be able to get and how can I just innately have a feel for?
18100:15:52,450 --> 00:15:53,360Okay,
18200:15:53,370 --> 00:15:54,250this is done,
18300:15:54,260 --> 00:15:58,120this is this project is finished and it's good to go.
18400:15:59,020 --> 00:16:11,500Maya also noted in her email that sometimes the approach to dealing with this difficulty is to get input from others about what might be just right in a situation,
18500:16:12,310 --> 00:16:15,570but that approach doesn't always feel practical.
18600:16:15,580 --> 00:16:23,180Like who could I ask or there's a deadline and people aren't around this just isn't practical.
18700:16:23,190 --> 00:16:25,520It also takes a lot of energy.
18800:16:25,530 --> 00:16:32,760And do I always bother the same person or how many times do I ask for input and who do I ask?
18900:16:34,050 --> 00:16:35,610So first of all,
19000:16:35,620 --> 00:16:40,850let's talk about that difficulty finding the just right state.
19100:16:41,510 --> 00:16:46,470So this could be within alertness and behavioral activation,
19200:16:46,480 --> 00:16:49,310it can be within attention.
19300:16:49,320 --> 00:16:52,790Like what is the just right amount of attention.
19400:16:52,800 --> 00:16:56,210It's somewhere between distractible and hyper focus.
19500:16:56,220 --> 00:17:08,840What is the just right space for our emotions while it's to be psychologically present and um clearheaded and calm.
19600:17:09,520 --> 00:17:12,010What is just right for test completion,
19700:17:12,010 --> 00:17:15,280finances working out nutrition,
19800:17:15,280 --> 00:17:17,130dieting all of these things.
19900:17:18,280 --> 00:17:26,470Let me give you an example for my own life that has to do with another physical just rate dilemma.
20000:17:27,400 --> 00:17:35,250So one of the things that I think about that I think also highlights this is that personally,
20100:17:35,260 --> 00:17:42,950it's kind of a joke in my family that I have really bad depth perception and again,
20200:17:42,950 --> 00:17:51,470it's kind of a joke because at some point you just have to laugh and luckily I always think I have less room.
20300:17:51,480 --> 00:17:55,770So it's not that I go around hitting things with the car,
20400:17:56,070 --> 00:17:57,870but you know,
20500:17:57,880 --> 00:18:01,350there's lots of room left and it does get kind of funny,
20600:18:02,960 --> 00:18:12,470I wish so in the back of my mind that I could learn to compensate for that because I do get tired of laughing at myself and having to be a good sport about this,
20700:18:12,490 --> 00:18:18,620just silly thing that I've parked so far away from where I could have parked,
20800:18:20,790 --> 00:18:29,250I realized that I always leave two ft from where I could have pulled up.
20900:18:29,780 --> 00:18:37,640So there's this remarkable consistency for me in that area that I can't tell what's just right,
21000:18:37,650 --> 00:18:42,600but somehow I'm always two ft from where I probably should be.
21100:18:42,600 --> 00:18:43,650So I thought,
21200:18:43,660 --> 00:18:45,100okay,
21300:18:45,110 --> 00:18:57,570well I will compensate for this difficulty with just right by going an extra two ft because I actually think I can Gauge what two ft would be.
21400:18:59,020 --> 00:19:06,830So I started to do that and lo and behold I that just does not work.
21500:19:06,840 --> 00:19:16,110I cannot compensate to get to intellectually get to the where the just right status.
21600:19:16,120 --> 00:19:31,770So as you can imagine I'm either to end up touching the wall or the um edge of the parking space with my car or I end up still being well below where I could be.
21700:19:33,350 --> 00:19:48,420So for me that's just another example that if my eyes in my brain are not able to show me the just rate state,
21800:19:50,120 --> 00:19:54,700there's not much I can do about that unfortunately.
21900:19:55,990 --> 00:20:02,700Um And even though I intellectually think of a strategy to compensate,
22000:20:02,710 --> 00:20:06,940it still doesn't mean that I can hit the just right spot.
22100:20:06,950 --> 00:20:08,680Well I should do this more,
22200:20:08,680 --> 00:20:10,140I should do this less.
22300:20:10,150 --> 00:20:29,430Um So I actually believe and in my experience with clients I think that ability that flow for that feel for the just rate state is something that is very difficult to compensate for.
22400:20:29,440 --> 00:20:33,770And I'm not sure that there are great ways to do that.
22500:20:34,900 --> 00:20:46,350I think what we typically do is we suggest intellectual compensations kind of like what I tried to do for my uh driving and parking.
22600:20:46,360 --> 00:21:15,230Um And I think those things are helpful in some ways but there's still this gap between where we would want to be as far as having a flow and an efficiency a feel for that would be so great rather than having to try to gauge to hit that spot a little bit better.
22700:21:17,430 --> 00:21:23,400Some of the compensations that are helpful would be,
22800:21:23,410 --> 00:21:24,330um,
22900:21:24,340 --> 00:21:28,280I think having the self awareness is helpful.
23000:21:28,290 --> 00:21:29,750So for example,
23100:21:29,760 --> 00:21:33,660I know that I have this difficulty,
23200:21:33,660 --> 00:21:36,480so if I have a passenger in the car and they're like,
23300:21:36,480 --> 00:21:37,040you know,
23400:21:37,050 --> 00:21:42,450you can pull up some more because I have that self awareness.
23500:21:42,460 --> 00:21:45,850I have a place for that to integrate that comment.
23600:21:45,850 --> 00:21:47,070And I can say,
23700:21:47,800 --> 00:21:49,080oh yeah,
23800:21:49,080 --> 00:21:50,320I probably can,
23900:21:50,330 --> 00:21:51,520I can't really tell you,
24000:21:51,520 --> 00:21:52,840tell me when to stop.
24100:21:53,470 --> 00:21:54,000Um,
24200:21:54,010 --> 00:21:57,510so I'm able to say yes to that comment.
24300:21:57,520 --> 00:21:58,060Like,
24400:21:58,070 --> 00:21:58,480oh yeah,
24500:21:58,480 --> 00:21:59,640I have a place for that.
24600:21:59,640 --> 00:22:00,680That makes sense.
24700:22:00,690 --> 00:22:01,900I have that awareness.
24800:22:01,900 --> 00:22:05,930I have that understanding of myself and I can't compensate myself.
24900:22:05,940 --> 00:22:09,010But if you're here and you're willing to help,
25000:22:09,010 --> 00:22:09,940let's do that.
25100:22:11,310 --> 00:22:14,460So having a place to put comments like,
25200:22:14,470 --> 00:22:15,650um,
25300:22:15,660 --> 00:22:16,350you know,
25400:22:16,350 --> 00:22:25,390you don't have to call me so many times or um I really don't think that person is mad at you.
25500:22:25,400 --> 00:22:25,840You know,
25600:22:25,840 --> 00:22:27,590when we get feedback like that,
25700:22:27,590 --> 00:22:30,950it it does help us to have a place where we say,
25800:22:30,960 --> 00:22:31,650oh,
25900:22:32,250 --> 00:22:33,400I didn't realize that,
26000:22:33,400 --> 00:22:39,570but I do know I can make errors in that in that area sometimes.
26100:22:40,420 --> 00:22:41,170Um,
26200:22:41,810 --> 00:22:47,440I also think that the awareness can be about what we lean toward.
26300:22:47,450 --> 00:22:50,780So if we have trouble finding the just right spot,
26400:22:50,780 --> 00:23:03,780sometimes we lean toward going toward too much or too little and in my case I lean toward uh leaving too much room or thinking I don't have enough room.
26500:23:03,780 --> 00:23:05,790So I lean in the same direction.
26600:23:07,100 --> 00:23:07,800Um,
26700:23:07,810 --> 00:23:17,440in the case of autism and the categories that we've talked about sometimes that's true for individuals in those categories as well.
26800:23:17,450 --> 00:23:28,640So I have clients that always lean toward thinking that they haven't done enough or they always lean toward thinking,
26900:23:28,900 --> 00:23:29,500um,
27000:23:29,510 --> 00:23:36,160someone's mad at them or thinking that they shouldn't spend money on something.
27100:23:36,170 --> 00:23:40,680So they have a way that they lean so they can say to themselves,
27200:23:40,690 --> 00:23:46,090I realize about myself that when I am off of just right,
27300:23:46,090 --> 00:23:48,780I'm usually in this direction in this category.
27400:23:50,230 --> 00:23:51,840That's also helpful.
27500:23:51,850 --> 00:23:52,600Um,
27600:23:52,610 --> 00:23:54,780because I do think again,
27700:23:54,780 --> 00:23:56,510it gives us a place to put things.
27800:23:56,510 --> 00:24:06,800So let's say that someone is working on a university project and there's nobody there to guide them through and they're thinking,
27900:24:08,050 --> 00:24:14,600I've checked all these specific boxes that the professor asked for,
28000:24:14,610 --> 00:24:17,390but I just have this feeling that I should do more.
28100:24:17,390 --> 00:24:19,290I know I could do more,
28200:24:19,300 --> 00:24:21,910at least they're able to say to themselves,
28300:24:21,910 --> 00:24:22,590you know,
28400:24:22,600 --> 00:24:26,720when I'm uncertain about whether I've done enough,
28500:24:26,720 --> 00:24:29,410usually I've already done too much.
28600:24:29,420 --> 00:24:30,060Um,
28700:24:30,060 --> 00:24:34,730so that can be a guide for them of sorts where they could say,
28800:24:34,730 --> 00:24:35,150okay,
28900:24:35,150 --> 00:24:36,170I'm gonna,
29000:24:36,180 --> 00:24:38,730I'm gonna complete this task,
29100:24:38,730 --> 00:24:42,370I'm gonna call it completed because um,
29200:24:43,210 --> 00:24:47,890I know I lean in that direction and I feel like I've ticked the basic boxes.
29300:24:52,170 --> 00:24:58,140Another thing that can be helpful then is to have some way to communicate.
29400:24:58,150 --> 00:25:06,210Maybe some uh sentences or phrases or ways of putting things that you've practiced ahead of time,
29500:25:06,890 --> 00:25:13,520that communicate to others about your difficulty finding just right in a specific area.
29600:25:15,040 --> 00:25:17,880So let's take some examples.
29700:25:17,890 --> 00:25:26,920And this could be communication beforehand or uh in the midst or after something has happened,
29800:25:27,960 --> 00:25:29,720an example would be,
29900:25:29,730 --> 00:25:42,750let's say someone is starting a new romantic relationship and they have the self awareness that sometimes when they come home from work,
30000:25:42,750 --> 00:25:48,130they are really shut down psychologically and they're in their own head,
30100:25:48,140 --> 00:25:48,780you know,
30200:25:48,780 --> 00:25:53,590that they don't talk a lot to their partners,
30300:25:53,590 --> 00:25:59,110they don't interact much and sometimes partners need something that they aren't,
30400:25:59,120 --> 00:26:00,180aren't giving.
30500:26:00,190 --> 00:26:02,410So with that awareness,
30600:26:02,420 --> 00:26:06,300they could say to the partner ahead of time,
30700:26:06,930 --> 00:26:07,640hey,
30800:26:07,640 --> 00:26:17,420I'm I've been learning about myself uh and one of the things I've learned is that I guess I tend to be shut down after work when I come home.
30900:26:17,430 --> 00:26:20,940So if you need help with something,
31000:26:20,950 --> 00:26:23,620if you um you know,
31100:26:23,620 --> 00:26:27,580want to tell me a specific story or something that's happened,
31200:26:27,580 --> 00:26:39,820you might really just have to um have me look you in the eye and tell me exactly what you need because I might not read the situation very well on my own.
31300:26:40,550 --> 00:26:43,360So that would be a case where,
31400:26:43,370 --> 00:26:44,020you know,
31500:26:44,020 --> 00:26:45,950you have difficulty finding just right,
31600:26:45,950 --> 00:26:49,600you're not going to be able to compensate after work,
31700:26:49,600 --> 00:26:52,210you're already kind of offline,
31800:26:52,220 --> 00:27:02,410but you could explain a bit of the context even though you can't compensate yourself or shift that you could give some context.
31900:27:03,990 --> 00:27:08,890I think the value of that is not only giving the person that information,
32000:27:08,890 --> 00:27:15,040but I think telling people that you're trying to learn more about yourself,
32100:27:15,050 --> 00:27:19,350I think is just a really good thing to communicate.
32200:27:19,360 --> 00:27:32,340People value that we all know we're imperfect humans and we're learning about ourselves and we're growing and that we're open to feedback.
32300:27:32,350 --> 00:27:33,350So,
32400:27:33,360 --> 00:27:33,830you know,
32500:27:33,830 --> 00:27:36,280if feel free to give me feedback,
32600:27:36,280 --> 00:27:49,630if I'm if I'm offline and and I can try to adjust an example of communicating after the fact or maybe in the midst of a fact.
32700:27:49,640 --> 00:27:52,540So let's take a different example.
32800:27:52,540 --> 00:28:06,350We're going to take the example of being at work and there is a project that you've been put in charge of and you miss the deadline and your boss is gonna do coaching with you about that.
32900:28:07,400 --> 00:28:15,290Um So you get feedback from your boss who is frustrated that the deadline was missed.
33000:28:15,860 --> 00:28:16,890That you know,
33100:28:16,890 --> 00:28:25,660he he really needs to be able to count on someone that can meet deadlines because these are very important to the bottom line of their department.
33200:28:25,670 --> 00:28:30,540And if you can't be a team player and get those deadlines done,
33300:28:30,540 --> 00:28:34,670then the whole team suffers again.
33400:28:34,670 --> 00:28:39,980This would be an opportunity for you to say in your head,
33500:28:39,990 --> 00:28:40,380you know,
33600:28:40,380 --> 00:28:43,970to think uh here here,
33700:28:43,970 --> 00:28:44,860this comes up.
33800:28:44,860 --> 00:28:53,530I know that I do tend to focus on accuracy more than speed and I didn't realize it,
33900:28:53,530 --> 00:28:58,300but uh that's come into play here and so out loud to your boss,
34000:28:58,310 --> 00:29:01,140you could say a similar thing,
34100:29:01,140 --> 00:29:02,330you could say,
34200:29:03,230 --> 00:29:04,700you know,
34300:29:04,710 --> 00:29:07,410I'm really sorry that that happened,
34400:29:07,420 --> 00:29:31,260I've been learning about myself that I really do tend toward getting into the detail and sometimes I sacrifice speed without really meaning to and what I realize helps me is and then you can give a specific thing that you would like.
34500:29:31,270 --> 00:29:36,870Um so one of the things an employee might ask for would be,
34600:29:36,880 --> 00:29:55,720it would help me if I could set uh deadlines for parts of the project rather than the completion so that I really stay on pace and what I'd like to do for this next project you've given me is break it into six parts and I'm going to,
34700:29:55,730 --> 00:29:56,390you know,
34800:29:56,390 --> 00:30:04,290give you dates for my deadlines for each of these parts and you can tell me if the deadlines need to be adjusted.
34900:30:04,800 --> 00:30:11,090Um so what you're doing is saying I have this self awareness and I'm growing in this area,
35000:30:11,630 --> 00:30:19,600you're showing that you're open to feedback and then you're also showing that you're going to try a new strategy.
35100:30:20,650 --> 00:30:31,310So sometimes there can be ways of trying to um navigate this difficulty with just right,
35200:30:31,320 --> 00:30:38,760we talked before about how another navigation tool might might be rules of thumb or general principles.
35300:30:38,760 --> 00:30:40,900So here's my budget,
35400:30:40,900 --> 00:30:50,230this is what I'm supposed to spend or not spend or um rules of thumb for completing a university course.
35500:30:51,540 --> 00:31:10,790But I think the truth of that struggle of not having that innate feel for just right really is something core in the autism neurology that I haven't found um a way to shift.
35600:31:10,790 --> 00:31:20,690I think that's really a core neurologic piece that I'm either too much or too little and if I hit just right,
35700:31:20,700 --> 00:31:21,590that's great.
35800:31:21,590 --> 00:31:23,760But I have such a hard time staying there.
35900:31:25,490 --> 00:31:39,900I want to thank my again for that insight and um I think even when there aren't answers to correct a challenge or to kind of make it easier over time,
36000:31:39,910 --> 00:31:46,180I think that awareness that conceptualization that oh why do I do this?
36100:31:46,180 --> 00:31:48,650Why am I really good at detail?
36200:31:48,650 --> 00:31:50,590But I really struggle with deadlines.
36300:31:50,600 --> 00:31:54,390Well this all hangs together neurologically,
36400:31:54,390 --> 00:32:05,120it's part of that difficulty finding just right and I do think that that conceptualization that self awareness is important in and of itself.
36500:32:05,130 --> 00:32:10,960Um and I do think the understanding that that crosses over categories,
36600:32:10,970 --> 00:32:21,170social and task completion and sleep and attention and all of these other things that are really difficult to balance.
36700:32:22,410 --> 00:32:26,960Thank you Maya and I hope you all join me for our next episode 
 
 

The Holidays and Autism: Holding Fast and Letting Go

Join Dr. Regan for this episode on neurodiversity and holiday celebrations. Sometimes the most memorable moments come from holding tightly to our foundations and releasing other things that don't fit our season of life or individual needs. 
Planning a Merry Holiday on the Autism Spectrum, podcast episode 2020
 
