Autism in the Adult

Recognizing Attempts at Regulation on the Autism Spectrum

Join Dr. Regan for the final episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on recognizing when an individual is attempting to regulate and using this information to partner toward the best outcome.
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
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
Transcript of Episode
100:00:00,340 --> 00:00:03,370This is Dr Theresa Regan.
200:00:03,380 --> 00:00:10,830I'm a neuropsychologist and I specialize in understanding the way that the brain is related to emotions,
300:00:10,830 --> 00:00:13,000behavior, cognition --
400:00:13,000 --> 00:00:16,430thinking skills -- and also personality.
500:00:16,440 --> 00:00:18,910I'm a certified autism specialist.
600:00:18,920 --> 00:00:24,060I'm the director of an autism diagnostic clinic for adults in Illinois.
700:00:24,070 --> 00:00:26,650And I'm the mother of a teen on the spectrum.
800:00:27,740 --> 00:00:35,960This is our final episode of a four point series on regulation and dysegulation on the autism spectrum.
900:00:36,440 --> 00:00:37,640In the first episode,
1000:00:37,640 --> 00:00:39,800we talked about what those words mean.
1100:00:39,800 --> 00:00:49,130So regulation has to do with the nervous system's ability to help us stay centered with alertness...
1200:00:49,140 --> 00:01:02,480whether we are able to wake up quickly and efficiently in the morning and are able to wind down to sleep in the evening ... that has to do with regulation of our alertness,
1300:01:02,490 --> 00:01:04,900Also regulation of attention...
1400:01:04,900 --> 00:01:14,000so sometimes we may feel spacey and inattentive and other times we may have too much hyper focus,
1500:01:14,000 --> 00:01:19,350too attentive to details that aren't really helping our situation.
1600:01:19,360 --> 00:01:21,530And also third,
1700:01:21,530 --> 00:01:24,370the regulation of emotions and behavior.
1800:01:24,370 --> 00:01:35,970And so this would be what we typically call fight, flight, or freeze modes when someone's overwhelmed and they may revert to an outburst or a meltdown,
1900:01:35,980 --> 00:01:39,230they may be an individual who has quieter struggle...
2000:01:39,230 --> 00:01:41,930So they may have flight reactions --
2100:01:41,930 --> 00:01:43,590like I'm leaving school,
2200:01:43,590 --> 00:01:46,580I can't come out of my room,
2300:01:46,580 --> 00:01:48,340I'm withdrawing.
2400:01:48,350 --> 00:01:52,880I'm hiding ... psychologically or physically.
2500:01:53,740 --> 00:01:57,440And some people have freeze reactions that ... I'm physically present,
2600:01:57,440 --> 00:01:59,430but I'm really shut down.
2700:01:59,430 --> 00:02:07,660I'm not psychologically present ... and it may even take the form of a dissociative episode like this person is shut down...
2800:02:07,670 --> 00:02:10,520They don't remember this conversation later.
2900:02:10,520 --> 00:02:14,360They're really just not able to be fully present.
3000:02:15,440 --> 00:02:18,590Another form of freeze reaction
3100:02:18,590 --> 00:02:25,130could be this expression of psychological stress through the physical body.
3200:02:25,140 --> 00:02:29,330So a person who's having what we call nonepileptic seizures.
3300:02:29,340 --> 00:02:39,150Those are seizures that are expressions of psychological struggle rather than based in electrical changes in the brain.
3400:02:39,160 --> 00:02:42,420That would be in this category.
3500:02:42,420 --> 00:02:49,150People who have feelings of physical pain in the context of emotional pain.
3600:02:49,540 --> 00:02:52,750People who have headaches or stomachaches etcetera.
3700:02:55,540 --> 00:03:02,510So we talked about ways to prevent dysregulation in the second episode.
3800:03:02,510 --> 00:03:06,960How to reduce those episodes of feeling uncentered.
3900:03:08,240 --> 00:03:09,490In the third episode,
4000:03:09,490 --> 00:03:26,260we talked about how to recover once dysregulation occurs, because it will ... it does for every human and there are just times in our life when we have more difficulties slipping into these dysregulated states.
4100:03:26,270 --> 00:03:27,850And then once that happens,
4200:03:27,850 --> 00:03:30,760we need to have strategies to recover.
4300:03:30,770 --> 00:03:33,360And that was our third topic.
4400:03:34,040 --> 00:03:52,950This is our fourth and final topic, and it's about how to recognize when the person you are with ... or how to recognize in yourself ... when you are attempting to regulate, because a lot of what we do as humans is say to ourselves,
4500:03:52,950 --> 00:03:53,310"Gosh,
4600:03:53,310 --> 00:03:55,540why is this person behaving that way?
4700:03:55,550 --> 00:03:57,150What does it mean?
4800:03:57,640 --> 00:03:59,980Why is my kid doing this?
4900:04:00,050 --> 00:04:01,770What's their intention?
5000:04:01,770 --> 00:04:02,820What does that mean?
5100:04:02,830 --> 00:04:06,790Or why did my spouse say this or didn't say this?
5200:04:06,790 --> 00:04:08,460What is the meaning behind that?"
5300:04:09,040 --> 00:04:15,620And it's really important if someone has a behavior and an attempt to regulate, that
5400:04:15,620 --> 00:04:19,740we understand that's what this behavior means.
5500:04:19,740 --> 00:04:24,760It's stemming, not from any personal issue between me and this person,
5600:04:24,770 --> 00:04:48,260It's stemming from an attempt to regulate and it's a sign ...it's revelation to the person and to those around him or her, that this is a person who's not feeling centered, and they're trying to get there and we all really want to support each individual's attempt to get to the center.
5700:04:48,740 --> 00:05:04,560And the first step is recognizing when someone is trying to do that and not interfering with their attempt to regulate unless we can offer them a better option for regulation and we'll talk about that in a little bit.
5800:05:06,140 --> 00:05:18,160One of the strategies that we talked about in previous episodes for regulating, whether that is alertness or attention or emotional calm,
5900:05:19,240 --> 00:05:34,590can have to do with the sensory system. The sensory inputs that people often use for adjusting that regulation state often has to do with pressure...
6000:05:34,600 --> 00:05:40,460So getting sensations of pressure, and that can be in the muscles or the joints.
6100:05:40,940 --> 00:05:44,560That's when we get what we call proprioceptive input.
6200:05:44,940 --> 00:06:02,550And that is why weighted blankets are calming for some people, that you have this pressure in the muscles and the nervous system gets these signals that it can kind of recenter, refocus, and get grounded.
6300:06:02,840 --> 00:06:09,760That's why yoga often is something that people gravitate toward for calming and centering,
6400:06:09,940 --> 00:06:19,520you often have these poses that you hold for a significant amount of time... enough that that pressure in the joint really gets settled in there.
6500:06:19,530 --> 00:06:35,590But there are a lot of other ways that people get pressure as well and we'll talk more about how to recognize that ... A lot of times the things people gravitate toward without really realizing why do I do this...
6600:06:35,600 --> 00:06:42,930There could be some sensory input part to it besides pressure...
6700:06:42,930 --> 00:06:45,740we're also going to be looking at movement.
6800:06:45,750 --> 00:06:50,360So that's when our brain receives vestibular input.
6900:06:50,840 --> 00:07:00,690So if person is riding their bike down through hills and down through neighborhoods,
7000:07:00,700 --> 00:07:04,950that person is getting vestibular input into their brain.
7100:07:05,340 --> 00:07:18,240And this kind of input is only present if the person is moving through space in the sense that they were in position one and now they're in position two... like they're down the street,
7200:07:18,250 --> 00:07:23,660that means the fluid in their ears starts to move and the brain gets this type of input...
7300:07:24,440 --> 00:07:32,360What doesn't give the brain vestibular movement input would be if the person is riding a stationary bike,
7400:07:32,740 --> 00:07:37,920they're moving their arms and legs and guess what ... they are getting proprioceptive input....
7500:07:37,920 --> 00:07:40,980that pressure in their muscles and their joints...
7600:07:41,020 --> 00:07:45,670but they're not moving through the neighborhood, down the hill,
7700:07:45,720 --> 00:07:53,560they're not getting that sense of movement into the brain, and that can be why a lot of people -- and you know who you are --
7800:07:53,640 --> 00:07:56,650will say, "I love running through the neighborhood,
7900:07:56,650 --> 00:07:58,590but I'm not going to run on a treadmill."
8000:07:58,600 --> 00:07:59,580You know,
8100:07:59,590 --> 00:08:04,670that is a clue that you are someone that needs that vestibular component,
8200:08:04,680 --> 00:08:07,950otherwise it just doesn't meet your sensory needs.
8300:08:09,740 --> 00:08:25,450Let me give some more examples of sensory strategies so that we recognize when someone around us may be using a sensory strategy. When kids or adults chew on things...
8400:08:25,840 --> 00:08:27,110pencils,
8500:08:27,120 --> 00:08:28,170shirts,
8600:08:28,180 --> 00:08:29,910chewing on gum,
8700:08:29,920 --> 00:08:34,280chewing on the tops or tabs of things.
8800:08:34,280 --> 00:08:39,010People put all kinds of things... like straws or tabs in their mouth.
8900:08:39,020 --> 00:08:42,710So our approach to correcting that is to say,
9000:08:42,710 --> 00:08:42,900"Hey,
9100:08:42,900 --> 00:08:44,330don't chew on your shirt,
9200:08:44,330 --> 00:08:45,460that's disgusting"...
9300:08:45,740 --> 00:08:48,410or don't chew on the pencil,
9400:08:48,410 --> 00:08:49,850it's not for chewing.
9500:08:50,140 --> 00:08:54,580Um but that kind of instruction doesn't really help.
9600:08:54,590 --> 00:09:06,710And the reason that in the long term the person kind of reverts back to that is it's probable that they actually are needing some pressure input through their jaw,
9700:09:06,720 --> 00:09:09,680through their uh the teeth into the jaw.
9800:09:09,690 --> 00:09:19,950And when you chew you get a lot of oral input and a lot of pressure input and that kind of input may be centering for that person.
9900:09:20,440 --> 00:09:30,240We even now ...at least in the United States, when there's an individualized educational plan for a student with attention problems or other difficulties in school,
10000:09:30,250 --> 00:09:47,750it may be written in their program that they're allowed to chew gum during class because it can help with focus and concentration and centering to have some pressure through the jaw and through the the teeth into the jaw.
10100:09:49,240 --> 00:10:09,850Another way that you might see people trying to get proprioceptive input would be that kid that is rolling on the ground, is crashing into people or things, and seems to like that.... um impact of hitting something or tackling in football,
10200:10:10,240 --> 00:10:16,260that kind of thing is going to give them pressure in their muscles and joints.
10300:10:16,940 --> 00:10:34,400Kds who like to run and jump into someone's lap or jump into a bear hug might really be wanting to get that pressure input ... for people who like to work on a laptop or on a project while they're laying on their stomach,
10400:10:34,400 --> 00:10:38,360you're getting a lot of pressure throughout your...
10500:10:38,740 --> 00:10:56,460the length of your body. When people are sitting and they're um kind of swinging their legs and they're hitting their ankles onto the the leg of the chair.
10600:10:56,940 --> 00:11:00,960Uh that gives pressure into the ankle joint there.
10700:11:01,440 --> 00:11:04,360People who like to go barefoot,
10800:11:04,370 --> 00:11:22,550you get a lot more proprioceptive input from the floor that way... by going barefoot rather than having a shoe on. Other people shuffle or drag their feet and they might be corrected by a parent and saying pick up your feet...
10900:11:23,440 --> 00:11:34,020the individual who sleeps with a ton of blankets or stuffed animals or really likes to be swaddled into something to sleep
11000:11:34,030 --> 00:11:39,250might be seeking pressure input. For people seeking vestibular input,
11100:11:39,640 --> 00:11:45,970you get that movement input ... and it may be riding the bike as I had talked about,
11200:11:45,980 --> 00:11:54,330It could be jumping on a trampoline (that also gives you pressure in your joints or when you flop on the bed of the trampoline).
11300:11:54,340 --> 00:11:55,010So you,
11400:11:55,020 --> 00:12:00,260you might be seeing that the person is getting both of those ...
11500:12:02,240 --> 00:12:06,720people who love roller coasters, who like to ride a motorcycle,
11600:12:07,140 --> 00:12:07,910Um,
11700:12:07,920 --> 00:12:20,790even just we can see that some people like to go for a ride in the car, and that clears their mind and it may be that there's some component of quiet that they find there,
11800:12:20,790 --> 00:12:27,260but they're also maybe just this predictable linear movement that might be calming.
11900:12:28,440 --> 00:12:30,980I want to tell you a story in particular.
12000:12:30,990 --> 00:12:35,480I saw a mother and her...
12100:12:35,490 --> 00:12:52,510I would say the son was probably about 10 years old, and it was one of those situations where unfortunately we were all in line to sign up for something that was related to a kids activity.
12200:12:52,520 --> 00:12:57,890And so there were parents in this long line and um,
12300:12:57,900 --> 00:13:01,930some parents had their kids with them and the line,
12400:13:01,940 --> 00:13:07,550I think it was raining outside and the interior of the office...
