Episódios
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Join Dr. Regan for this first episode of a new self-care series. Rather than becoming the victim of an intense world, constantly in survival mode, learn strategies to become powerful at self-care. The first step is self-awareness which can begin by noticing your fight, flight, freeze, and physical reactions to events and experiences.
Explore Dr. Regan's new Learning and Equipping page and the specific course page for "Empowered Parenting."
Dr. Regan's Resources:
Zur Institute courses for clinicians
Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
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Join Dr. Regan for the third and final episode of the Communication Series. This episode highlights ways to communicate while talking about challenging topics.
Explore Dr. Regan's new Learning and Equipping page and the specific course page for "Empowered Parenting."
Dr. Regan's Resources:
Zur Institute courses for clinicians
Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
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Join Dr. Regan for the second episode in the Communication Series. This episode highlights ways to use communication to protect and grow relationships.
Dr. Regan's Resources:
Zur Institute courses for clinicians
Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
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Join Dr. Regan for the first episode of the new Communication Series. This first episode highlights moments of connection, such as talking in the car, going out on date night, and catching up with a friend. Tune in to hear what to avoid and what to focus on to enhance connection.
Dr. Regan's Resources:
Zur Institute courses for clinicians
Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
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In this third episode of the executive function series, Dr. Regan discusses sticking, releasing, and switching gears in everyday life.
Related resources:
Podcast Episode: Autism and "Just Right"
Podcast Episode: Gaining Momentum for Activities
Amazon: Time Timer (I don't receive any income from your purchase)
Dr. Regan's Resources:
Zur Institute courses for clinicians
Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
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The Holidays and Autism: Holding Fast and Letting Go
Planning a Merry Holiday on the Autism Spectrum
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In this second episode of the executive function series, Dr. Regan breaks down how speed, working memory, and sequencing impact daily life.
I Love Lucy chocolate factory TV clip
Executive Function Book Series by Dawson and Guare:
Smart But Scattered (children's version)
Smart But Scattered (Teen version)
Smart But Scattered (adult version)
Dr. Regan's Master Class for Clinicians (Sept, Oct, Nov, Dec 2023)
Zur Institute: Master Class
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
100:00:05,570 --> 00:00:06,059Hello,
200:00:06,070 --> 00:00:06,820everyone.
300:00:06,829 --> 00:00:08,659This is Doctor Regan.
400:00:08,670 --> 00:00:13,670I'm joining you for an episode of Autism in the adult podcast.
500:00:14,020 --> 00:00:14,880For those of you.
600:00:14,890 --> 00:00:16,260New to the podcast.
700:00:16,270 --> 00:00:18,020I'm a neuropsychologist,
800:00:18,030 --> 00:00:20,190a certified autism specialist,
900:00:20,420 --> 00:00:25,180and the founder and director of an autism diagnostic clinic for adolescents,
1000:00:25,190 --> 00:00:28,940adults and aging adults in Central Illinois.
1100:00:29,549 --> 00:00:35,240And today you are listening to the second episode in a series on executive function.
1200:00:35,750 --> 00:00:47,139And this is a topic we're covering because many of the strengths and challenges that go along with the autistic neurology fall within the realm of executive function.
1300:00:48,849 --> 00:00:51,619Before we dive into that topic for today,
1400:00:51,759 --> 00:00:58,540I'd like to thank Amanda who pointed out that my diagnostic terms in the first episode were imprecise.
1500:00:58,830 --> 00:01:03,279I use terms that are common in my day to day interactions with patients,
1600:01:03,290 --> 00:01:04,819families and physicians,
1700:01:05,080 --> 00:01:07,900which are the terms ADD and ADHD.
1800:01:08,089 --> 00:01:09,099However,
1900:01:09,110 --> 00:01:16,800the most precise and current terminology is ADHD predominantly inattentive presentation.
2000:01:17,379 --> 00:01:21,389ADHD predominantly hyperactive -
2100:01:21,470 --> 00:01:26,199impulsive presentation, or ADHD combined presentation.
2200:01:27,379 --> 00:01:29,589And I guess in reviewing that in my mind,
2300:01:29,599 --> 00:01:32,720I think it's similar with the term dementia,
2400:01:32,730 --> 00:01:37,550which is often still used in day to day language in clinical settings,
2500:01:37,559 --> 00:01:42,690even though the most recent and precise term is major neurocognitive disorder.
2600:01:43,360 --> 00:01:43,650So,
2700:01:43,660 --> 00:01:44,410thanks Amanda,
2800:01:44,419 --> 00:01:51,279I'll stick to being precise and specific in podcasts about the topic of ADHD
2900:01:51,839 --> 00:01:55,230And instead of using each of the subtypes,
3000:01:55,239 --> 00:02:07,379I will just use the term ADHD unless I'm speaking about specific features of one subtype. As we discussed in the first episode,
3100:02:07,389 --> 00:02:16,580executive function is really a broad term and it's includes multiple subfunctions or subcategories.
3200:02:17,179 --> 00:02:33,800And this is a series that I really encourage you to listen to the first episode before listening to subsequent episodes because it really went through a lot of layers of explaining executive function, ADHD, and autism ...
3300:02:34,350 --> 00:02:37,160how those relate or don't relate to each other.
3400:02:38,539 --> 00:02:43,720So the subcategories of executive function include things like attention,
3500:02:43,990 --> 00:02:45,919goal directed persistence,
3600:02:45,929 --> 00:02:47,949organization, response
3700:02:47,960 --> 00:02:50,020inhibition and several more.
3800:02:50,440 --> 00:02:50,990In fact,
3900:02:51,000 --> 00:02:53,229depending on what source you're using,
4000:02:53,240 --> 00:02:57,669there can be about 12 or so sub functions identified,
4100:02:57,679 --> 00:03:06,410even though there's really no complete agreement on how to list out the sub functions within executive function.
4200:03:08,110 --> 00:03:17,000There are two main developmental diagnoses with large executive function components and these include ADHD and autism,
4300:03:18,710 --> 00:03:23,160the ADHD criteria, as we talked about in the previous episode,
4400:03:23,339 --> 00:03:28,899only describe symptoms falling within about four of the subcategories.
4500:03:29,720 --> 00:03:35,460I would label these subcategories in the ADHD as organization,
4600:03:35,500 --> 00:03:41,690attention, response inhibition, and goal directed persistence. For example,
4700:03:41,699 --> 00:03:50,500"fails to give close attention to details or makes careless mistakes" is one of the criteria that can be met in ADHD.
4800:03:50,919 --> 00:04:08,720And I would say that, as a symptom, that falls within the subcategory of attention. "Blurts out answers before questions have been completed" is an ADHD symptom that falls within the executive function
4900:04:08,729 --> 00:04:13,100subcategory of response inhibition.
5000:04:13,809 --> 00:04:20,420So is somebody able to inhibit or stop a response until they think it through?
5100:04:21,890 --> 00:04:31,679So autism will present with core executive function features in some combination as well across the totality of the 12 categories.
5200:04:31,959 --> 00:04:40,040And these features are some of the strengths and gifts within the autism presentation.
5300:04:40,049 --> 00:04:45,309and also some of the challenges. In this episode,
5400:04:45,320 --> 00:04:48,559we're going to focus on the executive function
5500:04:48,570 --> 00:04:53,600sub features of working memory, speed, and sequencing.
5600:04:54,100 --> 00:05:01,769And I've chosen these abilities to highlight together because we often use them together to accomplish daily tasks.
5700:05:02,059 --> 00:05:06,010And I'm hoping that in explaining them and presenting them together,
5800:05:06,049 --> 00:05:14,709you'll be able to watch yourself or watch other people in your life to see how these executive function abilities work for them.
5900:05:16,929 --> 00:05:18,720Similar to the last episode,
6000:05:18,730 --> 00:05:22,329I'm going to walk you through various levels of information.
6100:05:22,339 --> 00:05:24,940So stick with me.
6200:05:24,950 --> 00:05:34,839First, I want to make a comparison between the center of the brain, which is called the subcortical areas, and a conveyor belt.
6300:05:35,600 --> 00:05:36,329You'll,
6400:05:36,339 --> 00:05:41,320you've probably heard that the brain has both gray matter and white matter.
6500:05:42,929 --> 00:05:44,720The outside of the brain and
6600:05:45,089 --> 00:05:54,059certain areas in the center are gray and these gray matter sections are connected by white matter tracts.
6700:05:55,109 --> 00:06:04,440The color white comes from the fact that there's a fatty substance called myelin covering these neuron tracks.
6800:06:04,450 --> 00:06:13,290And the presence of the fatty covering allows the nerve signals to travel faster than without that covering.
6900:06:13,399 --> 00:06:19,579So the center of the brain impacts speed of thinking and processing.
7000:06:20,540 --> 00:06:23,829So in conditions like multiple sclerosis,
7100:06:23,839 --> 00:06:24,989for example,
7200:06:25,000 --> 00:06:27,869where you have demyelinating,
7300:06:28,410 --> 00:06:31,989that is the white matter starts to degrade,
7400:06:32,000 --> 00:06:37,029one of the features can be a slowing of processing.
7500:06:39,200 --> 00:06:51,100So the first point is that speed is a function of the subcortical pathways that impact executive function and several autistic characteristics.
7600:06:51,109 --> 00:06:55,640So we do want to focus on this subcategory of speed.
7700:06:57,649 --> 00:07:01,179Another subcategory is working memory.
7800:07:02,950 --> 00:07:05,600What is this part of executive function?
7900:07:05,869 --> 00:07:06,160Well,
8000:07:06,170 --> 00:07:08,880even though we call it working memory,
8100:07:09,239 --> 00:07:16,350a neuropsychologist or a cognitive scientist might say it's actually really more attention than memory
8200:07:16,829 --> 00:07:30,880in that it has to do with the amount of information a person can hold within their attention without storing it by really memorizing it for later.
8300:07:31,700 --> 00:07:35,589So it usually doesn't end up in permanent memory.
8400:07:35,929 --> 00:07:40,670But we're able to hold information our in our attention.
8500:07:41,549 --> 00:07:54,390And some people have a really strong working memory and others really struggle with this. And you'll see different estimates probably about how large working memory generally is.
8600:07:54,779 --> 00:08:02,779But most times a person can hold about five plus or minus two bits of information in their attention.
8700:08:03,679 --> 00:08:07,209This makes sense because if you were
8900:08:07,769 --> 00:08:12,690using phones in the old days where we didn't have cell phones and
9000:08:12,700 --> 00:08:14,670phone numbers in our phone ...
9100:08:14,970 --> 00:08:20,799a lot of times someone would tell us their phone number or we'd look at it in a phone book and we'd have to
9300:08:21,149 --> 00:08:26,350kind of rehearse it in our working memory while we dialed.
9400:08:26,359 --> 00:08:31,489So we held seven digits ... in those days...
9500:08:32,190 --> 00:08:38,090in our mind while we pushed in the information to the phone.
9600:08:40,789 --> 00:08:43,140So let me give another illustration.
9700:08:43,299 --> 00:08:45,469Working memory is what we use,
9800:08:45,479 --> 00:08:46,309for example,
9900:08:46,320 --> 00:08:48,609if we hear an instruction with ...
10000:08:48,619 --> 00:08:52,099let's say three parts to it and we go to carry it out.
10100:08:52,559 --> 00:08:57,010Our boss may ask us to print the schedule for the day,
10200:08:57,250 --> 00:09:01,809put a copy on her desk, and check the phone messages from overnight.
10300:09:02,929 --> 00:09:07,559So we have to keep these tasks in mind while doing them.
10400:09:07,570 --> 00:09:11,359We have to hold them in our mind.
10500:09:11,500 --> 00:09:15,849And although we may recall the sequence of requests later in the day,
10600:09:15,859 --> 00:09:22,320we're unlikely to remember them in a month or a year because we haven't memorized them.
10700:09:23,299 --> 00:09:25,190But while we're carrying them out.
10800:09:25,200 --> 00:09:31,179We may be able to keep them in mind because they're in our working memory.
10900:09:31,450 --> 00:09:37,469So the term working means that we keep things in mind while we're using them.
11000:09:37,479 --> 00:09:44,950I'm using this information of what the three tasks are while I'm accomplishing the tasks.
11100:09:46,280 --> 00:09:50,619Working memory is what we use when we walk into a room for something.
11200:09:50,900 --> 00:09:55,950And then sometimes if the information has left our working memory,
11300:09:55,960 --> 00:09:58,270we feel frustrated that oh,
11400:09:58,280 --> 00:10:01,869I walked into a room to get something and now it's gone.
11500:10:02,109 --> 00:10:05,489That's something that has slipped through our working memory.
11600:10:07,250 --> 00:10:08,229Similarly,
11700:10:08,239 --> 00:10:09,299we may say,
11800:10:09,309 --> 00:10:09,340oh,
11900:10:09,349 --> 00:10:10,219shoot,
12000:10:10,229 --> 00:10:12,599I was going to say something or ask something,
12100:10:12,609 --> 00:10:14,000but I forgot what it was.
12200:10:14,859 --> 00:10:21,489We were keeping it in our mind while the other person finished their sentence.
12300:10:21,500 --> 00:10:24,179But then by the time they were finished,
12400:10:24,229 --> 00:10:27,229our thought had slipped through our working memory.
12500:10:27,239 --> 00:10:30,789It wasn't held the way that we wanted it to be.
12600:10:30,799 --> 00:10:36,770And so we were unable to bring it back when the person,
12800:10:37,960 --> 00:10:39,789signaled that it was our turn.
12900:10:42,080 --> 00:10:51,950So to summarize our abilities within executive function stem anatomically from the center and the front part of the brain pathways,
13000:10:51,960 --> 00:10:55,780the subcortical pathways that connect with the frontal lobes.
13100:10:55,789 --> 00:11:01,719And these pathways include white matter which impacts how quickly someone can think,
13200:11:01,729 --> 00:11:03,340process and respond.
13300:11:03,900 --> 00:11:08,130And this part of the brain also impacts working memory,
13400:11:08,140 --> 00:11:14,349which is our ability to hold information in mind while we work with and use it.
13500:11:15,409 --> 00:11:26,900So let's tie these concepts speed and working memory with the conveyor belt image that I mentioned earlier in the talk about the third piece for today,
13600:11:26,909 --> 00:11:36,059which is sequencing. A sequence of something is the order in which the things occur or they're arranged.
13700:11:36,270 --> 00:11:41,020And when we listened to our boss ask us to do three things,
13800:11:41,030 --> 00:11:44,210she presented them in a certain sequence.
13900:11:44,219 --> 00:11:46,349And when we listen to someone,
14000:11:46,789 --> 00:11:50,820the words and their meanings and concepts,
14100:11:50,830 --> 00:12:00,309these come toward our ears and into our brains as sequences of data. Picture that conveyor belt.