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
 
Read the transcript here:
100:00:03,870 --> 00:00:09,800Hello and I'm glad you're joining me today for this episode of Autism in the Adult podcast.
200:00:09,810 --> 00:00:12,790I am your podcast host,
300:00:12,800 --> 00:00:14,430Dr Theresa Regan,
400:00:14,440 --> 00:00:16,530a neuropsychologist.
500:00:16,540 --> 00:00:25,010I am the founder and director of an autism diagnostic clinic in central Illinois for adolescents,
600:00:25,020 --> 00:00:27,830adults and geriatric patients.
700:00:27,840 --> 00:00:32,780I'm a certified autism specialist and the mother of a teen on the spectrum.
800:00:33,790 --> 00:00:37,770Today we are going to talk about the holiday season.
900:00:37,780 --> 00:00:41,460If you are listening to this shortly after its release,
1000:00:41,470 --> 00:00:45,980you may be within a holiday season as well.
1100:00:45,990 --> 00:01:01,120There are many different meaningful celebrations going on at this time of year across the world and those look different across families and countries and backgrounds and faith experiences.
1200:01:01,470 --> 00:01:07,150But many of us are celebrating a yearly,
1300:01:07,160 --> 00:01:09,310meaningful
1400:01:09,320 --> 00:01:12,910moment in our lives and that can get hectic.
1500:01:12,920 --> 00:01:24,980It can get exciting ... and we're going to talk about how to do that with intention and meaning and hopefully a bit more peace,
1600:01:24,990 --> 00:01:33,490particularly in light of the neuro diversity that may be within your home or your extended family.
1700:01:34,960 --> 00:01:49,930I published one other holiday episode two years ago and re ran that last year. I will link that in the show notes in case you're wanting even more ideas or information about holiday seasons.
1800:01:51,580 --> 00:02:00,770What I wanted to talk to you about today is really something that impacts everyone regardless of generation,
1900:02:00,770 --> 00:02:06,720regardless of region that you're from or what you're celebrating.
2000:02:07,260 --> 00:02:26,270It impacts those on the autism spectrum and impacts neurotypicals...  it's something that also is not specific to holidays that really these are concepts I want to talk about related to anything that we celebrate and re celebrate,
2100:02:26,270 --> 00:02:33,050that we have some kind of tradition for ... this meaningful moment or life season.
2200:02:33,510 --> 00:02:40,420And this could pertain to how we celebrate birthdays or the birth of a child,
2300:02:40,430 --> 00:02:42,290the death of a family member,
2400:02:42,300 --> 00:02:43,320a wedding,
2500:02:43,320 --> 00:02:44,570a graduation.
2600:02:44,580 --> 00:02:47,570You know that in addition to holidays,
2700:02:47,570 --> 00:02:52,450these are events that often have some tradition to them.
2800:02:52,450 --> 00:02:55,880Like this is how we 
2900:02:55,890 --> 00:02:57,510remember this person.
3000:02:57,510 --> 00:02:59,590This is how we celebrate this event.
3100:02:59,600 --> 00:03:02,190This is this is our tradition.
3200:03:02,190 --> 00:03:10,420And what happens in these moments is that we have reproducible 
3300:03:10,430 --> 00:03:13,290items to how we approach this season.
3400:03:13,290 --> 00:03:17,340So we reproduce the birthday celebration.
3500:03:17,340 --> 00:03:22,740We reproduce the holiday celebration... that this is what we do every year.
3600:03:22,740 --> 00:03:24,050This is our tradition.
3700:03:24,050 --> 00:03:35,950This is our expression of joy or meaning or sorrow in the celebration in addition to having a lot of reproduced elements.
3800:03:35,960 --> 00:03:47,990These are also times with heightened emotion and intensity and whether those emotions are joyous or sorrowful or complicated,
3900:03:48,000 --> 00:03:53,010they are there and particularly for the holiday season,
4000:03:53,020 --> 00:03:57,700I think a lot of times there's this feeling of "This year,
4100:03:57,700 --> 00:03:59,920we're going to heighten that excitement.
4200:03:59,930 --> 00:04:05,240We're going to heighten the anticipation and it will be the best holiday ever!"
4300:04:05,250 --> 00:04:14,580And whether we're doing that for ourselves or for kiddos in our household or why we're doing it ... a lot of times.
4400:04:14,580 --> 00:04:23,330there's this quest to reproduce and one-up the last time we celebrated these things.
4500:04:25,050 --> 00:04:39,440It's important to understand that the same adrenaline that feels exciting to many people during these events can also feel overwhelming.
4600:04:39,450 --> 00:04:48,360Adrenaline can feel like anxiety to someone particularly with a sensitive nervous system.
4700:04:48,360 --> 00:04:53,940So someone on the autism spectrum may experience that anticipation,
4800:04:53,940 --> 00:04:54,890the unknown,
4900:04:54,890 --> 00:04:56,580the surprises...
5100:04:57,670 --> 00:05:03,690and this heightened emotion and intense schedule as pretty overwhelming.
5200:05:03,690 --> 00:05:05,190Whereas someone else might say,
5300:05:05,200 --> 00:05:05,700oh,
5400:05:05,710 --> 00:05:06,590I love it.
5500:05:06,600 --> 00:05:09,910It's this anticipation,
5600:05:09,920 --> 00:05:11,440the emotion in the air,
5700:05:11,440 --> 00:05:14,720all the memories... I dive in.
5800:05:14,730 --> 00:05:16,840It's one of my favorite things.
5900:05:16,850 --> 00:05:27,540So here we see that different nervous systems are going to process these moments and celebrations and meaningful events differently.
6000:05:27,550 --> 00:05:31,050And that's one of the things we'll talk about today.
6100:05:34,130 --> 00:05:36,330I'm going to talk about some things that
6200:05:36,340 --> 00:05:56,420I'll invite you to try this holiday season ... or next birthday or next graduation celebration. And one is that I'd really like to invite you to pause and become really psychologically present.
6300:05:56,930 --> 00:06:04,280I think one thing that can happen particularly with the holidays that there is this momentum that comes,
6400:06:04,290 --> 00:06:18,100it's almost like a tidal wave or a tsunami of events and all of a sudden you are kind of just automatically riding this wave of things that are coming at you.
6500:06:18,640 --> 00:06:20,080Again,
6600:06:20,080 --> 00:06:21,500they may be fun things.
6700:06:21,500 --> 00:06:22,820They may be exciting things,
6800:06:22,820 --> 00:06:26,230but often there's really no moment to say,
6900:06:26,240 --> 00:06:26,800okay,
7000:06:26,800 --> 00:06:31,240let's pause and think about what's going on,
7100:06:31,250 --> 00:06:32,300what we need,
7200:06:32,300 --> 00:06:33,570what we'd like to do.
7300:06:33,580 --> 00:06:34,110Um,
7400:06:34,120 --> 00:06:39,040It's just kind of seeing what's coming at us next and riding the wave...
7600:06:40,000 --> 00:06:46,120So I do want to invite us to pause and realize,
7700:06:46,130 --> 00:06:48,130kind of what season we're in,
7800:06:48,340 --> 00:06:51,030what our celebration is about.
7900:06:51,040 --> 00:06:53,830And as we're pausing,
8000:06:53,830 --> 00:06:57,430I would like you to think about ...
8100:06:58,350 --> 00:07:02,230what the season is this year.
8200:07:02,240 --> 00:07:24,080One of the best things that I learned at a time in my life that I guess I needed to hear it was that it's okay for every holiday season to be different ... because it will be we reproduce these events and that's fine.
8300:07:24,080 --> 00:07:26,550But everything won't be reproducible.
8400:07:26,560 --> 00:07:37,680And so one person or family may have a different holiday season this year because they've lost a family member or they've gained family members.
8500:07:37,690 --> 00:07:42,510It may be different for health reasons or financial reasons.
8600:07:42,520 --> 00:07:47,280And sometimes it's not even an individual difference.
8700:07:47,290 --> 00:07:47,840It's
8900:07:48,450 --> 00:07:50,290throughout the whole world,
9000:07:50,290 --> 00:07:50,640you know...
9200:07:51,020 --> 00:07:58,370when we were in the midst of covid and that really just impacted 
9300:07:58,380 --> 00:07:59,190everyone.
9400:07:59,200 --> 00:08:28,990And so we have this ability to then pause and become a bit more self aware of what is happening this season that may be a bit different ... and to realize that it's okay to give space to that and to think about how we might want to engage a bit differently this year given these circumstances.
9600:08:30,690 --> 00:08:48,590I think that the intense desire to reproduce and to one-up the greatness and happiness of past holiday seasons can again be the only driving force.
9700:08:48,600 --> 00:08:51,770So if we take a moment and pause and think,
9800:08:51,770 --> 00:08:55,660what is this holiday season going to be like?
9900:08:55,660 --> 00:08:59,260What's what's the reality like in my household,
10000:08:59,270 --> 00:09:00,450in my personal life,
10100:09:00,450 --> 00:09:03,180my work life, in our region,
10200:09:03,190 --> 00:09:07,350in my faith system, in the country...
10300:09:07,360 --> 00:09:11,320And let me become aware of that for a moment.
10500:09:15,230 --> 00:09:27,680in addition to noticing that the seasons of life change... and that there may be different ways that we want to engage in the holiday season.
10600:09:27,690 --> 00:09:28,200(again,
10700:09:28,210 --> 00:09:29,510other birthdays,
10800:09:29,510 --> 00:09:30,310anniversaries,
10900:09:30,310 --> 00:09:31,160etcetera)
11000:09:31,810 --> 00:09:45,270there are also differences in people... that one person in your household is going to need something different than another person.
11100:09:45,620 --> 00:09:49,470And pausing and thinking about that can be really helpful.
11200:09:49,470 --> 00:09:49,850Again,
11300:09:49,850 --> 00:09:59,700the drive to reproduce all of these elements the same way the same year for all people around you...
11400:09:59,700 --> 00:10:01,460That's really difficult.
11500:10:01,470 --> 00:10:05,630And it often doesn't make this season as meaningful.
11600:10:06,830 --> 00:10:09,180So for example,
11700:10:09,180 --> 00:10:10,650one person,
11800:10:10,660 --> 00:10:19,480like we said in the beginning may love surprises and that may be the best part of the holiday season,
11900:10:19,480 --> 00:10:25,670that there are all these little surprises and gifts and wow moments like,
12000:10:25,680 --> 00:10:29,610oh look at this recipe that this person made,
12100:10:29,610 --> 00:10:31,010how new,
12200:10:31,010 --> 00:10:32,000how interesting,
12300:10:32,000 --> 00:10:43,750how exciting ...another person may really want peace and maybe internal introspection or alone time.
12400:10:43,750 --> 00:10:51,110And maybe they want the "silent night" of the Christmas carol ... or 
12500:10:51,120 --> 00:10:57,320they want to know ahead of time what will happen because they enjoy the experience
12600:10:57,330 --> 00:11:01,080but they don't like the excitement or the surprise,
12700:11:01,090 --> 00:11:05,720They want to calm down that intensity and that's where the autism piece comes in,
12800:11:05,980 --> 00:11:17,910that someone with a heightened neurology or a different neurology may have different desires and needs and to reproduce everything the same year and 
12900:11:17,920 --> 00:11:20,200for every different person,
13000:11:20,210 --> 00:11:26,970I think that takes away some of the real meaning and good memories that we could have.
13100:11:29,070 --> 00:11:36,290What I'd like to invite you to do is to think about what your reality is this year.
13200:11:36,300 --> 00:11:39,710What has gone on this year in your personal life,
13300:11:39,710 --> 00:11:40,680your family life,
13400:11:40,680 --> 00:11:44,070what's the reality for people in your home?
13500:11:45,080 --> 00:11:53,630And I'd also like you to take a personal inventory and to check in with the people that you're closest with,
13600:11:53,640 --> 00:12:08,910that you will be doing the holidays with, and see where they're at and what they need and to take this intentional pause and to ask for everybody's individual needs.
13700:12:08,920 --> 00:12:18,740... I think really helps the holiday season run more smoothly and helps for better connection and more meaning.
13800:12:21,910 --> 00:12:34,120Part of the way that an individual is going to respond will be based on their neurologic makeup and part will be based on their own life story this year,
13900:12:35,900 --> 00:12:45,790invite people to pick 1, 2, ... 3 things that really are the most meaningful for them during a holiday season.
14000:12:45,800 --> 00:12:55,390So you could conceptualize it as what do you want to hold tightly to and what could you hold loosely,
14100:12:56,140 --> 00:13:02,900what do you want to be your foundational holiday experience like ...this is meaningful,
14200:13:02,900 --> 00:13:03,840I love this.
14300:13:03,840 --> 00:13:07,400I look forward to this every year... and what could be,
14400:13:07,410 --> 00:13:08,420you know,
14500:13:08,420 --> 00:13:10,580something you enjoy and you've done,
14600:13:10,580 --> 00:13:13,040but you could hold loosely to it...
14700:13:13,050 --> 00:13:26,770you could release it this year and still feel OK. And when everyone has those one or two things and is able to come together,
14800:13:26,930 --> 00:13:41,160I would invite you to share that together and see what kinds of things come up that are most meaningful and important to people in this framework.
14900:13:41,670 --> 00:14:05,400There is a need to be able to release some things and I think if we are holding on to every reproducible piece of every holiday season tightly because we don't want to miss out or we don't want the kids to miss out or it wouldn't be Christmas without everything going on or Hanukkah,
15000:14:05,410 --> 00:14:10,540... it wouldn't be a birthday if we didn't do this again,
15100:14:10,540 --> 00:14:21,880I'd invite you to pause and think about whether we're doing all of those things out of fear that people will miss out on something.
15200:14:22,460 --> 00:14:31,100And if so maybe we could release that this year and maybe we could pause and make a few more meaningful choices.
15300:14:32,500 --> 00:14:45,060I cannot tell you the number of times I've talked to families in crisis who have a neuro diverse family ... and they're in crisis because you know,
15400:14:45,070 --> 00:14:51,190one or more of them is really having a lot more meltdowns and anxiety. And yet when they leave,
15500:14:51,190 --> 00:14:52,170they talk about
15600:14:52,180 --> 00:14:57,900"oh and we're going to this concert and we're going out of state to visit this relative and we're..." 
15700:14:57,910 --> 00:15:00,090and I kind of think,
15800:15:00,850 --> 00:15:01,690you know,
15900:15:01,690 --> 00:15:06,660I think that's an example of where we don't even kind of stop to think like,
16000:15:06,660 --> 00:15:11,850does that match where we're at this year in this family unit?
16100:15:11,850 --> 00:15:17,190And does it match the nervous system for people who are in the family?
16200:15:21,510 --> 00:15:33,510I want to give you an example of a family that went on this journey just to make it come alive and give you some ideas and encouragement to 
16300:15:33,520 --> 00:15:39,350focus on this pause and intentionality this year in some way,