12500:13:07,740 --> 00:13:23,220it was just very winding and it was like you could fit one person in this little hallway and then it it just um meandered like a snake around this whole building and so you didn't see any windows and you were kind of...
12600:13:23,230 --> 00:13:25,900it really was loud and claustrophobic,
12700:13:25,900 --> 00:13:29,460it was very difficult for me to wait in that line.
12800:13:30,340 --> 00:13:33,720And the boy who was next to me,
12900:13:33,730 --> 00:14:07,460I could hear his mom talking to another mom in line ...and she was talking about how her boys loved to ride down this a really, really steep hill by their house, and she she just worries about them a bit because it's so steep and they do things like you know riding on their handlebars and ...they just are so driven to go down this hill that she hasn't been able to figure out a way to keep them from doing that.
13000:14:08,540 --> 00:14:14,270And in my mind I'm thinking "oh those are kids that need a lot of vestibular input,
13100:14:14,270 --> 00:14:20,750they need that ... they're trying to regulate and that's the way that they found that really serves that purpose.
13200:14:21,340 --> 00:14:35,820And interestingly, the next thing that happened was the boy next to me started shaking his head back, back, back, back, back, back, back and forth... vigorously and then he'd stop and then he'd shake,
13300:14:35,820 --> 00:14:36,060shake,
13400:14:36,060 --> 00:14:36,290shake,
13500:14:36,290 --> 00:14:36,510shake,
13600:14:36,510 --> 00:14:36,780shake,
13700:14:36,780 --> 00:14:37,010shake,
13800:14:37,010 --> 00:14:50,930shake his head and then he'd stop... and in my head, I thought "oh that's a great way for this kid to try to regulate in a hallway, because there's no way he's riding his bike down this hallway,"
13900:14:50,940 --> 00:14:52,730but by shaking his head,
14000:14:52,730 --> 00:14:54,150he's standing still,
14100:14:54,150 --> 00:15:02,300he's not making any noise and he's getting vestibular input because his head is shaking and that fluid in the ears is moving.
14200:15:02,540 --> 00:15:03,230And I thought,
14300:15:03,230 --> 00:15:03,490wow,
14400:15:03,490 --> 00:15:05,660that's a really great strategy for him.
14500:15:06,240 --> 00:15:08,180And the mom though,
14600:15:08,190 --> 00:15:17,060didn't realize what was happening, and she saw that as bad behavior and she said "stop that."
14700:15:18,240 --> 00:15:23,480And that's really the purpose of this episode... that if we don't understand,
14800:15:23,520 --> 00:15:24,180you know,
14900:15:24,180 --> 00:15:32,630here is someone who is struggling to stand still in a winding hallway,
15000:15:32,630 --> 00:15:34,040that's not moving,
15100:15:34,050 --> 00:15:35,740the line's not moving,
15200:15:35,750 --> 00:15:37,290people are talking,
15300:15:37,290 --> 00:15:39,160it's a very close space.
15400:15:39,640 --> 00:15:42,360Um and he's not able to move at all.
15500:15:43,040 --> 00:15:47,060So here he comes up with this great strategy,
15600:15:47,060 --> 00:15:48,570I'm sure unconsciously,
15700:15:48,570 --> 00:15:49,550it's not like he thought,
15800:15:49,550 --> 00:15:51,060how can I get movement input?
15900:15:51,070 --> 00:15:54,120But his body helped him out by saying,
16000:15:54,120 --> 00:15:54,350hey,
16100:15:54,350 --> 00:15:55,210do this.
16200:15:55,740 --> 00:15:57,670And mom said no,
16300:15:57,680 --> 00:16:02,770and so what we can really do, if we recognize what is this behavior...
16400:16:02,770 --> 00:16:03,920we could say,
16500:16:03,930 --> 00:16:06,450"oh that's a great strategy,
16600:16:07,030 --> 00:16:15,000Does that feel good to move your head like that" -- and we can help the person identifying themselves,
16700:16:15,000 --> 00:16:17,160what feels calming and what they need.
16800:16:17,840 --> 00:16:18,470Now,
16900:16:18,480 --> 00:16:25,930if she felt like that was too disruptive or if he were somehow banging his head into people,
17000:16:25,940 --> 00:16:28,400she very well could say something like,
17100:16:28,410 --> 00:16:31,510oh I really see that your body has that itch
17200:16:31,520 --> 00:16:32,250to move,
17300:16:32,250 --> 00:16:33,940it really needs to move,
17400:16:33,950 --> 00:16:36,190That's kind of hard to do in here.
17500:16:36,190 --> 00:16:42,160But would you like to go to the indoor pool after we're done?
17600:16:42,160 --> 00:16:53,240So you can get some of that movement that you really need... so that she's offering an alternative, and she's acknowledging that that actually serves a very important need for him,
17700:16:53,250 --> 00:17:08,950that he needs a lot of movement throughout the day and offering him more opportunity to do that again in a way that is safe and healthy and doesn't disrupt other people is a much better strategy than saying "don't do that."
17800:17:09,140 --> 00:17:11,620So once she understands that,
17900:17:11,630 --> 00:17:18,080they'll get along well with it, once we have a detective's hat on and we can say,
18000:17:18,080 --> 00:17:18,520wow,
18100:17:18,520 --> 00:17:21,240I wonder if X,
18200:17:21,240 --> 00:17:22,480y and Z.
18300:17:22,490 --> 00:17:22,890You know,
18400:17:22,890 --> 00:17:28,960I wonder if this behavior that you're showing really serves a function for you that's important.
18500:17:29,440 --> 00:17:40,060Then our solution can be to help the person realize what's happening, to support their attempts to regulate, and to create more opportunities for good regulation.
18600:17:42,540 --> 00:17:50,170It also breaks up this adversarial stance between people where if I'm correcting this person and saying,
18700:17:50,180 --> 00:17:50,960um,
18800:17:50,970 --> 00:17:51,440you know,
18900:17:51,440 --> 00:17:52,380pick your feet up,
19000:17:52,380 --> 00:17:55,740don't drag your feet, and don't shake your head, and don't talk.
19100:17:55,750 --> 00:18:18,890It gets into this very constant kind of adversarial situation where I've established a relationship with the person where I'm making sure they fit into a very small space, and they feel like their needs aren't getting met ... and she's asking, let's take the son who likes to move or needs movement,
19200:18:18,900 --> 00:18:22,030She's asking him to be still and be quiet.
19300:18:22,030 --> 00:18:25,830So she's asking him to regulate in the hallway.
19400:18:25,840 --> 00:18:29,560But she's asking him not to use regulation strategies.
19500:18:29,570 --> 00:18:31,560So that's where the problem is.
19600:18:31,560 --> 00:18:43,910He can either stay in the line and tolerate it by moving his head -- or he might then become more disruptive.
19700:18:43,910 --> 00:18:48,450Like then "I just can't stay in the line if I can't use the movement."
19800:18:50,640 --> 00:19:11,790I want to give you another example I witnessed of someone who is using vestibular input to regulate, and that was a preschooler who I observed the class was walking in their single file line behind the teacher. One of the students that had a lot of difficulty regulating 
19900:19:11,790 --> 00:19:15,480-- I already knew from past observations --
20000:19:15,490 --> 00:19:21,740He was spinning while walking down in line.
20100:19:21,750 --> 00:19:23,940This kind of took a lot of coordination,
20200:19:23,940 --> 00:19:27,150but he was spinning in his own personal space,
20300:19:27,150 --> 00:19:31,260but while moving in a single file... line and again,
20400:19:31,260 --> 00:19:34,520that was something that he got reprimanded for.
20500:19:34,530 --> 00:19:36,050But it's a big revelation.
20600:19:36,050 --> 00:19:37,050It's a big clue.
20700:19:37,340 --> 00:19:38,410And if we can say,
20800:19:38,410 --> 00:19:38,890wow,
20900:19:38,890 --> 00:19:40,350that's a clue,
21000:19:40,360 --> 00:19:46,240maybe I should put this kid on a swing and and let him go before we go back into the classroom,
21100:19:46,250 --> 00:19:48,770then we can use that information.
21200:19:51,140 --> 00:19:54,130The person who wants to chew on everything.
21300:19:54,140 --> 00:19:59,030Maybe they can chew gum instead of chewing on pencils or ruining their shirts.
21400:19:59,040 --> 00:20:06,770Um maybe they can chew on a pencil topper ... so they make different things you can chew on that you could put on top of a pencil.
21500:20:07,040 --> 00:20:17,890Another strategy that sometimes works for kids to kind of give them another source of regulation is to have them do their homework or um you know,
21600:20:17,890 --> 00:20:23,940for an adult to do their projects, while sitting on an exercise ball because when you're doing that,
21700:20:23,940 --> 00:20:30,350you're getting more pressure into your seat and you have the opportunity to move and get that vestibular input as well.
21800:20:30,350 --> 00:20:39,660And sometimes that reduces the need for chewing because you're actually getting some pressure and movement and feel more centered.
21900:20:43,840 --> 00:20:48,020Another way that people tend to seek regulations...
22000:20:48,020 --> 00:20:58,150so we've talked about sensory inputs... and another way that people seek regulation is when they want to engage in their pleasurable activities.
22100:20:58,160 --> 00:21:00,640So for the individual on the spectrum,
22200:21:00,640 --> 00:21:07,010this might include something like sorting or patterning objects in their collections.
22300:21:07,340 --> 00:21:11,590So they may take time to sort and organize their colored pencils,
22400:21:11,590 --> 00:21:13,060they're playing cards,
22500:21:13,070 --> 00:21:16,140they may take out items to look at that
22600:21:16,150 --> 00:21:24,350... they have that are figurines that are ornaments, that are books in a collection with special covers signed by the author.
22700:21:25,940 --> 00:21:31,930It may be that this person is wanting to read their favorite book,
22800:21:31,930 --> 00:21:33,830watch their favorite tv show,
22900:21:33,840 --> 00:21:38,970eat their favorite meal ... and this is their attempt to regulate.
23000:21:38,970 --> 00:21:42,500So they're gonna like ... their pleasurable,
23100:21:42,500 --> 00:22:02,420go-to activities ... and they're also going to tend to like things that are familiar. And one of the biggest problems I encounter for families is when they misinterpret why the person is trying to grasp at these familiar and pleasurable things.
23200:22:02,430 --> 00:22:12,260So let's take the example of a teenage girl who comes home from school and she is exhausted,
23300:22:12,640 --> 00:22:14,910it's loud at school,
23400:22:14,920 --> 00:22:17,520she was previously homeschooled,
23500:22:17,520 --> 00:22:21,340so the high school environment is a big difference.
23600:22:21,350 --> 00:22:24,860And after school she gets off the bus,
23700:22:24,860 --> 00:22:34,600she comes in and she breaks the family rule about using mom's iPad.
23800:22:34,600 --> 00:22:41,910So she is allowed to use mom's ipad for a certain number of minutes a day,
23900:22:42,440 --> 00:22:47,770and it is not until she has done her homework that she's able to start with it.
24000:22:48,240 --> 00:23:05,170But she goes right in to get the iPad, and she goes to her closet and she sits in the dark with the iPad, um with the closet door closed and mom finds her in there and ... really,
24100:23:05,170 --> 00:23:08,550really gets upset! Like this...
24200:23:08,560 --> 00:23:10,870these kind of things have happened before.
24300:23:10,880 --> 00:23:16,900And mom really views her as being very defiant,
24400:23:16,910 --> 00:23:29,670even though she intellectually knows the rules. She interprets her sitting in the closet in the dark with the ipad as "I know I'm not supposed to be doing this and I'm doing it anyway"
24500:23:29,670 --> 00:23:36,200and that feels very, very intentionally willful and defiant to mom.
24600:23:36,200 --> 00:23:40,450And so she um takes a very hard stance about it...
24700:23:40,450 --> 00:23:43,960she starts to yell and get upset,
24800:23:43,960 --> 00:23:50,320she grabs the ipad and physically takes it out of her daughter's hands.
24900:23:50,840 --> 00:23:53,110the daughter loses it,
25000:23:53,190 --> 00:23:55,160she starts screaming,
25100:23:55,540 --> 00:23:58,540she slams doors,
25200:23:58,540 --> 00:24:03,560she takes one of the doors ... not completely off the hinge,
25300:24:03,560 --> 00:24:19,380but kind of breaks and bends one of the hinges, and it just turned into a very loud screaming and property breaking kind of episode.
25400:24:19,380 --> 00:24:29,700And so this was unfortunate because I think mom's interpretation of what was going on was inaccurate.
25500:24:29,720 --> 00:24:34,060In my working with this teen,
25600:24:34,540 --> 00:24:38,460this is a teen with straight A's in school,
25700:24:38,840 --> 00:24:43,760she is very rule-oriented in school,
25800:24:43,760 --> 00:24:47,860which makes her mom feel very upset that she breaks the rules at home ...
25900:24:48,640 --> 00:24:52,390but she's just exhausted by the time she gets home,
26000:24:52,400 --> 00:24:59,970it's a complex academic, sensory, and social environment ...and she has not been used to it,
26100:24:59,980 --> 00:25:05,320she's back in a public school environment, and even the bus drive there and the bus drive home,
26200:25:05,320 --> 00:25:06,570that adds another,
26300:25:06,580 --> 00:25:07,340you know,
26400:25:07,340 --> 00:25:15,330hour to the day of being around all these people ...and it's very overwhelming to her. When she gets overwhelmed,
26500:25:17,840 --> 00:25:32,000what she wants to do is look at pictures of animals, and she wants to look up animal facts and topics and charts, and she wants to learn about a new animal and see pictures of the animal.
26600:25:32,010 --> 00:25:54,060And so all she's doing on the ipad is looking up animal facts and pictures and this is soothing to her. I do get where mom's coming from, that there are some households where the rule is you get to do fun things after you do your homework,