14200:12:00,320 --> 00:12:01,109Now,
14300:12:01,440 --> 00:12:07,289a conveyor belt is a surface that moves and it brings items to you.
14400:12:07,809 --> 00:12:15,039A person in a factory may work with items coming toward them on a moving surface.
14500:12:15,380 --> 00:12:18,630Perhaps they're employed to sort the items.
14600:12:18,710 --> 00:12:19,869For example,
14700:12:19,880 --> 00:12:23,859here come green and red candies.
14800:12:23,869 --> 00:12:40,484And I'm employed to take the green candies coming toward me and put them in the green box and to take the red candies and put them in the red box. Or maybe someone's employed to assemble something. As the item comes toward you,
14900:12:40,494 --> 00:12:42,385you add this piece,
15000:12:42,395 --> 00:12:50,575then you place it back on the moving belt and the next person will add the next piece and so forth.
15100:12:50,585 --> 00:12:54,804So items come to you in a sequence,
15200:12:54,815 --> 00:12:57,205one item after another,
15300:12:57,215 --> 00:12:58,445after another,
15400:13:00,450 --> 00:13:09,960the items also come with a particular speed on this moving surface and it can be increased .. like wow,
15500:13:09,969 --> 00:13:14,260the items are really coming quickly now... or slowed down.
15600:13:15,520 --> 00:13:21,830You can see that if the speed is set for a pace that most people can keep up with,
15700:13:21,840 --> 00:13:24,900there will be success in completing the task.
15800:13:25,250 --> 00:13:31,169But maybe there would even be a pace that would be too slow for the workers.
15900:13:31,390 --> 00:13:32,489For example,
16000:13:32,500 --> 00:13:34,349a worker might get bored.
16100:13:34,539 --> 00:13:37,330If the items aren't coming fast enough.
16200:13:38,270 --> 00:13:42,039a bored worker might have distraction and restlessness.
16300:13:42,049 --> 00:13:42,059Oh,
16400:13:42,070 --> 00:13:42,969my gosh.
16500:13:42,979 --> 00:13:44,510This is so slow.
16600:13:45,080 --> 00:13:47,090If the pace were too fast,
16700:13:47,099 --> 00:13:50,770the worker wouldn't be able to use all the items coming toward them.
16800:13:50,780 --> 00:13:52,400Things would get past them,
16900:13:52,440 --> 00:13:59,609things would get missed and only a portion of the items could be manipulated and used for that task.
17000:14:00,659 --> 00:14:07,349So the speed and the number of items coming at us needs to be at a just right spot.
17100:14:08,780 --> 00:14:12,729My favorite image for this is a classic,
17200:14:12,739 --> 00:14:26,489I love Lucy clip from the Chocolate Factory television episode. This episode aired in 1952 and it's considered one of the funniest of the whole comedy series.
17300:14:26,760 --> 00:14:38,130I've linked a clip of the Chocolate Factory scene with the conveyor belt in the show notes for those of you who would like to view it or who haven't seen it.
17400:14:38,140 --> 00:14:51,250It's a great demonstration of what can go wrong if the speed of the moving belt is too slow or too fast or if too many items are being sequenced on the conveyor belt at once.
17500:14:54,169 --> 00:14:57,700Now let's get back to the conveyor belt in our minds.
17600:14:57,710 --> 00:15:03,270So if my boss is giving me instructions with multiple details or steps,
17700:15:03,739 --> 00:15:17,219it is as if the words or chunks of information are coming toward me from her voice into my mind ... just like the little pieces of chocolate on the conveyor belt
17800:15:17,229 --> 00:15:18,849in the comedy clip.
17900:15:19,080 --> 00:15:24,369The speed of the conveyor belt is how quickly she's speaking.
18000:15:24,780 --> 00:15:31,669And my perception of the speed is impacted by how quickly my brain can process and keep up.
18100:15:31,700 --> 00:15:35,340If my brain's conveyor belt is slower.
18200:15:35,349 --> 00:15:37,200If I have slower information
18300:15:37,210 --> 00:15:44,609processing, the speed that she's giving me information for the conveyor belt may be overwhelming to me.
18400:15:45,400 --> 00:15:48,559Or if I have really fast processing,
18500:15:48,750 --> 00:15:56,630I may get really bored and distracted while she's talking because there's just not enough that's new coming toward me.
18600:15:58,960 --> 00:16:01,130Let's take another example,
18700:16:01,229 --> 00:16:04,549this one involving a student in a class.
18800:16:04,630 --> 00:16:08,919So a teacher is presenting information to the class.
18900:16:08,950 --> 00:16:18,429The student is required to receive the bits of information at the speed they're presenting as if in the conveyor belt analogy.
19000:16:18,440 --> 00:16:20,369And here comes new information.
19100:16:20,380 --> 00:16:34,260Then the student must hold the information in mind while deciding what parts to write in their notebook or to type in their laptop.
19200:16:34,429 --> 00:16:38,099All of this must be done while the teacher is still speaking.
19300:16:38,489 --> 00:16:40,849And this is all executive function.
19400:16:40,859 --> 00:16:43,630So we'll touch on this in a different episode,
19500:16:43,640 --> 00:16:49,349but the student must use another piece of executive function in this task as well ...
19600:16:49,409 --> 00:16:50,909prioritization.
19700:16:51,440 --> 00:16:57,010So I'm receiving a lot of information on this conveyor belt from the teacher.
19800:16:57,020 --> 00:17:08,349But what information is important for my notes and what is not important. To what do I give priority when there's a lot on the conveyor belt.
19900:17:08,729 --> 00:17:09,668For example,
20000:17:09,678 --> 00:17:13,348it's not necessary to write down every word
20100:17:13,359 --> 00:17:16,668the teacher is saying. What the efficient,
20200:17:16,678 --> 00:17:22,529just-right thing to do would be to pick out these most important things,
20300:17:22,538 --> 00:17:23,409these themes,
20400:17:23,418 --> 00:17:25,529these categories, definitions,
20500:17:25,538 --> 00:17:26,188dates,
20600:17:26,239 --> 00:17:30,308these are the things we need to jot down in our notes.
20700:17:30,359 --> 00:17:35,668And our executive function is what helps us with this whole process.
20800:17:36,069 --> 00:17:36,520Now,
20900:17:36,530 --> 00:17:38,319if it's working well,
21000:17:38,449 --> 00:17:40,900the student just does this automatically.
21100:17:42,060 --> 00:17:45,949If things are hard in that area of executive function,
21200:17:46,329 --> 00:17:48,099the person may feel like,
21300:17:48,109 --> 00:17:48,540gosh,
21400:17:48,550 --> 00:17:48,560I,
21500:17:48,569 --> 00:17:49,760I cannot,
21600:17:50,729 --> 00:17:51,140you know...
21700:17:51,150 --> 00:17:53,500note taking is very difficult for me.
21800:17:53,510 --> 00:17:55,229I just can't keep up.
21900:17:55,239 --> 00:18:07,400I can't keep the things in my mind while I'm writing because I either lose them because the teacher is still speaking or I lose what the teacher is now saying.
22000:18:07,680 --> 00:18:15,839So it either is something that happens smoothly and automatically or it really becomes a very difficult thing.
22100:18:17,900 --> 00:18:20,290Let me give you a social example.
22200:18:20,579 --> 00:18:27,829Imagine a person at a social event where a group of people are speaking about a funny experience.
22300:18:28,300 --> 00:18:35,770An individual in the group will need to be taking in what multiple people are saying...
22400:18:35,890 --> 00:18:44,390So there are multiple conveyor belts and speeds all while holding parts of the conversation in mind.
22500:18:45,390 --> 00:18:59,500And this person also then has to think about what they might say or contribute to the conversation and how to time what they're going to contribute and still keep up with the speed of the exchange.
22600:19:01,930 --> 00:19:11,260This example also involves those executive function abilities of working memory and speed and sequencing.
22700:19:13,219 --> 00:19:15,989Let me give you a life activity example,
22800:19:16,770 --> 00:19:25,459driving is a good example of a life activity that requires a person to take in multiple streams of information.
22900:19:25,469 --> 00:19:26,040In this case
23000:19:26,050 --> 00:19:29,300visual ... at varying speeds.
23100:19:29,579 --> 00:19:36,520Oh, this visual information is coming at me as I'm driving through the visual space.
23200:19:36,920 --> 00:19:59,699So the individual must first notice incoming visual details, adapt to unpredictable changes in the visual field (like, oh now I have less space in this lane than I did because the car is coming over toward me), and make quick safe decisions about how to respond.
23300:20:00,310 --> 00:20:06,989So one individual may feel like this all comes very automatically and at a speed that really works for them,
23400:20:07,750 --> 00:20:15,699another individual may feel overwhelmed by the amount of visual information coming at them in such a quick time...
23500:20:15,839 --> 00:20:21,800particularly because it's unpredictable and it involves safety issues.
23600:20:21,810 --> 00:20:26,040So if I can't keep on top of this visual information,
23700:20:26,689 --> 00:20:31,400I really might get in a situation that's really pretty dangerous.
23800:20:32,479 --> 00:20:37,500Other people while they're driving may feel concerned because they get bored.
23900:20:37,729 --> 00:20:51,510There's just not enough new information in the visual field to keep their mind on the road and they may find their mind wandering in a way that kind of makes them nervous and and leads them feeling like...
24000:20:51,810 --> 00:20:54,469they just can't focus very well while they're driving.
24100:20:56,550 --> 00:21:00,859What is often the case is that for many on the autism spectrum,
24200:21:01,079 --> 00:21:18,439they'll take longer to adjust to driving than their non autistic peers ... most often because they feel like things are really happening quickly and they can feel overwhelmed by the amount the speed and the unpredictability of information on that conveyor belt.
24300:21:20,229 --> 00:21:22,069So going back to our episode,
24400:21:22,079 --> 00:21:25,569topics of speed, working memory, and sequencing,
24500:21:25,810 --> 00:21:31,199we've reviewed that an individual must adapt to the speed of incoming information,
24600:21:32,060 --> 00:21:35,949then sequence through the items coming toward them.
24700:21:36,479 --> 00:21:46,319Hold enough of the information in mind that is important while then doing something with or responding to the information.
24800:21:47,660 --> 00:21:57,680And this is all part of the subcortical frontal pathways of the brain and the ability that globally we call executive function.
24900:21:59,540 --> 00:22:00,479So far,
25000:22:00,489 --> 00:22:05,479we've emphasized information coming toward us on the conveyor belt.
25100:22:05,489 --> 00:22:15,589But we can also think of executive function abilities for the information that we send out on conveyor belts to other people or to the environment.
25200:22:16,900 --> 00:22:18,229For example,
25300:22:18,239 --> 00:22:25,199how quickly do we produce a product or a response to questions from others?
25400:22:26,219 --> 00:22:29,920One person may be quick and efficient with tasks,
25500:22:30,150 --> 00:22:37,920but maybe they make a few errors on the way. Another person may finish the task more slowly,
25600:22:37,930 --> 00:22:39,099but to them,
25700:22:39,109 --> 00:22:43,699accuracy is really important and they notice a lot of detail.
25800:22:45,390 --> 00:22:51,369Neither of these executive function styles is inherently better than the other
25900:22:51,380 --> 00:22:52,390all the time.
26000:22:52,630 --> 00:23:01,430But the person whose executive function is more methodical and detail oriented in producing output may struggle in a job where the boss says,
26100:23:01,439 --> 00:23:02,089hey,
26200:23:02,150 --> 00:23:05,020the priority on this project is speed.
26300:23:05,030 --> 00:23:08,130I need this quickly. And vice versa.
26400:23:08,140 --> 00:23:17,930The individual who works quickly and decisively may really struggle at jobs where the smallest detail can make or break a project.
26500:23:19,800 --> 00:23:27,930Individuals who make decisions more slowly may show resistance when pressed for an answer or an action.
26600:23:29,319 --> 00:23:37,910Other people may almost feel this psychological opposition when they try to encourage the person to decide or to move on.
26700:23:39,000 --> 00:23:40,500Let's take an action.
26800:23:40,510 --> 00:23:42,359Let's stop thinking about it.
26900:23:43,430 --> 00:23:52,579One example could be adult children trying to press their dad to get his roof fixed. If he has executive function
27000:23:52,589 --> 00:23:56,030that's significant for being very slow,
27100:23:56,040 --> 00:23:57,530methodical...
27200:23:57,680 --> 00:24:04,130He may forever be saying things like "I'll think about that" or "I'll know when the time is right,"
27300:24:04,400 --> 00:24:07,439but there's never any real movement toward action.
27400:24:07,449 --> 00:24:09,099There's this stickiness,
27500:24:09,109 --> 00:24:15,680the conveyor belt toward decisiveness kind of gets stuck. Again,
27600:24:15,689 --> 00:24:19,260this approach to action is not right or wrong,
27700:24:19,270 --> 00:24:25,800but it's about whether it works for him in certain instances and against him and others.
27800:24:26,030 --> 00:24:28,219And when the roof is falling in,
27900:24:28,229 --> 00:24:31,219it's really likely working against him.
28000:24:32,000 --> 00:24:43,489Another factor that impacts whether something helps a situation or not is how extreme or inflexible the executive function reaction is in that situation.
28100:24:44,079 --> 00:24:45,949So for example,
28200:24:46,239 --> 00:24:51,810 if we have this situation with the dad and his roof...
28400:24:51,839 --> 00:25:00,250a really extreme slow and resistant response to the need for action in that circumstance...
28500:25:00,260 --> 00:25:00,540well,
28600:25:00,550 --> 00:25:01,880that's creating safety,
28700:25:01,890 --> 00:25:02,530health,
28800:25:02,540 --> 00:25:05,930financial issues ... that it really could hurt the person.
28900:25:07,520 --> 00:25:08,349Ideally,
29000:25:08,359 --> 00:25:13,770our brain is supposed to help us have the just right amount of speed,
29100:25:14,359 --> 00:25:14,650(you know,
29200:25:14,660 --> 00:25:16,300not too quickly,
29300:25:16,310 --> 00:25:19,439not too slowly) and sequencing.
29400:25:19,790 --> 00:25:27,349I see details that are important but I can let other things go so that I can get to the best outcome.
29500:25:27,770 --> 00:25:30,199And when it's important to, you
29600:25:30,209 --> 00:25:33,510can adjust to the situation itself.
29700:25:33,520 --> 00:25:33,900Wow,
29800:25:33,910 --> 00:25:37,540I didn't expect this situation but I can adjust to that.
29900:25:39,459 --> 00:25:48,989But sometimes the struggle that a person is having is really that it's hard to get to that just right spot for ... for anything,
30000:25:49,000 --> 00:25:51,880whether it's speed or executive function or,
30100:25:51,890 --> 00:26:00,180or anything else in life ... rather than sometimes swinging to that too much extreme.