16400:15:40,730 --> 00:15:46,320This is a family with a couple who have been married 20 plus years.
16500:15:46,330 --> 00:15:48,610They are now empty nesters.
16600:15:48,610 --> 00:15:58,570They have three young adult Children and one of their adults kids is not going to be home for the holidays this year,
16700:15:58,570 --> 00:15:59,430which is different.
16800:15:59,430 --> 00:16:03,450So that's a piece of their life that is in transition.
16900:16:03,460 --> 00:16:05,780What is this holiday to them?
17000:16:05,780 --> 00:16:05,980Well,
17100:16:05,980 --> 00:16:08,470one of their loved ones won't be there...
17300:16:09,740 --> 00:16:14,770the gentleman in this couple lost his mother this year,
17400:16:14,770 --> 00:16:16,110she passed away.
17500:16:16,700 --> 00:16:17,240Um,
17600:16:17,250 --> 00:16:24,110they each work and they each have had some personal struggles and challenges at work.
17700:16:24,120 --> 00:16:26,530They've had some financial changes.
17800:16:26,540 --> 00:16:28,190Um,
17900:16:28,200 --> 00:16:41,030one of the two kids who is going to be home for the holiday season is doing really well and another of their adult kids whose coming home is struggling,
18000:16:42,110 --> 00:16:44,320their family is neuro diverse.
18100:16:44,330 --> 00:17:08,970And the gentleman in the couple has been diagnosed on the spectrum for a couple of years and the one individual who is actually doing well and really in a good place is also on the spectrum and they have extended family members that they suspect to have qualities or perhaps undiagnosed autism.
18200:17:10,490 --> 00:17:21,770So one of the things that they were invited to do as a couple that started off with the couple kind of focusing on the holiday season,
18300:17:21,780 --> 00:17:28,340They were invited to have this pause and awareness of what's going on in the family.
18400:17:29,000 --> 00:17:35,860What's the context for this year's holiday season and to become more aware of that.
18500:17:35,870 --> 00:17:43,100And they were invited to do this within the context of counseling because they really had had just um,
18600:17:43,110 --> 00:17:48,100about a rough year and a half of relationship issues.
18700:17:48,110 --> 00:17:49,290Um,
18800:17:49,300 --> 00:17:50,590it was complex,
18900:17:50,590 --> 00:17:55,640some of it had to do with empty nest issues and,
19000:17:55,650 --> 00:17:58,370and now that they didn't have the kids there,
19100:17:58,370 --> 00:18:03,270they wanted to rely on each other more for emotional support and companionship.
19200:18:03,270 --> 00:18:04,340And uh,
19300:18:04,350 --> 00:18:06,730there were some rough spots there,
19400:18:06,740 --> 00:18:09,520they had each had their own stressors.
19500:18:09,520 --> 00:18:13,060And so that impacted their ability to connect as well.
19600:18:14,260 --> 00:18:22,730So they were really hurting in their relationship and that was why they went to counseling and that is why the counselor brought up,
19700:18:22,740 --> 00:18:32,950what is this holiday season for you guys where you at in your life and how might the holiday season connect with all of this complexity.
19800:18:33,680 --> 00:18:38,010And that ended up being a really good pause for them.
19900:18:38,020 --> 00:18:39,170Um,
20000:18:39,180 --> 00:18:51,340and they were able to review all of these life events and to think about this concept of whether everything needed to be reproduced um,
20100:18:51,350 --> 00:18:54,590in their life this year again for the holidays.
20200:18:54,590 --> 00:18:57,260They were very active people.
20300:18:57,270 --> 00:19:00,070They both worked full time.
20400:19:00,080 --> 00:19:04,900They there were various volunteer things they did over the holiday season.
20500:19:04,910 --> 00:19:14,780They also hosted more than one holiday gathering at their home for extended family and also for a community organization.
20600:19:15,260 --> 00:19:16,000Uh,
20700:19:16,010 --> 00:19:16,800they just,
20800:19:16,810 --> 00:19:18,170they were busy people.
20900:19:18,170 --> 00:19:19,850They decorated their house.
21000:19:19,860 --> 00:19:23,780So kind of a lot of the normal stuff in there.
21100:19:23,790 --> 00:19:24,460Um,
21200:19:24,470 --> 00:19:32,390geographic region they participated in when they became more self aware,
21300:19:32,390 --> 00:19:41,120they tried to go through this process of what do I want to hold tightly to and what can I hold loosely?
21400:19:41,130 --> 00:19:43,790And they did have this initial reaction like,
21500:19:43,800 --> 00:19:44,060oh,
21600:19:44,060 --> 00:19:46,120I don't want to give this part up.
21700:19:46,130 --> 00:19:46,790Um,
21800:19:46,790 --> 00:20:04,090and they felt increased pressure to make it the best holiday ever because they were struggling that that almost made it more dire for them to make this wonderful.
21900:20:04,280 --> 00:20:11,730And there was the voice in the back of their head that felt like if we can't even make the holidays work.
22000:20:11,740 --> 00:20:12,920Uh,
22100:20:12,930 --> 00:20:13,400you know,
22200:20:13,400 --> 00:20:15,450is there hope for our relationship,
22300:20:15,450 --> 00:20:20,830Can we make other things work if we can't do this kind of very reproducible,
22400:20:20,830 --> 00:20:22,760happy kind of celebration.
22500:20:23,780 --> 00:20:26,270So they thought about that for a while.
22600:20:26,280 --> 00:20:33,140Um and they had a whole list of things they didn't feel like they could release,
22700:20:33,660 --> 00:20:36,360but then you know,
22800:20:36,360 --> 00:20:37,670with a bit more pause,
22900:20:37,670 --> 00:20:40,300they decided that this year they would try it,
23000:20:40,310 --> 00:20:45,660they would try to see and if next year they wanted to do the whole shebang,
23100:20:45,660 --> 00:20:47,180they really could do that.
23200:20:49,930 --> 00:20:58,360An interesting thing for them as a couple to was that they had recently had a really nice personal moments.
23300:20:58,370 --> 00:21:05,840Um they lived in a warm climate and they had this kind of slider um,
23400:21:05,850 --> 00:21:07,790it's kind of like a porch swing,
23500:21:07,790 --> 00:21:31,150but I guess it was on a slider kind of mechanism and they would be in the backyard in that slider swing kind of thing and they've had some nice conversations out there and that was not always the case for them in the season of their life and they both said those were moments recently that were really good.
23600:21:32,400 --> 00:21:48,570Now interestingly the therapist in working with them could see that the gentleman on the spectrum really sought a lot of the stimulator input and that is movement input and that was calming and regulating to his nervous system.
23700:21:48,580 --> 00:21:52,210He was an avid long distance cycler.
23800:21:52,220 --> 00:22:17,880Um he had done other things like downhill skiing and he was really drawn toward movement to feel centered and this was a way that he could get some gentle rocking input while having a conversation that had the potential to have kind of an emotional elevation or difficulty.
23900:22:18,810 --> 00:22:35,870Another thing that the therapist notice that probably made that swing a nice place for them to talk and connect was that there is not a social expectation that you're going to face each other and have this long extended eye contact.
24000:22:35,880 --> 00:22:39,260So when you're in this kind of swing mechanism,
24100:22:39,270 --> 00:22:50,950it's expected that you'll sit side to side and for him that was enough to reduce some of the intensity of the experience to a point where he felt more regulated.
24200:22:50,960 --> 00:22:54,140So this was actually a good place for them.
24300:22:54,140 --> 00:23:01,120And even though there's no reason they can't have a conversation in the house getting away from the house,
24400:23:01,120 --> 00:23:08,740psychologically felt like they were kind of leaving behind and and coming away together.
24500:23:08,940 --> 00:23:09,760Um,
24600:23:09,770 --> 00:23:16,520so that felt like a separating a part that was good for them to have those conversations.
24700:23:16,530 --> 00:23:30,180They also had a pagoda type set up in the backyard with comfy chairs and that was also just a nice place of respite for them both individually and as a couple.
24800:23:31,380 --> 00:23:42,380So in talking through what was going on in their life and what was most meaningful to them that they wanted to hold onto during the holiday season.
24900:23:42,390 --> 00:23:43,020Uh,
25000:23:43,030 --> 00:23:54,510the wife said that lights were really part of the holiday that brought her the most joy and she wouldn't want to not have lights in the house or christmas,
25100:23:54,510 --> 00:24:02,530lights in in what they were doing and so what they decided to do was not to decorate the whole house,
25200:24:02,540 --> 00:24:07,570they decided to put white lights all over the pagoda,
25300:24:07,580 --> 00:24:23,360all over the um swing mechanism chair and to have a little festive area in the back that they could retreat to and kind of connect in that space.
25400:24:23,370 --> 00:24:27,270And that ended up being um,
25500:24:28,000 --> 00:24:32,650both a really nice celebration of the holiday.
25600:24:32,660 --> 00:24:35,150It ended up bringing them together.
25700:24:35,160 --> 00:24:45,610So they worked together to create this space that was meaningful and pleasant and they were able to protect that space where they could communicate.
25800:24:45,620 --> 00:24:51,560And so that felt like a good exchange that a lot of the decorations were released,
25900:24:51,570 --> 00:24:57,510but they did focus on this nice space and on the lights that were important to her.
26000:24:59,590 --> 00:25:12,090Now the husband said that one of the things that was most important to him about the holidays that he wouldn't want to release is he had a whole list of dishes.
26100:25:12,100 --> 00:25:16,840Uh he liked to cook and she was never the cook in the home.
26200:25:16,840 --> 00:25:17,330He,
26300:25:17,340 --> 00:25:26,920he was always the cook and he really liked to reproduce uh family dishes and traditional dishes during the holiday season.
26400:25:27,250 --> 00:25:35,700The difficult thing about that though is that oftentimes because of the way the holiday schedule works.
26500:25:35,710 --> 00:25:36,350You know,
26600:25:36,350 --> 00:25:42,080you end up having to produce all this food in a very short period of time.
26700:25:42,090 --> 00:25:43,490You're having guests,
26800:25:43,490 --> 00:25:46,780you're having a celebration on a particular day.
26900:25:47,300 --> 00:25:53,030So what he held onto were 10 of those dishes?
27000:25:53,550 --> 00:26:03,580Uh he let some go and then he also released having to have these nice meals on a particular day.
27100:26:03,590 --> 00:26:09,450So what they did is they took Multiple weeks out of the season.
27200:26:09,450 --> 00:26:21,730So prior to their thanksgiving that they were celebrating through the Christmas season through the new year and they made 1-2 of those important dishes every week.
27300:26:22,380 --> 00:26:25,810And what they did was they also made them together.
27400:26:25,820 --> 00:26:27,720So now that the kids were gone,
27500:26:27,720 --> 00:26:34,160she actually was interested in learning not to cook mundane meals,
27600:26:34,160 --> 00:26:34,680but she,
27700:26:34,690 --> 00:26:38,700she kind of really did want to get in there and learn some fun stuff.
27800:26:38,710 --> 00:26:42,330So this became a good um,
27900:26:42,340 --> 00:26:52,140couples moment as well and they also had a nice time just having a calm meal together,
28000:26:52,350 --> 00:27:00,550having some of these fun traditional dishes and it offered them the opportunity to reminisce as well.
28100:27:00,560 --> 00:27:05,360And so he could tell his stories again about childhood and this is grandma,
28200:27:05,360 --> 00:27:05,630so,
28300:27:05,630 --> 00:27:08,550and so's recipe and um,
28400:27:08,560 --> 00:27:09,800some of these facts,
28500:27:09,800 --> 00:27:14,350she knew before and some were new and that felt like a meaningful,
28600:27:14,350 --> 00:27:17,380enjoyable thing that they did.
28700:27:17,380 --> 00:27:19,640And for some of these dishes,
28800:27:19,650 --> 00:27:22,020um their kids were home,
28900:27:22,020 --> 00:27:26,670the two kids and they were able to kind of have that family moment as well.
29000:27:28,380 --> 00:27:33,680So there were other things that they did things that each of their kids wanted or needed.
29100:27:33,690 --> 00:27:40,800But this story I think highlights the potential of a couple of things.
29200:27:40,800 --> 00:27:44,090One is realizing what the,
29300:27:44,100 --> 00:27:50,320the life season is for you during a particular birthday season,
29400:27:50,320 --> 00:27:51,840holiday season.
29500:27:51,850 --> 00:27:53,990What is your life season?
29600:27:53,990 --> 00:28:14,390How does that connect also who are the individuals that are in the celebration or this meaningful, reproduced event and what are their specific needs ... and that may be related to their age,
29700:28:14,390 --> 00:28:16,050to their neurology.
29800:28:16,060 --> 00:28:20,550Um lots of different things can impact what a person needs.
29900:28:21,710 --> 00:28:27,340Having this self awareness and pause of those two elements,
30000:28:27,350 --> 00:28:31,910the life season and the individuals that's really helpful.
30100:28:33,440 --> 00:28:41,190It also teaches us to have increased self awareness a lot of times.
30200:28:41,190 --> 00:28:41,800As I said,
30300:28:41,800 --> 00:28:46,280there's this tidal wave about this is what the season is,
30400:28:46,280 --> 00:28:51,040regardless and it it teaches us to be more aware of what we need.
30500:28:51,050 --> 00:28:58,500It encourages people around us to be aware of what they need and to communicate that that's huge.
30600:28:58,500 --> 00:29:00,130We can use that every day.
30700:29:00,330 --> 00:29:03,290This is a household where people have different needs,
30800:29:03,300 --> 00:29:15,600what do you need and let me tell you what I need and how can we bring together a moment and a celebration and a season that is life giving for the people in this home.
30900:29:17,300 --> 00:29:29,330It does require us to hold fast and strong to some foundational things and to release things and the releasing can feel hard,
31000:29:29,340 --> 00:29:36,850but I challenge you to do that this season and to see if there's joy and peace that comes from this.
31100:29:36,860 --> 00:29:39,280Um in a meaningful way.
31200:29:39,900 --> 00:29:42,030Every season can be different.
31300:29:42,040 --> 00:29:44,600You can go back to the whole shebang,
31400:29:44,610 --> 00:29:53,900You can pick different things next season but never feel that you have to go along with the tidal wave just because it's there.
31500:29:55,120 --> 00:30:15,520I hope you have a blessed and meaningful holiday season if you are in the midst of one and that all of your life moments that you celebrate and you pause to add meaning to that these come together to really be a calm and peaceful place in relationship building.
31600:30:16,420 --> 00:30:23,700I'm going to take the rest of the holiday season off and I will see you again for the next episode in january.
 