26700:25:54,940 --> 00:26:04,740but this person's nervous system really needs the opportunity to regroup before doing something again.
26800:26:04,750 --> 00:26:05,550That's hard.
26900:26:06,340 --> 00:26:18,300So she is at a breaking point when she comes home and it's actually her attempt to regulate that has her take this thing ... and I know she's hiding with it.
27000:26:18,300 --> 00:26:26,360But I also think that being in a dark, quiet space is also something she's trying to do to regulate as well.
27100:26:29,140 --> 00:26:41,150I think the misunderstanding is that mom feels that the daughter on the spectrum could easily comply and behave in a different way.
27200:26:41,160 --> 00:26:51,480And my view is that she's leaning toward trying to get her neurologic needs met and it breaks the household rule
27300:26:51,480 --> 00:26:54,540which puts everybody in a very tough position.
27400:26:54,550 --> 00:27:00,810So mom is essentially saying "I want you to regulate without doing your pleasant activities."
27500:27:00,820 --> 00:27:06,970And she is saying "I can't regulate if that's taken away from me."
27600:27:06,980 --> 00:27:14,580So mom's um kind of coming in and barging into the the bedroom area and the closet area,
27700:27:14,580 --> 00:27:17,860turning the lights on, physically taking away the
27800:27:18,540 --> 00:27:30,270ipad and raising her voice ... really added to this very overwhelming situation for her ... and then when she couldn't use flight... 
27900:27:31,040 --> 00:27:33,760here she had come home and used flight right?...
28000:27:33,760 --> 00:27:35,560I'm going to go to the closet.
28100:27:36,240 --> 00:27:36,440Um,
28200:27:36,440 --> 00:27:41,860and her favorite activity to prevent a meltdown.
28300:27:42,240 --> 00:27:44,310Once that was taken away from her,
28400:27:44,310 --> 00:27:48,350then she did have a meltdown, and it wasn't in defiance...
28500:27:48,360 --> 00:27:52,050it was just that what she was using to regulate was taken away.
28600:27:53,040 --> 00:27:58,300I think there would have been a much better outcome if the parent had seen her in the closet and thought,
28700:27:58,300 --> 00:27:58,720wow,
28800:27:58,730 --> 00:28:01,170it looks like you had a really rough day.
28900:28:01,740 --> 00:28:07,260Does it feel good to be in a dark cozy space and looking at your animals?
29000:28:07,740 --> 00:28:14,850And this could have started a real dialogue about what her system needs and what she notices.
29100:28:15,330 --> 00:28:23,200And it can introduce this concept that we can partner together to make sure that you're safe and healthy,
29200:28:23,200 --> 00:28:29,960but that your needs also get met because you are important and how you're doing is important.
29300:28:30,640 --> 00:28:30,990Um,
29400:28:30,990 --> 00:28:34,060and it sets up this collaboration and this partnership.
29500:28:35,740 --> 00:28:46,070Maybe there could be flexibility in the iPad rule and maybe they discussed that mom really does want her to feel centered after a hard day at work.
29600:28:46,080 --> 00:28:55,060And one option might be that mom and daughter could sit in a dark room together after school and look at animal facts for 30 minutes.
29700:28:55,540 --> 00:29:10,140If the reason that mom is restricting the ipad is that she thinks that she must be in the closet because she's looking at unapproved sites ... or maybe they could decide that having animal books from the library
29800:29:10,150 --> 00:29:10,880
29900:29:10,880 --> 00:29:19,170and the daughter could choose those books and go into an enclosed dark space and look at the books...
30000:29:19,180 --> 00:29:25,270if the reason for the rule is that mom doesn't want electronics all day in front of the daughter.
30100:29:26,540 --> 00:29:34,310Perhaps they could even have a tradition where after her alone time looking at animal facts and books,
30200:29:34,310 --> 00:29:37,810she could come out and tell mom some animal information.
30300:29:37,920 --> 00:29:42,660What was the most interesting that she learned... and this could also bring them together.
30400:29:43,140 --> 00:29:43,710
30500:29:43,710 --> 00:29:44,930once they have this,
30600:29:44,940 --> 00:29:49,510this better partnership and a tradition like 'this is how you unwind,
30700:29:49,520 --> 00:29:51,060this is how we connect'...
30800:29:53,350 --> 00:29:56,450And then once they figure out that that's helpful,
30900:29:56,940 --> 00:30:03,780they can talk about what else could we set up for you and give you access to that would help your system.
31000:30:03,790 --> 00:30:04,330You know,
31100:30:04,330 --> 00:30:22,270maybe this person needs a weighted blanket or a hammock or maybe laying in a bubble bath after school feels grounding, and they could come up with more ideas so that she has more access rather than less access to regulating activities.
31200:30:24,140 --> 00:30:28,080Consider an example of a husband who comes home from work
31300:30:28,090 --> 00:30:34,350to his wife and two preschool kids, and he walks straight to his home office,
31400:30:34,350 --> 00:30:35,570he shuts the door,
31500:30:35,580 --> 00:30:47,870he watches tv, plays games on his phone... and his kids had just thrown themselves at him when he came in the door only to be uh rejected and feel rejected.
31600:30:47,880 --> 00:30:54,320His wife is feeling like she's the one who needs to recharge because she's been with the kids all day.
31700:30:54,320 --> 00:30:59,760She hasn't seen another adult and she also feels ignored and rejected in her marriage.
31800:31:00,940 --> 00:31:03,360This again is a case of,
31900:31:03,940 --> 00:31:04,300um,
32000:31:04,300 --> 00:31:13,160an autistic adult who has given everything at work and comes in and actually does need some recentering time.
32100:31:13,640 --> 00:31:19,670And a discussion of this would probably be more fruitful
32200:31:20,100 --> 00:31:27,860than people talking about discontent with it, or telling him to do something different.
32300:31:28,440 --> 00:31:28,840Uh,
32400:31:28,850 --> 00:31:42,760it may be much more strategic to say "what do you need for these 30 or 40 minutes when you get home and then I'll tell you what I need and how can we get these things that we all need in the evening."
32500:31:45,040 --> 00:31:55,720Another strategy would be maybe he could start doing things at his office that would help him regulate during the day and then when he gets home,
32600:31:55,730 --> 00:31:58,800maybe he'd have a little bit more left.
32700:31:58,800 --> 00:32:00,880So maybe over a lunch break,
32800:32:00,890 --> 00:32:04,450he could eat his sandwich while he's walking around the block,
32900:32:04,830 --> 00:32:08,300Maybe he could listen to music when he's not in meetings.
33000:32:08,740 --> 00:32:18,850So this conscious working towards strategy helps us with the regulation piece.
33100:32:19,850 --> 00:32:21,320Then when he gets home,
33200:32:21,720 --> 00:32:26,330maybe he could go into his office and do some alone things for 30 minutes.
33300:32:26,740 --> 00:32:31,770And if wife needs alone time then or needs together time with him,
33400:32:32,140 --> 00:32:38,390they could pick maybe a restorative activity for the family... one that the kids never get to do.
33500:32:38,400 --> 00:32:53,170But they're going to pull this out in the evening because they really need something that's restorative and calm and so maybe they don't let let the kids watch movies or eat popcorn or eat anything in the living room.
33600:32:53,440 --> 00:33:05,000So maybe they could have a popcorn picnic or a pancake picnic in the living room while they put on a cartoon and they can turn off the lights.
33700:33:05,060 --> 00:33:07,540The kids might settle down in there,
33800:33:07,540 --> 00:33:15,490they can turn the volume down and then the parents could just cuddle on the couch and that level of activity
33900:33:15,490 --> 00:33:22,450may be something that he can regulate through and that actually is also restorative for them as a family.
34000:33:23,740 --> 00:33:35,700So once we recognize that the behavior is not intentionally defiant or manipulative at its core... and it doesn't represent a rejection of other people,
34100:33:35,700 --> 00:33:38,860we can problem solve and establish a partnership.
34200:33:39,240 --> 00:33:42,550And if you're the individual learning about yourself,
34300:33:42,550 --> 00:33:48,500you can say to the other person ... it looks like you have had a crazy day,
34400:33:48,510 --> 00:33:50,390I want to know what you need.
34500:33:50,400 --> 00:33:58,060Let me tell you what I think I need ... and so we can all grow in this self awareness and in these discussions about partnering.
34600:33:59,940 --> 00:34:07,230It's also important to note that flight can sometimes be an attempt to save regulation as well.
34700:34:07,240 --> 00:34:09,320And we talked about this a little bit.
34800:34:09,320 --> 00:34:31,190I just want to emphasize it before we end today ... that if someone leaves the room or if they shut down or if they stop the conversation and they are just going to leave ... one danger to chasing after them physically or psychologically,
34900:34:32,040 --> 00:34:36,180is that that flight may be the only thing
35000:34:36,180 --> 00:34:39,720saving them from melting down,
35100:34:39,730 --> 00:34:41,350that might be their strategy...
35200:34:41,350 --> 00:34:43,160flight might be their strategy.
35300:34:43,170 --> 00:34:45,360And so if it is,
35400:34:46,440 --> 00:34:53,540it often doesn't help to chase after the person and prevent them from flight.
35500:34:53,550 --> 00:35:00,900That's not to say that we don't want to work toward a more sustained level of communication.
35600:35:01,340 --> 00:35:09,630It's just that what doesn't seem to work -- and even though it's understandable ---is to go kind of in chase mode,
35700:35:09,630 --> 00:35:11,770like "I'm not going to let this go,
35800:35:11,770 --> 00:35:12,600this is important,
35900:35:12,600 --> 00:35:13,860we need to do this."
36000:35:14,840 --> 00:35:16,080Again,
36100:35:16,080 --> 00:35:18,600there are lots of caveats to all these,
36200:35:18,600 --> 00:35:24,740these are kind of general principles that I found helpful,
36300:35:24,750 --> 00:35:30,960but there may be times that you do block an activity or escape because of safety reasons.
36400:35:31,340 --> 00:35:35,100Um but most of the time when I see it happening,
36500:35:35,100 --> 00:35:36,970it's in frustration.
36600:35:37,340 --> 00:35:42,170Uh that ... I'm not gonna let you leave or I'm not gonna let you be defiant.
36700:35:43,140 --> 00:35:48,360Another approach that may work better in the flight mode issue is saying,
36800:35:48,370 --> 00:35:51,750I know that having this conversation is really tough for you,
36900:35:52,240 --> 00:35:56,340but it's also really important to me to communicate about this.
37000:35:56,340 --> 00:36:01,250And what would help you feel more centered and still be able to communicate.
37100:36:02,130 --> 00:36:14,160So some people may do better communicating about a sensitive topic when you're sitting in the dark so that they don't have to be face to face with you and they don't have to have eye contact.
37200:36:14,630 --> 00:36:26,540Another person may want to email about things for the same reason... that anything you can do to reduce the intensity of the conversation might make it more successful.
37300:36:26,550 --> 00:36:29,390So if they're overwhelmed enough that they want to leave,
37400:36:29,400 --> 00:36:35,950how can you reduce the intensity without reducing the core of what you want to accomplish?
37500:36:36,230 --> 00:36:39,710So maybe you can reduce the eye contact.
37600:36:39,720 --> 00:36:49,960Maybe you can reduce um you know turn down the lights or go in a quieter spot or schedule a time instead of having it spontaneous.
37700:36:50,930 --> 00:37:05,450So the bottom line summary of today's episode on recognizing when someone is attempting to regulate is that the way that we interpret someone's behavior ...
37800:37:06,140 --> 00:37:07,850you know, "what does this mean?"
37900:37:08,430 --> 00:37:17,490... it ends up impacting a lot, and if we think the behavior means someone's being disrespectful,
38000:37:17,490 --> 00:37:36,300manipulative, defiant, rejecting us ... then we are often going to respond in a way that's less effective than if we recognize that "oh this is a person who is dysregulated and trying to regulate.
38100:37:36,300 --> 00:37:37,950They're trying to get back.
38200:37:37,960 --> 00:37:47,010... this is a person who's overwhelmed ... then we can make better choices about how to respond in that situation to get the better outcome,
38300:37:47,020 --> 00:37:55,580the best outcome ... and that may include "wow it looks like you've had a rough day" or "it's really noisy in here isn't it?"
38400:37:55,590 --> 00:38:01,670Or "it seems like your system might need to move"... and really problem solving together.
38500:38:03,130 --> 00:38:07,440I hope this four part series on regulation has been helpful to you.
38600:38:08,330 --> 00:38:15,550It's certainly a topic that people often contact our clinic for ... for advice and education.
38700:38:17,430 --> 00:38:22,840Next time you join me it will be for the beginning of our next series, and I'm going to call it,
38800:38:22,840 --> 00:38:24,450Talking About Autism.
38900:38:24,830 --> 00:38:28,140This is a listener request, and I think it's a great one.
39000:38:28,140 --> 00:38:30,140It was sent in by several people,
39100:38:30,150 --> 00:38:36,950all wanting to really hear my input about how to talk about autism with each other.
39200:38:37,630 --> 00:38:39,110Hope you can join me then.
 