30200:26:02,329 --> 00:26:13,569One more example of the sequencing of output could be seen when multiple smaller actions are needed to complete a larger task.
30300:26:14,099 --> 00:26:20,699So a classic example of this would be the parental request that their child clean his room.
30400:26:21,680 --> 00:26:32,449So the child has to think through all of the pieces of action that will need to be engaged with in order to get this finished product.
30500:26:32,849 --> 00:26:37,989It's almost like saying what are all the pieces I need to put on this conveyor belt,
30600:26:38,020 --> 00:26:46,030all the pieces that I need to to bring together for the whole action of having a clean room or the whole outcome.
30700:26:47,310 --> 00:26:48,500There's a first step,
30800:26:48,510 --> 00:26:49,400a second step,
30900:26:49,410 --> 00:27:01,109a third step ... all on the conveyor belt until a finished product is reached. Some ways in which this executive function task can get stuck would include...
31000:27:01,400 --> 00:27:01,930"Wow,
31100:27:01,939 --> 00:27:06,599there are so many actions or pieces to the task.
31200:27:07,040 --> 00:27:10,829 I just don't know where to start.
31300:27:11,949 --> 00:27:12,930I'm stuck.
31400:27:12,939 --> 00:27:16,599I'm overwhelmed by the amount of possibility.
31500:27:16,880 --> 00:27:23,709I can't get my direction to navigate the task even though I could do all of these little pieces,
31600:27:23,760 --> 00:27:25,310where should I start?"
31700:27:25,930 --> 00:27:28,400And this is often the situation.
31800:27:29,089 --> 00:27:31,959And the parent may say,
31900:27:31,969 --> 00:27:32,170"Hey,
32000:27:32,180 --> 00:27:33,369start wherever you want,
32100:27:33,380 --> 00:27:34,449it doesn't matter."
32200:27:35,349 --> 00:27:41,739But that's not likely to help the child who actually needs someone to sequence the task with them.
32300:27:42,089 --> 00:27:43,810Tell me where to start.
32400:27:43,829 --> 00:27:46,319How can I get going with this task?
32500:27:46,709 --> 00:27:49,630And then after I do the task,
32600:27:50,239 --> 00:27:51,619... the first task,
32800:27:51,849 --> 00:27:53,739what's the second task I should do?
32900:27:53,750 --> 00:27:59,199How should I string things along without getting overwhelmed or stuck or lost?
33000:28:00,739 --> 00:28:11,000The child knows how to do each little part of the task but doesn't have the sequencing ability to navigate this larger task without assistance.
33100:28:11,010 --> 00:28:22,510And so the parent who realizes this might take a picture representing each smaller task ... like a photo of clothes in the laundry basket,
33200:28:23,010 --> 00:28:25,750a photo of books on the bookshelf,
33300:28:25,760 --> 00:28:34,650a photo of the bed made ... whatever the five or seven steps to having a clean room might be.
33400:28:34,920 --> 00:28:39,849You can put these photos up in a place where the child can see them.
33500:28:41,369 --> 00:28:45,739The child then can look at the photos independently and see...
33600:28:45,750 --> 00:28:50,199Oh the first photo is clothes in the the clothes hamper.
33700:28:50,209 --> 00:28:56,800So I'm gonna do that first... and sometimes the child likes to take the photo down when the task is done.
33800:28:57,099 --> 00:28:58,959And so "I know that's done."
33900:29:01,010 --> 00:29:10,609That's just one way to help teach an executive function skill for someone who is overwhelmed and trying to do that independently.
34000:29:13,040 --> 00:29:21,750Knowing that the full anatomical maturity of executive function isn't complete until the age of 20 or 21 or so.
34100:29:21,959 --> 00:29:29,050The parent realizes that part of their role is to help the child learn strategies for approaching tasks
34200:29:29,060 --> 00:29:37,170requiring executive function ... and to assist in areas where the child is still really developing that ability.
34300:29:38,719 --> 00:29:39,479Additionally,
34400:29:39,489 --> 00:29:42,089as we noted in the previous episode,
34500:29:42,170 --> 00:29:47,069everyone will have individual strengths and struggles in executive function.
34600:29:47,880 --> 00:29:52,810If this is a child who grows up and continues to have a weakness
34700:29:52,819 --> 00:29:56,369organizing a sequence to complete a task,
34800:29:56,410 --> 00:30:02,300they can really benefit from a strategy approach to give their brain some assistance.
34900:30:02,780 --> 00:30:04,729So their strategy might be...
35000:30:04,739 --> 00:30:09,880What if I think about this task as seven smaller tasks?
35100:30:09,890 --> 00:30:10,979What would those be?
35200:30:12,170 --> 00:30:24,239I would invite you to notice tasks in your everyday life that are easy or difficult for you and consider if they have executive function components like speed,
35300:30:24,349 --> 00:30:26,500working memory, or sequencing.
35400:30:27,219 --> 00:30:29,000Notice what's easy for you,
35500:30:29,010 --> 00:30:31,890what's difficult for you in these situations.
35600:30:32,449 --> 00:30:40,930This increased self-awareness can be a first step toward getting the best outcome in a variety of situations.
35700:30:41,349 --> 00:30:48,170You may realize "my nervous system default is to process information slowly.
35800:30:48,719 --> 00:30:54,170But this new job that I have requires speed in these areas.
35900:30:54,380 --> 00:30:56,650And how can I get a better outcome?"
36000:30:57,750 --> 00:30:58,130Well,
36100:30:58,140 --> 00:31:03,170the basic neurology of speed that your nervous system is set toward,
36200:31:03,410 --> 00:31:03,890you know,
36300:31:03,900 --> 00:31:06,890you may not be able to adjust that piece.
36400:31:06,959 --> 00:31:16,819But perhaps you could focus on strategies to reduce anything that would take away from the speed you're capable of neurologically.
36500:31:17,160 --> 00:31:20,589So perhaps you want to reduce distractions,
36600:31:20,920 --> 00:31:32,089maybe ask someone for input about what the most important thing to focus on is and really make sure that you're accountable to someone who can see the big picture a little better.
36700:31:33,599 --> 00:31:36,140As I noted in the previous episode,
36800:31:36,189 --> 00:31:43,150I like the book series Smart but Scattered when it comes to strategies for executive function,
36900:31:43,160 --> 00:31:47,949but you can choose whatever resources best fit your needs.
37000:31:48,119 --> 00:31:52,010And if you want to dive into more about executive function,
37100:31:52,170 --> 00:31:58,609learn about more strategies for success in areas that are causing you difficulty... by all means,
37200:31:58,619 --> 00:32:01,969reach out and find things that work well for you.
37300:32:04,079 --> 00:32:08,390I wanna thank you for joining me to learn about the executive function
37400:32:08,400 --> 00:32:12,560sub features of speed, sequencing, and working memory.
37500:32:12,849 --> 00:32:21,650And I hope it increases your understanding of what makes you tick. We'll be continuing our series on executive function next time.
37600:32:21,660 --> 00:32:24,810So I invite you to join me for that third episode.
-
Do you understand what Executive Function (EF) refers to and why it is important? If you have EF difficulties, have you been diagnosed with ADHD? Do you wonder if you have a diagnosis of autism or if you should have a dual diagnosis of autism and ADHD? Dr. Regan breaks down the concepts and shares about the relationship between EF, ADHD, and autism.
Executive Function Book Series by Dawson and Guare:
Smart But Scattered (children's version)
Smart But Scattered (Teen version)
Smart But Scattered (adult version)
Dr. Regan's Master Class for Clinicians:
Zur Institute: Master Class
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
100:00:07,670 --> 00:00:08,560Hi there.
200:00:08,569 --> 00:00:13,960This is Doctor Regan joining you for an episode of Autism in the Adult podcast.
300:00:14,850 --> 00:00:16,670I'm a neuropsychologist,
400:00:16,680 --> 00:00:24,350the founder and director of an autism diagnostic clinic in Central Illinois and the parent of a teen on the spectrum.
500:00:25,180 --> 00:00:25,899Today,
600:00:25,909 --> 00:00:31,610you are joining me for the first episode in a new series about executive function.
700:00:31,989 --> 00:00:36,509And I'm really excited for the series since announcing the topic.
800:00:36,520 --> 00:00:38,509At the end of our last episode,
900:00:38,520 --> 00:00:45,709I've received lots of emails from interested listeners before we dive into today's episode.
1000:00:45,720 --> 00:00:45,990Though,
1100:00:46,000 --> 00:00:50,490I wanna give a shout out to the clinicians and professionals who may be listening.
1200:00:50,799 --> 00:01:00,610I'm currently developing a master class with the continuing education platform called Zur Institute.
1300:01:01,020 --> 00:01:04,010This offering is unique for several reasons.
1400:01:04,019 --> 00:01:05,449One is the format,
1500:01:06,050 --> 00:01:09,550there will be four 2-hour webinars,
1600:01:09,559 --> 00:01:11,949one in each of September,
1700:01:12,209 --> 00:01:13,099October,
1800:01:13,110 --> 00:01:16,180November and December of 2023.
1900:01:16,809 --> 00:01:23,629And the first hour will be education while the second full hour will be reserved for discussion,
2000:01:23,639 --> 00:01:32,519question and answer and interaction with you about clinical questions and practice issues related to the topic for that day.
2100:01:32,889 --> 00:01:44,419Another unique feature of this offering will be the focus on advanced topics. So click on the link in the show notes to read more about the topics and how to sign up.
2200:01:45,330 --> 00:01:49,569If you are a clinician wanting beginner or intermediate courses,
2300:01:49,599 --> 00:01:54,440check out my other offerings on Zur or at my website,
2400:01:54,449 --> 00:01:57,819which is also linked through the show notes.
2500:01:58,440 --> 00:01:59,040All right,
2600:01:59,050 --> 00:02:01,580let's talk about executive function.
2700:02:02,449 --> 00:02:07,800I'll warn you that today's episode will require some executive function to get through.
2800:02:08,350 --> 00:02:14,740And I've spent a lot of time trying to make sure that I'm linking all of the themes together.
2900:02:15,179 --> 00:02:16,649So with that in mind,
3000:02:16,800 --> 00:02:22,440I want to start off with just a general definition of executive function.
3100:02:24,440 --> 00:02:26,500Later in our talks,
3200:02:26,509 --> 00:02:34,229we will cover a more precise and descriptive definition including sub elements and what we might call those.
3300:02:35,020 --> 00:02:45,990So executive function refers to a set of brain based abilities related to the functioning of the pathways connecting the center and the front of the brain.
3400:02:46,679 --> 00:02:48,710And the reason for the name,
3500:02:48,720 --> 00:02:59,850executive functioning is that executive is defined as having the power to put plans and actions into effect.
3600:03:00,860 --> 00:03:04,710So a CEO for example,
3700:03:05,240 --> 00:03:14,669is the chief executive officer of a business company and is in charge of directing the tiers of the company,
3800:03:14,679 --> 00:03:16,250the regional officers,
3900:03:16,259 --> 00:03:17,059managers,
4000:03:17,070 --> 00:03:18,270direct workers,
4100:03:18,490 --> 00:03:24,440directing all the pieces to work together toward the same goal.
4200:03:24,970 --> 00:03:33,339So these pathways of the brain help the parts of the brain work together to achieve a goal.
4300:03:34,259 --> 00:03:38,360Another image that I like is the symphony conductor,
4400:03:38,899 --> 00:03:42,190directing all the instruments in the orchestra,
4500:03:42,199 --> 00:03:46,130even if all the instruments are performing perfectly,
4600:03:46,240 --> 00:03:48,300if there's no conductor,
4700:03:48,679 --> 00:03:56,179there's no unified sound with melody and movement and this synchrony of sound.
4800:03:56,399 --> 00:04:04,309So the sounds don't come together to create a moving and meaningful piece of music without the conductor.
4900:04:05,039 --> 00:04:09,100So executive function is like the symphony conductor,
5000:04:09,490 --> 00:04:14,199it should bring all of the working parts of the brain together to perform.
5100:04:14,210 --> 00:04:17,049So that something meaningful happens.
5200:04:18,998 --> 00:04:19,688As I said,
5300:04:19,699 --> 00:04:22,848executive function is a set of brain skills,
5400:04:22,859 --> 00:04:24,408it's not one skill.
5500:04:25,160 --> 00:04:29,929And as we understand what the center of the brain,
5600:04:30,109 --> 00:04:37,130the subcortical areas of the brain and the connections through the center with the front of the brain,
5700:04:37,140 --> 00:04:38,350the frontal lobes.
5800:04:38,809 --> 00:04:42,209When we understand what these areas are in charge of,
5900:04:42,220 --> 00:04:46,820we refer to those set of abilities as executive function.
6000:04:46,829 --> 00:04:53,149So these executive function abilities hang together anatomically in the brain.
6100:04:53,540 --> 00:04:56,640So through that subcortical frontal system,
6200:04:57,339 --> 00:05:04,059so the number one point is that executive function refers to a series of skills,
6300:05:04,070 --> 00:05:05,519not one skill.
6400:05:05,850 --> 00:05:10,190And these skills are linked with anatomy,
6500:05:10,200 --> 00:05:13,290with the subcortical frontal systems of the brain.
6600:05:13,609 --> 00:05:21,279And the skills help the brain produce a meaningful synchronous um behavior or,
6700:05:21,290 --> 00:05:22,489or product.
6800:05:24,070 --> 00:05:24,470Now,
6900:05:24,480 --> 00:05:32,950let's talk about the diagnosis of AD D and A DH D and just for simplicity's sake,
7000:05:32,959 --> 00:05:33,920from now on,
7100:05:33,929 --> 00:05:39,920I'll really just refer to these as AD D but I'm referring to both diagnoses.
7200:05:41,269 --> 00:05:45,839This diagnosis was introduced in the diagnostic manual,
7300:05:45,850 --> 00:05:57,970the DSM - III in 1980 it was important because it described a developmental neurologic condition of executive function.
7400:05:58,950 --> 00:06:02,820So executive function was not a new concept,
7500:06:02,989 --> 00:06:10,739but the diagnosis of ADD was the one that captured this developmental piece.
7600:06:11,190 --> 00:06:22,299So here we have a diagnosis then that we can use to describe a difficulty that an individual has based on their developmental wiring.
7700:06:22,309 --> 00:06:26,200The way that the brain system has developed,
7800:06:26,239 --> 00:06:38,600the way they're wired in the executive function areas of the brain don't finish their anatomic development until about the age of 20 or 21.
7900:06:38,980 --> 00:06:39,440So,
8000:06:39,450 --> 00:06:40,799anatomically,
8100:06:40,989 --> 00:06:45,730executive function is still developing until about that age.
8200:06:47,119 --> 00:07:02,500So the number two point is that ADD was a notable addition to the diagnostic manual in 1980 because it represents a diagnosis for executive function difficulties that are developmental in nature.