 

Autism and Misdiagnosis: Anxiety, Trauma, and OCD

Join Dr. Regan for the final episode in this series on autism misdiagnosis. This episode focuses on anxiety-related conditions and when their diagnosis may mean that autism is never considered. Wrapping up this series, Dr. Regan also discusses that after all assessments are concluded, there will be instances when no diagnosis of autism can or should be made.
Previous episode -- Abuse, Neglect, and Relational Pain on the Autism Spectrum
 
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:06,730 --> 00:00:07,190Hello,200:00:07,190 --> 00:00:09,130this is Dr Theresa Regan.300:00:09,140 --> 00:00:11,790I am the host of this podcast,400:00:11,800 --> 00:00:13,320autism in the adult.500:00:13,330 --> 00:00:15,480I'm a neuropsychologist,600:00:15,490 --> 00:00:23,650the director of an adult diagnostic autism clinic in central Illinois and a certified autism specialist.700:00:24,330 --> 00:00:32,480You are joining me for the 4th and final episode of a series on autism and misdiagnosis.800:00:32,490 --> 00:00:36,480The first episode covered foundational information.900:00:36,490 --> 00:00:39,320Why does misdiagnosis occur?1000:00:40,390 --> 00:00:47,110That is, why is autism missed while other conditions may be diagnosed Instead.1100:00:48,040 --> 00:01:02,860The next episode focused on personality disorders and we specifically reviewed information about borderline personality and narcissistic personality as potential misdiagnoses for autism.1200:01:03,640 --> 00:01:12,730The 3rd episode covered information about bipolar disorder and depression and today's episode will focus on anxiety.1300:01:14,620 --> 00:01:25,760I should say that we could continue this misdiagnosis series for quite some time and cover other really common areas of misdiagnosis ... like schizophrenia,1400:01:25,760 --> 00:01:27,390psychotic conditions,1500:01:27,400 --> 00:01:34,810dementia and those involving behavioral dysregulation things like oppositional defiant disorder.1600:01:35,930 --> 00:01:52,250I'm not going to dive into all the possible categories because I feel like we've covered several common misdiagnoses and also because the main goal of the series has been to just introduce the concept that misdiagnosis does occur.1700:01:52,260 --> 00:02:08,990And also to illustrate why ... essentially to point out what kinds of elements in the neurology of autism may lead to diagnoses describing these single points but missing the big picture diagnosis of autism.1800:02:12,090 --> 00:02:32,480So we covered the possible misdiagnosis of depression last episode and we're going to talk about anxiety today ... and so I'll share with you my own thoughts based on my personal experiences that anxiety seems to stem at least in part from the neurobiology of autism.1900:02:33,040 --> 00:02:39,560Whereas depressed mood as I would define it with this component of emotional struggle,2000:02:39,570 --> 00:02:40,790hopelessness,2100:02:40,790 --> 00:02:41,520helplessness,2200:02:41,520 --> 00:02:42,540worthlessness,2300:02:42,550 --> 00:02:44,950loss of pleasure in activities.2400:02:44,960 --> 00:02:51,540This seems to be more reactive in the autistic individual to difficult life circumstances.2500:02:52,320 --> 00:02:59,000It seems to me that most individuals on the spectrum do experience difficulty with anxiety,2600:02:59,010 --> 00:03:07,470although the strength of this anxiety and how much it impacts their daily life can vary across life seasons.2700:03:10,860 --> 00:03:34,090There is research that has attempted to capture information on the prevalence of anxiety disorders and autism and there are such wide ranging findings that it is a little difficult to really come to a conclusion about the percentage of autistic individuals who do experience noticeable anxiety.2800:03:34,970 --> 00:03:43,560One thing about the research is that many studies focus on individuals who meet full criteria for a certain anxiety disorder.2900:03:43,570 --> 00:03:54,510So, many individuals who experience anxiety and are impacted by this may not meet full criteria and may not be counted in the studies.  Also,3000:03:54,510 --> 00:03:59,620I find that it's really common for some individuals to have significant anxiety,3100:03:59,630 --> 00:04:01,920but it looks like something else.3200:04:01,930 --> 00:04:03,160For example,3300:04:03,160 --> 00:04:08,990meltdowns and outbursts are often triggered by anxiety in the autistic,3400:04:09,000 --> 00:04:13,460but they're interpreted as opposition or conduct disorders.3500:04:14,360 --> 00:04:18,000A flight reaction or a freeze reaction...3600:04:18,190 --> 00:04:24,260These are often so quiet that the anxiety piece of the reaction gets missed.3700:04:25,840 --> 00:04:26,490So,3800:04:26,500 --> 00:04:33,850my experience is that anxiety is more prevalent than it might at first seem in autism and it's also true,3900:04:33,850 --> 00:04:34,290however,4000:04:34,290 --> 00:04:40,860that I should keep in mind that people do seek appointments with me when they have a season of struggle,4100:04:40,870 --> 00:04:49,150they're coming to a clinic setting because something has really hit them at a time that they need input.4200:04:49,370 --> 00:04:59,050And so it's certainly true that my point of view might be skewed as far as working in this particular setting.4300:04:59,050 --> 00:05:05,660Now, rather than going through each anxiety disorder separately as listed in the diagnostic manual,4400:05:05,670 --> 00:05:10,610let's consider the grouping of generalized anxiety disorder,4500:05:10,620 --> 00:05:12,720social anxiety disorder,4600:05:12,720 --> 00:05:16,160separation anxiety, and agoraphobia together.4700:05:18,530 --> 00:05:28,900It's easy to see that individuals who have this baseline anxiousness, and as I said...4800:05:28,910 --> 00:05:33,790some of which seems to be neurobiological degenerated,4900:05:34,360 --> 00:05:37,680that "my system really leans toward anxiety,"5000:05:37,710 --> 00:05:43,870that this could easily be diagnosed as generalized anxiety disorder.5100:05:44,470 --> 00:05:46,530The social anxiety disorder.5200:05:46,530 --> 00:05:47,250Again,5300:05:47,260 --> 00:05:59,170very understandable why the individual on the spectrum may have anxiety related to social interactions and possibly being evaluated negatively.5400:05:59,180 --> 00:06:09,960Many people on the spectrum have a fear of being misunderstood and they don't feel solid enough in their interactions and their comprehension of what's going on... to feel like,5500:06:09,970 --> 00:06:10,300"Yeah,5600:06:10,300 --> 00:06:11,290that really went well,5700:06:11,290 --> 00:06:16,430I feel calm and confident about my social interaction."5800:06:16,440 --> 00:06:21,440So that can lead to this anxiety that brings them in for assistance.5900:06:22,370 --> 00:06:27,920Separation anxiety again could be seen in the autistic individual.6000:06:27,930 --> 00:06:36,280It's often the case that the person on the spectrum would really love to feel safe and connected with someone who's supportive.6100:06:36,290 --> 00:06:49,760This might be a parent in younger years, it could also be a particular friend or a sibling that they don't want to go out you know unless they're paired with them, and it could also be a spouse.6200:06:50,710 --> 00:06:56,820And agoraphobia is also something that could be diagnosed for the person on the spectrum.6300:06:56,820 --> 00:07:01,270In the sense that this could be a person who doesn't like to leave their home,6400:07:01,280 --> 00:07:03,110feels overwhelmed in crowds,6500:07:03,110 --> 00:07:08,800wants to be in their own space and just have time alone in their own setting.6600:07:11,060 --> 00:07:20,680So we can see how an individual with autistic neurology may acquire one or more of these diagnoses based on a few elements of their experience.6700:07:20,690 --> 00:07:26,120The problem ends up being not that those features aren't present.6800:07:26,120 --> 00:07:28,830For example there is a social anxiety,6900:07:28,830 --> 00:07:30,230there is an agoraphobia.7000:07:30,230 --> 00:07:31,270However,7100:07:31,280 --> 00:07:37,890once those are diagnosed the diagnostic picture stops.7200:07:37,900 --> 00:07:46,170So um, they don't say "hey, we should also look for autism." And that's the piece that's difficult.7300:07:46,180 --> 00:07:50,230We want autism to be in that differential at the beginning.7400:07:51,970 --> 00:07:55,740For more information on differentials and what that means.7500:07:55,750 --> 00:07:58,520See the first episode in this series.7600:07:58,530 --> 00:08:06,090But essentially what we're saying is that if someone is being evaluated for a diagnosis of generalized anxiety,7700:08:06,100 --> 00:08:07,250social anxiety,7800:08:07,250 --> 00:08:16,090separation anxiety, or agoraphobia ... there should be a trigger in our minds that also puts autism in that assessment process.7900:08:18,400 --> 00:08:23,960The current edition of the diagnostic manual does not include PTSD or OCD8200:08:24,420 --> 00:08:26,500under anxiety disorders.8300:08:26,510 --> 00:08:37,930Instead the manual gives these their own sections including trauma and stress or related disorders, and obsessive compulsive and related disorders.8400:08:38,610 --> 00:08:39,660However,8500:08:39,670 --> 00:08:42,770for the cohesiveness of our talk,8600:08:42,770 --> 00:08:47,280I am going to include them in this episode on anxiety.8700:08:48,680 --> 00:08:50,780With regard to PTSD,8800:08:50,790 --> 00:08:57,500you may wish to refer to my previous episode entitled Abuse, Neglect, and Relational Pain8900:08:57,500-> 00:09:01,700On the Autism Spectrum in May of 2021.9000:09:02,600 --> 00:09:18,890I'll link the episode in the show notes today. In summary, trauma is a more frequent experience for those on the spectrum than for neurotypical and there are a lot of reasons that this probably occurs. For one,9100:09:18,900 --> 00:09:31,280some infants and children on the spectrum really have difficulty regulating ...and what that means is their ability to feel steady and calm and safe.9200:09:31,860 --> 00:09:37,400This difficulty can be quite a struggle and it can be very externalized.9300:09:37,410 --> 00:09:41,350So the child may be crying and not sleeping.9400:09:41,360 --> 00:09:52,500They might have frequent or prolonged meltdowns, may struggle with everyday aspects of life like wearing socks or eating food. Because of these high levels of needs,9500:09:52,500 --> 00:09:58,480the caregivers of the child may also struggle to get enough sleep, to stay calm...9600:09:58,490 --> 00:10:05,470This may lead to difficult interactions both emotionally and psychologically ... and sometimes physically,9700:10:06,820 --> 00:10:14,370The individual on the spectrum may also struggle to recognize risk interpersonally... when they do encounter this.9800:10:14,370 --> 00:10:15,830So for example,9900:10:15,840 --> 00:10:28,330many females on the spectrum report that they've been in dating situations and really haven't realized the sexual overtures until they found themselves in a really sexually traumatic situation.10000:10:29,390 --> 00:10:38,420There are other reasons that individuals on the spectrum may experience trauma. And PTSD may not be a misdiagnosis at all.10100:10:38,430 --> 00:10:45,900However many times once this diagnosis is entered in someone's chart,10200:10:45,900 --> 00:10:48,170once it's made... a lot of times,10300:10:48,180 --> 00:11:00,150everything about the person is attributed to trauma reactions and there's been no investigation done to see if the underlying neurologic framework for autism can be detected.10400:11:01,460 --> 00:11:09,290Now ... sometimes the trauma has been so extensive that trauma and neurology just can't be teased apart very easily.10500:11:10,010 --> 00:11:14,480But more often there has never even been a consideration of autism.10600:11:14,480 --> 00:11:30,770Nobody has tried to make this distinction, and there's been this overall conclusion that everything the person experiences and the way they react has to do with the trauma experience. And finally, obsessive compulsive disorder.10700:11:32,150 --> 00:11:38,330Now there are seven diagnostic criteria for autism and the first three are social in nature.10800:11:38,370 --> 00:11:46,340They all must be met. And the last four are described as restricted and repetitive patterns of behavior.10900:11:46,350 --> 00:11:48,490Only two of those need to be met.11000:11:49,080 --> 00:11:55,420Now these criteria include elements of thoughts and behaviors that can be labeled as OCD11300:11:55,900 --> 00:11:58,250if someone's not looking at the big picture.11400:11:59,170 --> 00:12:13,910Examples of these kinds of behaviors or elements might include scrupulosity. For example, being very particular about details, thinking in a black and white manner about what's good and what's bad,11500:12:13,910 --> 00:12:15,400what's right and wrong.11600:12:16,110 --> 00:12:18,590This can include literal thinking.11700:12:18,600 --> 00:12:20,470For those on the spectrum.11800:12:20,480 --> 00:12:27,300They may correct others when they're wrong about something and get upset when people break the rules.11900:12:27,310 --> 00:12:30,310They might want to get all the details correct12000:12:30,320 --> 00:12:33,930rather than being able to move on to more important things.12100:12:35,160 --> 00:12:46,160These individuals may repeat certain sequences of movements or speech and they may want objects lined up and arranged in particular patterns or a particular order.12200:12:46,470 --> 00:12:49,280They may care about symmetry and repetition.12300:12:49,880 --> 00:12:54,480So this focus on repetition and ritual can resemble OCD12600:12:55,310 --> 00:13:00,190Which can mean that the diagnosis of autism is never explored.12700:13:01,310 --> 00:13:02,240So now,12800:13:02,240 --> 00:13:06,250if we step back and we think about all the episodes in this series,12900:13:06,260 --> 00:13:11,550we can see how an individual who presents with a history of multiple diagnoses,13000:13:11,640 --> 00:13:14,740let's say social anxiety disorder,13100:13:14,740 --> 00:13:16,090bipolar disorder,13200:13:16,090 --> 00:13:17,780borderline personality.13300:13:17,790 --> 00:13:18,380Well,13400:13:18,380 --> 00:13:25,840they may actually have one diagnosis that has never even been considered and that is autism.13500:13:27,700 --> 00:13:28,170Now,13600:13:28,170 --> 00:13:30,490before we end this series entirely,13700:13:30,490 --> 00:13:41,920let me add a caveat to balance out this information. Because autism often doesn't get enough attention with clinicians when they're performing assessments,13800:13:41,920 --> 00:13:44,330particularly those perhaps with adults,13900:13:44,350 --> 00:13:54,250I do focus a lot on the importance of autism assessment and also the fact that these diagnoses can be specifically included in a differential.14000:13:55,400 --> 00:13:59,910Since I've emphasized evaluation and differential diagnosis so much,14100:13:59,920 --> 00:14:10,880I also want to say that in reality there will be times when a skilled clinician will not be able to identify whether autism is present or not.14200:14:12,670 --> 00:14:12,990Now,14300:14:12,990 --> 00:14:19,840autism is identified by a specific pattern in the results and for many reasons,14400:14:19,840 --> 00:14:28,710there will be subsets of patients who present without a clear pattern of features and this may reflect how complex their background is,14500:14:28,720 --> 00:14:30,680how much distress they're in.14600:14:30,690 --> 00:14:35,910But if an autistic pattern is not present or it's obscured by other issues,14700:14:35,930 --> 00:14:41,130then the clinician will not be able to rule in or out the diagnosis of autism.14800:14:41,140 --> 00:14:43,640And rightly so. Now,14900:14:43,640 --> 00:14:44,340ultimately,15000:14:44,340 --> 00:14:51,040our first goal needs to be that autism is included in the differential assessment process.15100:14:51,150 --> 00:14:55,440The second goal is that everyone has a correct diagnosis,15200:14:55,450 --> 00:14:57,470whether that's bipolar,15300:14:57,480 --> 00:14:59,990social anxiety, or autism...15400:15:01,350 --> 00:15:01,660Now,15500:15:01,670 --> 00:15:04,690if the autism pattern is not clearly present,15600:15:04,700 --> 00:15:07,770a diagnosis can't and shouldn't be given.15700:15:08,430 --> 00:15:18,080Some individuals will receive feedback that the autism pattern is clearly not present and this is an important piece of information for them.15800:15:18,790 --> 00:15:22,600Others will receive feedback that autism features are present,15900:15:22,600 --> 00:15:25,460but not all the criteria are met.16000:15:25,470 --> 00:15:28,000So a full diagnosis is not made.16100:15:29,030 --> 00:15:29,530Third,16200:15:29,530 --> 00:15:41,950there will be individuals who receive feedback that there are things obscuring any kind of pattern and figuring out how to untangle these things may really actually be impossible.16300:15:43,060 --> 00:15:43,900Lastly,16400:15:43,900 --> 00:15:50,190about 2% of individuals will receive the feedback that they meet full criteria for autism.16500:15:51,170 --> 00:15:57,850Whatever the conclusions are, dedication toward including neurology in the assessment process,16600:15:57,860 --> 00:15:58,900for example,16700:15:58,900 --> 00:16:09,220including autism in the differential ... it can add to the self awareness that clients receive and awareness is key to well-being and growth.16800:16:10,590 --> 00:16:23,270I thank you for joining me for this series on misdiagnosis, those times when people receive a diagnosis that's describing one little element of their presentation,16900:16:23,270 --> 00:16:25,160but not their whole experience.17000:16:25,170 --> 00:16:29,040And autism is one of those big picture diagnoses.17100:16:30,660 --> 00:16:32,420Thanks again for listening,17200:16:32,420 --> 00:16:34,490and I hope you join me next time.
 
 
 