Recovering from Dysregulation on the Autism Spectrum

Join Dr. Regan for the third episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on strategies for recovering from dysregulated states. 
 
As referenced in the podcast: 
Exhaustion in Autism: Balancing Momentum for Daily Activities
Gaining Momentum for Activities: Shifting from Sluggish to Active
Keeping Momentum for Activities on the Autism Spectrum
 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
 
Transcript of Episode
100:00:03,540 --> 00:00:07,840Hello everyone and welcome to this episode of the podcast,
200:00:07,850 --> 00:00:09,680autism in the adult,
300:00:09,690 --> 00:00:10,910I am your host,
400:00:10,910 --> 00:00:12,450Dr Theresa Regan.
500:00:13,040 --> 00:00:14,870I am a neuropsychologist,
600:00:14,870 --> 00:00:20,640which means that I specialize in understanding how the brain impacts things like thinking,
700:00:20,640 --> 00:00:21,320skills,
800:00:21,330 --> 00:00:22,410emotions,
900:00:22,420 --> 00:00:24,560behavior and personality.
1000:00:25,160 --> 00:00:30,460I'm the founder and director of an adult diagnostic autism clinic in central Illinois.
1100:00:30,840 --> 00:00:40,560And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum.
1200:00:41,440 --> 00:00:42,960In the first episode,
1300:00:42,960 --> 00:00:51,080we defined these terms where regulation is feeling just right in the area of alertness,
1400:00:51,090 --> 00:01:03,630attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions,
1500:01:03,630 --> 00:01:11,960they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down,
1600:01:12,410 --> 00:01:19,850they might include physical expressions of stress, or what we call dissociation.
1700:01:20,540 --> 00:01:31,760Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real.
1800:01:33,640 --> 00:01:34,800In the first episode,
1900:01:34,800 --> 00:01:38,030we also reviewed that within the autism spectrum,
2000:01:38,030 --> 00:01:43,360dysregulation is more common than for those with different neurology.
2100:01:44,540 --> 00:01:46,760In the second episode of this series,
2200:01:46,760 --> 00:02:08,760we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into.
2300:02:10,520 --> 00:02:12,120For our third episode,
2400:02:12,120 --> 00:02:16,460our focus will be on what to do when dysregulation hits.
2500:02:16,940 --> 00:02:21,650We all have dysregulated states... for the person on the spectrum,
2600:02:21,650 --> 00:02:28,970they may be more likely to have these and, even when we do all that we can do to support the nervous system,
2700:02:29,440 --> 00:02:38,260we're going to have periods where we're really not just right with regard to alertness or attention or emotional status.
2800:02:38,840 --> 00:02:40,860So when someone is dysregulated,
2900:02:40,860 --> 00:02:47,170they might appear to be sluggish or have difficulty getting going or unmotivated.
3000:02:47,180 --> 00:02:53,360That would be when their motor is running too low in the area of alertness and activation.
3100:02:54,040 --> 00:03:04,330This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism.
3200:03:04,330 --> 00:03:10,290And I will post the links to these episodes below today,
3300:03:10,290 --> 00:03:15,530We're going to focus on the dysregulation that looks like anxiety,
3400:03:15,540 --> 00:03:17,310upset, anger,
3500:03:17,310 --> 00:03:18,360restlessness.
3600:03:18,930 --> 00:03:24,570These things that may manifest in fight, flight, or freeze reactions.
3700:03:28,540 --> 00:03:37,480So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing.
3800:03:37,480 --> 00:03:41,650So we're gonna start with this category of what not to do.
3900:03:42,040 --> 00:03:49,540Many of the things that we have an instinct for when someone is dysregulated actually may make things worse.
4000:03:49,550 --> 00:03:51,270So what do we tend to do?
4100:03:51,270 --> 00:03:51,470Well,
4200:03:51,470 --> 00:03:55,010we might ask the person to talk about how they're feeling,
4300:03:55,010 --> 00:03:56,760why they're feeling that way,
4400:03:56,760 --> 00:04:01,320what triggered this really strong emotional reaction.
4500:04:02,240 --> 00:04:08,560We may reason with them about why they should be feeling or reacting differently.
4600:04:08,940 --> 00:04:10,390We might say things like,
4700:04:10,390 --> 00:04:13,130"Well they didn't mean it" or "it's not a big deal,"
4800:04:13,130 --> 00:04:28,420"don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better.
4900:04:28,440 --> 00:04:31,000So we may say to them calm down,
5000:04:31,010 --> 00:04:32,180don't yell,
5100:04:32,190 --> 00:04:43,490look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system.
5200:04:43,500 --> 00:04:52,360It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed.
5300:04:54,040 --> 00:04:56,530For the person on the spectrum,
5400:04:56,530 --> 00:05:02,300it's already going to be effortful for them to figure out what their emotions are,
5500:05:02,310 --> 00:05:09,250what triggered them, and to talk about them face to face and eye to eye with another person.
5600:05:10,040 --> 00:05:18,350And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves.
5700:05:18,940 --> 00:05:26,280Um and so it's probably not only not realistic for them to be able to do that when overwhelmed,
5800:05:26,840 --> 00:05:33,750but talking to the individual who's overwhelmed also just adds stimulus,
5900:05:33,760 --> 00:05:35,150It adds demand,
6000:05:35,150 --> 00:05:36,860it adds noise.
6100:05:37,740 --> 00:05:45,750And so to the extent that talking is just adding stimulus to the situation,
6200:05:46,540 --> 00:05:50,490I really would recommend being calm,
6300:05:50,490 --> 00:05:51,840being quiet.
6400:05:52,340 --> 00:05:59,360Not necessarily engaging with the person in the moment that they are overwhelmed.
6500:06:00,540 --> 00:06:21,560So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time
6600:06:24,440 --> 00:06:34,060Other things that I would recommend not doing would be ... I would not take away possessions from them at this time.
6700:06:34,540 --> 00:06:37,820So don't try to take something out of their hands.
6800:06:37,830 --> 00:06:43,810Don't try to take something away from their space or their room...
6900:06:43,820 --> 00:06:51,070the place where maybe they find comfort. Objects are often very important to the individual on the spectrum.
7000:06:51,070 --> 00:06:55,530And when someone's dysregulated and overwhelmed,
7100:06:55,530 --> 00:07:01,660it's often not a good time to try to separate them from something that's that important to them.
7200:07:03,640 --> 00:07:09,120Likewise touching them or wrestling with them ...kind of getting into their space.
7300:07:09,130 --> 00:07:16,060Um It's generally again going to add stimulus to what they're trying to process.
7400:07:16,070 --> 00:07:26,660So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state.
7500:07:27,640 --> 00:07:35,830Again just kind of thinking how much information is coming at this individual who's already overwhelmed.
7600:07:35,830 --> 00:07:46,660So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them...
7700:07:48,520 --> 00:07:50,970So during a period of dysregulation,
7800:07:50,970 --> 00:08:09,650the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ...
7900:08:09,660 --> 00:08:12,090adding your speech, adding...
8000:08:12,090 --> 00:08:13,990being in in their space,
8100:08:14,000 --> 00:08:17,080taking away things that are comforting to them...
8200:08:17,080 --> 00:08:20,860that's likely to increase the dysregulated state.
8300:08:23,440 --> 00:08:36,660Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion.
8400:08:37,440 --> 00:08:45,220So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum.
8500:08:45,220 --> 00:09:06,420And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed.
8600:09:08,040 --> 00:09:14,760I would recommend staying very calm and even and predictable.
8700:09:17,240 --> 00:09:27,650I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process.
8800:09:28,240 --> 00:09:31,670If you do approach the person with high reactivity,
8900:09:31,680 --> 00:09:43,970you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own.
9000:09:43,980 --> 00:09:52,760And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated.
9100:09:55,840 --> 00:10:08,350The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated.
9200:10:10,040 --> 00:10:26,190We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual.
9300:10:26,240 --> 00:10:38,930The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs.
9400:10:38,940 --> 00:10:43,950And we talked about some of the strategies for this during the last episode.
9500:10:44,440 --> 00:10:53,160But, for example, an individual on the spectrum may really like pressure inputs or movement inputs.
9600:10:53,730 --> 00:11:06,880So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub,
9700:11:06,890 --> 00:11:09,660they feel a lot more centered after that.
9800:11:10,240 --> 00:11:13,360Some people recenter by lifting weights,
9900:11:13,360 --> 00:11:14,330doing yoga,
10000:11:14,330 --> 00:11:26,460swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding.
10100:11:28,340 --> 00:11:30,830Those experiences may be calming,
10200:11:30,840 --> 00:11:38,750they may be centering for the individuals so if you can add calming and centering inputs without talking,
10300:11:39,440 --> 00:11:43,250this can really help getting back to a regulated state.
10400:11:44,140 --> 00:11:55,150And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them.
10500:11:55,740 --> 00:11:58,480So thinking about this individual,
10600:11:58,480 --> 00:12:01,210what do they lean towards doing ... that
10700:12:01,210 --> 00:12:04,050they seem to find rejuvenating.
10800:12:05,240 --> 00:12:17,860Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos,
10900:12:18,840 --> 00:12:28,460another person may love sorting through their collections or sorting through images on Pinterest,
11000:12:28,840 --> 00:12:36,510looking at various colors that are so ... they're just so compelled by these colors,
11100:12:36,520 --> 00:12:40,760they capture their attention and it's almost like they just fill,
11200:12:40,770 --> 00:12:45,290fill this person up ... and they feel so rejuvenated.
11300:12:46,240 --> 00:12:53,980A third person may love to listen to history podcasts or to watch a favorite movie,
11400:12:53,990 --> 00:12:57,870even one that they've watched 100 times,
11500:12:57,880 --> 00:13:04,560It may be their go-to movie when they want to regroup and settle back to the center.
11600:13:05,540 --> 00:13:10,020In these moments of being uncentered and wanting to recenter,
11700:13:10,030 --> 00:13:17,640it's very likely that familiar things will be more calming than new things.
11800:13:17,640 --> 00:13:24,650So um a lot of times if people watch what they're drawn to on a difficult day,
11900:13:24,740 --> 00:13:27,850it may give them this information.
12000:13:27,860 --> 00:13:38,590This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment.
12100:13:38,600 --> 00:14:05,300And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far.
12200:14:05,300 --> 00:14:35,050We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time
12300:14:35,640 --> 00:14:37,320some type of game plan,
12400:14:37,350 --> 00:14:53,130a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?"
12500:14:53,270 --> 00:14:53,690You know,
12600:14:53,690 --> 00:14:56,800what should I do during this episode to feel better?
12700:14:57,340 --> 00:15:10,650So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time.
12800:15:11,240 --> 00:15:13,260People do it all different ways.
12900:15:13,260 --> 00:15:23,230Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered.
13000:15:23,240 --> 00:15:24,200Oh yes,
13100:15:24,210 --> 00:15:24,590you know,
13200:15:24,590 --> 00:15:25,940I wouldn't have thought of this,
13300:15:25,940 --> 00:15:32,060but I can take a walk outside of the weather permits and I actually do feel better then.
13400:15:32,840 --> 00:15:41,890Sometimes people make a box ahead of time of items in it that are soothing.
13500:15:41,890 --> 00:15:46,070They might have a lava lamp in there that they can just watch,
13600:15:46,070 --> 00:15:47,960they might have a stress ball.
13700:15:48,440 --> 00:15:57,350Uh there might be slime or different scents like lavender or vanilla that are soothing or calming.
13800:15:59,140 --> 00:16:06,550So this detective work ahead of time can be really helpful and then adding cues to the person
13900:16:06,550 --> 00:16:09,000either from familiar people who can say,
14000:16:09,000 --> 00:16:09,280hey,
14100:16:09,280 --> 00:16:14,900I wonder if it would feel good for you to do this or to have it in the environment,
14200:16:14,900 --> 00:16:17,460like a list or a box of items...
14300:16:19,840 --> 00:16:27,240Ideally the individual will have a sense over time of when a dysegulated state is coming on.
14400:16:27,250 --> 00:16:28,660So for example,
14500:16:28,670 --> 00:16:37,060if they lean toward starting to shut down or disassociate during difficult times or difficult conversations,
14600:16:37,470 --> 00:16:43,520they may start to catch themselves when their mind starts to go blank and they're talking to somebody.
14700:16:44,540 --> 00:16:49,630They also may have a sense over time of when this happens at home,
14800:16:49,670 --> 00:16:55,320it often helps me to do these kinds of things-- and when it happens in public,
14900:16:55,330 --> 00:16:57,860I've learned to do these other kinds of things.
15000:16:59,140 --> 00:17:02,700Being able to recognize dysregulation, know
15100:17:02,700 --> 00:17:11,670what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening...
15200:17:11,680 --> 00:17:21,090that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people,
15300:17:21,100 --> 00:17:25,370we can really stabilize these situations and these relationships.
15400:17:25,380 --> 00:17:26,850So for example,
15500:17:26,850 --> 00:17:33,770if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown,
15600:17:34,140 --> 00:17:40,530it's generally very acceptable and professional in most work settings to step out...
15700:17:40,540 --> 00:17:49,670if you offer some type of explanation...  walking out of the room without explanation would not be considered okay or professional,
15800:17:50,040 --> 00:17:55,250but someone may use a very generic explanation and just say,
15900:17:55,260 --> 00:17:55,870"You know,
16000:17:55,880 --> 00:17:58,340I'm starting to not feel very well,
16100:17:58,340 --> 00:18:13,360I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work.
16200:18:14,940 --> 00:18:17,480So in that case the person might say,
16300:18:17,480 --> 00:18:17,840"You know,
16400:18:17,840 --> 00:18:21,450I can see that I'm really feeling passionate about this topic,
16500:18:21,840 --> 00:18:29,660but I also want to be able to hear what you have to say and ways in what your opinion is different from mine.
16600:18:29,670 --> 00:18:34,050And I think I just need to step out to regroup for a few minutes,"
16700:18:34,740 --> 00:18:45,960or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate.
16800:18:46,440 --> 00:18:48,310They may say to their boss,
16900:18:48,320 --> 00:18:48,720"You know,
17000:18:48,720 --> 00:18:52,890I can feel myself getting really passionate about my own opinion,
17100:18:52,890 --> 00:18:55,920but I know that your perspective is important too,
17200:18:55,920 --> 00:19:08,140and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized.
17300:19:08,260 --> 00:19:11,440I'd really love for you to hear them,
17400:19:11,440 --> 00:19:14,320but I also would like to read your thoughts.
17500:19:14,320 --> 00:19:15,960If you could send them to me.
17600:19:15,970 --> 00:19:32,670I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps.
17700:19:33,940 --> 00:19:39,360Then I would like to come back and talk more about our opinions and talk them through."
17800:19:40,340 --> 00:19:51,640Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things.
17900:19:51,650 --> 00:19:55,330So this could be a technique that's done in a workplace,
18000:19:55,340 --> 00:20:06,600in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on.
18100:20:06,600 --> 00:20:07,970But it's very important,
18200:20:07,970 --> 00:20:08,290you know,
18300:20:08,290 --> 00:20:17,670being able to have time and space to process before you come back together can help stabilize that interaction.
18400:20:20,940 --> 00:20:35,920It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you,
18500:20:35,920 --> 00:20:38,430even though you disagree with it.
18600:20:38,440 --> 00:20:46,530Um that it kind of helps show that you want there to be a good exchange.
18700:20:46,540 --> 00:20:48,000If you're walking out,
18800:20:48,000 --> 00:20:52,110sometimes people feel like they're not even committed to a good exchange.
18900:20:52,110 --> 00:20:54,950So what ... what good is this partnership?
19000:20:54,960 --> 00:21:09,600But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now.
19100:21:09,610 --> 00:21:16,260Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work.
19200:21:18,540 --> 00:21:28,670That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ...
19300:21:29,440 --> 00:22:07,960what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time.
19400:22:08,640 --> 00:22:14,960So we've talked now about several ways to approach periods of dis regulation.
19500:22:15,340 --> 00:22:31,060One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation,
19600:22:31,140 --> 00:22:38,260but all I can say certainly is that these are general things I've noticed that do help or don't help.
19700:22:40,120 --> 00:22:44,630Focus should also always be on the person's safety in that moment,
19800:22:44,630 --> 00:22:47,690if there's something unsafe that needs to be stopped,
19900:22:47,700 --> 00:22:52,260that's really something to immediately intervene with.
20000:22:53,340 --> 00:23:01,460But in general reducing stimuli and demand and increasing soothing inputs can be really helpful.
20100:23:03,840 --> 00:23:12,810I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life.
20200:23:12,810 --> 00:23:36,960So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing.
20300:23:37,440 --> 00:23:48,800So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial --
20400:23:48,800 --> 00:23:54,860so that goals with some challenge can be added once regulation has improved.
20500:23:57,640 --> 00:24:05,670Now our next episode will be the final in our four episode series on regulation and dysregulation.
20600:24:07,140 --> 00:24:09,360In the 4th and final episode,
20700:24:09,360 --> 00:24:19,670we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations.
20800:24:20,740 --> 00:24:28,060So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.
 