8300:07:04,059 --> 00:07:05,190Now,
8400:07:05,399 --> 00:07:19,910I want to talk about the relationship between executive function and AD D executive function is not specific to ADD or ADHD.
8500:07:20,690 --> 00:07:23,239So the difficulties in that domain,
8600:07:23,540 --> 00:07:26,559they're not specific to this diagnosis.
8700:07:26,570 --> 00:07:36,290We're discussing executive function is one of the most sensitive brain functions to any kind of stress,
8800:07:36,299 --> 00:07:39,619whether that is physical or psychological.
8900:07:40,049 --> 00:07:45,429One of the first things to show difficulty is going to be executive function.
9000:07:47,630 --> 00:07:56,119It's often the first thing to become difficult and the last thing to resolve or heal after some type of challenge.
9100:07:57,390 --> 00:07:58,829For example,
9200:07:59,089 --> 00:08:02,600if an 80 year old has a bladder infection.
9300:08:02,609 --> 00:08:11,040What's probably the most sensitive cognitive function that's going to be disrupted first ... executive function.
9400:08:11,739 --> 00:08:25,959And if someone is recovering from a traumatic brain injury and they've gone through rehab and it's two or three months after ... what's probably the residual problem that's still kind of healing up.
9500:08:25,970 --> 00:08:26,299Well,
9600:08:26,309 --> 00:08:28,679that would be executive function as well.
9700:08:31,179 --> 00:08:39,059So there may be developmental differences in executive function and that's what we discuss
9800:08:39,070 --> 00:08:41,969when we talk about the diagnosis of ADD,
9900:08:43,000 --> 00:08:47,960there can also be acquired differences in executive function.
10000:08:48,409 --> 00:08:51,690This would include differences after,
10100:08:51,700 --> 00:08:52,450as we said,
10200:08:52,460 --> 00:08:53,869a traumatic brain injury,
10300:08:53,880 --> 00:08:58,830a stroke, within the context of a dementia... acquired
10400:08:58,840 --> 00:09:02,070meaning that this is not developmental.
10500:09:02,080 --> 00:09:06,469It's something that has occurred in the course of the life span.
10600:09:08,809 --> 00:09:10,039Executive function,
10700:09:10,049 --> 00:09:15,609difficulties can occur with acute or chronic medical problems.
10800:09:15,619 --> 00:09:19,820So an acute medical issue would be like an infection.
10900:09:19,830 --> 00:09:20,599For example,
11000:09:20,609 --> 00:09:23,340this is something that comes and then it goes,
11100:09:23,609 --> 00:09:24,500it's acute,
11200:09:24,510 --> 00:09:25,460it's new,
11300:09:25,619 --> 00:09:35,299it kind of can hit kind of hard and then heal up and go. Or executive function can be disrupted due to chronic medical problems.
11400:09:35,330 --> 00:09:37,510So someone with kidney failure,
11500:09:37,520 --> 00:09:38,469for example,
11600:09:38,479 --> 00:09:40,090who's on dialysis,
11700:09:40,289 --> 00:09:45,484what's the most likely thing they're going to have some difficulties with in the cognitive domain.
11800:09:45,585 --> 00:09:45,955Well,
11900:09:45,965 --> 00:09:47,765that would be executive function,
12000:09:47,914 --> 00:09:52,255someone with sugar fluctuations in the context of diabetes,
12100:09:52,284 --> 00:09:56,525someone with metabolic differences like their sodium is too low.
12200:09:56,554 --> 00:10:02,385These can also cause a disruption in someone's executive function system,
12300:10:04,080 --> 00:10:10,169even differences in the load that the person is carrying with regard to stress,
12400:10:10,179 --> 00:10:11,530emotional pain,
12500:10:11,539 --> 00:10:12,330trauma,
12600:10:12,340 --> 00:10:13,679lack of sleep,
12700:10:13,710 --> 00:10:17,429and even just having too much on our schedule.
12800:10:17,780 --> 00:10:25,729These examples of things don't change the anatomy of the brain and how the parts of the brain are working.
12900:10:25,739 --> 00:10:32,450But it really does interfere with our access to using our full capacity,
13000:10:32,460 --> 00:10:37,109our full anatomic, biologic capacity for executive function.
13100:10:37,530 --> 00:10:37,880So,
13200:10:37,890 --> 00:10:39,359if we've had trauma,
13300:10:39,479 --> 00:10:39,830you know,
13400:10:39,840 --> 00:10:43,409our brain may just go offline if we dissociate.
13500:10:43,659 --> 00:10:50,400And even though our anatomy is working well to produce this executive function,
13600:10:50,750 --> 00:10:55,419we may experience a psychological process that takes us offline.
13700:10:56,520 --> 00:10:57,299In addition,
13800:10:57,309 --> 00:10:59,390even with normal aging,
13900:10:59,469 --> 00:11:02,750what's the first thing to start to show difficulty?
14000:11:02,830 --> 00:11:03,270Yes,
14100:11:03,280 --> 00:11:04,830it's executive function.
14200:11:05,200 --> 00:11:08,419And if you are aging really well,
14300:11:08,440 --> 00:11:08,900you're,
14400:11:08,909 --> 00:11:10,820you're really aging nicely.
14500:11:10,900 --> 00:11:13,380You don't have any additional medical issues,
14600:11:13,390 --> 00:11:14,719you haven't had an injury.
14700:11:15,059 --> 00:11:20,659The first thing you're gonna start to notice is some problem in the area of executive function.
14800:11:20,849 --> 00:11:26,770That's just the aging process and how it impacts that subcortical frontal system.
14900:11:27,210 --> 00:11:37,190So you may walk into a room and you can't remember why, or you have this tip of the tongue phenomenon where you know what you wanna say
15000:11:37,200 --> 00:11:38,549but you can't get it out.
15100:11:38,570 --> 00:11:40,049That's executive function.
15200:11:40,619 --> 00:11:45,500You may have to think more slowly or take in less information at a time.
15300:11:47,140 --> 00:11:53,719So all individuals are likely to experience executive function difficulty in these contexts.
15400:11:54,270 --> 00:11:56,609So consider this comparison,
15500:11:57,869 --> 00:12:01,799executive function is similar to fatigue,
15600:12:01,809 --> 00:12:02,739for example,
15700:12:02,750 --> 00:12:10,200in that it's a nonspecific feature of many different kinds of conditions.
15800:12:10,849 --> 00:12:12,820So if someone has fatigue,
15900:12:13,409 --> 00:12:18,700there would be hundreds... thousands of conditions that could produce fatigue,
16000:12:19,020 --> 00:12:22,039anything from lack of sleep to infection,
16100:12:22,109 --> 00:12:23,799autoimmune conditions.
16200:12:23,809 --> 00:12:25,440And so many more things.
16300:12:26,419 --> 00:12:27,340Similarly,
16400:12:27,349 --> 00:12:34,140executive function difficulty can be caused by so so many conditions and situations,
16500:12:34,150 --> 00:12:34,880trauma,
16600:12:34,890 --> 00:12:35,520aging,
16700:12:35,530 --> 00:12:36,320ADD,
16800:12:36,330 --> 00:12:37,780autoimmune conditions,
16900:12:37,789 --> 00:12:39,669delirium, autism, and many,
17000:12:39,679 --> 00:12:40,429many more.
17100:12:40,799 --> 00:12:49,750So the third point we've really focused on here so far is that executive function is not specific to ADD.
17200:12:50,080 --> 00:12:55,119So many many things can trigger this executive function problem.
17300:12:57,539 --> 00:12:58,150Therefore,
17400:12:58,159 --> 00:13:01,859if someone presents with executive function difficulty --
17500:13:02,200 --> 00:13:05,030so I'm having a hard time paying attention,
17600:13:05,039 --> 00:13:07,700I just can't take in information very well.
17700:13:07,729 --> 00:13:10,349I can't organize myself well --
17800:13:10,359 --> 00:13:20,570the clinician should consider differentials in the diagnostic process because so many things can present with those features.
17900:13:20,840 --> 00:13:24,369There should be this process of taking into account.
18000:13:24,630 --> 00:13:26,590What is this person's age?
18100:13:26,599 --> 00:13:28,750What is their recent life experience?
18200:13:28,760 --> 00:13:30,679What are their medical issues?
18300:13:30,690 --> 00:13:33,390When did the executive function issue start?
18400:13:34,210 --> 00:13:39,469But executive function difficulty does not automatically mean ADD.
18500:13:39,479 --> 00:13:41,549It does not equal ADD,
18600:13:41,559 --> 00:13:43,739it's not equivalent to ADD.
18700:13:45,469 --> 00:14:00,440So we would consider a handful of things that could cause executive function problems in this person, and then would perform an evaluation to see what the most likely contributors are in this case.
18800:14:01,289 --> 00:14:04,830So let's go over our first three points.
18900:14:05,109 --> 00:14:09,489Executive function refers to a series of skills,
19000:14:09,500 --> 00:14:16,190not one skill and these skills are linked anatomically within the same pathways --
19100:14:16,200 --> 00:14:27,729these subcortical frontal system pathways -- and they also work together to provide some meaningful and organized output from the brain.
19200:14:29,229 --> 00:14:47,950The second point is that ADD was added to the diagnostic manual in 1980 to describe developmental executive function differences, and that was really helpful to have a diagnosis for developmental differences in executive function.
19300:14:49,669 --> 00:15:00,539The third point is that executive function is not specific to ADD -- many many things can trigger executive function difficulty.
19400:15:01,239 --> 00:15:10,909And so we would never want to hear executive function difficulty and then translate that automatically into ADD.
19500:15:15,289 --> 00:15:20,659So we talked about how executive function refers to a series of skills.
19600:15:21,270 --> 00:15:28,479There's not a unanimous consensus about what constitutes all these subparts,
19700:15:28,489 --> 00:15:30,979how to number them and what to call them.
19800:15:31,090 --> 00:15:37,080But many conceptualizations may refer to about 12 to 15 components.
19900:15:37,090 --> 00:15:38,039Give or take.
20000:15:39,330 --> 00:15:44,460These often include things like organization, sequencing,
20100:15:44,469 --> 00:15:46,020processing speed,
20200:15:46,030 --> 00:15:48,260prioritizing, planning,
20300:15:48,270 --> 00:15:49,960task initiation,
20400:15:50,070 --> 00:15:52,130sustained attention, goal
20500:15:52,140 --> 00:15:53,510directed persistence,
20600:15:53,520 --> 00:15:54,859impulse control,
20700:15:54,869 --> 00:15:56,099time management,
20800:15:56,109 --> 00:15:57,640generation of ideas,
20900:15:57,650 --> 00:15:58,739working memory,
21000:15:58,750 --> 00:16:01,880flexibility and emotional regulation.
21100:16:03,119 --> 00:16:06,030So it's not important for you to know what those mean.
21200:16:06,250 --> 00:16:14,309But I want you to get the sense that there are these multiple components and we'll look at each of these later in our series.
21300:16:14,320 --> 00:16:15,559But for now,
21400:16:15,570 --> 00:16:16,150wow,
21500:16:16,159 --> 00:16:19,669executive function is a broad category.
21600:16:22,250 --> 00:16:28,020ADD, which as we said describes a condition of developmental
21700:16:28,030 --> 00:16:36,700executive function difficulty, includes four areas as I would describe them.
21800:16:36,710 --> 00:16:38,880So someone may say,
21900:16:38,890 --> 00:16:38,909oh,
22000:16:38,919 --> 00:16:40,869I think it's more like five.
22100:16:40,940 --> 00:16:42,520so it doesn't matter,
22200:16:42,530 --> 00:16:44,270but it's a small subset.
22300:16:44,280 --> 00:16:45,679We've got attention,
22400:16:45,909 --> 00:16:47,119organization,
22500:16:47,130 --> 00:16:47,940goal directed
22600:16:47,950 --> 00:16:50,109persistence, and impulse control.
22700:16:51,869 --> 00:17:09,130The diagnostic criteria for ADD only describe four areas of executive function even though our current understanding is that there are probably more like 12 to 15 components.
22800:17:10,900 --> 00:17:28,949So you can see that someone could have significant difficulty with executive function developmentally and not meet the criteria for ADD because these four specific areas included may not be the ones that are causing this problem.
22900:17:29,290 --> 00:17:31,949This person's individual difficulty...
23000:17:33,109 --> 00:17:36,160I also want you to know that every single person,
23100:17:37,189 --> 00:17:40,119regardless of developmental neurology,
23200:17:40,130 --> 00:17:41,920health background,
23300:17:42,130 --> 00:17:46,449all humans will have a pattern of executive function,
23400:17:46,630 --> 00:17:48,839strengths and weaknesses.
23500:17:49,040 --> 00:17:51,599That's the normal way of our neurology.
23600:17:52,329 --> 00:17:56,780So out of those 12 to 15 subsets of skills,
23700:17:56,959 --> 00:18:11,640you can kind of imagine this graph across the all of these different points and sometimes we'll have ups and downs there that can help inform us what we struggle with and what we're really finding easy.
23800:18:12,449 --> 00:18:18,640So a person who's really good in the areas of generating ideas and flexibility,
23900:18:18,650 --> 00:18:21,339this person might be called creative.
24000:18:21,349 --> 00:18:22,920All these ideas,
24100:18:22,930 --> 00:18:24,140they're very flexible,
24200:18:24,150 --> 00:18:25,579they go from here to there,
24300:18:25,839 --> 00:18:29,609but they may struggle with other areas of executive function,
24400:18:30,040 --> 00:18:31,959they may be impulsive,
24500:18:32,000 --> 00:18:35,979have difficulty with time management, organization...
24600:18:36,180 --> 00:18:41,780So everybody has their own pattern with an executive function.
24700:18:43,069 --> 00:18:45,640So let's go back here.
24800:18:45,650 --> 00:18:52,219We are setting up a discussion of the relationship between executive function and ADD.
24900:18:52,819 --> 00:19:01,339And one of the difficulties we currently have is that our understanding of executive function has evolved since 1980.
25000:19:01,780 --> 00:19:12,500But we have a diagnosis that covers only a small subset of how we currently conceptualize executive function.
25100:19:13,349 --> 00:19:25,880This creates difficulty in that someone may clearly have developmental executive function problems but not fit into the box of the ADD diagnostic criteria.
25200:19:28,280 --> 00:19:29,010Now,
25300:19:29,849 --> 00:19:33,420let's compare ADD and autism.
25400:19:35,489 --> 00:19:43,300Everyone on the autism spectrum will have executive function difficulty in some form or pattern.
25500:19:45,040 --> 00:19:48,290That's because of the neurology of autism.