Autism and Misdiagnosis: Bipolar and Depression

Join Dr. Regan for the third in this series on autism misdiagnosis. This episode focuses on the misdiagnosis of mood conditions for the autistic individual. Specifically bipolar disorder and depression are reviewed.  
Exhaustion in Autism: Balancing Momentum for Daily Activities
Recognizing Dysregulation on the Autism Spectrum: Fight, Flight, Freeze
Dr. Regan's Resources
New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
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100:00:06,900 --> 00:00:07,470Hello,
200:00:07,470 --> 00:00:09,420this is Dr Theresa Regan.
300:00:09,430 --> 00:00:15,040I'm glad you're joining us for today's episode of autism in the adult podcast.
400:00:15,050 --> 00:00:25,570I am a neuropsychologist and the director and founder of a diagnostic autism clinic for adolescents through aging adults in central Illinois.
500:00:25,580 --> 00:00:26,940I am an author,
600:00:26,940 --> 00:00:30,600your podcast host, and the parent of a teen on the spectrum.
700:00:31,550 --> 00:00:41,780You are joining us for the third episode in our series on misdiagnosis for those on the spectrum, and, at a very basic level,
800:00:41,790 --> 00:01:02,980the diagnosis of autism is something that helps us distinguish whether the core emotions and behavioral patterns we see for an individual are the result of their neurology or the result of learning, life experiences, or willful behavior...
900:01:02,990 --> 00:01:07,290that "this is a decision for me to respond this way."
1000:01:08,530 --> 00:01:15,470This is a really important starting point to understand the basis for the patterns that we experience or express.
1100:01:15,480 --> 00:01:24,730And this distinction helps us make good goals and use strategies that are most likely to help us reach the best outcomes for well being.
1200:01:25,400 --> 00:01:25,820Now,
1300:01:25,820 --> 00:01:35,170of course it would be too simplistic to say that a behavioral pattern could be the result entirely of neurology or experience.
1400:01:35,180 --> 00:01:39,780But because we often miss that neurology piece,
1500:01:39,790 --> 00:01:42,280I am highlighting it in this episode.
1600:01:44,100 --> 00:01:44,390Now,
1700:01:44,390 --> 00:02:02,060one of the things that happens for individuals who receive mental health diagnoses is that there's never even a starting point in the diagnostic process where neurology is invited into consideration into the differential.
1800:02:02,070 --> 00:02:04,980So the differential process is when we say,
1900:02:04,990 --> 00:02:05,440okay,
2000:02:05,440 --> 00:02:10,040these features could be present and these five diagnoses.
2100:02:10,040 --> 00:02:18,090Now we're going to do our detective work to figure out which diagnosis really matches this individual.
2200:02:18,100 --> 00:02:21,170If neurology is not in that process,
2300:02:21,180 --> 00:02:22,010of course,
2400:02:22,010 --> 00:02:23,420we're not going to find it,
2500:02:23,430 --> 00:02:24,710we're not looking for it,
2600:02:24,710 --> 00:02:26,140we're not looking at it.
2700:02:28,140 --> 00:02:35,880The assumption is that the experience of the individual stems from their life experience from their choices.
2800:02:35,890 --> 00:02:43,440Uh and that putting diagnoses into two categories of neurologic versus experiential.
2900:02:43,450 --> 00:02:46,660Um although it's not that simple,
3000:02:46,670 --> 00:02:50,470it is a starting point for the beginning framework.
3100:02:50,480 --> 00:02:50,840So,
3200:02:50,840 --> 00:02:58,750I want to raise this idea of neurology being considered in the diagnostic process as really an important place to start,
3300:03:00,000 --> 00:03:06,830because autism often is not considered as a possibility and the initial diagnostic process.
3400:03:06,830 --> 00:03:09,640Many autistic individuals on the spectrum,
3500:03:09,640 --> 00:03:10,250really,
3600:03:10,260 --> 00:03:18,750particularly adults, are given mental health diagnoses that may capture pieces of the picture.
3700:03:19,140 --> 00:03:26,570Um but that are not the best description of the person's overall pattern of experience and behavior,
3800:03:26,570 --> 00:03:31,920and also really missing the point of describing the neurology.
3900:03:32,780 --> 00:03:33,180Now,
4000:03:33,180 --> 00:03:38,500if you have not listened to the first episode in this series on misdiagnosis,
4100:03:38,500 --> 00:03:40,070please do that.
4200:03:40,080 --> 00:03:59,860The foundation for understanding each of these subsequent episodes is really in that first offering. The second episode covered misdiagnosis of personality disorders, and we specifically spent time talking about borderline personality and narcissistic personality.
4300:03:59,880 --> 00:04:00,360Now,
4400:04:00,360 --> 00:04:05,330today we are going to cover diagnoses that have to do with mood.
4500:04:05,370 --> 00:04:09,990So specifically including bipolar disorder and depression.
4600:04:11,250 --> 00:04:11,550Now,
4700:04:11,550 --> 00:04:13,970as in all the episodes in this series,
4800:04:13,970 --> 00:04:20,300we will not be discussing how to distinguish autism from mood conditions.
4900:04:20,310 --> 00:04:30,740This really is an important thing to understand because it's something that would require a skilled clinician to do with lots of training.
5000:04:30,750 --> 00:04:38,270Um it's really on a very individualized basis and it's beyond the scope of anyone podcast episode.
5100:04:39,030 --> 00:04:39,690We will,
5200:04:39,690 --> 00:04:40,280however,
5300:04:40,280 --> 00:04:52,160be covering why a mood diagnosis might be assigned to the autistic individual incorrectly while the autism diagnosis gets missed.
5400:04:52,170 --> 00:04:56,290I think that's an important thing that all of us can understand,
5500:04:56,290 --> 00:04:57,650"why does this happen."
5600:04:57,660 --> 00:05:03,290and then we can start discussions about this with our providers or family...
5700:05:03,490 --> 00:05:12,120so that we're really trying to get at that ability to start with the neurology included in the differential.
5800:05:13,970 --> 00:05:16,370So let's start with bipolar disorder.
5900:05:16,380 --> 00:05:16,940Now,
6000:05:16,940 --> 00:05:17,920at a basic level,
6100:05:17,920 --> 00:05:21,790bipolar describes things like manic episodes,
6200:05:21,800 --> 00:05:26,120lability of mood and emotional expression. 'Lability' 
6300:05:26,120 --> 00:05:34,190meaning that there's this quick change of emotional expression or these mood swings.
6400:05:35,100 --> 00:05:36,210Specifically,
6500:05:36,210 --> 00:05:39,670the following elements may be present in mania:
6600:05:39,680 --> 00:05:43,560inflated self esteem or grandiosity.
6700:05:43,570 --> 00:05:44,010So,
6800:05:44,010 --> 00:05:48,050feeling that the person really has a great knowledge,
6900:05:48,050 --> 00:05:50,460skill, and ability that other people don't.
7000:05:50,990 --> 00:05:52,980For some on the spectrum,
7100:05:52,990 --> 00:05:56,600there are qualities of categorical thinking,
7200:05:56,610 --> 00:06:04,770A love for facts and ideas and inventions, and difficulty understanding the perspectives of others.
7300:06:04,780 --> 00:06:05,230So,
7400:06:05,230 --> 00:06:07,810when these qualities are present,
7500:06:07,820 --> 00:06:27,390the individual may feel that their knowledge (particularly about their topics of greatest interest)... that their knowledge level or skill level is so exceptional that others really have a lot to learn from them... and as noted in the previous episode on personality,
7600:06:27,400 --> 00:06:37,410the individual on the spectrum with these characteristics might appear narcissistic or grandiose ... particularly regarding their
7800:06:38,330 --> 00:06:39,930particular interests.
7900:06:39,930 --> 00:06:48,140So let's say they love history and they dive in and perhaps they really...
8000:06:48,150 --> 00:06:57,460emphasize their skill level in this area and may feel that they are really well above people in their sphere...
8100:06:57,470 --> 00:07:08,640other people that they're interacting with. Another feature of mania that's recognizable to the clinician is a decreased need for sleep.
8200:07:08,650 --> 00:07:12,580So the person in the midst of a manic episode
8300:07:12,590 --> 00:07:15,380may be sleeping a lot less,
8400:07:15,390 --> 00:07:18,660may even stay up for a few days at a time.
8500:07:19,550 --> 00:07:26,130Sleep disturbance is a common characteristic in autism because the brain is in charge of sleep.
8600:07:26,140 --> 00:07:33,350So ... there is variability in what the sleep disturbance looks like for the autistic individual,
8700:07:33,360 --> 00:07:35,840including if it's present at all,
8800:07:35,850 --> 00:07:43,080but a common pattern for the autistic is this trouble falling asleep... very late
8900:07:43,090 --> 00:07:44,180sleeping,
9000:07:44,190 --> 00:07:48,350late waking, or sometimes even reversed sleep cycles.
9100:07:48,350 --> 00:07:52,810So I'm a person that goes to bed at two and wakes up at noon.
9300:07:53,730 --> 00:08:03,670There can even be at least seasons of time where this is an individual that will be up for two days at a time and just can't fall asleep for... three days.
9400:08:03,680 --> 00:08:13,580Sometimes they crash then from exhaustion and spend a lot of time in bed for a period before they're up and at it again.
9500:08:14,870 --> 00:08:16,110The decreased sleep,
9600:08:16,120 --> 00:08:23,140particularly if it's within a season of being even more difficult than usual for this individual...
9700:08:23,150 --> 00:08:23,690Again,
9800:08:23,690 --> 00:08:25,730staying up for days at a time...
9900:08:25,740 --> 00:08:32,930this can trigger concerns for mania in the individual who is actually on the autism spectrum.
10000:08:34,480 --> 00:08:43,840Another piece of mania that people can focus on when they meet someone on the spectrum (and again,
10100:08:43,840 --> 00:08:45,100miss that
10200:08:45,100 --> 00:08:48,830this could be part of autism) is increased talkativeness.
10300:08:49,920 --> 00:08:53,560So for the person with mania,
10400:08:53,570 --> 00:08:57,630they may have a very rapid speech pattern.
10500:08:57,640 --> 00:09:04,630They may not let the other person contribute to the conversation or slow down for the other person.
10600:09:04,640 --> 00:09:08,110It may be difficult to really follow.
10800:09:08,760 --> 00:09:14,010everything that's floating through their head and and coming out.
11000:09:14,450 --> 00:09:18,390so that the listener might feel lost in the case of mania.
11100:09:19,520 --> 00:09:20,000Now,
11200:09:20,000 --> 00:09:25,900for the person on the spectrum who loves to talk about really particular topics...
11400:09:27,000 --> 00:09:30,680they may dominate conversations without realizing it,
11500:09:30,690 --> 00:09:37,740or they may struggle to really understand when others need to stop or take a break or switch topics.
11600:09:37,750 --> 00:09:42,550They might resist talking about topics that they're not interested in.
11700:09:42,560 --> 00:09:50,470Perhaps where they're the listener and the other person is talking about things they enjoy,
11800:09:50,480 --> 00:09:55,580even though the autistic person really is not interested in that.
11900:09:57,080 --> 00:10:07,670And many people on the spectrum also feel like they have racing thoughts and it can be difficult to turn their brain off at night or when they have down time,
12000:10:07,680 --> 00:10:09,700that at least in seasons,
12100:10:09,710 --> 00:10:12,650racing thoughts can interfere with sleep,
12200:10:12,660 --> 00:10:21,530or they can't slow their thoughts down in order to pay attention to a class or a work project.
12300:10:22,520 --> 00:10:30,370And they may even dive deep into particular topics of interest to the extent that they seem obsessed with them in mania.
12500:10:32,950 --> 00:10:35,810You can picture the seasons of poor sleep,
12600:10:35,820 --> 00:10:38,270intense interest, racing thoughts,
12700:10:38,280 --> 00:10:50,290perhaps looking like a mania uh ... particularly if there's a season where these features are really emphasized, like...
12800:10:50,300 --> 00:10:50,530oh,
12900:10:50,530 --> 00:10:55,700I usually get a bit better sleep and now I'm just so into this topic,
13000:10:55,710 --> 00:10:57,790I've been up all night.
13100:11:00,510 --> 00:11:04,320The person with the mania may be distracted easily.
13200:11:04,330 --> 00:11:07,130So executive function...
13300:11:07,140 --> 00:11:17,730part of that is the ability to stay focused, to have flexible attention based on what's most important, to be able to concentrate well.
13400:11:17,730 --> 00:11:24,830Executive function is also an area of challenge for the autistic individual in some pattern.
13500:11:25,640 --> 00:11:32,470So the executive function difficulty for one person on the spectrum may look like distractibility.
13600:11:33,980 --> 00:11:41,170They may struggle with having too little attention for things that people want them to focus on,
13700:11:41,180 --> 00:11:49,720but also too much attention to other things that really capture their interest. Also within the bipolar realm,
13800:11:49,730 --> 00:11:56,240we can see this increase in goal directed activity or what's called psychomotor agitation,
13900:11:56,240 --> 00:11:56,710where,
14100:11:57,300 --> 00:11:59,480the person just can't stop...
14200:11:59,480 --> 00:12:02,790their motor is really running too high.
14300:12:03,710 --> 00:12:08,500The autistic individual who has a motor that's running too high.
14400:12:08,510 --> 00:12:11,140We call that dysregulation.
14500:12:11,150 --> 00:12:17,020And we talked about these concepts and issues when we focused on regulation.
14600:12:17,030 --> 00:12:25,690And one form of dysregulation in the neurologic sphere is when our internal motor is running too high...
14700:12:25,700 --> 00:12:30,490we're not centered in our activity level.
14800:12:30,710 --> 00:12:40,720And so this is an individual neurologically who may rock or pace or stay up all night researching fish tanks instead of sleeping.
14900:12:41,520 --> 00:12:50,970And this is dysregulation for the autistic individual that ...may look like a manic or a hypomanic episode.
15000:12:52,390 --> 00:13:04,030Another feature listed in the diagnostic manual for a manic episodes include engaging in activities that hold the potential for painful consequences.
15100:13:04,040 --> 00:13:09,000This would be things like ...purchasing lots of items,
15200:13:09,000 --> 00:13:10,200spending lots of money,
15300:13:10,200 --> 00:13:11,440for example.
15400:13:13,190 --> 00:13:16,980This characteristic may also be present for the autistic.
15500:13:16,990 --> 00:13:18,680If their executive function
15600:13:18,680 --> 00:13:30,040difficulty leads to poor planning of finances, and if their intense interests really lead to that hunger for more...
15700:13:30,050 --> 00:13:33,600"I want to add to my collection of interesting items,
15800:13:33,600 --> 00:13:36,200I want to add to my book series.
15900:13:36,200 --> 00:13:40,190I need to finish the series of things that I really love."
16000:13:42,820 --> 00:13:48,480Now... spending is not the only type of behavior that could lead to risk or consequences,