 

Reducing Dysregulation on the Autism Spectrum

Join Dr. Regan for the second episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on three strategies to help reduce the frequency and intensity of dysregulation episodes for the autistic individual. 
 
Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan
 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
100:00:03,540 --> 00:00:07,840Hello everyone and welcome to this episode of the podcast,
200:00:07,850 --> 00:00:09,680autism in the adult,
300:00:09,690 --> 00:00:10,910I am your host,
400:00:10,910 --> 00:00:12,450Dr Theresa Regan.
500:00:13,040 --> 00:00:14,870I am a neuropsychologist,
600:00:14,870 --> 00:00:20,640which means that I specialize in understanding how the brain impacts things like thinking,
700:00:20,640 --> 00:00:21,320skills,
800:00:21,330 --> 00:00:22,410emotions,
900:00:22,420 --> 00:00:24,560behavior and personality.
1000:00:25,160 --> 00:00:30,460I'm the founder and director of an adult diagnostic autism clinic in central Illinois.
1100:00:30,840 --> 00:00:40,560And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum.
1200:00:41,440 --> 00:00:42,960In the first episode,
1300:00:42,960 --> 00:00:51,080we defined these terms where regulation is feeling just right in the area of alertness,
1400:00:51,090 --> 00:01:03,630attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions,
1500:01:03,630 --> 00:01:11,960they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down,
1600:01:12,410 --> 00:01:19,850they might include physical expressions of stress, or what we call dissociation.
1700:01:20,540 --> 00:01:31,760Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real.
1800:01:33,640 --> 00:01:34,800In the first episode,
1900:01:34,800 --> 00:01:38,030we also reviewed that within the autism spectrum,
2000:01:38,030 --> 00:01:43,360dysregulation is more common than for those with different neurology.
2100:01:44,540 --> 00:01:46,760In the second episode of this series,
2200:01:46,760 --> 00:02:08,760we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into.
2300:02:10,520 --> 00:02:12,120For our third episode,
2400:02:12,120 --> 00:02:16,460our focus will be on what to do when dysregulation hits.
2500:02:16,940 --> 00:02:21,650We all have dysregulated states... for the person on the spectrum,
2600:02:21,650 --> 00:02:28,970they may be more likely to have these and, even when we do all that we can do to support the nervous system,
2700:02:29,440 --> 00:02:38,260we're going to have periods where we're really not just right with regard to alertness or attention or emotional status.
2800:02:38,840 --> 00:02:40,860So when someone is dysregulated,
2900:02:40,860 --> 00:02:47,170they might appear to be sluggish or have difficulty getting going or unmotivated.
3000:02:47,180 --> 00:02:53,360That would be when their motor is running too low in the area of alertness and activation.
3100:02:54,040 --> 00:03:04,330This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism.
3200:03:04,330 --> 00:03:10,290And I will post the links to these episodes below today,
3300:03:10,290 --> 00:03:15,530We're going to focus on the dysregulation that looks like anxiety,
3400:03:15,540 --> 00:03:17,310upset, anger,
3500:03:17,310 --> 00:03:18,360restlessness.
3600:03:18,930 --> 00:03:24,570These things that may manifest in fight, flight, or freeze reactions.
3700:03:28,540 --> 00:03:37,480So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing.
3800:03:37,480 --> 00:03:41,650So we're gonna start with this category of what not to do.
3900:03:42,040 --> 00:03:49,540Many of the things that we have an instinct for when someone is dysregulated actually may make things worse.
4000:03:49,550 --> 00:03:51,270So what do we tend to do?
4100:03:51,270 --> 00:03:51,470Well,
4200:03:51,470 --> 00:03:55,010we might ask the person to talk about how they're feeling,
4300:03:55,010 --> 00:03:56,760why they're feeling that way,
4400:03:56,760 --> 00:04:01,320what triggered this really strong emotional reaction.
4500:04:02,240 --> 00:04:08,560We may reason with them about why they should be feeling or reacting differently.
4600:04:08,940 --> 00:04:10,390We might say things like,
4700:04:10,390 --> 00:04:13,130"Well they didn't mean it" or "it's not a big deal,"
4800:04:13,130 --> 00:04:28,420"don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better.
4900:04:28,440 --> 00:04:31,000So we may say to them calm down,
5000:04:31,010 --> 00:04:32,180don't yell,
5100:04:32,190 --> 00:04:43,490look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system.
5200:04:43,500 --> 00:04:52,360It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed.
5300:04:54,040 --> 00:04:56,530For the person on the spectrum,
5400:04:56,530 --> 00:05:02,300it's already going to be effortful for them to figure out what their emotions are,
5500:05:02,310 --> 00:05:09,250what triggered them, and to talk about them face to face and eye to eye with another person.
5600:05:10,040 --> 00:05:18,350And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves.
5700:05:18,940 --> 00:05:26,280Um and so it's probably not only not realistic for them to be able to do that when overwhelmed,
5800:05:26,840 --> 00:05:33,750but talking to the individual who's overwhelmed also just adds stimulus,
5900:05:33,760 --> 00:05:35,150It adds demand,
6000:05:35,150 --> 00:05:36,860it adds noise.
6100:05:37,740 --> 00:05:45,750And so to the extent that talking is just adding stimulus to the situation,
6200:05:46,540 --> 00:05:50,490I really would recommend being calm,
6300:05:50,490 --> 00:05:51,840being quiet.
6400:05:52,340 --> 00:05:59,360Not necessarily engaging with the person in the moment that they are overwhelmed.
6500:06:00,540 --> 00:06:21,560So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time
6600:06:24,440 --> 00:06:34,060Other things that I would recommend not doing would be ... I would not take away possessions from them at this time.
6700:06:34,540 --> 00:06:37,820So don't try to take something out of their hands.
6800:06:37,830 --> 00:06:43,810Don't try to take something away from their space or their room...
6900:06:43,820 --> 00:06:51,070the place where maybe they find comfort. Objects are often very important to the individual on the spectrum.
7000:06:51,070 --> 00:06:55,530And when someone's dysregulated and overwhelmed,
7100:06:55,530 --> 00:07:01,660it's often not a good time to try to separate them from something that's that important to them.
7200:07:03,640 --> 00:07:09,120Likewise touching them or wrestling with them ...kind of getting into their space.
7300:07:09,130 --> 00:07:16,060Um It's generally again going to add stimulus to what they're trying to process.
7400:07:16,070 --> 00:07:26,660So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state.
7500:07:27,640 --> 00:07:35,830Again just kind of thinking how much information is coming at this individual who's already overwhelmed.
7600:07:35,830 --> 00:07:46,660So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them...
7700:07:48,520 --> 00:07:50,970So during a period of dysregulation,
7800:07:50,970 --> 00:08:09,650the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ...
7900:08:09,660 --> 00:08:12,090adding your speech, adding...
8000:08:12,090 --> 00:08:13,990being in in their space,
8100:08:14,000 --> 00:08:17,080taking away things that are comforting to them...
8200:08:17,080 --> 00:08:20,860that's likely to increase the dysregulated state.
8300:08:23,440 --> 00:08:36,660Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion.
8400:08:37,440 --> 00:08:45,220So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum.
8500:08:45,220 --> 00:09:06,420And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed.
8600:09:08,040 --> 00:09:14,760I would recommend staying very calm and even and predictable.
8700:09:17,240 --> 00:09:27,650I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process.
8800:09:28,240 --> 00:09:31,670If you do approach the person with high reactivity,
8900:09:31,680 --> 00:09:43,970you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own.
9000:09:43,980 --> 00:09:52,760And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated.
9100:09:55,840 --> 00:10:08,350The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated.
9200:10:10,040 --> 00:10:26,190We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual.
9300:10:26,240 --> 00:10:38,930The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs.
9400:10:38,940 --> 00:10:43,950And we talked about some of the strategies for this during the last episode.
9500:10:44,440 --> 00:10:53,160But, for example, an individual on the spectrum may really like pressure inputs or movement inputs.
9600:10:53,730 --> 00:11:06,880So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub,
9700:11:06,890 --> 00:11:09,660they feel a lot more centered after that.
9800:11:10,240 --> 00:11:13,360Some people recenter by lifting weights,
9900:11:13,360 --> 00:11:14,330doing yoga,
10000:11:14,330 --> 00:11:26,460swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding.
10100:11:28,340 --> 00:11:30,830Those experiences may be calming,
10200:11:30,840 --> 00:11:38,750they may be centering for the individuals so if you can add calming and centering inputs without talking,
10300:11:39,440 --> 00:11:43,250this can really help getting back to a regulated state.
10400:11:44,140 --> 00:11:55,150And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them.
10500:11:55,740 --> 00:11:58,480So thinking about this individual,
10600:11:58,480 --> 00:12:01,210what do they lean towards doing ... that
10700:12:01,210 --> 00:12:04,050they seem to find rejuvenating.
10800:12:05,240 --> 00:12:17,860Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos,
10900:12:18,840 --> 00:12:28,460another person may love sorting through their collections or sorting through images on Pinterest,
11000:12:28,840 --> 00:12:36,510looking at various colors that are so ... they're just so compelled by these colors,
11100:12:36,520 --> 00:12:40,760they capture their attention and it's almost like they just fill,
11200:12:40,770 --> 00:12:45,290fill this person up ... and they feel so rejuvenated.
11300:12:46,240 --> 00:12:53,980A third person may love to listen to history podcasts or to watch a favorite movie,
11400:12:53,990 --> 00:12:57,870even one that they've watched 100 times,
11500:12:57,880 --> 00:13:04,560It may be their go-to movie when they want to regroup and settle back to the center.
11600:13:05,540 --> 00:13:10,020In these moments of being uncentered and wanting to recenter,
11700:13:10,030 --> 00:13:17,640it's very likely that familiar things will be more calming than new things.
11800:13:17,640 --> 00:13:24,650So um a lot of times if people watch what they're drawn to on a difficult day,
11900:13:24,740 --> 00:13:27,850it may give them this information.
12000:13:27,860 --> 00:13:38,590This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment.
12100:13:38,600 --> 00:14:05,300And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far.
12200:14:05,300 --> 00:14:35,050We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time
12300:14:35,640 --> 00:14:37,320some type of game plan,
12400:14:37,350 --> 00:14:53,130a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?"
12500:14:53,270 --> 00:14:53,690You know,
12600:14:53,690 --> 00:14:56,800what should I do during this episode to feel better?
12700:14:57,340 --> 00:15:10,650So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time.
12800:15:11,240 --> 00:15:13,260People do it all different ways.
12900:15:13,260 --> 00:15:23,230Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered.
13000:15:23,240 --> 00:15:24,200Oh yes,
13100:15:24,210 --> 00:15:24,590you know,
13200:15:24,590 --> 00:15:25,940I wouldn't have thought of this,
13300:15:25,940 --> 00:15:32,060but I can take a walk outside of the weather permits and I actually do feel better then.
13400:15:32,840 --> 00:15:41,890Sometimes people make a box ahead of time of items in it that are soothing.
13500:15:41,890 --> 00:15:46,070They might have a lava lamp in there that they can just watch,
13600:15:46,070 --> 00:15:47,960they might have a stress ball.
13700:15:48,440 --> 00:15:57,350Uh there might be slime or different scents like lavender or vanilla that are soothing or calming.
13800:15:59,140 --> 00:16:06,550So this detective work ahead of time can be really helpful and then adding cues to the person
13900:16:06,550 --> 00:16:09,000either from familiar people who can say,
14000:16:09,000 --> 00:16:09,280hey,
14100:16:09,280 --> 00:16:14,900I wonder if it would feel good for you to do this or to have it in the environment,
14200:16:14,900 --> 00:16:17,460like a list or a box of items...
14300:16:19,840 --> 00:16:27,240Ideally the individual will have a sense over time of when a dysegulated state is coming on.
14400:16:27,250 --> 00:16:28,660So for example,
14500:16:28,670 --> 00:16:37,060if they lean toward starting to shut down or disassociate during difficult times or difficult conversations,
14600:16:37,470 --> 00:16:43,520they may start to catch themselves when their mind starts to go blank and they're talking to somebody.
14700:16:44,540 --> 00:16:49,630They also may have a sense over time of when this happens at home,
14800:16:49,670 --> 00:16:55,320it often helps me to do these kinds of things-- and when it happens in public,
14900:16:55,330 --> 00:16:57,860I've learned to do these other kinds of things.
15000:16:59,140 --> 00:17:02,700Being able to recognize dysregulation, know
15100:17:02,700 --> 00:17:11,670what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening...
15200:17:11,680 --> 00:17:21,090that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people,
15300:17:21,100 --> 00:17:25,370we can really stabilize these situations and these relationships.
15400:17:25,380 --> 00:17:26,850So for example,
15500:17:26,850 --> 00:17:33,770if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown,
15600:17:34,140 --> 00:17:40,530it's generally very acceptable and professional in most work settings to step out...
15700:17:40,540 --> 00:17:49,670if you offer some type of explanation...  walking out of the room without explanation would not be considered okay or professional,
15800:17:50,040 --> 00:17:55,250but someone may use a very generic explanation and just say,
15900:17:55,260 --> 00:17:55,870"You know,
16000:17:55,880 --> 00:17:58,340I'm starting to not feel very well,
16100:17:58,340 --> 00:18:13,360I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work.
16200:18:14,940 --> 00:18:17,480So in that case the person might say,
16300:18:17,480 --> 00:18:17,840"You know,
16400:18:17,840 --> 00:18:21,450I can see that I'm really feeling passionate about this topic,
16500:18:21,840 --> 00:18:29,660but I also want to be able to hear what you have to say and ways in what your opinion is different from mine.
16600:18:29,670 --> 00:18:34,050And I think I just need to step out to regroup for a few minutes,"
16700:18:34,740 --> 00:18:45,960or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate.
16800:18:46,440 --> 00:18:48,310They may say to their boss,
16900:18:48,320 --> 00:18:48,720"You know,
17000:18:48,720 --> 00:18:52,890I can feel myself getting really passionate about my own opinion,
17100:18:52,890 --> 00:18:55,920but I know that your perspective is important too,
17200:18:55,920 --> 00:19:08,140and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized.
17300:19:08,260 --> 00:19:11,440I'd really love for you to hear them,
17400:19:11,440 --> 00:19:14,320but I also would like to read your thoughts.
17500:19:14,320 --> 00:19:15,960If you could send them to me.
17600:19:15,970 --> 00:19:32,670I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps.
17700:19:33,940 --> 00:19:39,360Then I would like to come back and talk more about our opinions and talk them through."
17800:19:40,340 --> 00:19:51,640Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things.
17900:19:51,650 --> 00:19:55,330So this could be a technique that's done in a workplace,
18000:19:55,340 --> 00:20:06,600in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on.
18100:20:06,600 --> 00:20:07,970But it's very important,
18200:20:07,970 --> 00:20:08,290you know,
18300:20:08,290 --> 00:20:17,670being able to have time and space to process before you come back together can help stabilize that interaction.
18400:20:20,940 --> 00:20:35,920It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you,
18500:20:35,920 --> 00:20:38,430even though you disagree with it.
18600:20:38,440 --> 00:20:46,530Um that it kind of helps show that you want there to be a good exchange.
18700:20:46,540 --> 00:20:48,000If you're walking out,
18800:20:48,000 --> 00:20:52,110sometimes people feel like they're not even committed to a good exchange.
18900:20:52,110 --> 00:20:54,950So what ... what good is this partnership?
19000:20:54,960 --> 00:21:09,600But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now.
19100:21:09,610 --> 00:21:16,260Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work.
19200:21:18,540 --> 00:21:28,670That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ...
19300:21:29,440 --> 00:22:07,960what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time.
19400:22:08,640 --> 00:22:14,960So we've talked now about several ways to approach periods of dis regulation.
19500:22:15,340 --> 00:22:31,060One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation,
19600:22:31,140 --> 00:22:38,260but all I can say certainly is that these are general things I've noticed that do help or don't help.
19700:22:40,120 --> 00:22:44,630Focus should also always be on the person's safety in that moment,
19800:22:44,630 --> 00:22:47,690if there's something unsafe that needs to be stopped,
19900:22:47,700 --> 00:22:52,260that's really something to immediately intervene with.
20000:22:53,340 --> 00:23:01,460But in general reducing stimuli and demand and increasing soothing inputs can be really helpful.
20100:23:03,840 --> 00:23:12,810I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life.
20200:23:12,810 --> 00:23:36,960So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing.
20300:23:37,440 --> 00:23:48,800So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial --
20400:23:48,800 --> 00:23:54,860so that goals with some challenge can be added once regulation has improved.
20500:23:57,640 --> 00:24:05,670Now our next episode will be the final in our four episode series on regulation and dysregulation.
20600:24:07,140 --> 00:24:09,360In the 4th and final episode,
20700:24:09,360 --> 00:24:19,670we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations.
20800:24:20,740 --> 00:24:28,060So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.
 