25600:19:50,880 --> 00:19:57,329The term executive function is not specifically used in the autism criteria,
25700:19:57,359 --> 00:20:09,849but many of the criteria describe behavioral patterns that tap into that neurology and that reflect difficulty in executive function and that subcortical frontal system.
25800:20:11,849 --> 00:20:21,040So autism has this executive function component plus many nonexecutive function elements as well.
25900:20:22,930 --> 00:20:28,709So ADD is a diagnosis of four or so elements of executive function.
26000:20:29,219 --> 00:20:37,819Autism is a diagnosis that includes elements of executive function and elements outside of executive function.
26100:20:39,469 --> 00:20:52,160The diagnostic manual indicates that the diagnosis of ADD cannot be made if another diagnosis better accounts for the client's whole presentation.
26200:20:54,359 --> 00:21:15,699The diagnostic manual says about autism that ADD can also be in diagnosed along with autism when attentional difficulties or hyperactivity exceeds that typically seen in autism.
26300:21:19,569 --> 00:21:21,280So let's regroup.
26400:21:21,969 --> 00:21:23,310Executive function,
26500:21:23,319 --> 00:21:28,189difficulties occur secondary to so many developmental,
26600:21:28,199 --> 00:21:30,339physical and psychological states.
26700:21:30,859 --> 00:21:39,660And ADD and autism are two developmental diagnoses that include executive function difficulty.
26800:21:40,829 --> 00:21:49,989ADD includes about four elements of the 12 to 15 sub elements of executive function that we generally think of.
26900:21:50,359 --> 00:22:02,369And autism includes some pattern of executive function difficulty across elements and also has nonexecutive function
27000:22:02,680 --> 00:22:04,239parts to the criteria.
27100:22:06,560 --> 00:22:18,890what should happen is that an individual presenting with developmental executive function difficulty would see a clinician who develops an appropriate differential,
27200:22:19,770 --> 00:22:24,810that is the person has developmental executive function difficulty,
27300:22:24,839 --> 00:22:27,569but that's not specific to ADD.
27400:22:27,579 --> 00:22:33,810So let's consider other developmental conditions like autism.
27500:22:33,819 --> 00:22:40,819And also let's consider other relevant information like the trauma history,
27600:22:40,829 --> 00:22:42,640medical conditions,
27700:22:42,670 --> 00:22:44,229intellectual abilities,
27800:22:44,239 --> 00:22:45,839learning disabilities,
27900:22:45,849 --> 00:22:47,810language processing ability.
28000:22:48,040 --> 00:22:53,819And let's figure out what the basis of this executive function problem is.
28100:22:56,089 --> 00:23:02,239But what actually happens is that a teacher, doctor, or clinician says,
28200:23:02,359 --> 00:23:02,979oh,
28300:23:02,989 --> 00:23:06,750this person has developmental executive function difficulty.
28400:23:07,010 --> 00:23:07,900Therefore,
28500:23:07,910 --> 00:23:10,280we're going to diagnose them with ADD.
28600:23:11,709 --> 00:23:13,319Then years later,
28700:23:13,569 --> 00:23:17,390they come to see a professional who does an evaluation and says,
28800:23:17,400 --> 00:23:18,050well,
28900:23:18,469 --> 00:23:21,589this person does have executive function problems,
29000:23:21,599 --> 00:23:32,270but the root of their attention problem is that they have an intellectual disability and nobody's ever checked or they can't process language well.
29100:23:32,280 --> 00:23:33,239And so of course,
29200:23:33,250 --> 00:23:42,689they can't attend in the classroom... or they have a learning disability so they can't attend if they can't understand what they're learning.
29300:23:44,040 --> 00:23:52,050Some of these individuals have executive function difficulty because they've been on the autism spectrum all along.
29400:23:52,060 --> 00:23:56,359But autism was never included in the differential process.
29500:23:56,890 --> 00:24:00,250So they've never been assessed for autism.
29600:24:01,310 --> 00:24:11,819It's kind of like hearing that someone has difficulty with fatigue and then assigning a diagnosis of chronic fatigue syndrome without thinking through any differential.
29700:24:12,660 --> 00:24:12,880Now,
29800:24:12,890 --> 00:24:18,630not everyone with fatigue is best served by a diagnosis of chronic fatigue syndrome.
29900:24:18,829 --> 00:24:40,849And not everyone with executive function difficulty is best described by a diagnosis of ADD. ADD should be given if another diagnosis or condition does not more fully explain the full constellation of characteristics.
30000:24:42,290 --> 00:24:51,180So even if the individual meets all the criteria for difficulty in those four subs skills,
30100:24:52,859 --> 00:25:04,869the diagnosis is not made if this executive function difficulty is better explained by autism or intellectual disability or learning disability,
30200:25:04,880 --> 00:25:05,550et cetera.
30300:25:05,630 --> 00:25:11,089So the question in the case of ADD diagnosis shouldn't just be,
30400:25:11,099 --> 00:25:15,319are the criteria met ... but are the criteria met
30500:25:15,329 --> 00:25:29,270and is this the diagnosis that best explains the whole presentation for this student or client or patient? In autism,
30600:25:29,280 --> 00:25:41,550executive function difficulties for one individual may include maybe two of those four subs skills that are in our definition of ADD and maybe three other executive function skills.
30700:25:42,910 --> 00:25:44,500They still have autism,
30800:25:44,619 --> 00:25:48,989they still have executive function difficulty as we would expect.
30900:25:49,260 --> 00:25:54,510But perhaps they're less likely to have a pairing of an ADD diagnosis.
31000:25:56,579 --> 00:26:06,150Another person on the autism spectrum may have all four of those difficulties in the ADD category and maybe a couple that aren't.
31100:26:06,500 --> 00:26:12,170And so they get these two diagnoses autism and ADD.
31200:26:14,069 --> 00:26:14,900However,
31300:26:14,910 --> 00:26:22,260if the executive function difficulty is not excessive for what we expect to see in autism,
31400:26:22,640 --> 00:26:24,650they shouldn't have that diagnosis.
31500:26:24,660 --> 00:26:25,869That second one,
31600:26:26,209 --> 00:26:27,239it's redundant.
31700:26:27,250 --> 00:26:28,500It's repetitive.
31800:26:29,599 --> 00:26:37,270So then do we take away the ADD diagnosis once someone has a diagnosis of autism?
31900:26:37,640 --> 00:26:39,449And it's not excessive?
32000:26:39,760 --> 00:26:40,099Well,
32100:26:40,109 --> 00:26:40,989we could,
32200:26:41,130 --> 00:26:42,829if we wanted to be precise,
32300:26:42,839 --> 00:26:47,369This is really what the manual talks about as making the most sense.
32400:26:48,699 --> 00:26:49,250However,
32500:26:49,260 --> 00:26:50,390practically speaking,
32600:26:50,400 --> 00:26:51,790this gets difficult.
32700:26:51,800 --> 00:27:02,290So one reason is that people don't understand the context of this ADD diagnosis and what it means and what it doesn't mean.
32800:27:03,219 --> 00:27:04,930And many times after I see a
32900:27:04,939 --> 00:27:07,349a client for an autism evaluation,
33000:27:07,359 --> 00:27:11,079I'll tell them their diagnosis is autism spectrum disorder.
33100:27:11,239 --> 00:27:12,719And then they will ask,
33200:27:12,729 --> 00:27:15,910did you also check for ADD I think I have that too.
33300:27:16,800 --> 00:27:21,949And so it's a difficult thing to just answer with a couple sentences as you can see.
33400:27:22,489 --> 00:27:25,150Do they have executive function difficulty?
33500:27:25,160 --> 00:27:26,359Absolutely.
33600:27:26,719 --> 00:27:36,709Do they have executive function difficulty that fits into that four subset category that we have as our diagnosis for ADD? Possibly
33700:27:36,719 --> 00:27:37,790yes or possibly no.
33800:27:37,800 --> 00:27:48,400Depending on the case. And does the executive function difficulty exceed what is generally seen in autism? Really infrequently.
33900:27:48,410 --> 00:27:49,260Honestly,
34000:27:49,670 --> 00:27:52,079I have made both diagnoses,
34100:27:52,089 --> 00:28:00,579but I don't frequently see the executive function as really standing out higher than you know...
34200:28:00,589 --> 00:28:02,369the group of people that I see.
34300:28:03,780 --> 00:28:04,890So conceptually,
34400:28:04,900 --> 00:28:05,640to me,
34500:28:05,959 --> 00:28:11,540it makes no actual sense to talk about autism with and without ADD.
34600:28:11,979 --> 00:28:12,589In fact,
34700:28:12,599 --> 00:28:13,339at this stage,
34800:28:13,349 --> 00:28:15,630in our understanding of the nervous system,
34900:28:15,949 --> 00:28:27,680it doesn't make sense to talk about a diagnosis that is ADD that only includes four or so subsets of the executive function skills.
35000:28:29,040 --> 00:28:36,209I would propose that it would make more sense to just have a diagnosis that says executive function disorder.
35100:28:37,050 --> 00:28:45,969And then you could say comma developmental or comma acquired or perhaps you could list the pattern ... like for this person,
35200:28:45,979 --> 00:28:48,920these are the strengths and these are the difficulties.
35300:28:49,760 --> 00:29:00,569It would be nice to increase the understanding that saying the diagnosis of autism automatically communicates that there are executive function difficulties present.
35400:29:02,079 --> 00:29:04,569That's not really our reality right now though.
35500:29:05,920 --> 00:29:11,339So even though that makes the most sense to me as a neuropsychologist,
35600:29:12,650 --> 00:29:22,829one of the practical difficulties (aside from people not understanding the terms) is that if we take away the ADD diagnosis for an autistic client,
35700:29:23,229 --> 00:29:26,390the individual can't get their attention medication,
35800:29:26,719 --> 00:29:32,670even if it has helped their executive function difficulty within the autism spectrum.
35900:29:33,890 --> 00:29:34,699Now,
36000:29:34,709 --> 00:29:41,439the medication is often not as effective on the spectrum as off the spectrum.
36100:29:41,619 --> 00:29:44,380But if someone has been helped by it,
36200:29:44,500 --> 00:29:47,099there's no reason to take it away because,
36300:29:47,390 --> 00:29:47,619you know,
36400:29:47,630 --> 00:29:50,670just because that ADD doesn't entirely fit.
36500:29:51,239 --> 00:29:54,130So practically speaking,
36600:29:54,569 --> 00:30:01,030they're gonna end up keeping that diagnosis because they understand what it means
36700:30:01,310 --> 00:30:04,770snd they don't understand what not having it means.
36800:30:04,979 --> 00:30:11,170And also they need medication or benefit from medication that requires that diagnosis.
36900:30:12,540 --> 00:30:17,469The other thing that's really a caution that I'd like you to think about...
37000:30:20,109 --> 00:30:33,630I really advise a lot of caution when reading things and listening to people speak about ADD and ADHD because we'll start to hear things...
37100:30:33,640 --> 00:30:34,609You know,
37200:30:34,619 --> 00:30:35,489people will say,
37300:30:35,500 --> 00:30:35,930well,
37400:30:35,939 --> 00:30:38,969you know what's really common for people with ADD,
37500:30:39,140 --> 00:30:49,670it's common that they become hyper focussed or it's common that they have difficulty with social interactions or it's common that they have sensory processing difficulties.
37600:30:51,680 --> 00:30:52,030The
37700:30:52,040 --> 00:31:07,280the problem with these statements is that the individuals who have received diagnoses of ADD often receive this just because they've had executive function difficulty,
37800:31:07,900 --> 00:31:11,900but they haven't had much if any differential assessment.
37900:31:13,010 --> 00:31:25,439So we don't know if it's really true that individuals with a pure ADD often have these coexisting features.
38000:31:26,739 --> 00:31:33,219Because what makes a lot of sense is that within the ADD population,
38100:31:33,229 --> 00:31:42,439there's some subset of it autistic individuals who say I have ADD and I notice that I also have trouble reading social cues.
38200:31:43,380 --> 00:31:44,109Well,
38300:31:44,219 --> 00:31:47,780the difficulty reading social cues then becomes a
38400:31:47,790 --> 00:31:51,130"common feature" associated with ADD.
38500:31:51,140 --> 00:31:53,239But we don't know,
38600:31:53,780 --> 00:31:55,880does this person have autism?
38700:31:55,890 --> 00:31:57,150Have they been assessed?
38800:31:57,160 --> 00:31:57,520And,
38900:31:57,869 --> 00:31:58,770and if so,
39000:31:58,780 --> 00:32:08,359if we get this group of just really pure ADD diagnoses and nothing else explains those features better,
39100:32:08,650 --> 00:32:12,369I would love to know what ... kind of... is associated with that.
39200:32:13,420 --> 00:32:14,670But at this point,
39300:32:14,939 --> 00:32:21,119we really don't know. The research using people diagnosed with ADD...
39400:32:21,520 --> 00:32:24,770They don't go through any differential process.
39500:32:24,780 --> 00:32:25,969They just look and say,
39600:32:25,979 --> 00:32:27,739oh you have a diagnosis,
39700:32:27,750 --> 00:32:30,670let's put you in the ADD group and study you.
39800:32:31,280 --> 00:32:33,890So you see why this is a huge problem.
39900:32:34,050 --> 00:32:36,270It's a very messy group,
40000:32:36,280 --> 00:32:43,810a mixed group of people who have executive function problems from childhood.
40100:32:45,310 --> 00:33:08,609But it hasn't really been distinguished as to whether other contributors to executive function difficulty may have actually been there rather than just a pure developmental difficulty within these four categories or subtypes/subsets within that executive function definition.
40200:33:10,469 --> 00:33:15,219So that was a long meandering explanation,
40300:33:15,229 --> 00:33:16,660but really important.
40400:33:16,670 --> 00:33:19,959And I'm glad you followed me through those twists and turns.
40500:33:20,719 --> 00:33:22,780What do I want you to walk away with?
40600:33:22,790 --> 00:33:23,760Let me recap.
40700:33:23,770 --> 00:33:24,270Again.
40800:33:24,750 --> 00:33:28,199Executive function refers to a series of skills,
40900:33:28,209 --> 00:33:32,189not one skill that are linked anatomically,
41000:33:32,199 --> 00:33:41,599they hang together in the subcortical frontal systems of the brain and they work together to help us make a cohesive and meaningful product.
41100:33:42,540 --> 00:33:51,050ADD was added to the diagnostic manual in 1980 to describe developmental executive function differences.
41200:33:51,060 --> 00:33:54,630And that was really a good advancement at the time.
41300:33:56,219 --> 00:34:01,199Executive function is not specific to ADD and many,
41400:34:01,209 --> 00:34:05,250many things can trigger executive function difficulty.
41500:34:05,959 --> 00:34:09,209So we would never want to hear...
41600:34:09,219 --> 00:34:15,669executive function difficulty ...and translate that automatically into ADD.