16100:13:48,480 --> 00:13:53,800but it's one example in this category of potentially risky activities.
16200:13:55,100 --> 00:14:07,750A characteristic of the bipolar individual may also be difficulty with emotional regulation which is called labile mood in bipolar ...where you have mood swings.
16300:14:07,760 --> 00:14:10,840So instead of being regulated,
16400:14:10,850 --> 00:14:16,100which again means centered with emotions,
16500:14:17,000 --> 00:14:23,060the individual with bipolar may experience difficulty with mood swings.
16600:14:23,070 --> 00:14:25,630So this ability to stay centered...
16800:14:27,620 --> 00:14:36,770and perhaps someone with dysregulation who has bipolar may become very upset or angry without much warning.
16900:14:38,670 --> 00:14:39,180Now,
17000:14:39,190 --> 00:14:44,450all individuals on the spectrum will struggle with emotional regulation.
17100:14:44,460 --> 00:14:50,810But the individual on the spectrum who leans toward externalized dysregulation...
17200:14:50,820 --> 00:14:55,880So "we let out all of this emotion"... a meltdown...
17300:14:55,890 --> 00:15:00,240this may be a person who rolls on the ground, or shouts, or throws
17400:15:00,240 --> 00:15:02,850things ... has crying spells.
17500:15:02,870 --> 00:15:04,960These are the external ...
17600:15:04,970 --> 00:15:07,160you know that... when they're dysregulated,
17700:15:07,170 --> 00:15:09,800it's very loud and noticeable.
17800:15:10,530 --> 00:15:11,060Well,
17900:15:11,060 --> 00:15:15,910this person on the spectrum who has externalized dysregulation,
18000:15:15,950 --> 00:15:20,010they are at risk of being misdiagnosed as bipolar.
18100:15:21,340 --> 00:15:21,640Now,
18200:15:21,640 --> 00:15:27,650the person who has quiet dysregulation... like I'm hiding,
18300:15:27,650 --> 00:15:30,230I'm retreating and withdrawing...
18400:15:30,240 --> 00:15:34,930That's the flight reaction.  Or... I'm frozen.
18500:15:34,940 --> 00:15:36,000I'm shut down.
18600:15:36,000 --> 00:15:37,630I've dissociated.
18800:15:38,830 --> 00:15:40,940This is the freeze reaction.
18900:15:41,810 --> 00:15:47,990These individuals on the spectrum are not likely to be diagnosed with bipolar.
19000:15:48,050 --> 00:15:51,910They may be diagnosed with other things like depression,
19100:15:51,910 --> 00:15:53,540which we'll talk about in a bit.
19200:15:55,690 --> 00:15:56,040So,
19300:15:56,040 --> 00:16:10,430one thing to remember is that the type of dysregulation for this specific autistic individual may influence what misdiagnoses they may be likely to receive.
19400:16:10,440 --> 00:16:22,290So someone with externalized fight reactions when dysregulated may look bipolar to a clinician who's not looking at the big neurologic picture.
19500:16:24,540 --> 00:16:29,980It is possible for an individual to have both bipolar and autism.
19600:16:29,980 --> 00:16:30,900However,
19700:16:30,910 --> 00:16:34,160most of the time that I see bipolar present,
19800:16:34,170 --> 00:16:43,230it's a misdiagnosis or it's assigned by clinicians who don't understand that emotional dysregulation is expected in autism,
19900:16:43,240 --> 00:16:46,260it doesn't need a separate label.
20000:16:47,070 --> 00:16:47,750Um,
20100:16:47,760 --> 00:16:53,940If the dysregulation is not explained by the autism diagnosis,
20200:16:53,950 --> 00:17:08,460then you also diagnose bipolar. And I think I've diagnosed both in about two of my clients out of nearly 550 assessments.
20400:17:09,500 --> 00:17:12,600So that could be particular to my clinic,
20500:17:12,610 --> 00:17:18,260but it does show you that really it's not a very common overlap,
20600:17:18,270 --> 00:17:21,170that most of the time when there's overlap there...
20700:17:21,170 --> 00:17:26,810just describing the fact that there's an externalized dysregulation when someone's overwhelmed.
20900:17:27,720 --> 00:17:33,830But that is to be expected. For the people that I did diagnose,
21000:17:33,840 --> 00:17:48,900I really was able to work with them over a long period of time and I could see acute episodes of mania that really were not typical for autism and were very different from their baseline of autistic dysregulation.
21100:17:49,870 --> 00:17:55,170Another thing to note is that medications typically are not going to change
21200:17:55,180 --> 00:17:59,560if the diagnosis switches from bipolar to autism.
21300:18:00,510 --> 00:18:12,740The medication choices tend to be symptom based and therefore not really dependent on the specific diagnosis as much as the presentation of the characteristics.
21400:18:12,750 --> 00:18:16,630So there may still be a mood stabilizer,
21500:18:16,630 --> 00:18:17,730for example,
21600:18:17,740 --> 00:18:20,970prescribed for someone who has difficulty 
21700:18:20,980 --> 00:18:23,400staying centered with emotions.
21800:18:24,620 --> 00:18:24,900Now,
21900:18:24,900 --> 00:18:27,530let's look at the diagnosis of depression,
22000:18:29,960 --> 00:18:38,360certainly the individual on the spectrum can have mood difficulties based on life struggles just as any human does.
22100:18:38,370 --> 00:18:39,190Um,
22200:18:39,190 --> 00:18:40,280in my experience,
22300:18:40,280 --> 00:18:46,400anxiety is much more inherent to the neurology of autism than depression,
22400:18:46,410 --> 00:18:50,360but depressed mood occurs secondary to struggles.
22500:18:51,440 --> 00:19:01,260Other characteristics that the autistic may have could be labeled as depression but appear to be a misdiagnosis ...
22600:19:01,270 --> 00:19:04,490trying to describe some neurologic characteristics.
22700:19:05,400 --> 00:19:08,140So if there's a misdiagnosis,
22800:19:08,140 --> 00:19:16,820what characteristics of autism would be likely misdiagnosed as part of a depressive episode or part of depression?
22900:19:17,450 --> 00:19:19,390Let's look at these examples.
23000:19:19,390 --> 00:19:19,980So,
23100:19:19,990 --> 00:19:22,760someone with a flat affect ...
23200:19:22,770 --> 00:19:29,730Affect is the emotions ... and in this case we're talking about emotions in the face and the voice.
23300:19:29,740 --> 00:19:33,010And for the individual on the spectrum,
23400:19:33,010 --> 00:19:39,510their neurology may be that there are muted expressions.
23500:19:39,520 --> 00:19:51,940There's a limited range of emotion that comes through the face and the voice so that there's a flatness or a lack of range in their nonverbal expression.
23600:19:51,940 --> 00:20:08,340And this can be part of what fits this criteria of nonverbal communication difficulties when there is not much emotional expression.
23700:20:08,350 --> 00:20:10,630Whether it's neurologic or not...
23800:20:10,640 --> 00:20:12,430another person may say,
23900:20:12,430 --> 00:20:12,850oh,
24000:20:12,850 --> 00:20:16,920this looks like the person is depressed.
24100:20:16,930 --> 00:20:21,990There could be this kind of hidden struggle inside,
24200:20:22,000 --> 00:20:24,750let's treat this person for depression,
24300:20:25,820 --> 00:20:28,050but this is an individual who says,
24400:20:28,050 --> 00:20:28,350gosh,
24500:20:28,350 --> 00:20:29,610I don't feel sad,
24600:20:29,620 --> 00:20:32,130I don't feel hopeless or helpless.
24700:20:32,140 --> 00:20:33,810I don't feel worthless.
24800:20:33,820 --> 00:20:35,750I don't feel discouraged.
24900:20:35,760 --> 00:20:37,100I feel fine,
25000:20:37,640 --> 00:20:39,920but people tell me I'm depressed.
25100:20:39,920 --> 00:20:41,720So I guess I must be...
25200:20:42,490 --> 00:20:46,010So that could be one person who's at risk for,
25300:20:46,020 --> 00:20:48,120misdiagnosis.
25400:20:48,120 --> 00:20:51,140And then of course the depression interventions,
25500:20:51,140 --> 00:20:59,200whether that's counseling or medication, are not going to change the neurology of that nonverbal expression.
25600:21:01,670 --> 00:21:02,890Also,
25700:21:02,900 --> 00:21:11,380there are a subset of individuals on the spectrum who struggle to consistently engage in things like self care...
25800:21:11,390 --> 00:21:12,930taking showers,
25900:21:12,940 --> 00:21:14,060brushing their teeth,
26000:21:14,060 --> 00:21:15,040wearing deodorant,
26100:21:15,050 --> 00:21:16,030eating regular...
26200:21:16,030 --> 00:21:17,280nutritious food,
26300:21:17,290 --> 00:21:20,310uh engaging in exercise,
26400:21:20,320 --> 00:21:21,270getting the sleep
26500:21:21,270 --> 00:21:23,390they need, cleaning the environment,
26600:21:23,400 --> 00:21:24,090working,
26700:21:24,090 --> 00:21:25,940engaging in relationships...
26800:21:26,760 --> 00:21:30,190If the individual rarely leaves the house,
26900:21:30,200 --> 00:21:31,450eats junk food,
27000:21:31,450 --> 00:21:32,960has a reversed sleep cycle,
27100:21:32,960 --> 00:21:34,120doesn't bathe,
27200:21:34,130 --> 00:21:36,140only plays video games...
27300:21:36,150 --> 00:21:39,710Others may conclude that this person is depressed,
27400:21:40,640 --> 00:21:43,880particularly if something in life has changed.
27500:21:43,890 --> 00:21:45,230For example,
27600:21:45,230 --> 00:21:50,540let's say the individual graduated from high school and really can't get going with life.
27700:21:53,150 --> 00:21:56,460The problem is that for the autistic individual,
27800:21:57,260 --> 00:22:10,330their neurology may struggle without structure and high school may have been that input that gave them a reason to get up in the morning, and to get going, and a place to go.
27900:22:10,340 --> 00:22:19,140And the removal of that structure could really lead to a loss of what we call behavioral momentum,
28000:22:19,150 --> 00:22:22,430which is neurologically based...
28100:22:24,410 --> 00:22:30,470creating their own structure and momentum (because of their neurology on the spectrum)...
28200:22:30,470 --> 00:22:32,320that can really be difficult.
28300:22:32,330 --> 00:22:36,120So, even in the absence of emotional struggle,
28400:22:36,130 --> 00:22:45,550you may see this real struggle to initiate behaviors and keep momentum for daily life.
28500:22:49,700 --> 00:22:50,070Now,
28600:22:50,070 --> 00:22:51,580speaking of momentum,
28700:22:51,580 --> 00:22:54,760the brain is in charge of this...
28800:22:54,770 --> 00:22:58,420The issue of getting started...
28900:22:59,230 --> 00:23:02,570let's get going with the task or behavior.
29000:23:02,590 --> 00:23:03,740Let's go,
29100:23:03,740 --> 00:23:04,670let's start,
29200:23:04,680 --> 00:23:09,370let's transition from a resting state to an active state.
29300:23:09,380 --> 00:23:12,770And in my book Understanding Autistic Behaviors,
29400:23:12,780 --> 00:23:16,020I have a chapter called The Physics of Behavior...
29500:23:16,050 --> 00:23:23,150just to explain these kinds of phenomenon where ... if we take the concept of inertia,
29600:23:23,160 --> 00:23:24,510for example,
29700:23:24,520 --> 00:23:27,870so this is a physics concept,
29800:23:27,880 --> 00:23:30,360that's something that is in a resting state
29900:23:30,370 --> 00:23:35,330tends to stay there unless there's energy put into moving it.
30000:23:35,330 --> 00:23:43,160So how do I get going from a resting state... from a stopped state?
30100:23:43,750 --> 00:23:47,240When the individual with autism is in a resting state,
30200:23:48,140 --> 00:23:52,700they may have difficulty getting going into a state of activity.
30300:23:54,410 --> 00:23:54,790Now,
30400:23:54,790 --> 00:23:55,800interestingly,
30500:23:55,810 --> 00:24:01,650the last section on mania describes the same difficulty of transitioning states,
30600:24:01,650 --> 00:24:04,300but this time it's in the opposite direction.
30700:24:04,310 --> 00:24:14,450So the brain should help us both start an activity and stop an activity depending on what's most meaningful,
30800:24:14,450 --> 00:24:16,040important, and healthy.
30900:24:16,050 --> 00:24:16,520Now.
31000:24:16,520 --> 00:24:19,520For the individual with autistic neurology,
31100:24:19,520 --> 00:24:29,390they may have difficulty neurologically doing this... so I can't get going, or when I'm going,
31200:24:29,400 --> 00:24:31,690I have not only momentum,
31300:24:31,690 --> 00:24:35,090but I'm accelerating and I can't stop.
31400:24:35,720 --> 00:24:36,030So,
31500:24:36,030 --> 00:24:40,150if you can't get going that can look like depression, and if you can't stop,
31600:24:40,160 --> 00:24:47,300that can look like mania ... and you can have these elements in the same person at different times.
31700:24:47,310 --> 00:24:56,750So the neurology has difficulty getting to the "just right state" of activity level. Fourth,
31800:24:56,750 --> 00:24:58,000and finally,
31900:24:58,010 --> 00:25:02,970the social withdrawal in autism can also be mistaken for depression.
32000:25:02,980 --> 00:25:19,210So the individual on the spectrum who is content to have alone time, to not leave the house for periods of time, to engage in solitary pursuits... may appear depressed to people who prefer a lot more social interaction and activity.
32100:25:20,060 --> 00:25:20,480Uh,
32200:25:20,490 --> 00:25:23,600So let's talk and visit and talk about our lives...
32300:25:23,610 --> 00:25:24,630Let's play games,
32400:25:24,630 --> 00:25:25,500Let's watch a movie.
32500:25:25,500 --> 00:25:33,060Let's have people over for dinner, and when the individual on the spectrum resists this level of interaction,
32600:25:33,070 --> 00:25:40,550others may wonder if there's a mood issue present and ... kind of at the root of this difficulty.
32700:25:42,590 --> 00:25:48,520So ...certain individuals on the spectrum can struggle significantly with depressed mood....
32800:25:48,530 --> 00:25:51,260But this section highlights,
33000:25:51,680 --> 00:26:18,020that depressed mood can also be misapplied ... and sometimes can prevent the person from getting a really accurate diagnosis of autism because there's this assumption that this must be depression. Now because we've talked about behavioral momentum and we've talked about getting going with activities.
33100:26:18,960 --> 00:26:24,870I'm going to link a few of our previous podcast series that cover these issues.
33300:26:26,710 --> 00:26:35,190I did a series on exhaustion in autism... and issues of gaining and keeping momentum for daily activities.
33400:26:35,200 --> 00:26:41,430This started in September of 2021, and I will put a link to that first episode.
33500:26:41,440 --> 00:26:43,950But there are a couple in that series
33600:26:43,950 --> 00:26:45,510you might want to review.
33700:26:46,210 --> 00:27:00,880I also did a series on dysregulation and autism... and what that can look like, and what to do to prevent dysregulation, to recover from dysregulation, and to recognize dysregulation...
33800:27:00,890 --> 00:27:05,130and that series started in January of 2022.
33900:27:05,140 --> 00:27:09,660I will also link the first episode down in the show notes.
34000:27:11,580 --> 00:27:16,020Thank you for joining me for this episode about mood and autism,
34100:27:16,030 --> 00:27:22,030and we are going to keep talking about this important subject of misdiagnosis in autism
34200:27:22,030 --> 00:27:26,600next time when we focus on anxiety based conditions,
34300:27:26,610 --> 00:27:28,020I hope you join me then.
 