 

Recognizing Dysregulation on the Autism Spectrum: Fight, Flight, Freeze

Individuals on the spectrum who are going through a season of struggle often describe episodes of dysregulation (not feeling centered in their alertness, attention, or emotions). Join Dr. Regan for this first episode in a 4 part series on dysregulation to learn how to recognize a dysregulated state and why these states are often misinterpreted or mishandled. 
 
The Alert Program: Your Best Self
The Testing Psychologist podcast: Best of 2021
Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan
 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
 
Episode Transcript
100:00:00,340 --> 00:00:17,760Welcome to autism in the adult podcast.
200:00:17,770 --> 00:00:18,750I'm your host,
300:00:18,760 --> 00:00:20,290Dr Theresa Regan,
400:00:20,300 --> 00:00:22,560an adult neuropsychologist.
500:00:22,640 --> 00:00:28,050I specialize in brain behavior relationships for those 14 and older.
600:00:28,540 --> 00:00:35,050I'm the parent of an amazing teen on the autism spectrum and a certified autism specialist.
700:00:35,740 --> 00:00:38,200I am deeply grateful to bring validation,
800:00:38,200 --> 00:00:42,850hope and purpose to individuals and their families living on the autism spectrum.
900:00:43,540 --> 00:00:45,430With this mission at its core,
1000:00:45,440 --> 00:00:52,580I founded and currently direct the OsF healthcare adult diagnostic autism center in central Illinois.
1100:00:52,590 --> 00:01:10,560My books include Understanding Autism in Adults and Aging Adults and Understanding Autistic Behaviors. For more information and to join my online community for free visit www.adultandgeriatricautism.com.
1200:01:11,440 --> 00:01:13,550Please join me in helping individuals,
1300:01:13,560 --> 00:01:18,550couples and families thrive while living life on the autism spectrum.
1400:01:20,540 --> 00:01:24,460Hello and welcome to this episode of Autism in the Adult.
1500:01:25,240 --> 00:01:29,460And I'm glad you joined me for this first episode of 2022.
1600:01:30,240 --> 00:01:35,050I just want to highlight a few things that have gone on recently.
1700:01:35,050 --> 00:01:44,680I was happy to be named in the episode Best Of for 2021 that The Testing Psychologist produces.
1800:01:44,680 --> 00:01:46,520This is a podcast by Dr.
1900:01:46,520 --> 00:01:47,550Jeremy Sharp
2000:01:47,940 --> 00:02:02,790talking about issues related to assessment in psychology, and my episode in august Identifying Adult Autism was the second downloaded episode of the season.
2100:02:02,800 --> 00:02:03,290So,
2200:02:03,290 --> 00:02:14,720I was so honored to be among many very accomplished people talking about important topics and assessment of Autism in the adult was right up there at # two.
2300:02:14,720 --> 00:02:14,990So,
2400:02:14,990 --> 00:02:16,900I was happy about that.
2500:02:16,900 --> 00:02:19,920I'll put the link below if you or someone you know
2600:02:19,920 --> 00:02:22,800would like to learn more about assessment.
2700:02:23,340 --> 00:02:29,160This episode of the testing psychologist was produced for clinicians.
2800:02:29,160 --> 00:02:36,450So people who are trying to understand how to assess and evaluate autistic characteristics in their clients.
2900:02:37,040 --> 00:02:44,660I also have an exciting opportunity for clinicians coming up in February on the 26th of 2022.
3000:02:45,100 --> 00:02:50,030This is a two hour live interactive webinar with Zur Institute.
3100:02:50,040 --> 00:02:50,480And again,
3200:02:50,480 --> 00:02:52,330I'll put the link below.
3300:02:52,840 --> 00:02:58,210This is entitled Autism Spectrum Disorder: Interventions Across the Lifespan.
3400:02:58,640 --> 00:03:05,150So not everyone on the spectrum will need support or intervention at all seasons of life.
3500:03:05,540 --> 00:03:26,890But for those who are clinicians, we have people come to us asking for assistance during a tough period or about a difficult thing that they're grappling with and to understand the neurology of the client is so important to drive the strategies that will be most helpful for them.
3600:03:27,140 --> 00:03:42,770So I'll be talking specifically about strategies that are likely to help the autistic client and ... things that we typically do in a counseling sessions, will highlight those that wouldn't be likely to be as helpful.
3700:03:42,770 --> 00:03:45,730So that's February 26,
3800:03:45,730 --> 00:03:46,3402022.
3900:03:46,350 --> 00:03:48,850And I'll go ahead and put that link below.
4000:03:51,540 --> 00:03:55,260Today's topic is dysregulation.
4100:03:55,840 --> 00:04:00,240I envision this to be the first episode in a four part series.
4200:04:00,250 --> 00:04:04,160And so today we're going to talk about what this regulation is and
4300:04:04,170 --> 00:04:06,060how to recognize it.
4400:04:06,840 --> 00:04:09,290In the next episode of the series,
4500:04:09,290 --> 00:04:15,880we're going to talk about how to reduce the amount of dysregulation that someone experiences.
4600:04:15,890 --> 00:04:20,550The third episode will be how to recover from dysregulation.
4700:04:21,040 --> 00:04:27,820The fourth will be how can you recognize when someone is trying to regulate.
4800:04:27,830 --> 00:04:31,350So someone around us maybe trying to regulate,
4900:04:31,360 --> 00:04:35,650and we may criticize them or ask them to stop it,
5000:04:35,660 --> 00:04:37,230but there would be other,
5100:04:37,230 --> 00:04:41,050more impactful ways to get a good outcome.
5200:04:41,940 --> 00:04:44,020You'll understand more about what I mean
5300:04:44,020 --> 00:04:48,750when we start to talk about this thing called regulation and dysregulation,
5400:04:50,440 --> 00:05:05,650Everyone's brain and nervous system are in charge of helping us to stay centered with various things and part of what we stay centered with has to do with alertness.
5500:05:05,660 --> 00:05:08,070Can we wake up in the morning?
5600:05:08,070 --> 00:05:11,690Can we calm down and fall asleep at night?
5700:05:11,700 --> 00:05:16,830That's kind of our ... the tone of our alertness,
5800:05:16,940 --> 00:05:18,760our brain helps us with that.
5900:05:19,440 --> 00:05:23,900We also have this attention regulation.
6000:05:23,900 --> 00:05:31,520So our brain is supposed to help us focus on what's most important and just release and let go
6100:05:31,520 --> 00:05:38,670things that are no longer important or uh you know... if the information in our environment has changed.
6200:05:38,680 --> 00:05:46,990So we need to switch gears and attend to something else... so our brain helps us regulate alertness and attention.
6300:05:47,740 --> 00:05:53,190So when we talk about these two aspects of regulation (alertness and attention),
6400:05:53,740 --> 00:06:05,050there is an analogy that is commonly used with the occupational therapists that often try to help people learn how to regulate better.
6500:06:05,540 --> 00:06:09,560And that analogy is "how is your motor running today?"
6600:06:10,340 --> 00:06:14,560So if your motor is running sluggish,
6700:06:15,340 --> 00:06:17,420you are tired,
6800:06:17,470 --> 00:06:20,370you may describe yourself as feeling lazy,
6900:06:20,370 --> 00:06:21,540unmotivated.
7000:06:21,540 --> 00:06:22,910I can't get going,
7100:06:22,910 --> 00:06:24,250I feel sleepy.
7200:06:24,730 --> 00:06:31,750I'm just a bump on a log ... that is when your motor is running too low.
7300:06:32,640 --> 00:06:35,620Your motor can also sometimes run too high.
7400:06:36,140 --> 00:06:41,260It's revved up and it's not in that just right state.
7500:06:41,640 --> 00:06:47,250And a motor that's too high will be someone who is hyper, restless,
7600:06:47,640 --> 00:06:48,290angry,
7700:06:48,300 --> 00:06:49,240agitated,
7800:06:49,250 --> 00:06:50,070anxious,
7900:06:50,070 --> 00:06:54,700that extra alertness that we just don't need all the time.
8000:06:54,800 --> 00:06:56,970This high level of alertness.
8100:06:57,440 --> 00:07:07,360Um that is the motor that is running too high, and we would like our motor to be running just right.
8200:07:09,240 --> 00:07:13,370The Alert Program is one program you might want to investigate.
8300:07:13,380 --> 00:07:19,830It's run by occupational therapists who are very experienced in regulation strategies.
8400:07:19,840 --> 00:07:23,160And I have a link to the alert program below.
8500:07:23,640 --> 00:07:23,960Now,
8600:07:23,960 --> 00:07:28,870they train occupational therapists in strategies to help others.
8700:07:28,870 --> 00:07:41,060But they also have a new online program called Your Best Self that people can investigate to figure out regulation strategies for themselves.
8800:07:43,040 --> 00:07:43,540Now,
8900:07:43,540 --> 00:07:46,450we've talked about alertness and attention.
9000:07:46,840 --> 00:07:51,280There's also this area of emotional regulation.
9100:07:51,290 --> 00:07:54,160So when we have a strong emotion,
9200:07:54,170 --> 00:07:58,700our brain should help us make sense of it.
9300:07:58,710 --> 00:08:06,810Our brain should help us center it and help it be present in our mind that we're aware of it,
9400:08:06,810 --> 00:08:08,400but it's not overwhelming,
9500:08:08,410 --> 00:08:10,070it doesn't hijack us,
9600:08:10,080 --> 00:08:11,770it doesn't take control of us,
9700:08:11,780 --> 00:08:13,550It doesn't hurt other people.
9800:08:13,560 --> 00:08:20,160And that would be regulation or dysregulation of emotional experiences.
9900:08:22,440 --> 00:08:28,060When we talk about a dysregulated state in the area of emotions,
10000:08:28,120 --> 00:08:31,560we can talk about a fight reaction,
10100:08:32,240 --> 00:08:36,950flight reactions or freeze reactions.
10200:08:38,040 --> 00:08:56,000So a fight reaction in the area of emotions is that this very strong emotional experience ... comes in and the person feels so overwhelmed that there is this externalized expression of distress.
10300:08:56,640 --> 00:09:01,950And what I mean by that is I would include meltdowns in this category.
10400:09:01,960 --> 00:09:04,170I would include outbursts,
10500:09:04,180 --> 00:09:05,320crying spells.
10600:09:05,320 --> 00:09:08,480I even include, even though it's not fight,
10700:09:08,490 --> 00:09:14,960but I'd like to capture all the externalized reactions in this category.
10800:09:15,440 --> 00:09:18,050That I am going to argue with you.
10900:09:18,050 --> 00:09:19,950I am going to explode.
11000:09:19,960 --> 00:09:23,230And you can picture this volcano,
11100:09:23,240 --> 00:09:23,820right?
11200:09:23,830 --> 00:09:29,480that is just to the point of being uncontained and out comes
11300:09:29,480 --> 00:09:41,650this spewing of tears or yelling or throwing things... so that is the externalized sign of a dysregulated state.
11400:09:41,920 --> 00:09:43,890In the area of emotions,
11500:09:46,040 --> 00:09:52,660flight is another reaction that someone could have when they are dysregulated.
11600:09:53,340 --> 00:09:58,650This could look like ... I'm going to walk away from you and quit this conversation.
11700:09:59,040 --> 00:10:04,460I'm going to spend all day in my room doing things I enjoy but not interacting with you.
11800:10:05,140 --> 00:10:08,760I'm going to quit school and do home schooling.
11900:10:08,760 --> 00:10:10,450I'm going to quit this job.
12000:10:10,940 --> 00:10:15,560I'm going to quit this relationship because it's so up and down.
12100:10:15,560 --> 00:10:17,000It's like a roller coaster.
12200:10:17,000 --> 00:10:18,650It's just too intense for me.
12300:10:18,650 --> 00:10:20,000It's too unpredictable.
12400:10:20,040 --> 00:10:21,620I have to quit this,
12500:10:21,630 --> 00:10:23,060I have to escape,
12600:10:23,440 --> 00:10:28,630I have to withdraw. Then there are freeze reactions.
12700:10:28,630 --> 00:10:32,150So this is the time when you're physically present,
12800:10:32,160 --> 00:10:34,980but you're not psychologically present,
12900:10:34,990 --> 00:10:36,710that your brain shuts down,
13000:10:36,720 --> 00:10:46,300Someone might say the veil just seemed to go over his eyes and I just knew he was there but not processing what was happening during that time,
13100:10:46,300 --> 00:10:47,720someone may say,
13200:10:47,730 --> 00:10:48,200you know,
13300:10:48,200 --> 00:10:49,320I hear what you're saying,
13400:10:49,320 --> 00:10:52,460but my mind is blank and I don't know what to respond.
13500:10:52,470 --> 00:10:54,140That's a freeze reaction.
13600:10:54,150 --> 00:10:59,010So it signals that the person is dysregulated.
13700:10:59,010 --> 00:11:04,260They're having difficulty being fully present in the midst of the strong emotion.
13800:11:05,940 --> 00:11:28,150Another part of the freeze reaction can be what we call a somatization response to stress and that just means that the stress is not able to come into the person's emotional awareness and kind of sit there and be recognized and felt.
13900:11:28,740 --> 00:11:30,300And so the body says,
14000:11:30,300 --> 00:11:30,910hey,
14100:11:30,910 --> 00:11:35,150I will help you escape from this really difficult emotion.
14200:11:35,160 --> 00:11:45,140I will process the stress for you so that you don't have to feel this deep fear or this deep pain or anguish or anger.
14300:11:45,150 --> 00:11:52,690I'll just process that stress right through the physical system in these cases,
14400:11:52,700 --> 00:11:56,390the symptom which could be a staring spell.
14500:11:56,400 --> 00:11:59,740It could be something that looks like an electrical seizure,
14600:11:59,740 --> 00:12:01,350but it's really not.
14700:12:02,040 --> 00:12:08,600It could be something like a loss of memory for chunks of time or days or weeks,
14800:12:09,040 --> 00:12:17,000it could be a weakness where the person feels like their limbs are weak or paralyzed.
14900:12:17,010 --> 00:12:19,860So it could be a variety of things like that.
15000:12:20,240 --> 00:12:24,340Physical systems also could include issues of pain,
15100:12:24,350 --> 00:12:27,600issues of stomach distress,
15200:12:27,600 --> 00:12:28,470headaches,
15300:12:28,480 --> 00:12:30,550so lots of different things.
15400:12:30,550 --> 00:12:35,960Lots of different physical systems can process stress for us.
15500:12:36,340 --> 00:12:39,570And these symptoms,
15600:12:39,570 --> 00:12:42,760these physical expressions are real.
15700:12:43,140 --> 00:12:46,580They are not produced by the individual,
15800:12:46,580 --> 00:12:47,850They're not feigned,
15900:12:47,860 --> 00:12:50,290they're not exaggerated,
16000:12:50,290 --> 00:12:51,760they're not used to manipulate,
16100:12:51,760 --> 00:12:56,250they are really experienced and they are distressing in themselves.
16200:12:56,840 --> 00:13:04,260But they do help the individual ... kind of shield the individual from having to process in their awareness
16300:13:04,260 --> 00:13:05,660such strong emotion.
16400:13:07,340 --> 00:13:11,560And it can also include what we call dissociation.
16500:13:11,940 --> 00:13:17,410So I feel like I'm not even in my own body right now,
16600:13:17,420 --> 00:13:22,620I don't feel like I even know who I am or what's reality and what's not reality.
16700:13:22,630 --> 00:13:25,550I don't remember parts of the day,
16800:13:25,550 --> 00:13:28,090I feel disconnected from myself.
16900:13:28,100 --> 00:13:34,790So this dissociation can also be this form of a freeze state,
17000:13:34,800 --> 00:13:36,550a dysregulated state.
17100:13:38,040 --> 00:13:39,200So in summary,
17200:13:39,200 --> 00:13:48,820I'm talking about regulation as being that centered state that the brain should help us maintain,
17300:13:48,840 --> 00:13:58,410its that state where you're just right with alertness, with attention, and with emotional centeredness,
17400:13:59,040 --> 00:14:03,080you're not too low and sluggish and out of it,
17500:14:03,540 --> 00:14:05,090you're not too high,
17600:14:05,090 --> 00:14:06,620being overwhelmed,
17700:14:06,620 --> 00:14:08,460restless or agitated,
17800:14:09,840 --> 00:14:13,420You're not in a fight, flight, or freeze mode,
17900:14:13,840 --> 00:14:17,010you're psychologically present,
18000:14:17,020 --> 00:14:23,520You're physically present and you can maintain some sense of centeredness,
18100:14:23,520 --> 00:14:25,060you're not overwhelmed.
18200:14:26,640 --> 00:14:27,040Now,
18300:14:27,050 --> 00:14:33,850every human who lives life has periods with where they are dysregulated.
18400:14:33,860 --> 00:14:35,750It's a very human thing,
18500:14:35,760 --> 00:14:36,320right?
18600:14:36,330 --> 00:14:52,450We're living in a life day to day that is sometimes very difficult to navigate and we'll have periods of times where we lose it or where we go in our room and shut the door or we just freeze.
18700:14:52,840 --> 00:14:58,170And that's just a very human thing. For individuals on the spectrum,
18800:14:58,180 --> 00:15:06,440that nervous system pathway through the center and the front of the brain is particularly involved for them
18900:15:06,440 --> 00:15:10,760and it also is particularly in charge of regulation.
19000:15:11,240 --> 00:15:26,240So everyone on the spectrum will have difficulty in some way with getting to a regulated state and they'll probably have seasons of life where that is much more achievable,