41700:34:17,688 --> 00:34:25,579This is where the differential diagnostic process should come in someone presenting with executive function difficulty.
41800:34:26,089 --> 00:34:27,579Then we would say,
41900:34:27,589 --> 00:34:27,878well,
42000:34:27,888 --> 00:34:35,039what conditions that could produce this kind of difficulty may present in the specific student,
42100:34:35,049 --> 00:34:36,269client, or patient?
42200:34:36,519 --> 00:34:40,648And what would be most likely do they have a medical condition?
42300:34:40,849 --> 00:34:43,638Has someone looked for an intellectual disability,
42400:34:43,648 --> 00:34:45,358auditory processing problems,
42500:34:45,368 --> 00:34:46,519learning disability,
42600:34:47,399 --> 00:34:47,739you know,
42700:34:47,750 --> 00:34:57,810perhaps an older individual presents with concerns that they have ADD and yet they have some medical issues,
42800:34:57,820 --> 00:34:58,850normal aging,
42900:34:58,860 --> 00:34:59,860some trauma.
43000:35:00,270 --> 00:35:02,590So what has the differential been,
43100:35:02,820 --> 00:35:04,909has there been a differential?
43200:35:06,429 --> 00:35:10,280What often happens instead is that especially during childhood,
43300:35:10,290 --> 00:35:12,189adolescence and young adulthood,
43400:35:12,340 --> 00:35:26,300someone presents with executive function difficulty and they're given a diagnosis of ADD without ruling out autism or other possible contributors to the inattention and other features.
43500:35:27,939 --> 00:35:56,770This leads to personal stories and articles and research studies about common features in ADD that are actually describing features in this huge mix of individuals with a variety of factors impacting their executive function rather than a research study with a group of people who have features specific to our definition of ADD and do not have other diagnostic conditions like autism.
43600:35:58,129 --> 00:35:58,739To me,
43700:35:58,750 --> 00:36:03,409it rarely makes sense to describe both ADD and autism.
43800:36:03,649 --> 00:36:13,639Usually the ADD diagnosis is describing these four subs skills of executive function when actually there are more like 12 to 15.
43900:36:14,030 --> 00:36:22,580And they're describing it in autism where executive function difficulty is always present in some form.
44000:36:24,379 --> 00:36:40,040And the diagnostic manual says that ADD should only be diagnosed when it's the diagnosis that explains the features the best you don't diagnose it just because the criteria are met,
44100:36:40,300 --> 00:36:46,689you diagnose it if the criteria are met and other things are not better explanations.
44200:36:47,669 --> 00:36:56,580I rarely see executive function difficulties in clients that extend beyond what I would expect for the autism profile.
44300:36:56,800 --> 00:36:59,919I have seen it certainly and I have diagnosed it.
44400:37:00,179 --> 00:37:01,739But by definition,
44500:37:01,750 --> 00:37:04,139if it's more than you'd expect,
44600:37:04,149 --> 00:37:04,459it's,
44700:37:04,469 --> 00:37:07,500it's not going to be common. To me,
44800:37:07,510 --> 00:37:08,979it makes sense to talk about
44900:37:08,989 --> 00:37:18,189executive function as including a series of sub abilities of which we can look at patterns of strengths and weaknesses in everyone,
45000:37:18,459 --> 00:37:20,260including those on the spectrum.
45100:37:20,879 --> 00:37:22,129But for now,
45200:37:22,250 --> 00:37:37,090we have this tiny subset of executive function characteristics in the DSM five called ADD that I would suggest should be expanded to reflect all of the executive function characteristics with,
45300:37:37,100 --> 00:37:39,770with specifiers like developmental.
45400:37:40,610 --> 00:37:42,959Thank you for listening to the recap.
45500:37:42,969 --> 00:37:48,899Thank you for going on this pathway of information with me today about executive function,
45600:37:48,909 --> 00:37:50,540ADD, and autism.
45700:37:50,800 --> 00:37:51,919In future episodes,
45800:37:51,929 --> 00:37:57,370we will break down some of the subsets of executive function and talk more about those.
45900:37:58,219 --> 00:38:07,370My favorite book series on Executive Function is The Smart But Scattered series which I will link in the show notes.
46000:38:07,979 --> 00:38:09,439Now there are many,
46100:38:09,449 --> 00:38:16,669many good books and resources on executive function and I certainly have not read or reviewed them all.
46200:38:16,909 --> 00:38:20,729You are encouraged to use the resources that best meet your needs.
46300:38:20,979 --> 00:38:23,530So look for the link for the smart but scattered.
46400:38:23,540 --> 00:38:26,449If you don't already have a series that meets your need,
46500:38:26,889 --> 00:38:34,830I do want to say that I don't get any financial compensation for recommending any of the resources that I list for you in my podcast episodes.
46600:38:34,939 --> 00:38:39,370These are just recommendations from things that have helped me in the past.
46700:38:39,379 --> 00:38:47,659I hope you have a great few weeks, and I look forward to you joining me for our next episode on Executive Function.
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Have you ever struggled over whether to accept an invitation or opportunity? Should I say yes, or no? Join Dr. Regan as she discusses the importance of identifying goals and asking "what might that look like" before making a final decision.
Previous podcast episodes mentioned:
Attention Deficit Disorder and Autism: Similarities and Differences
Dr. Regan's Master Class for Clinicians:
Zur Institute: Master Class
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
100:00:07,670 --> 00:00:08,520Hi there.
200:00:08,529 --> 00:00:13,520This is Doctor Regan joining you for an episode of Autism in the Adult podcast.
300:00:13,760 --> 00:00:15,029I'm your host.
400:00:15,039 --> 00:00:18,739I'm also a neuropsychologist, author and speaker,
500:00:19,000 --> 00:00:24,719a certified autism specialist and the parent of a teen on the autism spectrum.
600:00:25,850 --> 00:00:29,040You are joining me today for an episode entitled,
700:00:29,049 --> 00:00:30,620"what might that look like?"
800:00:30,909 --> 00:00:35,240One of the things that clients and families often ask me is,
900:00:35,250 --> 00:00:39,909"should we plan on this" or "should I say yes to this?"
1000:00:40,189 --> 00:00:40,669Now,
1100:00:40,680 --> 00:00:48,659this could mean being the best man at a family wedding or taking a family vacation to a cabin in the woods.
1200:00:49,419 --> 00:00:53,509It could mean accepting a full time job in an office setting.
1300:00:54,299 --> 00:00:55,029Now,
1400:00:55,529 --> 00:00:58,509my response is rarely yes or no,
1500:00:58,520 --> 00:01:01,270but rather "what might that look like?"
1600:01:02,590 --> 00:01:05,519So before we jump into the topic for today,
1700:01:05,529 --> 00:01:09,559we are coming up to the third anniversary of this podcast,
1800:01:09,879 --> 00:01:19,639the first episode launched on August 7th 2020 it highlighted similarities and differences between autism and ADD or ADHD.
1900:01:20,050 --> 00:01:20,379Now,
2000:01:20,389 --> 00:01:33,279this premiere episode is one of the most popular of the podcast and I plan to expand this topic into a series after today's episode which will further define executive function,
2100:01:33,550 --> 00:01:41,050its presentation in autism and ADD, and resources for harnessing the power of executive function.
2200:01:42,199 --> 00:01:43,089Secondly,
2300:01:43,099 --> 00:01:46,930I want to inform clinicians about an upcoming master class.
2400:01:46,940 --> 00:01:52,069I'm offering through Zur Institute about autism across the lifespan.
2500:01:53,190 --> 00:02:04,459I received so many emails and messages through my website about people seeking autism informed clinicians to provide them with diagnostic input information,
2600:02:04,470 --> 00:02:08,919education and solutions for roadblocks they may have encountered.
2700:02:09,649 --> 00:02:17,270So the bottom line is that more clinicians are needed to serve individuals who are searching for this specialization.
2800:02:17,600 --> 00:02:28,779And my response has been to offer multiple courses through Zur Institute. It's a continuing education site for clinicians.
2900:02:29,330 --> 00:02:36,809My goal is to equip clinicians across various regions to assist individuals in their communities.
3000:02:36,860 --> 00:02:39,320When this type of service is needed,
3100:02:39,979 --> 00:02:51,729the master class offering will focus on advanced topics and it starts in September space is limited and I'll have the link in the show notes.
3200:02:52,360 --> 00:02:55,449So let's jump into our topic for today.
3300:02:56,380 --> 00:03:10,369The autistic individual may have opportunities to accept or decline invitations and the invitation may be to enter an advanced academic program rather than the basic program.
3400:03:10,789 --> 00:03:13,770Perhaps the invitation is to travel.
3500:03:14,429 --> 00:03:24,199The invitation may be to lead a group such as being the best man at a family wedding or presenting research to professionals.
3600:03:25,720 --> 00:03:33,619My experience is that there's value in viewing the invitation not so much as a yes or no question.
3700:03:33,889 --> 00:03:35,369Do I accept this?
3800:03:35,380 --> 00:03:36,580Do I say no.
3900:03:36,759 --> 00:03:38,880But by asking ourselves,
4000:03:38,889 --> 00:03:40,410what might that look like?
4100:03:41,149 --> 00:03:41,710A yes,
4200:03:41,720 --> 00:03:47,160no view would be to see the invitation as a formed and complete package.
4300:03:47,289 --> 00:03:51,080So if I say yes to being the best man,
4400:03:51,089 --> 00:03:53,080I will plan the bachelor party,
4500:03:53,089 --> 00:03:54,240make a speech,
4600:03:54,380 --> 00:03:55,020toast,
4700:03:55,029 --> 00:03:56,509the couple at the reception,
4800:03:56,520 --> 00:04:00,869et cetera saying no to the invitation means I'll,
4900:04:00,880 --> 00:04:03,440I won't participate in these activities.
5000:04:03,990 --> 00:04:05,360But instead of a yes,
5100:04:05,369 --> 00:04:06,589no mindset,
5200:04:07,100 --> 00:04:11,199we can often talk through alternatives by asking,
5300:04:11,210 --> 00:04:12,919what might that look like?
5400:04:13,300 --> 00:04:14,990What might it look like to say?
5500:04:15,000 --> 00:04:15,729Yes,
5600:04:16,170 --> 00:04:19,630in a way that works for me and for the people around me.
5700:04:22,149 --> 00:04:26,200The first point to think about is what is the ultimate goal?
5800:04:26,209 --> 00:04:28,320What is the desired outcome?
5900:04:29,779 --> 00:04:36,600The goal for a vacation with family members may be to have relaxing experiences,
6000:04:36,660 --> 00:04:43,480to see natural landscapes that you've never seen and to connect with other family in a meaningful way.
6100:04:44,829 --> 00:04:50,709The goal for presenting your research to professionals may be to advance your career,
6200:04:50,720 --> 00:04:57,040make professional connections with others and highlight your role in the work that's been done.
6300:04:58,730 --> 00:05:09,549Identifying what a good outcome would look like is empowering because it helps us identify a handful of core foundational objectives.
6400:05:10,029 --> 00:05:12,640And when we work toward those objectives,
6500:05:12,649 --> 00:05:17,220we can release some of the trappings that may be part of the activity,
6600:05:17,230 --> 00:05:23,959but they're really not core to what we're going after for the individual,
6700:05:23,970 --> 00:05:26,440considering a full-time office job,
6800:05:26,470 --> 00:05:31,089he may decide that the foundational goals would be to have work stability.
6900:05:31,510 --> 00:05:34,140If he's currently doing consulting work,
7000:05:34,149 --> 00:05:35,200for example,
7100:05:35,290 --> 00:05:35,769he would,
7200:05:35,779 --> 00:05:45,109he may want more of a predictable salary and to have his name associated with a company that has a respected reputation in his field.
7300:05:46,239 --> 00:05:53,489So the first step you can focus on is determining what would be a good outcome.
7400:05:54,480 --> 00:06:02,549What would it look like in this situation to really dive in and also to feel like things went well.
7500:06:04,519 --> 00:06:10,970The first step you should focus on is determining what a good outcome would look like in this situation.
7600:06:11,589 --> 00:06:15,779What would a good outcome for participating in the wedding look like?
7700:06:16,140 --> 00:06:21,519What about going on a family vacation or accepting an office job?
7800:06:22,910 --> 00:06:32,970The second part after we've identified what the core features we're going after are those core foundational goals?
7900:06:33,179 --> 00:06:35,000We can ask ourselves,
8000:06:35,010 --> 00:06:36,459what might it look like?
8100:06:36,470 --> 00:06:41,559What might the situation look like that would allow for those outcomes?
8200:06:42,480 --> 00:06:44,950So let's go back to the examples.
8300:06:45,410 --> 00:06:49,690The gentleman invited to be best man at an out of town family wedding.
8400:06:49,700 --> 00:06:51,200Let's call him Joe.
8500:06:51,790 --> 00:06:54,510He may realize his instinct is to say,
8600:06:54,519 --> 00:06:55,160no,
8700:06:55,679 --> 00:06:58,809he knows that he gets overwhelmed in crowds.
8800:06:58,820 --> 00:07:09,809He dislikes being the center of attention and he relies on routine and specific favorite activities to remain grounded in daily life.
8900:07:10,170 --> 00:07:24,489He feels pulled in different directions because he wants to support his family member and he knows that it's really an honor to be asked to connect with the couple in this way at the ceremony.
9000:07:25,890 --> 00:07:28,390So Joe and his family may want to discuss,
9100:07:28,399 --> 00:07:31,570what would it look like for you to be best man?
9200:07:31,809 --> 00:07:36,630What might it look like for Joe to be best man in a relational,
9300:07:36,640 --> 00:07:38,899satisfying and meaningful way?
9400:07:38,940 --> 00:07:44,929But in a way that also offers him the freedom and the space to take care of his needs.
9500:07:45,790 --> 00:07:46,920So at this point,
9600:07:46,929 --> 00:07:57,320there is a commitment to the core goals and there is flexibility with the trappings that might otherwise go along with a wedding ceremony.
9700:07:59,109 --> 00:08:00,369In the case of the wedding,
9800:08:00,380 --> 00:08:02,769Joe may have a separate hotel room,
9900:08:02,779 --> 00:08:07,369so he has a quiet alone space to regroup as needed.
10000:08:08,350 --> 00:08:20,239Joe may know that he is grounded and centered when he gets pressure inputs in his muscles and joints and he gets these inputs at home with a weighted blanket,
10100:08:20,260 --> 00:08:22,339rock climbing and bike riding.
10200:08:23,239 --> 00:08:36,650He's decided to choose a hotel that has a swimming pool and an elliptical machine so that he can get these pressure inputs in ways that will still feel grounding to him.
10300:08:38,489 --> 00:08:48,789Joe also plans to use small noise canceling earbuds as needed just to shield himself from some of the noise in crowded areas.