Autism and Misdiagnosis: Personality Disorders

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 -- 
100:00:07,070 --> 00:00:08,390Hello everyone.
200:00:08,400 --> 00:00:12,770This is Dr Theresa Regan joining you for the podcast,
300:00:12,780 --> 00:00:14,560autism in the adult.
400:00:15,800 --> 00:00:18,180I am a neuropsychologist.
500:00:18,190 --> 00:00:24,480I specialize in understanding how the brain impacts personality emotions,
600:00:24,480 --> 00:00:26,720behavior and thinking skills.
700:00:26,730 --> 00:00:38,440I'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.
800:00:39,400 --> 00:00:49,180You are joining us for the second episode of a series we're doing on misdiagnosis for those who are on the autism spectrum.
900:00:50,210 --> 00:00:53,070If you did not listen to the first episode,
1000:00:53,070 --> 00:00:54,890I really encourage you to do that.
1200:00:55,670 --> 00:01:04,100There are foundational things that I think will really be illuminating and that I'm not going to be repeating in this episode.
1300:01:05,230 --> 00:01:06,550For today's episode,
1400:01:06,550 --> 00:01:15,940we're going to focus about when the misdiagnosis has to do with the category of personality disorders.
1500:01:17,120 --> 00:01:17,340Now,
1600:01:17,340 --> 00:01:34,990personality disorders originally really focused on the impact of the environment and early life experiences and parenting and the development of the personality structure.
1700:01:35,650 --> 00:01:55,910And 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.
1800:01:55,910 --> 00:02:06,170So this was through adoptive studies and looking at the personality traits of adopted Children as compared to their biological parents.
1900:02:07,020 --> 00:02:31,810So 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.
2000:02:32,890 --> 00:02:42,420Now today a lot of the literature explaining that personality disorders are likely caused by multifactorial issues.
2100:02:42,430 --> 00:02:49,460So issues of biochemistry and genetics and experience are more prominent.
2200:02:49,470 --> 00:03:10,390So 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.
2300:03:11,350 --> 00:03:15,850There are three clusters of personality disorders,
2400:03:15,850 --> 00:03:17,060cluster a, b, and c.
2500:03:17,670 --> 00:03:25,220And there are a total of 10 conditions listed in the current diagnostic manual.
2600:03:25,230 --> 00:03:35,380So what will the scope of our discussion today be about as regards personality disorders and autism?
2700:03:36,320 --> 00:03:47,230What 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,
2800:03:47,240 --> 00:03:50,990that's really not in the scope of what we can focus on.
2900:03:51,260 --> 00:03:58,390And it takes an expert clinician with many years of training and study to do that well.
3000:03:58,400 --> 00:04:05,400But what we are going to focus on is why this happens and how often it seems to happen.
3100:04:05,410 --> 00:04:09,950So why does this misdiagnosis occur?
3200:04:09,960 --> 00:04:14,180And and how many people does that impact?
3300:04:15,910 --> 00:04:17,270As you probably know,
3400:04:17,270 --> 00:04:22,200a lot of the literature about autism focuses on early childhood and development.
3500:04:23,230 --> 00:04:29,790And more of the literature is beginning to focus on autism across the lifespan.
3600:04:30,820 --> 00:04:45,170And 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.
3700:04:45,170 --> 00:04:45,360So,
3800:04:45,360 --> 00:04:54,790the first article that I want to talk about actually was published last year 2021 and it came from the Netherlands.
3900:04:54,790 --> 00:04:59,070And I have a link in the show notes if you'd like to read more about it.
4000:05:00,930 --> 00:05:01,550So,
4100:05:01,550 --> 00:05:07,810this article was based in their national health system.
4200:05:07,820 --> 00:05:12,940They have a database of individuals who are on the autism spectrum.
4300:05:12,950 --> 00:05:19,490And then they contacted individuals to ask them about their diagnostic history.
4400:05:20,790 --> 00:05:27,370They surveyed a 1019 adults in this way,
4500:05:27,950 --> 00:05:33,550and it was very nearly an even split between males and females.
4600:05:35,360 --> 00:05:51,020And 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,
4700:05:52,810 --> 00:06:00,900They report that 63% of the females and 37% of the males had a previous diagnosis.
4800:06:02,940 --> 00:06:07,810Females had more previous diagnoses than males.
4900:06:07,820 --> 00:06:16,220So they had a larger number of diagnoses on their list in the mental health area.
5000:06:17,770 --> 00:06:28,000And this suggests that men in their sample were more likely to be diagnosed correctly the first time rather than carrying incorrect mental health diagnoses.
5100:06:30,320 --> 00:06:30,810Now,
5200:06:30,810 --> 00:06:36,500the top categories in their list of frequently misdiagnosed
5300:06:36,510 --> 00:06:42,270conditions for the autistic were mood disorders.
5400:06:42,280 --> 00:06:45,260And it didn't specifically say,
5500:06:45,260 --> 00:06:48,980I'm assuming this may include depression and bipolar.
5700:06:50,190 --> 00:06:53,670and then the second category was personality disorder.
5800:06:53,670 --> 00:06:53,930So,
5900:06:53,930 --> 00:07:05,17026% of the total sample had a history of mood disorder diagnosis and 20% had a history of personality disorders.
6000:07:07,080 --> 00:07:11,140They also asked the individuals who did have previous diagnoses.
6100:07:11,140 --> 00:07:17,090So that was 512 people out of the 1019,
6200:07:17,100 --> 00:07:25,260if any of their previous diagnoses were then removed from their list once autism was diagnosed.
6300:07:25,270 --> 00:07:29,910So this is really getting at that phenomenon of misdiagnosis,
6400:07:29,910 --> 00:07:30,420where,
6500:07:30,430 --> 00:07:30,680oh,
6600:07:30,680 --> 00:07:36,760now that we know that what we're actually looking at here is autism.
6700:07:36,770 --> 00:07:38,770What diagnoses,
6800:07:38,780 --> 00:07:39,540if any,
6900:07:39,550 --> 00:07:41,490might we removed from the list
7000:07:41,490 --> 00:07:50,240...these were misdiagnoses. Of the 512 participants who did have a previous diagnosis,
7100:07:50,250 --> 00:07:59,700382 reported that one or more of the diagnoses were removed once autism was diagnosed.
7200:08:00,550 --> 00:08:07,630So that's 75% of the participants who did have a history of diagnosis.
7300:08:08,680 --> 00:08:15,930And the authors also report this as 38% of the total sample of 1,019.
7400:08:15,940 --> 00:08:19,560I'm not sure that this is as meaningful because of course,
7500:08:19,560 --> 00:08:25,940people who did not have a prior diagnosis would not report that a diagnosis was removed.
7600:08:25,950 --> 00:08:26,590So,
7700:08:26,590 --> 00:08:26,960to me,
7800:08:26,960 --> 00:08:35,470it makes the most sense to to show that half the people had at least one previous mental health diagnoses.
7900:08:36,400 --> 00:08:38,330And of these participants,
8000:08:38,340 --> 00:08:44,60075% reported that at least one of the diagnoses were removed,
8100:08:44,610 --> 00:08:44,880then,
8200:08:44,880 --> 00:08:59,570once 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,
8300:09:01,830 --> 00:09:05,300I'm gonna look at two other articles before we keep going.
8400:09:06,970 --> 00:09:20,300Uh 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.
8500:09:20,300 --> 00:09:23,580So I don't feel like it's quite as representative.
8600:09:23,590 --> 00:09:27,550Probably not something that we can generalize as much from.
8700:09:28,670 --> 00:09:35,030But one thing that was interesting that they found was that the age,
8800:09:35,040 --> 00:09:44,440the median age of first evaluation by a mental health professional for these individuals was age 13.
8900:09:45,320 --> 00:09:55,380And then there was a gap of averaging about 11 years before any autism evaluation was even performed or considered.
9000:09:55,380 --> 00:09:55,970So,
9100:09:55,980 --> 00:10:13,800these 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,
9200:10:13,810 --> 00:10:21,060a third of participants had never received a psychiatric diagnosis prior to autism diagnosis.
9300:10:21,060 --> 00:10:26,260So two thirds of their sample did have a history of mental health diagnoses.
9400:10:27,940 --> 00:10:38,360The 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.
9500:10:38,370 --> 00:10:41,690In addition to narcissistic personality.
9600:10:41,700 --> 00:10:42,230Now,
9700:10:42,230 --> 00:10:51,570these are the two personality disorders that I see most often in my clinic as misdiagnoses for the autism spectrum,
9800:10:51,770 --> 00:10:58,990But really I have seen all 10 of them listed incorrectly for the autistic in the past,
9900:11:00,000 --> 00:11:06,050but let's take a look at borderline personality and talk about why
10000:11:06,060 --> 00:11:12,930 there may be a misdiagnosis of this condition.
10100:11:14,380 --> 00:11:30,480So 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.
10200:11:31,780 --> 00:11:39,800So it says a pattern of unstable and intense interpersonal relationships characterized by extremes.
10300:11:41,320 --> 00:12:01,450Um 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.
10400:12:01,450 --> 00:12:03,330I want to be in a relationship.
10500:12:03,340 --> 00:12:04,870And of course,
10600:12:04,870 --> 00:12:07,990there can be difficulties in that connection,
10700:12:07,990 --> 00:12:13,760particularly when they're trying to maintain this relationship over time.
10800:12:14,040 --> 00:12:14,400Now,
10900:12:14,400 --> 00:12:20,930that is not to say that the autistic individual doesn't have close relationships,
11000:12:20,940 --> 00:12:29,180but there may be some history of dissatisfaction with the ability to connect or feeling like the relationships didn't work out,
11100:12:29,190 --> 00:12:32,370Maybe the person isn't quite sure why or what happened.
11200:12:32,380 --> 00:12:42,380So this area of difficulty maintaining relationships may overlap in someone's concept...
11300:12:42,390 --> 00:12:49,080and if you did listen to the first episode of the series,
11400:12:49,090 --> 00:12:57,000it's kind of like looking at what's right in front of you without seeing the big autistic picture.
11500:12:57,000 --> 00:13:07,910You 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,
11600:13:07,920 --> 00:13:24,680that 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.
11700:13:24,680 --> 00:13:37,310Like 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.
11800:13:37,320 --> 00:13:47,780So for the autistic that can be present in the sense that it can be difficult to um delve into the internal world.
11900:13:47,790 --> 00:13:49,600Like what am I feeling?
12000:13:49,600 --> 00:13:49,990What,
12100:13:50,000 --> 00:13:52,390what is going on inside of me?
12200:13:52,390 --> 00:13:54,680How do people perceive me?
12300:13:54,690 --> 00:13:57,400What is their evaluation of me?
12400:13:57,410 --> 00:13:59,700How would people describe me?
12500:13:59,700 --> 00:14:14,100What'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.
12600:14:14,110 --> 00:14:18,190That's part of a neurologic ability called Theory of Mind,
12700:14:18,200 --> 00:14:31,920where 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.
12800:14:32,910 --> 00:14:33,290So,
12900:14:33,290 --> 00:14:35,100you can see again,
13000:14:35,100 --> 00:14:49,930if 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.
13100:14:49,940 --> 00:14:51,280This of course,
13200:14:51,280 --> 00:14:54,750can have to do with the masking and autism.
13300:14:55,260 --> 00:15:04,110You can see how that one piece may trigger someone to think about a borderline personality.
13400:15:05,790 --> 00:15:12,370There also is this characteristic lability of mood and emotions.
13500:15:12,370 --> 00:15:13,540So by that,
13600:15:13,540 --> 00:15:19,380I just mean that this kind of roller coaster of intense emotions.
13700:15:19,390 --> 00:15:25,970Um so it talks about um difficulty controlling anger,
13800:15:25,970 --> 00:15:27,950frequent displays of temper,
13900:15:27,950 --> 00:15:29,320constant anger,
14000:15:29,330 --> 00:15:39,430recurrent physical fights for the individual on the spectrum who has dis regulation that looks external realized.
14100:15:39,440 --> 00:15:40,000So,
14200:15:40,000 --> 00:15:45,320if you've listened to the dysegulation series, and I'll put a link in the show notes,
14300:15:45,330 --> 00:15:47,110you'll know that for that...
14400:15:47,120 --> 00:15:56,320Everyone on the autism spectrum will have difficulty feeling centered with their emotions and behavior.
14500:15:56,320 --> 00:15:58,680And that is called dysregulation.
14600:15:59,130 --> 00:16:04,410And that's neurologically based for the autistic... and for some people,
14700:16:04,420 --> 00:16:07,130this regulation is very quiet.
14800:16:07,140 --> 00:16:11,190It's this shutting down.
14900:16:11,200 --> 00:16:16,940It could be a disassociative episode which can also occur in borderline.
15000:16:17,520 --> 00:16:21,280It can be a very quiet withdrawal.
15100:16:21,290 --> 00:16:22,810I'm going to my room,
15200:16:22,810 --> 00:16:24,550I'm quitting this relationship,
15300:16:24,550 --> 00:16:26,250I can't make it to work.
15400:16:26,260 --> 00:16:32,000Um but it can also be this externalized reaction,
15500:16:32,010 --> 00:16:34,470this explosive reaction,
15600:16:34,480 --> 00:16:35,520a meltdown,
15700:16:35,520 --> 00:16:36,130a crying 
15800:16:36,130 --> 00:16:37,650spell... shaking.
15900:16:38,220 --> 00:16:42,720And for people who have that externalized reaction,
16000:16:42,730 --> 00:16:49,200this can look like borderline to a clinician who's not looking at the big neurologic picture.
16100:16:50,730 --> 00:16:51,630And finally,
16200:16:51,630 --> 00:17:02,180one of the aspects of borderline personality can be this recurrent self harm behavior or impulsive,
16300:17:02,190 --> 00:17:04,470self damaging behavior.
16400:17:04,480 --> 00:17:22,050You 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,
16500:17:22,050 --> 00:17:23,340cutting themselves,
16600:17:23,340 --> 00:17:24,490banging their head.
16700:17:24,500 --> 00:17:25,490Um,
16800:17:25,500 --> 00:17:27,070and that is part of,
16900:17:27,080 --> 00:17:29,810of dysregulation for the autistic.
17000:17:29,820 --> 00:17:30,570Um,
17100:17:30,580 --> 00:17:38,900and so there are certainly differences in borderline personality as compared to autism,
17200:17:38,940 --> 00:17:43,020in this dynamic of when dysregulation occurs.
17300:17:43,190 --> 00:17:43,560Uh,
17400:17:43,560 --> 00:17:49,500and also what you don't see in the borderline is the broader neurologic picture.
17500:17:49,510 --> 00:17:50,300So,
17600:17:50,300 --> 00:17:52,270these sensory elements,
17700:17:52,270 --> 00:17:54,610these stereotyped behaviors.
17800:17:54,620 --> 00:17:55,480Again,
17900:17:55,480 --> 00:18:01,400we're not going to end on a note where people know how to distinguish the two conditions,
18000:18:01,400 --> 00:18:05,150but I do want you to have a sense of why this occurs.
18100:18:05,150 --> 00:18:17,480Why does this mistake happen where someone looks at pieces of an individual and their history and comes up with borderline instead of autism.
18200:18:18,480 --> 00:18:32,040This 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.
18300:18:32,050 --> 00:18:34,620And the link is in the show notes,
18400:18:34,630 --> 00:18:46,900this article was published in Norway In February of 2022 and I'll just read you some elements that I think are important.
18500:18:48,780 --> 00:18:57,950The patient received treatment for borderline personality disorder without any observable improvement in his difficulties for several years.
18600:18:59,320 --> 00:19:00,290And that's end,
18700:19:00,290 --> 00:19:00,870quote.
18800:19:02,470 --> 00:19:12,920The authors note that the case highlights the need for mental health professionals to have the quote knowledge necessary to recognize and diagnose autism.
18900:19:12,990 --> 00:19:14,250End quote,
19000:19:14,300 --> 00:19:21,990they suggest that the evaluation for autism may be warranted in patients with non suicidal self injury.
19100:19:22,000 --> 00:19:24,680So that's the cutting the banging,
19200:19:24,690 --> 00:19:35,030those kinds of things that we talked about and assumed personality disorder who are not benefiting from the treatments that have been used.
19300:19:35,980 --> 00:19:37,340So essentially,
19500:19:38,720 --> 00:19:48,490they're suggesting that if there's a patient that has been diagnosed with a personality disorder but is not benefiting from the treatment.
19700:19:49,650 --> 00:19:51,500and staff feel like,
19800:19:51,510 --> 00:19:51,940gosh,
19900:19:51,940 --> 00:19:56,690I just feel like we're missing something...that might be a good trigger.
20000:19:56,700 --> 00:20:02,290I would say any time borderline personality is on the table,
20100:20:02,300 --> 00:20:10,290autism should specifically be in the differential because of some of these features that can look similar.
20200:20:10,300 --> 00:20:13,280And if you want to know more about differentials,
20300:20:13,290 --> 00:20:27,300go ahead and listen to the first episode in our series. With regard to the young adult that they were describing in the article.
20400:20:28,690 --> 00:20:29,580Um,
20500:20:29,590 --> 00:20:38,210they could see that there were characteristics of several different personality disorder conditions.
20600:20:38,220 --> 00:20:39,040Um,
20700:20:39,040 --> 00:20:45,250but nothing that really hit the spot with any one personality disorder.
20800:20:45,260 --> 00:20:45,900Uh,
20900:20:45,910 --> 00:20:47,600so they looked at schizoid,
21000:20:47,600 --> 00:20:50,350avoidant. dependent, and borderline,
21100:20:52,060 --> 00:20:57,110but there were not sufficient symptoms to meet criteria for any of those.
21200:20:57,120 --> 00:20:58,970And it was noted that,
21300:20:58,980 --> 00:20:59,340quote,
21400:20:59,340 --> 00:21:05,900his difficulties with regard to social engagement were pervasive rather than transient.
21500:21:05,910 --> 00:21:25,110So 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
21600:21:25,120 --> 00:21:28,100social reciprocity and conversation.
21700:21:28,100 --> 00:21:36,890So they concluded that his social difficulties really were not the result of his intense personality,
21800:21:36,890 --> 00:21:48,430but more the result of a neurologic wiring that it was different and he was not able to navigate social interactions in that context.
21900:21:50,920 --> 00:22:03,090They also state he did not display a pattern of attachment and rejection in interpersonal relationships, and his non suicidal self injury.
22000:22:03,100 --> 00:22:09,890(And for him this was cutting) rarely occurred as a response to an interpersonal conflict.
22100:22:09,900 --> 00:22:18,380So they're also just trying to point out that although he had dysregulation, and he had self harm in that context,
22200:22:18,390 --> 00:22:19,390it didn't have...
22300:22:19,400 --> 00:22:25,700it wasn't triggered by the same kinds of things that a borderline personality might be triggered by.
22400:22:27,680 --> 00:22:28,080Now,
22500:22:28,080 --> 00:22:29,500in my own clinic,
22600:22:29,510 --> 00:22:36,290what I see is that in addition to the borderline personality as a common misdiagnosis,
22700:22:36,300 --> 00:22:46,280I also frequently see narcissism or narcissistic personality disorder uh as a misdiagnosis as well.
22800:22:47,240 --> 00:22:52,550So where does this misdiagnosis stem from?
22900:22:53,800 --> 00:22:54,330Well,
23000:22:54,330 --> 00:22:59,930if you listened to the episode two sessions ago,
23100:22:59,940 --> 00:23:03,030it was called why pattern is important.
23200:23:03,040 --> 00:23:10,920And in our episode today we are making some generalizations about how the autistic neurology,
23300:23:10,920 --> 00:23:13,300when it has a certain pattern,
23400:23:13,310 --> 00:23:18,340it can lend itself to misdiagnosis of certain conditions.
23500:23:18,580 --> 00:23:36,700So 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.
23600:23:37,330 --> 00:23:49,780Now 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.
23700:23:51,430 --> 00:24:11,470So 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.
23800:24:11,480 --> 00:24:12,380Um,
23900:24:12,380 --> 00:24:20,150and they love um certain pieces of information so that their special interest,
24000:24:20,150 --> 00:24:24,780maybe politics or religion or the environment and ... boy,
24100:24:24,780 --> 00:24:27,110they deep dive into this.
24200:24:27,110 --> 00:24:37,850They love talking about this particular topic or handful of topics and being correct about the facts is also very important to them.
24300:24:37,860 --> 00:24:43,700And so they have this deep commitment to being right now.
24400:24:43,700 --> 00:24:51,670What they are less attuned to neurologically is understanding the internal of the other person.
24500:24:51,680 --> 00:24:56,800How does this conversation affect the personhood...
24600:24:56,810 --> 00:24:57,750The person,
24700:24:57,750 --> 00:25:01,710the internal person of this individual I'm speaking with.
24800:25:01,710 --> 00:25:05,620So they have less of a sense of do they feel criticized?
24900:25:05,620 --> 00:25:29,490How 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.
25000:25:30,010 --> 00:25:37,200And some of the autistic individuals with this pattern may say,
25100:25:37,210 --> 00:25:45,340well I will shift my beliefs if someone proves that I'm wrong but I'm not wrong.
25200:25:45,350 --> 00:25:46,360Um,
25300:25:46,370 --> 00:25:54,850and so that quality of having difficulty with thinking in gray areas.
25400:25:54,850 --> 00:26:00,410So someone who may have that black and white thinking this is right and this is wrong.
25500:26:00,630 --> 00:26:12,460Someone who has difficulty shifting and giving um like they are committed to a thought or an idea or an opinion and it really does.
25600:26:12,470 --> 00:26:14,740Uh they're not wishy washy,
25700:26:14,750 --> 00:26:15,310you know,
25800:26:15,310 --> 00:26:24,950their strength is that they have this very strong commitment and so when they have that and they're gonna stick to it neurologically,
25900:26:24,950 --> 00:26:32,340and they don't have as much sense of what you need during a conversation as the other person.
26000:26:32,350 --> 00:26:40,260Uh then you can get the sense of narcissism and somebody may say they want to lecture me or talk to me,
26100:26:40,260 --> 00:26:44,520but they don't want my opinion or they don't want me to participate.
26200:26:44,910 --> 00:26:50,670Um and that could be a feeling that lends itself to this descriptor,
26300:26:52,160 --> 00:26:55,850another piece of this really...
26400:26:55,860 --> 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.
26500:27:05,980 --> 00:27:08,160Um one of the things can,
26600:27:08,170 --> 00:27:32,020that 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.
26700:27:32,030 --> 00:27:34,570And if the only thing left,
26800:27:34,580 --> 00:27:37,970once they make a mistake is the bad category,
26900:27:37,980 --> 00:27:48,870that'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,
27000:27:48,870 --> 00:27:55,750I'm this mix of good things and difficult things and I have achieved,
27100:27:55,760 --> 00:27:56,910um,
27200:27:56,920 --> 00:27:58,600correct things here,
27300:27:58,600 --> 00:28:00,590but I really missed the boat here.
27400:28:00,600 --> 00:28:01,290Um,
27500:28:01,300 --> 00:28:09,870so you can have this real resistance to losing or being wrong or falling short.
27600:28:12,060 --> 00:28:17,370There's another feature in the list of narcissistic personality,
27700:28:17,380 --> 00:28:17,910um,
27800:28:17,920 --> 00:28:21,350criteria and that is lacks empathy,
27900:28:21,360 --> 00:28:26,800is unwilling to recognize or identify with the feelings and needs of others.
28000:28:26,810 --> 00:28:27,340Now,
28100:28:27,340 --> 00:28:28,750for the autistic,
28200:28:28,750 --> 00:28:31,260that is really not the case.
28300:28:31,260 --> 00:28:33,020It's not that they're unwilling.
28400:28:33,030 --> 00:28:36,810And some people have a deep empathy for,
28500:28:37,260 --> 00:28:38,260um,
28600:28:38,270 --> 00:28:38,850you know,
28700:28:38,850 --> 00:28:43,350wanting every person to be good and to be doing well.
28800:28:43,360 --> 00:28:43,940Um,
28900:28:43,950 --> 00:28:52,070but sometimes in their mind you will be doing really well if you have the correct facts,
29000:28:52,080 --> 00:28:58,700so they may not be in tune with the internal emotions and relational needs of the other person.
29100:28:58,710 --> 00:28:59,620Um,
29200:28:59,630 --> 00:29:04,850but it's not that they're unwilling to recognize the feelings or needs of others.
29300:29:07,070 --> 00:29:08,470And as I mentioned,
29400:29:08,470 --> 00:29:15,460there are many other personality disorders that end up being misdiagnoses for autism.
29500:29:16,960 --> 00:29:29,190But hopefully this gives you a flavor of how someone might see the interaction style and behavioral pattern of someone presenting for,
29600:29:29,190 --> 00:29:29,650let's say,
29700:29:29,650 --> 00:29:58,410counseling 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.
29800:29:58,410 --> 00:30:01,880When considering these other personality structures,
29900:30:01,890 --> 00:30:07,200then we would get a much more beneficial diagnostic process.
30000:30:07,470 --> 00:30:15,030We don't want someone with another mental health condition to be mistakenly diagnosed as autistic and vice versa.
30100:30:15,040 --> 00:30:28,550So 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.
30200:30:29,500 --> 00:30:36,950Thank you for joining me today as we talked about personality disorders as misdiagnoses for autism.
30300:30:36,960 --> 00:30:38,570We reviewed borderline,
30400:30:38,570 --> 00:30:54,310we 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.
30500:30:54,310 --> 00:30:56,660To get these diagnoses correct.
I hope you can join me for the next episode. 
 