19100:15:26,250 --> 00:15:29,940but seasons where... if anything gives them trouble,
19200:15:29,950 --> 00:15:32,550it very well may be the issue of regulation.
19300:15:34,840 --> 00:15:40,860That is why we talk about regulation on this program for Autism in the Adult.
19400:15:41,240 --> 00:15:49,970Because oftentimes when people are seeking assistance or they are in pain or there's something that they're struggling with...
19500:15:49,980 --> 00:15:50,570Uh,
19600:15:50,580 --> 00:15:55,960it very well may be in the area of getting to a regulated state.
19700:15:58,230 --> 00:15:58,570Now,
19800:15:58,570 --> 00:16:06,930one thing to understand is that the type of dysregulation that the individual shows can be somewhat specific to them.
19900:16:06,930 --> 00:16:09,470We kind of have our,
20000:16:09,480 --> 00:16:12,950our general ways of handling things.
20100:16:12,960 --> 00:16:13,480Um,
20200:16:13,480 --> 00:16:20,970and so one thing I recommend is knowing what you as an individual, or this person that you love,
20300:16:20,980 --> 00:16:30,950what they lean toward when they're dysregulated, because one thing we want to do is recognize what dysregulation looks like in this person.
20400:16:32,840 --> 00:16:34,960So for example,
20500:16:35,640 --> 00:16:47,590the person who is exploding and ranting because their usual parking space at work is being used by someone else,
20600:16:47,600 --> 00:16:56,300and the person at the entryway to work gave them a hard time because they don't have their badge on, and on the way to work
20700:16:56,300 --> 00:16:59,660they couldn't get the gas that they typically like to get...
20800:17:00,040 --> 00:17:02,690So they're feeling very uncentered,
20900:17:02,690 --> 00:17:08,260They're feeling off, and for this particular person when they're uncentered,
21000:17:08,260 --> 00:17:11,270they tend to get elevated.
21100:17:12,140 --> 00:17:16,490Um and tend to externalize that stress.
21200:17:17,940 --> 00:17:19,860So for this person,
21300:17:20,240 --> 00:17:22,830this outburst that they may have,
21400:17:22,830 --> 00:17:26,560maybe they come in and they have an outburst toward their colleague or something.
21500:17:26,940 --> 00:17:32,220Well that is often nothing to do with the colleague in particular.
21600:17:32,220 --> 00:17:33,680It just may be that,
21700:17:33,690 --> 00:17:34,060wow,
21800:17:34,060 --> 00:17:36,050this is a sign,
21900:17:36,060 --> 00:17:37,810this is a clue.
22000:17:37,820 --> 00:17:40,860This person is really off center.
22100:17:40,870 --> 00:17:45,100They're struggling to feel in that just right state.
22200:17:45,110 --> 00:17:46,480And for this person,
22300:17:46,480 --> 00:17:48,190when they struggle to feel that way,
22400:17:48,190 --> 00:17:51,960it happens to be that it comes out as irritability.
22500:17:53,740 --> 00:17:58,560Another person may lean toward quieter reactions.
22600:17:59,140 --> 00:18:00,930So this person,
22700:18:00,940 --> 00:18:06,120let's say we have another individual who experiences the very same thing,
22800:18:06,130 --> 00:18:17,590but this person comes in quietly, walks to their office and shuts the door, and doesn't open their office door as typical.
22900:18:17,600 --> 00:18:24,080Uh maybe they're in there for three hours without opening it, when typically they would go get some coffee,
23000:18:24,080 --> 00:18:26,460maybe say good morning to their coworkers.
23100:18:26,840 --> 00:18:27,760So wow,
23200:18:27,760 --> 00:18:30,350they've really retreated and become quiet.
23300:18:31,840 --> 00:18:45,350Now the difference between the fight reaction and the flight reaction is that one is very noticeable and everyone around that first person is like,
23400:18:45,350 --> 00:18:45,780wow,
23500:18:45,780 --> 00:18:50,600stay away from Joe today because he got up on the wrong side of the bed.
23600:18:50,600 --> 00:18:51,390He's really,
23700:18:51,400 --> 00:18:52,860he's really irritable.
23800:18:53,540 --> 00:19:03,940Um Now they may misunderstand the reason for that and they may not like the fact that he is loud and irritable.
23900:19:03,950 --> 00:19:05,080So they may not say,
24000:19:05,090 --> 00:19:07,490oh he's really in a dysregulated state,
24100:19:07,490 --> 00:19:08,450that poor guy.
24200:19:08,940 --> 00:19:11,940Um but they do notice it.
24300:19:11,950 --> 00:19:16,310They notice he's off center. On the other hand,
24400:19:16,310 --> 00:19:21,500for the person who reacts with flight to being dysregulated,
24500:19:21,510 --> 00:19:23,580they are often missed,
24600:19:23,590 --> 00:19:24,250right?
24700:19:24,250 --> 00:19:32,550So they may spend all morning in their office and either nobody will notice or they might misinterpret it and say,
24800:19:33,420 --> 00:19:33,910you know,
24900:19:33,910 --> 00:19:35,350she's kind of stuck up.
25000:19:35,360 --> 00:19:37,130She's just in her own little world.
25100:19:37,130 --> 00:19:47,160She doesn't socialize ... when really both the first person and the second person are in a state of dysregulation,
25200:19:47,160 --> 00:19:49,160which means that they are struggling.
25300:19:50,240 --> 00:19:51,460They're not doing well,
25400:19:52,840 --> 00:19:58,660But the quieter one may not be noticed and the louder one may be misunderstood.
25500:20:02,140 --> 00:20:14,430Now we also have freeze, of course, and let's say that there's a third individual and they have the exact same thing happen and yet they're walking into work...
25600:20:14,450 --> 00:20:19,560and someone asked them a question about a recent project.
25700:20:19,940 --> 00:20:21,890They can't think of the details.
25800:20:21,890 --> 00:20:25,960They're really feeling shut down and kind of out of their own system.
25900:20:26,340 --> 00:20:36,770And they're also realizing that they ... their stomach doesn't feel that well and they are starting to get some chronic pain in their muscles that they're feeling.
26000:20:37,140 --> 00:20:41,060Uh they just really don't physically feel well.
26100:20:41,940 --> 00:20:49,760Um Now this may be their state of dysregulation... that I'm feeling disconnected.
26200:20:50,140 --> 00:20:56,160It's hard to think through things and they may even say it's probably because of my headache.
26300:20:56,170 --> 00:21:01,860I can't think clearly because of my headache or my stomach ache and then they may go home for the day.
26400:21:03,140 --> 00:21:03,760Again,
26500:21:03,760 --> 00:21:07,990this is actually... in this scenario I'm describing...
26600:21:07,990 --> 00:21:10,890this is the same thing.
26700:21:10,890 --> 00:21:12,500It's dysregulation.
26800:21:12,760 --> 00:21:24,860It looks different, but it's the state of having things happen in your day that threw you off center and you're really struggling to know how to get back to center.
26900:21:25,740 --> 00:21:31,050And so all three of these people may look very different,
27000:21:31,320 --> 00:21:33,860but they're all struggling with dysregulation.
27100:21:34,210 --> 00:21:43,050Now one of the interesting things can be... if these people were sent to get help for their dysregulation.
27200:21:43,740 --> 00:21:57,450The first one might be sent to anger management training and perhaps he'd be diagnosed with something like bipolar because he has these swings of mood and regulation...
27300:21:58,140 --> 00:22:13,490Perhaps the second person goes for help and they coach her on social skills with colleagues and they tell her that as part of her job
27400:22:13,490 --> 00:22:15,770she really needs to speak up more,
27500:22:15,840 --> 00:22:16,750be a leader,
27600:22:16,750 --> 00:22:20,340be more engaged in the social milieu of the office.
27700:22:20,540 --> 00:22:24,760And so she's being coached on getting out there and maybe she,
27800:22:24,770 --> 00:22:26,370she gets a diagnosis,
27900:22:26,370 --> 00:22:27,860if she goes to a clinician,
28000:22:27,870 --> 00:22:30,280maybe she gets a diagnosis of anxiety,
28100:22:30,280 --> 00:22:32,860generalized anxiety or social anxiety.28200:22:34,340 --> 00:22:45,200The third person goes to get help because they often leave work feeling cloudy in there thinking they have some staring spells,
28300:22:45,200 --> 00:22:46,320they feel disconnected,
28400:22:46,320 --> 00:22:47,770they feel physically ill.
28500:22:48,440 --> 00:22:52,860So they go to the doctor and they get diagnosed with chronic headaches,
28600:22:52,860 --> 00:22:54,470maybe fibromyalgia,
28700:22:54,480 --> 00:23:10,470maybe um some um digestive sensitivities... and I'm definitely not here to say that nobody has those diagnoses and physical issues and this person may as well...
28800:23:10,480 --> 00:23:15,270What I'm saying though is that for this hypothetical individual,
28900:23:15,280 --> 00:23:16,950it's just not that simple.
29000:23:16,960 --> 00:23:32,940We don't want to miss the internal struggle of it because... if we understood that those physical symptoms in that state of fogginess were at least worsened by some of this dysregulated state,
29100:23:32,950 --> 00:23:33,240you know,
29200:23:33,240 --> 00:23:34,170that trigger,
29300:23:34,540 --> 00:23:45,460we could help much more efficiently without adding medications that may make things worse or extra doctor's appointments or extra stress.
29400:23:45,940 --> 00:23:46,780Um,
29500:23:46,790 --> 00:23:47,600we could say,
29600:23:47,600 --> 00:23:47,900hey,
29700:23:47,900 --> 00:23:48,590you know what,
29800:23:48,590 --> 00:23:51,370when you are are off center,
29900:23:51,370 --> 00:23:53,970when you are stressed and things have gone wrong.
30000:23:53,980 --> 00:23:58,510I feel like your system responds in this way,
30100:23:58,520 --> 00:24:05,590you know that your stress is expressed through your system and that you feel disconnected.
30200:24:05,590 --> 00:24:13,860I'm wondering if we could hypothesize about that and see if there's a more efficient way to get you to feel more centered.
30300:24:14,840 --> 00:24:18,100And I bring this up for a couple of reasons.
30400:24:18,220 --> 00:24:22,160One is ... dysregulation is common on the spectrum.
30500:24:23,640 --> 00:24:24,860Two is,
30600:24:25,440 --> 00:24:31,870it can be misunderstood and depending on the type of dysregulation,
30700:24:31,880 --> 00:24:39,660it can add diagnoses to a person's list that aren't the most helpful diagnosis.
30800:24:40,540 --> 00:24:41,090Um,
30900:24:41,100 --> 00:24:43,360often autism isn't on there.
31000:24:43,940 --> 00:24:44,510Um,
31100:24:44,520 --> 00:24:52,080but there may be this gathering of diagnoses that fit the symptoms in the moment.
31200:24:52,080 --> 00:24:54,040Like they fit some characteristic in the moment,
31300:24:54,040 --> 00:24:58,060but they missed the big picture of why this person is dysregulated.
31400:24:58,840 --> 00:24:59,200You know,
31500:24:59,200 --> 00:25:03,070they're dysregulated because the rhythm of their day,
31600:25:03,070 --> 00:25:18,260the structure of their day that they depend on as an autistic individual... that that was disrupted and that triggered this dysregulated state and in them it happens to look like fight or flight or freeze.
31700:25:19,240 --> 00:25:25,660And so the topic of this podcast then is to introduce you to this concept of regulation.
31800:25:27,840 --> 00:25:33,620And when you see yourself or someone you love in a dysregulated state.
31900:25:33,630 --> 00:25:38,030And instead of telling them to get it together,
32000:25:38,040 --> 00:25:39,290calm down,
32100:25:39,290 --> 00:25:40,380get out there,
32200:25:40,380 --> 00:25:41,360get over it.
32300:25:41,740 --> 00:25:42,370Um,
32400:25:42,700 --> 00:25:45,060you can say to yourself,
32500:25:45,440 --> 00:25:46,110wow,
32600:25:46,110 --> 00:25:48,230this is dysregulation.
32700:25:48,630 --> 00:25:49,890I know what this is.
32800:25:51,040 --> 00:25:52,580For example,
32900:25:53,140 --> 00:26:02,730if my son, who's on the autism spectrum, comes home from school and drops his book bag on the floor and walks past me without saying hello,
33000:26:02,810 --> 00:26:07,060lays on the couch and puts a cover over his whole body... over his head.
33100:26:08,040 --> 00:26:09,220I could say,
33200:26:09,230 --> 00:26:10,050Hey,
33300:26:10,540 --> 00:26:12,010you didn't say hi to me.
33400:26:12,020 --> 00:26:13,630You threw your stuff on the ground,
33500:26:13,630 --> 00:26:14,140which you know,
33600:26:14,140 --> 00:26:15,300it doesn't go there!
33700:26:15,420 --> 00:26:16,740Come out here and make this
33800:26:16,740 --> 00:26:17,070right.
33900:26:17,080 --> 00:26:18,610This isn't a hotel for you.
34000:26:18,610 --> 00:26:20,350I'm not your maid.
34100:26:21,340 --> 00:26:24,230But, if I really wanted to get the best outcome,
34200:26:24,240 --> 00:26:25,320I would say,
34300:26:25,330 --> 00:26:26,110oh,
34400:26:26,120 --> 00:26:27,300I know what this is.
34500:26:27,300 --> 00:26:29,740This is a clue to me.
34600:26:29,750 --> 00:26:30,650This is data.
34700:26:30,650 --> 00:26:31,860This is information.
34800:26:32,240 --> 00:26:50,200This is telling me he is dysregulated ... so it's not going to help things for me to punish him for being dysregulated, and it's not going to help me to tell him to get better regulated because he already doesn't know how to do that.
34900:26:50,200 --> 00:26:51,460He's already overwhelmed.
35000:26:52,240 --> 00:26:55,020What would really help is if I said,
35100:26:55,640 --> 00:26:56,080wow,
35200:26:56,080 --> 00:26:58,500this is a flight reaction,
35300:26:58,500 --> 00:26:58,750right?
35400:26:58,750 --> 00:26:59,690He's hiding.
35500:26:59,700 --> 00:27:00,950He's withdrawing.
35600:27:01,340 --> 00:27:02,760He must have had a bad day.
35700:27:02,760 --> 00:27:04,590So then I can go in and say,
35800:27:04,590 --> 00:27:05,060hey,
35900:27:05,540 --> 00:27:07,270it looks like you had a rough day.
36000:27:08,040 --> 00:27:16,290I'm going to give you five minutes, and I'll be back and we can figure out what you need to get more centered.
36100:27:17,540 --> 00:27:18,800So number one,
36200:27:18,810 --> 00:27:20,330I'm recognizing it,
36300:27:20,340 --> 00:27:21,460which is important.
36400:27:22,240 --> 00:27:22,590You know,
36500:27:22,590 --> 00:27:23,850this isn't bad behavior.
36600:27:23,850 --> 00:27:25,270This is dysregulation.
36700:27:25,840 --> 00:27:33,170This is someone who is overwhelmed and uncentered and it's expressed as flight in this particular person.
36800:27:34,640 --> 00:27:43,610I'm also explaining to him what I see because ... you know when we're overwhelmed, we often don't know what we're feeling,
36900:27:43,620 --> 00:27:45,510we're just surviving,
37000:27:45,510 --> 00:27:46,060right?
37100:27:46,540 --> 00:27:48,360So I'm saying to him,
37200:27:48,940 --> 00:27:49,550wow,
37300:27:49,560 --> 00:27:56,460it looks like you've had a hard day and you probably need something to get centered.
37400:27:57,740 --> 00:28:05,150And then we're also introducing this topic that there are strategies that you could use to help yourself get centered.
37500:28:05,150 --> 00:28:11,570Let's figure out what those are and let me partner with you to get centered to get regulated.
37600:28:12,040 --> 00:28:19,450So in the future in this series we're going to talk about not only how to recognize it ... which we did today.
37700:28:20,340 --> 00:28:29,400We're going to talk about how to prevent episodes of dysregulation or you know lessen them as humans.
37800:28:29,400 --> 00:28:34,550We're going to have them but... not to have them so frequent that someone's not functioning well.
37900:28:35,240 --> 00:28:46,160How to recover from a dysregulated state, and how to recognize when someone around you is trying to regulate.
38000:28:46,740 --> 00:28:48,400Um for example,
38100:28:48,400 --> 00:28:50,270my son under the cover,
38200:28:51,140 --> 00:28:54,300his being under the cover is him trying to regulate.
38300:28:55,040 --> 00:28:57,210So I don't want to punish him for that.
38400:28:57,220 --> 00:28:59,250I don't want to chastise him for that.
38500:28:59,260 --> 00:29:20,330I want to recognize what that is and then help him have different strategies ...more effective strategies to regulate and to let him know that I come alongside him to do that with him because I also really commit that his well being is important and I'm on his side.
38600:29:20,490 --> 00:29:21,060You know,
38700:29:21,070 --> 00:29:24,360I want him to feel just right.
38800:29:26,540 --> 00:29:39,670I'm glad you joined me for this first episode of 2022 as we dive into this concept of regulation and dysregulation and the role that the nervous system has in helping us be centered.
38900:29:40,140 --> 00:29:43,900And I hope you'll check out the links below.
39000:29:43,900 --> 00:29:46,180I have the alert program link,
39100:29:46,190 --> 00:29:52,250I have the link to the Best Episode of the Testing Psychologist podcast in 2021.
39200:29:52,260 --> 00:30:04,460I'm happy, happy to be the number two episode... and I have a link to my upcoming webinar for clinicians about interventions for the autistic client,
39300:30:04,840 --> 00:30:05,390um,
39400:30:05,400 --> 00:30:07,100across the lifespan.
39500:30:07,120 --> 00:30:12,460So I will see you for next episode on how to prevent dysregulation.
 