10400:08:48,968 --> 00:08:50,289They're barely visible,
10500:08:50,299 --> 00:08:55,698they help him a lot and it'll be a step toward really increasing his comfort.
10600:08:56,940 --> 00:09:00,880Joe and his family agree that he won't attend the bachelor party,
10700:09:01,150 --> 00:09:09,630but still he'll have a time that evening where he and the groom have a private drink together to celebrate the union.
10800:09:11,020 --> 00:09:18,960Joe also decides to record a video of him toasting the couple rather than making a live toast.
10900:09:19,409 --> 00:09:26,979These things in combination with others really help him or regulate himself to have a relation,
11000:09:27,010 --> 00:09:33,950meaningful contribution at the ceremony and to also protect what his nervous system needs.
11100:09:34,820 --> 00:09:38,260The main points are that Joe and his family are thinking,
11200:09:38,450 --> 00:09:39,950what might this look like?
11300:09:39,960 --> 00:09:47,789What do we want to work toward and how can we best get there with a mindset toward getting everyone's needs met.
11400:09:49,020 --> 00:09:50,140Similarly,
11500:09:50,150 --> 00:09:53,250the researcher invited to present her work.
11600:09:53,260 --> 00:09:54,030Let's call her,
11700:09:54,039 --> 00:10:03,669Susan may avoid the invitation because handling unexpected situations during a presentation is very stressful to her.
11800:10:04,080 --> 00:10:10,799She also really shies away from being the center of attention and speaking in front of others.
11900:10:11,409 --> 00:10:19,219If she does present her goals would be to take credit for her work and to connect with like minded professionals.
12000:10:20,369 --> 00:10:26,169Perhaps her focus on what might this look like leads to the following plan,
12100:10:27,190 --> 00:10:35,840Susan and her mentor decide to present the information together with specific slides identified for each of them.
12200:10:36,559 --> 00:11:02,320So this plan allows Susan to have an experienced partner to guide her through unexpected glitches and it also ensures that Susan can count on presenting specific material but also have expected breaks while her mentor is speaking during the question and answer section at the end of the presentation,
12300:11:02,539 --> 00:11:13,679Susan will take the lead on questions she feels comfortable with and her mentor may cue and structure her thoughts by adding prompts like saying Susan,
12400:11:13,690 --> 00:11:19,400this may be a good time to discuss your findings in the area of XY or Z.
12500:11:21,340 --> 00:11:37,650So what might that look like process allowed Susan to work toward her desired goals without taking an all or nothing approach to all of the trappings that may typically accompany a professional presentation.
12600:11:38,219 --> 00:11:47,140So the first thing we talked about was figuring out what's foundational in the goals and then figuring out how to get there,
12700:11:47,150 --> 00:11:52,770what might it look like to accommodate these goals and to let some other things go.
12800:11:54,070 --> 00:11:57,070The third thing to think about is when to say no.
12900:11:57,840 --> 00:11:59,729So having said all this,
13000:11:59,739 --> 00:12:12,960there will be times when what might this look like when that process leads to the conclusion that really this is probably unlikely to help achieve our best,
13100:12:12,969 --> 00:12:14,179our best outcome,
13200:12:14,190 --> 00:12:15,369our best goals.
13300:12:16,030 --> 00:12:17,479Um So saying,
13400:12:17,489 --> 00:12:20,460no may be the best decision in that case,
13500:12:21,900 --> 00:12:27,979although there would be benefits to finding a compromise that meets the needs of multiple people.
13600:12:27,989 --> 00:12:45,590The process may be unrealistic in a particular situation and that may be because the individual's needs at that time are so high in this season of struggle or it may be because features of the situation just can't be adjusted.
13700:12:47,289 --> 00:12:53,179Let's take the consultants situation who's considering a full-time office job.
13800:12:53,390 --> 00:13:15,960Let's call him a the best answer for him may be no if he is in an unusual season of struggle and maybe he's having difficulty consistently getting his consulting work done and to then switch to a setting that would be more challenging for him may really not be good timing,
13900:13:16,719 --> 00:13:22,520his needs as an individual may be so far from what the job can offer him.
14000:13:22,770 --> 00:13:25,729That the best answer in this season is no.
14100:13:27,179 --> 00:13:28,309Alternatively,
14200:13:28,320 --> 00:13:32,619the answer may be no if he's doing well in his consulting work.
14300:13:32,830 --> 00:13:42,119But there are core features of the job that would prevent him from having the flexibility that he would really need to thrive.
14400:13:42,809 --> 00:13:47,280He may realize that he would need a hybrid work model,
14500:13:47,289 --> 00:13:50,280combining office work and remote work.
14600:13:51,070 --> 00:13:57,289He may have the self awareness that working on new business proposals keeps his interest level up,
14700:13:57,650 --> 00:14:06,549but he needs help maintaining interest in projects that feel like old hat that the work can get boring very quickly.
14800:14:06,640 --> 00:14:21,630And the consulting job allows him to pick and choose the types of projects that he does and for things not to get stale if the office job offers him stability in one sense,
14900:14:21,729 --> 00:14:26,719but a lack of flexibility to kind of meet in the middle.
15000:14:27,530 --> 00:14:30,950He may need to say no to that invitation.
15100:14:31,330 --> 00:14:33,929Uh Based on what he knows about himself,
15200:14:38,130 --> 00:14:42,099an individual invited to come along for a family vacation.
15300:14:42,239 --> 00:14:44,090Let's call her MEREDITH.
15400:14:44,460 --> 00:14:49,940She may realize that no is the answer that makes the most sense in her season.
15500:14:50,799 --> 00:14:53,890After thinking through what might this look like,
15600:14:53,900 --> 00:15:02,969she can't envision any way that realistically meets her needs and achieves the goal of connecting with family on this trip.
15700:15:04,080 --> 00:15:05,250For example,
15800:15:05,260 --> 00:15:14,809she may have a really severe fear of flying and taking multiple planes is the only way to participate in the vacation as planned.
15900:15:16,049 --> 00:15:23,179MEREDITH may realize that her core goal is to connect with two family members in particular.
16000:15:23,880 --> 00:15:26,580So her next thought process might be,
16100:15:27,229 --> 00:15:30,859I'm going to have to say no to the invitation of the trip.
16200:15:30,929 --> 00:15:34,429But how else could I connect with those family members?
16300:15:34,500 --> 00:15:37,849Even I'm if I'm going to turn down this invitation,
16400:15:39,489 --> 00:15:55,979this process of evaluating invitations and opportunities by asking what might that look like can help us identify what our core goals and needs are while adjusting or releasing things that really aren't foundational.
16500:15:57,039 --> 00:15:59,809The decisions often don't need to be all or nothing.
16600:15:59,820 --> 00:16:03,750Although after thinking through what might this look like?
16700:16:03,940 --> 00:16:08,150We might see that some opportunities just aren't a good fit.
16800:16:10,030 --> 00:16:22,359I hope you have invitations that help you grow toward your goals and that your decision making process can also reflect your values and your needs at all seasons of your life.
16900:16:22,460 --> 00:16:24,500Thank you for joining me today.
17000:16:24,750 --> 00:16:36,599The next episode will launch our new series on Executive Function and clinicians ... check out the link to the master class opportunity with Zur Institute coming up in the fall.
17100:16:36,690 --> 00:16:41,710I hope you can join me next time for our episode on Executive Function.
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Do you want to live with more intention to achieve your goals? In this 6th episode in a series on Intentional Living, Dr. Regan discusses ways to grow in areas of interest by expanding skills and using free or low cost methods of networking and introducing products or services to others.
Previous podcast episodes mentioned:
Shifting Autistic Characteristics Across the Lifespan
Autism in Women
Coursera (online courses)
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
100:00:06,019 --> 00:00:06,829Hello,
200:00:06,840 --> 00:00:16,920this is Doctor Regan joining you for the sixth episode of Our Living With Intention series on the Autism in the Adult podcast.
300:00:17,290 --> 00:00:20,159I am the mom of a teen on the spectrum.
400:00:20,459 --> 00:00:26,180I have a doctorate in the field of brain behavior relationships called neuropsychology.
500:00:26,440 --> 00:00:28,549I'm also an author and speaker,
600:00:28,559 --> 00:00:36,279a certified autism specialist and the founder and director of an autism diagnostic clinic in Central Illinois,
700:00:36,290 --> 00:00:38,000serving adolescents,
800:00:38,009 --> 00:00:40,060adults and aging adults.
900:00:42,180 --> 00:00:45,069Before we jump into our topic for today,
1000:00:45,090 --> 00:00:48,250let's take a throwback to past episodes.
1100:00:48,619 --> 00:00:51,790Looking back to two years ago at this time,
1200:00:51,869 --> 00:00:54,779I published an episode about autism in women.
1300:00:55,299 --> 00:00:59,330It's been one of the most listened to episodes of the podcast.
1400:00:59,779 --> 00:01:02,270And one year ago at this time,
1500:01:02,279 --> 00:01:13,699we were in the midst of a series about how autism characteristics may shift somewhat across the lifespan during puberty across life,
1600:01:13,709 --> 00:01:17,879seasons in women and throughout the aging years,
1700:01:19,120 --> 00:01:23,569I'll go ahead and link these episodes in the show notes in case you miss them.
1800:01:24,989 --> 00:01:25,199Now,
1900:01:25,209 --> 00:01:30,139let's talk about our current episode in The Living With Intention series.
2000:01:32,319 --> 00:01:37,309I've named the series Living With Intention because sometimes as humans,
2100:01:37,319 --> 00:01:53,690we just kind of get swept up in the demands of daily life or we get stuck in some areas and it can help to pause and consider where we would like to be in various areas of our lives.
2200:01:54,370 --> 00:02:02,739And then to think about how to take small achievable steps on a path toward our intention.
2300:02:03,839 --> 00:02:04,629And so far,
2400:02:04,639 --> 00:02:13,050we've spoken about three areas of life that someone may have goals for such as improving regulation,
2500:02:13,539 --> 00:02:15,539that means feeling centered,
2600:02:15,550 --> 00:02:18,619calm and psychologically present.
2700:02:19,720 --> 00:02:27,210We talked about communicating and connecting and also about addressing issues of household culture.
2800:02:28,750 --> 00:02:29,449Today,
2900:02:29,460 --> 00:02:32,679we will look at the area of interests.
3000:02:32,690 --> 00:02:44,070Many people that I work with share that they're so captivated by a certain topic or activity that they would love to expand this in their life.
3100:02:44,100 --> 00:02:45,500For example,
3200:02:45,509 --> 00:02:47,470if someone is an artist,
3300:02:47,710 --> 00:02:52,380they may share that they think they would like to sell designs on Etsy,
3400:02:54,000 --> 00:03:01,710another person may share that they are immersed in sewing and this is so interesting and calming to them.
3500:03:02,210 --> 00:03:09,970They've developed quite a skill in this area and they're wondering if they could expand by doing some things in their community.
3600:03:11,270 --> 00:03:21,240Another may have an amazing brain for sports statistics and wish that they could get into sports casting as a niche in life.
3700:03:23,399 --> 00:03:23,929Again,
3800:03:23,940 --> 00:03:29,149it's important to emphasize that these are goals that the individual presents with.
3900:03:29,360 --> 00:03:33,800This is not an episode about what someone's goals should be,
4000:03:33,949 --> 00:03:37,210but rather to address the thought of gosh,
4100:03:37,220 --> 00:03:48,089I love this stuff and I would love to do more or use it in a way that reaches a wider area or a wider audience.
4200:03:49,759 --> 00:03:58,970So how does one start a path toward getting more involved in the area of an intense interest?
4300:04:00,710 --> 00:04:07,130So how to get started as we talked about in the second episode on this series,
4400:04:07,399 --> 00:04:14,979it is recommended that we take small defined achievable steps in the direction we would like to go.
4500:04:15,850 --> 00:04:22,579So one such step may be to gain some additional skills in the area of interest.
4600:04:22,869 --> 00:04:23,880For example,
4700:04:23,890 --> 00:04:29,679if someone produces a product and they would like to offer the product on the internet,
4800:04:29,920 --> 00:04:39,200they may wish to get training in things like basic marketing strategies using social media for sales and creating a website.
4900:04:40,209 --> 00:04:44,359Someone who creates a myriad of characters and stories,
5000:04:44,549 --> 00:04:59,209this individual may want to write fiction books in order to bridge the gap from having great ideas and wonderful creativity to bringing together some stories into a book.
5100:04:59,239 --> 00:05:03,730The individual may wish to take a formal course in creative writing.
5200:05:06,600 --> 00:05:07,010Now,
5300:05:07,019 --> 00:05:12,209I know taking a course can feel daunting but a wonderful place to learn.
5400:05:12,220 --> 00:05:20,209Some of these skills is on the internet and there are Myriads of free online courses in various areas.
5500:05:21,209 --> 00:05:21,739In fact,
5600:05:21,750 --> 00:05:28,390there are so many options that I just can't even list the top opportunities in the show note links.
5700:05:28,399 --> 00:05:29,690There are so many,
5800:05:30,160 --> 00:05:34,279but I'll share a few things about learning from the internet.
5900:05:35,190 --> 00:05:37,279Have you ever heard of a MOOC?
6000:05:38,040 --> 00:05:41,059That's M - O - O - C.
6100:05:41,480 --> 00:05:46,750It's a massive open online course - MOOC.
6200:05:47,040 --> 00:05:54,359And this is a free web-based distance learning program that's designed for huge numbers of people.
6300:05:54,369 --> 00:05:59,869Thus the word massive ... of geographically dispersed students.
6400:06:00,049 --> 00:06:08,380So open means that these are accessible to multiple levels of people very often,
6500:06:08,390 --> 00:06:11,929these are free and they're online.
6600:06:11,940 --> 00:06:13,820So this is all web based.
6700:06:15,440 --> 00:06:21,950I myself have been a student in several MOC courses to learn things that I can't learn locally.
6800:06:22,079 --> 00:06:23,089For example,
6900:06:23,100 --> 00:06:28,390I got to take a Behavioral Genetics course through the University of Minnesota.
7000:06:28,609 --> 00:06:33,429I took a neuroanatomy course through the University of Illinois Chicago.
7100:06:34,790 --> 00:06:39,619And what happens is that you earn a participation certificate from the course,
7200:06:39,630 --> 00:06:41,079which is free,
7300:06:41,910 --> 00:06:50,410but the benefits are both the information you learn and also having this on your resume as an area of self study.
7400:06:50,839 --> 00:07:00,309So the MOOC platforms also have developed paid versions of courses where you earn some type of verified credit or certificate.
7500:07:00,739 --> 00:07:16,459And they also have programs that are kind of compilation certificates... like, take seven writing courses and get this advanced writing certificate or a grouping of computer courses for an IT specialization certificate.