Autism and Misdiagnosis: Foundational Knowledge

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:
100:00:01,890 --> 00:00:04,590Hello and welcome to autism.
200:00:04,590 --> 00:00:06,170In the adult podcast.
300:00:06,180 --> 00:00:07,450I am your host,
400:00:07,450 --> 00:00:08,890Dr Theresa Regan.
500:00:08,900 --> 00:00:10,830I'm a neuropsychologist.
600:00:10,840 --> 00:00:19,210The director of an adult diagnostic autism clinic in central Illinois and the parent of an autistic teen.
700:00:19,220 --> 00:00:27,060I am going to be starting a new series today and that's going to focus on misdiagnosis...
800:00:27,060 --> 00:00:27,360So...
900:00:27,360 --> 00:00:35,630people who are on the autism spectrum, who have that autistic neurology, but are diagnosed with something else...
1000:00:35,640 --> 00:00:42,180typically a mental health diagnosis and oftentimes several diagnoses.
1100:00:42,950 --> 00:00:50,480We're going to talk about why that happens and how to understand how we can do better.
1200:00:51,620 --> 00:00:53,560As we're starting off,
1300:00:53,570 --> 00:01:02,030I am going to tell you a story and the story is called The Parable of the Elephant.
1400:01:02,040 --> 00:01:04,890And this is a very ancient parable.
1500:01:04,900 --> 00:01:08,320It has a few variations across cultures.
1600:01:08,330 --> 00:01:09,370But it really,
1700:01:09,370 --> 00:01:15,260I think. speaks to this dilemma that we have about misdiagnosis.
1800:01:16,520 --> 00:01:23,610There was an ancient village and they had never seen an elephant before.
1900:01:23,620 --> 00:01:30,450And you can imagine that when someone brought an elephant into their village it was a big deal.
2000:01:30,460 --> 00:01:36,070People wanted to know "what does a creature called an elephant look like?"
2100:01:36,540 --> 00:01:46,990And 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,
2200:01:46,990 --> 00:01:56,670but 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.
2300:01:58,350 --> 00:02:02,660So indeed the villagers went to the center of town.
2400:02:02,670 --> 00:02:06,250They stood around this creature called an elephant.
2500:02:06,260 --> 00:02:12,830In each person put out their hand and they were able to experience the elephant.
2600:02:14,020 --> 00:02:17,690So what happened is that the first person said,
2700:02:17,700 --> 00:02:19,650oh I get it.
2800:02:19,660 --> 00:02:22,470An elephant is like a fan,
2900:02:22,480 --> 00:02:28,900I've put out my hand and I can feel that it's broad and wavy and thin.
3000:02:28,910 --> 00:02:31,150An elephant is like a fan.
3100:02:32,000 --> 00:02:37,980And here the person had felt the ear of the elephant.
3200:02:37,990 --> 00:02:40,510Well the next person said,
3300:02:40,520 --> 00:02:52,780I 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.
3400:02:52,790 --> 00:02:55,130I can't even put my arms out,
3500:02:55,130 --> 00:03:00,660but I can just say that that an elephant is like a wall,
3600:03:00,670 --> 00:03:04,400it's so big and massive and strong.
3700:03:05,390 --> 00:03:07,820The next person disagreed as well,
3800:03:08,750 --> 00:03:10,290this person said no,
3900:03:10,290 --> 00:03:10,480no,
4000:03:10,480 --> 00:03:11,150no,
4100:03:11,160 --> 00:03:14,660it's... I can put my arms around it,
4200:03:14,670 --> 00:03:24,490it's thick and tall but there is an end to it and and it's kind of like a tree trunk or a pillar.
4300:03:24,500 --> 00:03:30,010And this person was experiencing the leg ... touching the leg of the elephant.
4400:03:30,410 --> 00:03:32,740The next person was at the tail.
4500:03:32,750 --> 00:03:34,100They said no,
4600:03:34,100 --> 00:03:34,890no,
4700:03:34,900 --> 00:03:36,850not like that at all.
4800:03:36,860 --> 00:03:38,400This is thin,
4900:03:38,410 --> 00:03:41,370it's really... an elephant is like a rope,
5000:03:41,380 --> 00:03:44,200it's corded and thin and long.
5100:03:44,210 --> 00:03:46,900No said the next person,
5200:03:47,220 --> 00:03:58,960the 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,
5300:03:58,960 --> 00:04:01,670it's really like a snake,
5400:04:01,680 --> 00:04:03,820that's what an elephant is like.
5500:04:03,830 --> 00:04:08,290And the last person was feeling the tusk and said,
5600:04:08,290 --> 00:04:08,610no,
5700:04:08,610 --> 00:04:10,440not like a snake at all.
5800:04:10,450 --> 00:04:12,220It's curved a bit,
5900:04:12,220 --> 00:04:22,020but it's really hard and ah strong and smooth, and I would say an elephant is like a sword or a spear.
6000:04:24,250 --> 00:04:30,670So the parable is meant to teach that here,
6100:04:30,680 --> 00:04:35,080every person was correct about what was right in front of them,
6200:04:35,640 --> 00:04:48,340but 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.
6300:04:48,400 --> 00:04:58,730It's really many things put together in that description and an elephant is a whole creature with many of those features.
6400:04:58,740 --> 00:05:06,480So that is the lesson and it applies really well to this process of diagnosis regarding autism.
6500:05:07,250 --> 00:05:07,570So,
6600:05:07,570 --> 00:05:13,530what happens in the area of diagnosis is that a client or patient will present,
6700:05:13,540 --> 00:05:18,800they'll have concerns and some characteristics that maybe they're struggling with.
6800:05:18,810 --> 00:05:24,670And the clinician will see that one little piece and label it with a diagnosis,
6900:05:24,680 --> 00:05:28,360but they won't see the big picture diagnosis,
7000:05:28,370 --> 00:05:29,810which is autism.
7100:05:30,640 --> 00:05:30,950So,
7200:05:30,950 --> 00:05:35,600let me step away from the animal analogy for a moment,
7300:05:35,600 --> 00:05:41,130but we're going to go back and kind of weave this image through to make some other points.
7400:05:41,140 --> 00:05:48,130One point I want to make is that we define diagnoses based on certain criteria.
7500:05:48,140 --> 00:05:55,320So these are pieces of the condition or the diagnosis.
7600:05:55,330 --> 00:05:55,890So,
7700:05:55,890 --> 00:05:58,920depression has a list of criteria.
7800:05:58,920 --> 00:06:00,290Things that we look for.
7900:06:00,290 --> 00:06:04,590Do you have these features? and then we diagnose depression.
8000:06:04,600 --> 00:06:07,650Alzheimer's has a list of criteria,
8100:06:07,660 --> 00:06:09,820bipolar has a list of criteria,
8200:06:09,830 --> 00:06:12,140autism has a list of criteria.
8300:06:12,150 --> 00:06:23,700Now 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.
8400:06:23,700 --> 00:06:25,810We really want to know more about it.
8500:06:25,820 --> 00:06:27,530We want to help people,
8600:06:27,530 --> 00:06:35,330we want to understand what kinds of things are not helpful and we want to know the prognosis.
8700:06:36,310 --> 00:06:39,900So we have to agree on some language for it.
8800:06:39,900 --> 00:06:41,350And some criteria.
8900:06:42,280 --> 00:06:44,020When will we call something
9000:06:44,020 --> 00:06:48,730Alzheimer's? When will we call something bipolar instead of something else?
9100:06:51,140 --> 00:06:53,510In the example of the parable of the elephant,
9200:06:53,520 --> 00:07:00,810each person who encountered the elephant described a small element of one large thing.
9300:07:00,820 --> 00:07:05,290They defined it on the basis of one piece rather than the whole.
9400:07:05,300 --> 00:07:11,330So in this case it was like creating criteria for an elephant ear.
9500:07:11,710 --> 00:07:21,430And then calling the ear the elephant... an elephant is like a fan because I've experienced this piece,
9600:07:21,440 --> 00:07:26,250this ear. or a criteria for the tusk,
9700:07:26,260 --> 00:07:29,800and saying that an elephant is something with the tusk.
9800:07:29,810 --> 00:07:38,880Instead of realizing that a tusk is a little piece of an elephant that does not define the elephant.
9900:07:38,880 --> 00:07:50,960So you get the picture that there is a problem with defining such a large creature based on one feature or one experience with ...
10000:07:50,970 --> 00:07:58,710with the characteristic. So related to diagnoses ... autism like the elephant ... the big picture.
10100:07:58,720 --> 00:08:08,110It's the diagnosis with seven diagnostic criteria and each of the criteria could be diagnosed separately as something else.
10200:08:08,700 --> 00:08:20,220So 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,
10300:08:20,240 --> 00:08:22,650they might diagnose social anxiety.
10400:08:22,660 --> 00:08:24,010Well that's what autism is ...
10500:08:24,010 --> 00:08:25,040social anxiety,
10600:08:25,040 --> 00:08:28,080let's just call this social anxiety.
10700:08:28,250 --> 00:08:35,920Another person could encounter autism and say actually... really autism is a difficulty with flexibility,
10800:08:35,930 --> 00:08:37,770difficulty with change.
10900:08:37,780 --> 00:08:41,910The person wanting to repeat things... for things to be predictable,
11000:08:41,910 --> 00:08:44,150perhaps having rituals for the day.
11100:08:44,730 --> 00:08:46,510So let's call this OCD.
11400:08:48,680 --> 00:08:53,680They're looking at this one piece of the larger autistic picture.
11500:08:54,540 --> 00:09:01,490Another individual may encounter the executive function difficulty that an individual on the spectrum has.
11600:09:01,500 --> 00:09:02,960And they may say,
11700:09:02,960 --> 00:09:06,540well look this is executive function difficulty.
11800:09:06,540 --> 00:09:07,670I know what this is.
11900:09:07,680 --> 00:09:08,320It's ADD.
12200:09:10,550 --> 00:09:23,300Another person may encounter problems that the individual presents with ... emotional regulation, with sleep, and sometimes a really encompassing obsessive interest in an activity.
12300:09:23,310 --> 00:09:33,580And 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.
12400:09:33,590 --> 00:09:36,690That's what this creature is.
12500:09:36,690 --> 00:09:39,710That's what this autistic experiences.
12600:09:43,190 --> 00:09:53,060So 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.
12700:09:53,070 --> 00:10:24,090In 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.
12800:10:24,100 --> 00:10:33,040A differential is a list of diagnoses to consider that could be present based on the few things that we first encounter.
12900:10:33,050 --> 00:10:35,490So let's take the animal example.
13000:10:35,490 --> 00:10:36,050Again,
13100:10:36,240 --> 00:10:41,100if we encounter a huge, gray, lumbering animal with eyes,
13200:10:41,110 --> 00:10:41,720ears,
13300:10:41,720 --> 00:10:43,390four legs and a tail,
13400:10:43,400 --> 00:10:44,420someone may say,
13500:10:44,420 --> 00:10:48,020well that's all the criteria for a rhinoceros.
13600:10:48,770 --> 00:10:52,660So I think this animal is a rhinoceros.
13700:10:54,200 --> 00:11:02,640But the person who understands the importance of differentials will say... other animals also have these features.
13800:11:02,640 --> 00:11:05,250You're right ... a rhinoceros does.
13900:11:05,260 --> 00:11:07,100But you know,
14000:11:07,110 --> 00:11:13,000there are also things to consider such as an elephant or a hippo.
14100:11:13,010 --> 00:11:15,800So based on what we know,
14200:11:15,800 --> 00:11:19,140we can't quite conclude that this is a rhinoceros,
14300:11:19,150 --> 00:11:21,670we have to do a little more detective work.
14400:11:23,960 --> 00:11:28,640The differential then is rhinoceros, elephant, hippo.
14500:11:28,650 --> 00:11:35,360That's the list of considerations in our consideration of diagnosis.
14600:11:35,370 --> 00:11:38,330A person may struggle with executive function.
14700:11:38,340 --> 00:11:39,290Yes, ADD
15000:11:39,670 --> 00:11:41,300Could be diagnosed.
15100:11:41,310 --> 00:11:47,300But after all... there is executive function difficulty in other conditions as well.
15200:11:47,310 --> 00:11:47,920ADD
15500:11:48,310 --> 00:11:49,370Is one.
15600:11:49,920 --> 00:11:50,520However,
15700:11:50,520 --> 00:11:56,730every autistic individual will also have some pattern of executive function difficulty,
15800:11:57,430 --> 00:12:05,760we would also want to know... has this person had any recent injury or illness, because this can also cause executive function difficulty.
15900:12:05,770 --> 00:12:08,110And how old is this person?
16000:12:08,110 --> 00:12:09,970What characteristics do they have?
16100:12:09,980 --> 00:12:13,990Is this someone who's showing some early signs of dementia?
16200:12:14,270 --> 00:12:16,070Also have there been an MRI or any other neurologic features?
16600:12:18,580 --> 00:12:20,590Perhaps this is part of a demyelinating process like multiple sclerosis.
16900:12:23,810 --> 00:12:29,510So that could be the differential ... rather than seeing executive function problems,
17000:12:29,520 --> 00:12:31,110noting that that's what ADD
17300:12:31,530 --> 00:12:32,780Is and calling it ADD
17600:12:33,480 --> 00:12:45,610We 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.
17700:12:48,860 --> 00:13:00,710The clinician using the process of differential diagnosis is differentiating autism from other states with similar features.
17800:13:02,190 --> 00:13:04,650Although it's true that a rhino is large,
17900:13:04,650 --> 00:13:05,710has four legs,
18000:13:05,720 --> 00:13:06,290ears,
18100:13:06,290 --> 00:13:07,160reproduces,
18200:13:07,170 --> 00:13:08,300eats and urinates.
18300:13:08,330 --> 00:13:18,100We can't define the creature based on that description without differentiating it from other animals with the same features such as hippos or elephants.
18400:13:18,150 --> 00:13:25,170Now it's not that we would mistake a hippo for an elephant if we really could see the big picture.
18500:13:25,460 --> 00:13:29,530But if we're only presented with little clues at the beginning,
18600:13:29,540 --> 00:13:34,740we know that there are distinct creatures that may have similar elements.
18700:13:34,780 --> 00:13:42,370Not that the creatures are so similar that they can't be distinguished when we see the whole big picture,
18800:13:42,380 --> 00:13:47,820but that if we're only seeing a few elements present at a time,
18900:13:47,830 --> 00:13:50,810we need to know what kind of detective work to do.
19000:13:51,790 --> 00:13:53,190For example,
19100:13:53,200 --> 00:13:56,540how fast does this animal run?
19200:13:56,560 --> 00:14:05,020A Rhino runs faster than an elephant or a hippo at about 34 mph or 55 km/h.
19300:14:06,220 --> 00:14:09,040All three are found on the african continent,
19400:14:09,040 --> 00:14:13,760but hippos gravitate toward environments with aquatic elements nearby.
19500:14:13,990 --> 00:14:14,580Now,
19600:14:14,580 --> 00:14:18,060both rhinos and elephants have horns or tusks.
19700:14:18,070 --> 00:14:18,930However,
19800:14:18,930 --> 00:14:22,650the material in the horn of a rhino is more like our fingernails,
19900:14:22,660 --> 00:14:27,100while the tusk of the elephant is made of material closer to our teeth,
20000:14:27,130 --> 00:14:32,830Of course an elephant has that distinctive trunk not found in the other creatures.
20100:14:33,990 --> 00:14:37,720So this process is the differential process.
20200:14:37,730 --> 00:14:40,180If we're only seeing a few elements.
20300:14:40,180 --> 00:14:51,480At first we do detective work and we say what other creatures or diagnoses have these same features.
20400:14:53,000 --> 00:14:57,790We're aware that certain elements are present that occur in one category,
20500:14:57,790 --> 00:15:00,020whether that's a species or a diagnosis,
20600:15:00,020 --> 00:15:08,660but we realize that this needs to be tested to differentiate it between other categories with those features as well.
20700:15:08,670 --> 00:15:12,640So the differential process for diagnosis should be similar.
20800:15:12,650 --> 00:15:13,440For example,
20900:15:13,450 --> 00:15:17,200if an individual presents with emotional regulation difficulty,
21000:15:17,380 --> 00:15:21,710let's say in this case that looks like mood swings or anger outbursts,
21100:15:21,720 --> 00:15:28,600although in others it could look much quieter like dissociation or fleeing,
21300:15:28,920 --> 00:15:30,030withdrawing.
21400:15:30,630 --> 00:15:31,640But in this case,
21500:15:31,650 --> 00:15:34,080if there's mood swings or anger outbursts,
21600:15:34,090 --> 00:15:43,160a clinician might diagnose bipolar and maybe even show the person that all the criteria for bipolar are present.
21700:15:44,000 --> 00:15:45,020However,
21800:15:45,030 --> 00:15:49,130no one has checked whether there's social reciprocity,
21900:15:49,130 --> 00:15:52,500difficulty or sensory processing characteristics,
22000:15:52,510 --> 00:15:54,430stereotyped movements.
22100:15:54,550 --> 00:15:55,890In other words,
22200:15:55,890 --> 00:16:03,100nobody has done detective work to see if a different big picture is actually present in this case,
22300:16:03,100 --> 00:16:05,510the big picture being autism.
22400:16:07,750 --> 00:16:13,130Another individual may present with difficulty understanding "who am I?
22500:16:13,130 --> 00:16:16,360I just don't have the stable sense of who I am,
22600:16:16,370 --> 00:16:19,910I can't reach my internal state,
22700:16:19,920 --> 00:16:22,120what's going on inside of me?"
22800:16:22,860 --> 00:16:26,960They also have difficulty keeping an even keeled mood.
22900:16:26,970 --> 00:16:36,800They struggle to start and maintain and understand relationships well. A person may present with these features and the clinician will say,
23000:16:36,800 --> 00:16:37,330look,
23100:16:37,340 --> 00:16:41,880all the criteria for borderline personality disorder have been met.
23200:16:43,800 --> 00:16:45,190That may be true.
23300:16:45,200 --> 00:16:46,220However,
23400:16:46,230 --> 00:16:49,690even though all the criteria for one condition may be met,
23500:16:49,700 --> 00:17:01,860the diagnostic manual stresses that you make that diagnosis only if the characteristics are not better explained by a different diagnosis,
23600:17:02,750 --> 00:17:05,670it's not that the features aren't present.
23700:17:05,680 --> 00:17:13,900It's whether the big picture of features is explained best by that diagnosis or by a different one.
23800:17:13,910 --> 00:17:15,990If these features are present,
23900:17:15,990 --> 00:17:19,110but there are also stereotype verbalization,
24000:17:19,120 --> 00:17:20,560ritualistic behaviors,
24100:17:20,560 --> 00:17:23,220difficulty processing social information,
24200:17:23,230 --> 00:17:26,050all of which have been present in childhood,
24300:17:26,060 --> 00:17:29,690then the better big picture diagnosis is autism.
24400:17:31,960 --> 00:17:43,030So the crux of the problem is this autism is rarely, rarely, rarely included in a clinician's differential process.
24500:17:44,170 --> 00:17:46,250This is improving somewhat.
24600:17:46,260 --> 00:17:51,870But most patients I see who have been misdiagnosed carry often multiple diagnoses,
24700:17:51,880 --> 00:17:55,110all of which reflect core autistic characteristics.
24800:17:55,120 --> 00:17:57,550It maybe schizophrenia,
24900:17:57,560 --> 00:18:00,720maybe borderline personality, eating disorder,
25000:18:00,720 --> 00:18:01,750social anxiety,
25100:18:01,750 --> 00:18:01,850OCD
25400:18:03,230 --> 00:18:10,500But really the suspicion should be that all of these together maybe describing the big picture diagnosis of autism.
25500:18:10,510 --> 00:18:13,890But autism has never been considered.
25600:18:13,950 --> 00:18:19,650It's not been ruled out and the better diagnosis assigned.
25700:18:19,660 --> 00:18:22,570No it's just never been considered.
25800:18:23,730 --> 00:18:32,580Someone has seen the characteristics they are familiar with and they have not met this creature called autism.
25900:18:32,960 --> 00:18:38,400So they assign diagnoses to the parts based on what they're familiar with.
26000:18:38,410 --> 00:18:42,430Not realizing that autism can also present similarly.
26100:18:42,430 --> 00:18:43,960But for different reasons.
26200:18:43,970 --> 00:18:53,890And of course that the big picture of autism is different than the pieces that they've labeled schizophrenic, OCD...
26500:18:54,930 --> 00:18:56,990Just as in the case of animals,
26600:18:56,990 --> 00:19:00,330it's not that bipolar and autism are so similar.
26700:19:00,330 --> 00:19:02,010We just can't tell the difference.
26800:19:02,020 --> 00:19:06,840Well no, we can tell that an elephant is not a hippo.
26900:19:06,840 --> 00:19:28,610If 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.
27000:19:28,610 --> 00:19:46,200And 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.
27100:19:46,640 --> 00:19:53,580I'm not going to get into the nitty gritty of when autism and another diagnosis should be made together.
27200:19:53,590 --> 00:19:56,950There are rules and guidelines for that as clinicians,
27300:19:56,960 --> 00:20:02,870but there are situations where you will have more than one diagnosis.
27400:20:02,870 --> 00:20:06,290So let's say autism and bipolar,
27500:20:07,340 --> 00:20:16,810essentially a second diagnosis would be made if there's a constellation of characteristics that are not entirely accounted for by autism.
27600:20:16,820 --> 00:20:18,230So for example,
27700:20:18,230 --> 00:20:22,410in over 500 patients that I've diagnosed,
27800:20:22,420 --> 00:20:38,870I 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.
27900:20:39,460 --> 00:20:40,340Likewise,
28000:20:40,340 --> 00:20:43,560I believe I also made a diagnosis of OCD
28300:20:44,610 --> 00:20:45,560At least once,
28400:20:45,560 --> 00:20:46,680perhaps twice.
28500:20:46,690 --> 00:20:50,430And borderline essentially the same...  once or twice.
28600:20:51,160 --> 00:20:52,120In addition,
28700:20:52,130 --> 00:21:00,340a second diagnosis may be appropriate if ... even though the characteristics are rooted in autism ...
28800:21:00,350 --> 00:21:12,950if 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.
28900:21:12,960 --> 00:21:14,920For example,
29000:21:15,270 --> 00:21:24,000even though many individuals on the spectrum have differences in their eating profiles that can lead to restricted eating,
29100:21:24,490 --> 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.
29200:21:38,440 --> 00:21:43,380So even though we know it's not separate from autism neurology,
29300:21:43,390 --> 00:21:50,560it still has become an area of significant and distinct concern that needs its own intervention.
29400:21:51,260 --> 00:21:51,820However,
29500:21:51,820 --> 00:21:56,160the intervention should be made in light of the neurologic base.
29600:21:58,940 --> 00:22:02,990Similarly for depression or PTSD.
29700:22:03,000 --> 00:22:10,190Sometimes people have these diagnoses ... and they are misdiagnoses for what is actually autism.
29800:22:10,190 --> 00:22:11,360However,
29900:22:11,370 --> 00:22:19,110certainly if autism has been diagnosed or if it has been assessed and ruled out,
30000:22:19,120 --> 00:22:25,480you can still also have depression or post traumatic stress disorder.
30100:22:27,220 --> 00:22:55,830These 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
30300:22:57,110 --> 00:23:00,600the differences between autism and other diagnoses.
30400:23:01,400 --> 00:23:05,760The reason for that is that a study will take,
30500:23:05,760 --> 00:23:06,550for example,
30600:23:06,550 --> 00:23:12,590people who have been diagnosed with autism and people who have been diagnosed with bipolar and compare them.
30700:23:12,600 --> 00:23:13,570However,
30800:23:13,570 --> 00:23:16,800when you really read how that process has gone,
30900:23:16,810 --> 00:23:26,160nobody has culled through this group of bipolar individuals to make sure that none of them are actually misdiagnosed autistics.
31000:23:26,160 --> 00:23:26,320So,
31100:23:26,320 --> 00:23:36,990you've got really strong potential for an autistic group being compared to a group of mixed diagnosis,
31200:23:36,990 --> 00:23:40,640perhaps bipolar and autism,
31300:23:40,650 --> 00:23:43,910... similarly for other diagnoses.
31400:23:45,970 --> 00:23:50,060Other research studies don't even use diagnosed groups.
31500:23:50,060 --> 00:24:05,710Sometimes 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.
31600:24:05,810 --> 00:24:14,920The group with the different diagnosis or even no diagnosis has not been specifically assessed and autism ruled out.
31700:24:15,080 --> 00:24:16,080And secondly,
31800:24:16,080 --> 00:24:29,200you 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,
31900:24:29,210 --> 00:24:30,920another diagnosis.
32000:24:32,060 --> 00:24:33,850For example,
32100:24:33,860 --> 00:24:36,210a lot of people with ADD
32400:24:36,850 --> 00:24:38,450Say well I know ADD
32700:24:38,840 --> 00:24:41,240Can include social difficulties.
32800:24:41,250 --> 00:24:41,390ADD
33100:24:41,820 --> 00:24:43,480Can include sensory issues.
33200:24:43,480 --> 00:24:43,610ADD
33500:24:43,980 --> 00:24:45,920Can include hyper focus.
33600:24:47,180 --> 00:24:53,100... That may be true but we actually don't know that it's true because the ADD
33900:24:53,470 --> 00:25:02,890group has not been actually professionally assessed for people missing a correct diagnosis of autism.
34000:25:03,400 --> 00:25:09,400So many of my clients that come for diagnosis have had a diagnosis of ADD
34300:25:09,870 --> 00:25:12,400since very early in their life.
34400:25:12,410 --> 00:25:22,480And not everyone ... but you do get this problematic mixing and so you can't really be sure what the overlap is.
34500:25:23,000 --> 00:25:30,520We do know that people with these other diagnoses have been misdiagnosed to some extent.
34600:25:30,520 --> 00:25:39,520We don't know how much because we don't have a correct diagnosis of autism across adulthood and across the lifespan yet.
34700:25:39,530 --> 00:25:42,380So we're moving in a good direction,
34800:25:42,390 --> 00:25:44,540but these are the complexities.
34900:25:44,550 --> 00:25:48,240If we want to talk about diagnosis and why it gets missed,
35000:25:48,250 --> 00:25:50,080why it gets misunderstood,
35100:25:50,090 --> 00:25:54,380and how come the research can be a little difficult to interpret.
35200:25:55,730 --> 00:25:59,660This is foundational knowledge about misdiagnosis.
35300:25:59,670 --> 00:26:03,920We are going to be doing a series of a few more episodes,
35400:26:03,920 --> 00:26:08,300looking at some of the common misdiagnoses in more detail.
35500:26:09,230 --> 00:26:13,060I'm glad you could join me for this conversation about autism,
35600:26:13,070 --> 00:26:14,230diagnosis,
35700:26:14,240 --> 00:26:16,120elephants and hippos,
35800:26:16,130 --> 00:26:23,480and I hope it was illustrative to just set that foundation for the complexity that we are diving into.
35900:26:24,190 --> 00:26:25,840I hope you join me next time.