Planning a Merry Holiday on the Autism Spectrum

Take a moment to listen again to this holiday episode originally published in 2020. Celebrations may be draining or overwhelming to the individual on the spectrum. A little advanced awareness and planning can make a big difference! Enjoy ~
 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
 

Autism and Eating Disorders

Autism is found at higher than expected rates in those with eating disorders or problematic eating patterns. Join Dr. Regan to hear about this link and why it is important to understand.
article: Autism Spectrum Disorders in Eating Disorder Populations. A Systematic Review
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians
 
article: Autism Spectrum Disorders in Eating Disorder Populations. A Systematic Review

Guilt and Worry in Relationships: Four Strategies Toward Freedom

In this episode, hear why repetitive fears about social interactions may chase the autistic individual and learn four strategies for escaping those worries. 
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website
Resources for Clinicians

Keeping Momentum for Activities on the Autism Spectrum

Individuals on the spectrum may have more difficulty than others finding and staying in a "just right" state for activities and tasks. Join Dr. Regan to hear recommendations for keeping momentum without crashing into an exhausted state. 
Related Resources
Dr. Regan's videos on using sensory input for regulation
Dr. Regan's Resources
The Understanding Autism book series (paperback, hardback, ebook)
Audiobook
Autism in the Adult website
Resources for Clinicians

Gaining Momentum for Activities: Shifting from Sluggish to Active

Individuals on the spectrum may have more difficulty than others shifting from a stopped state (exhausted, "lazy," sluggish) to a "just right" active state for daily activities. Join Dr. Regan to hear three recommendations for getting past the stuck state. 
Related Resources
Dr. Regan's videos on using sensory input for regulation
The Vestibular System
The Effects of Spinning
Vestibular Activities
Dr. Regan's Resources
The Understanding Autism book series (paperback, hardback, ebook)
Audiobook
Autism in the Adult website
Resources for Clinicians

Exhaustion in Autism: Balancing Momentum for Daily Activities

Resiliency for daily life can be a difficult state to achieve on the autism spectrum. Individuals may struggle to gain momentum for tasks while still finding the recovery time they need to avoid coming to a complete stop. Join Dr. Regan to understand why this occurs, and look for the next episode to cover strategies for balance. 
Dr. Regan's resources
The Understanding Autism book series (paperback, hardback, ebook)
Audiobook
Autism in the Adult website
Resources for Clinicians