7600:07:18,709 --> 00:07:25,670The particular site for MOOC courses that I used was Coursera.org and I'll put that in the show notes.
7700:07:25,899 --> 00:07:29,600But there are so many sites to choose from.
7800:07:30,920 --> 00:07:38,549I encourage you to use an internet search engine for free online courses in the area of your interest.
7900:07:41,500 --> 00:07:57,809Another opportunity for learning more skills in your area of interest would be youtube tutorials and also programs like Adobe that offer video instruction to become more expert in their program offerings.
8000:07:58,720 --> 00:07:59,809In this context,
8100:07:59,820 --> 00:08:03,690you could learn things like video and audio editing,
8200:08:03,700 --> 00:08:04,609photography
8300:08:04,619 --> 00:08:05,399editing,
8400:08:05,459 --> 00:08:08,390how to use website design software...
8500:08:08,799 --> 00:08:19,959Podcast platforms like Podbean and others also provide podcasts about how to become and succeed as a podcaster in your area of interest.
8600:08:20,200 --> 00:08:27,609And they also offer blog posts and articles about all the things their sites offer to support your goals.
8700:08:27,619 --> 00:08:52,500So there's a lot of free learning opportunities in the form of videos, in the form of programs that offer their own education about their products and also podcasts that just talk about how to develop your niche in addition to increasing skills in your area.
8800:08:52,780 --> 00:09:09,849Another way to take a step toward your goal of expanding your interest would be to start doing some things on a volunteer basis or to provide giveaways or free products as promotions to highlight your work or skills.
8900:09:10,549 --> 00:09:11,380So again,
9000:09:11,390 --> 00:09:14,409this doesn't need to be the end goal,
9100:09:14,489 --> 00:09:14,799you know,
9200:09:14,809 --> 00:09:18,950to be volunteering as the ultimate end,
9300:09:19,299 --> 00:09:28,400but it can be one step to help you become more comfortable in this area to gain experience and also to get your offerings out there.
9400:09:30,989 --> 00:09:40,159Someone who bakes may wish to donate cookies to the local elementary school open house with a nicely crafted sign about their business,
9500:09:40,169 --> 00:09:42,229including their contact information.
9600:09:42,630 --> 00:09:51,179They could even put a QR code on the sign so parents can scan the sign and save their contact information in their website location.
9700:09:52,320 --> 00:10:03,489The individual who loves sports statistics and wants to become a sportscaster may wish to volunteer time to local sports teams as the sports announcer during the games.
9800:10:04,450 --> 00:10:07,229This helps the person create contacts,
9900:10:07,510 --> 00:10:13,479get used to the tasks involved in doing the work and lets other people see their skills.
10000:10:15,929 --> 00:10:24,049There are other ways to use free venues to increase your credentials and get your work out there.
10100:10:27,109 --> 00:10:30,419Looking for free opportunities to get involved,
10200:10:30,440 --> 00:10:32,510advance your skills and get your work out.
10300:10:32,520 --> 00:10:38,219There is a really good way to step toward that intention of expansion.
10400:10:38,539 --> 00:10:39,739So for example,
10500:10:39,750 --> 00:10:45,809someone who's trying to develop creative writing skills may wish to enter their stories into contests.
10600:10:46,270 --> 00:10:48,960And once you have a body of work developed,
10700:10:49,119 --> 00:11:02,169you might find it fairly straightforward to enter appropriate work in various contests for review and as your work earns mentions or comments or awards,
10800:11:02,280 --> 00:11:06,270these can be highlighted in your credentials on your website.
10900:11:09,760 --> 00:11:21,210Someone who loves making characters and writing may also want to write fan fiction on the internet as a way of using a resource to get their work out there.
11000:11:23,190 --> 00:11:25,659For an individual who loves,
11100:11:25,669 --> 00:11:26,229loves,
11200:11:26,239 --> 00:11:35,909loves running and decides they may wish to do some personal training for other long distance runners locally or in their community,
11300:11:36,080 --> 00:11:42,500this person may wish to enter races and keep track of these credentials to market their services.
11400:11:43,030 --> 00:11:47,200Some races or events may be free and others may have a fee.
11500:11:47,250 --> 00:11:48,000But in the end,
11600:11:48,010 --> 00:11:52,440this could be a way of meeting people with similar interests,
11700:11:52,460 --> 00:12:02,169getting your name out there as someone who's actively pursuing running and training and getting some race placements to add to your credentials.
11800:12:05,869 --> 00:12:12,099The important things about these approaches are that they're small steps,
11900:12:12,640 --> 00:12:14,979they're toward your desired outcome.
12000:12:14,989 --> 00:12:22,760Whatever you've decided your intention is this is where I'd like to be in this area of my life.
12100:12:23,669 --> 00:12:30,200And these small steps help you get a feel for what your goal may feel like in the end.
12200:12:31,190 --> 00:12:32,320For example,
12300:12:32,330 --> 00:12:46,000someone who thinks that they might want to become a teacher will gain a lot of information about teaching by volunteering to teach a course at the community center every Saturday for four weeks.
12400:12:46,400 --> 00:12:53,440So they get a taste of what it feels like to instruct a small group of adults or Children.
12500:12:54,250 --> 00:13:03,460They get a taste for some of the paperwork or the communication demands in between the actual classes and instruction.
12600:13:04,229 --> 00:13:10,000Some people who love a particular topic and they think they might want to teach,
12700:13:10,030 --> 00:13:19,200end up realizing after some of these volunteer opportunities that the actual process of teaching is not something they love.
12800:13:22,530 --> 00:13:28,270Another important thing about this approach is that for some of the options.
12900:13:28,609 --> 00:13:35,520There's really not a high demand for in-person contact or being in crowded classrooms.
13000:13:36,059 --> 00:13:52,239Some individuals may feel that expanding their interests into well formed skills or offerings is most daunting because they really can't imagine themselves opening a whole storefront or running a restaurant full of people.
13100:13:52,640 --> 00:13:58,770But this approach can harness all of the online opportunities for learning,
13200:13:58,780 --> 00:13:59,909for creating,
13300:13:59,919 --> 00:14:05,880for selling through the internet while engaging in certain community events that you choose.
13400:14:06,159 --> 00:14:16,099You get to decide how much uh event based activity do I want to do in the community or how much do I want to travel?
13500:14:16,229 --> 00:14:23,330How much customer interaction do I want versus time to regroup in my own space?
13600:14:26,590 --> 00:14:31,000I'm a firm believer that your community needs your gifts,
13700:14:31,010 --> 00:14:32,159your knowledge,
13800:14:32,169 --> 00:14:40,070your passion and whatever area you find that in and finding ways to take steps to your passion,
13900:14:40,080 --> 00:14:42,229not only blesses you,
14000:14:42,440 --> 00:14:49,280but those around you and having ways of expressing that also is something that fills you up.
14100:14:49,619 --> 00:14:50,969I love creating.
14200:14:50,979 --> 00:14:51,929I love writing,
14300:14:51,940 --> 00:14:52,909I love running.
14400:14:52,919 --> 00:14:54,690I love sports statistics.
14500:14:54,960 --> 00:15:06,270We like to have some balanced way of allowing you to learn and grow in this area to feed that passion and to serve your community.
14600:15:09,030 --> 00:15:16,119Thank you so much for joining me for the sixth episode of the Living With Intention series.
14700:15:16,349 --> 00:15:27,099And I invite you to check out the show notes for links to opportunities mentioned in this episode and for links to other offerings on my website.
14800:15:27,349 --> 00:15:31,880And I hope that you join me for the next podcast episode.
-
Do you want to live with more intention to achieve your goals? In this 5th episode in a series on Intentional Living, Dr. Regan identifies ways to improve household interactions by attending to the needs of the group and establishing traditions and structured activities.
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:06,139 --> 00:00:06,480Hi,
200:00:06,489 --> 00:00:07,110everyone.
300:00:07,119 --> 00:00:12,170This is Doctor Regan joining you for an episode of Autism in the Adult podcast.
400:00:12,489 --> 00:00:14,970I'm the mom of a teen on the spectrum.
500:00:14,979 --> 00:00:17,500I have a doctorate in neuropsychology.
600:00:17,700 --> 00:00:20,790It's the field of brain behavior relationships.
700:00:20,909 --> 00:00:25,649And I'm the director of an autism diagnostic clinic for adolescents,
800:00:25,659 --> 00:00:29,149adults and aging adults in Central Illinois.
900:00:30,010 --> 00:00:30,459Today,
1000:00:30,469 --> 00:00:38,180you're joining me for the fifth episode in a series about living with intention making goals,
1100:00:38,189 --> 00:00:43,500shifting in areas of life to get you closer to where you would like to be.
1200:00:44,240 --> 00:00:55,540So there were two episodes about how to choose an area of life to target and how to approach change with some specific goals and strategies.
1300:00:56,009 --> 00:01:02,369We had episodes about improving regulation and about communicating and connecting.
1400:01:02,979 --> 00:01:09,629So today we have an episode focused on household living and the culture of the household.
1500:01:10,400 --> 00:01:10,690Now,
1600:01:10,699 --> 00:01:13,250before we dive into the topic for today,
1700:01:13,260 --> 00:01:20,519I want to invite you to check out the resources on my website at adult in geriatric autism dot com.
1800:01:20,959 --> 00:01:28,410There are posts and videos for many different types of listeners and learners including clinicians.
1900:01:29,019 --> 00:01:29,529Also,
2000:01:29,540 --> 00:01:31,610you may find one of my books helpful,
2100:01:31,620 --> 00:01:32,580many of you know,
2200:01:32,589 --> 00:01:39,069that my first book called Understanding Autism in Adults and Aging Adults is in the second edition.
2300:01:39,500 --> 00:01:40,589And if you don't know,
2400:01:40,599 --> 00:01:44,550I have a second book called Understanding Autistic Behaviors,
2500:01:44,559 --> 00:01:47,250which is more of a workbook format.
2600:01:47,540 --> 00:01:55,809So it explains the neurology ... kind of the neurologic-why of some of the behavioral patterns.
2700:01:55,819 --> 00:02:02,110And it outlines ways to work toward increased well-being if someone's in a season of struggle.
2800:02:04,419 --> 00:02:07,430So let's focus on household living.
2900:02:07,470 --> 00:02:16,449So I want to highlight this topic because many people talk to me about the complexities of living in a household with other people.
3000:02:16,949 --> 00:02:22,330Most often this has to do with spouses or partners or with couples who have Children.
3100:02:22,690 --> 00:02:27,350Not only is the individual trying to increase their own self awareness.
3200:02:27,360 --> 00:02:27,559You know,
3300:02:27,570 --> 00:02:29,050this is how I'm wired,
3400:02:29,059 --> 00:02:30,529this is what makes me tick,
3500:02:30,539 --> 00:02:31,770this is what I need.
3600:02:32,059 --> 00:02:33,830But in a household,
3700:02:33,860 --> 00:02:41,160this is really next level awareness because there's now this demand to be aware of yourself,
3800:02:41,169 --> 00:02:46,289multiple other people and the interplay between all of the people.
3900:02:46,500 --> 00:02:47,630And on top of that,
4000:02:47,639 --> 00:02:52,100the needs and interplay change from day to day and from life,
4100:02:52,110 --> 00:02:53,770season to life season.
4200:02:54,789 --> 00:03:00,240It's so so easy to default to this kind of household interaction.
4300:03:00,449 --> 00:03:02,039Stop doing that.
4400:03:02,050 --> 00:03:03,440Why are you doing that?
4500:03:03,449 --> 00:03:08,440I've told you 100 times to X Y Z.
4600:03:08,860 --> 00:03:09,800Oh my gosh,
4700:03:09,809 --> 00:03:12,440you are so loud,
4800:03:12,449 --> 00:03:21,630messy clingy and guess what this focus on telling people to be different every day is just not that effective.
4900:03:21,960 --> 00:03:27,679And that's why we find ourselves saying the same things every day over and over.
5000:03:27,690 --> 00:03:28,770And not only that,
5100:03:28,910 --> 00:03:35,339but these repetitive interactions cause a strain on the relationships in the household.
5200:03:35,369 --> 00:03:40,940And they create this kind of adversarial connection rather than a partnering connection.
5300:03:41,330 --> 00:03:50,050So the big message is I want you to be different now rather than I want to partner with you to make things better,
5400:03:50,110 --> 00:03:51,339better for you,
5500:03:51,350 --> 00:03:53,839better for me and better for the household.
5600:03:54,520 --> 00:04:01,009So let's talk about some specific areas of focus and strategy that might help.
5700:04:01,820 --> 00:04:05,509The first thing we're gonna talk about is focus on the other.
5800:04:05,889 --> 00:04:06,199Now,
5900:04:06,210 --> 00:04:07,690during the previous episode,
6000:04:07,699 --> 00:04:14,910we talked about the importance of expanding our awareness from only what do I need right now,
6100:04:14,919 --> 00:04:22,100which actually can be difficult to figure out to what does the other person need right now.
6200:04:22,399 --> 00:04:24,170And when we add that element,
6300:04:24,420 --> 00:04:28,109we can get away from this push and pull of,
6400:04:28,119 --> 00:04:31,769stop doing that to oh,
6500:04:31,779 --> 00:04:35,309things might be able to go smoother in this area.
6600:04:35,660 --> 00:04:42,910I wonder what the need is that's connected with that behavior and how could I support change?
6700:04:43,250 --> 00:04:46,109So as we're talking about households,
6800:04:46,119 --> 00:05:00,899this concept of focus on the other then becomes expanded and that makes things a little more complex but also much more important and potentially really helpful,
6900:05:00,950 --> 00:05:04,730especially if this becomes the culture of the household,
7000:05:04,760 --> 00:05:09,079meaning that this is how we do things it becomes more automatic.
7100:05:09,089 --> 00:05:13,880It becomes something that everyone's focusing on as best they can.
7200:05:14,980 --> 00:05:28,660Let's imagine that a gentleman who's on the autism spectrum is also a dad and a husband and he's coming home from work after what's been a really draining and complex day,
7300:05:29,059 --> 00:05:36,130he's had work demands but also lots of other layers of unexpected changes in his schedule,
7400:05:36,140 --> 00:05:38,230detours on the route home.
7500:05:38,600 --> 00:05:43,970There were lots of sensory overload moments and a disagreement with a work colleague.
7600:05:44,750 --> 00:05:51,579So he comes home and mom who is home with three kids is not on the spectrum,
7700:05:51,589 --> 00:05:55,070but she does have sensory processing sensitivities,
7800:05:55,200 --> 00:05:56,220stickiness,
7900:05:56,230 --> 00:05:58,529and kids hanging on her and noise.
8000:05:58,540 --> 00:06:02,600And she's getting to the point that that has been really overwhelming today.
8100:06:03,359 --> 00:06:05,149She is home with three kids.
8200:06:05,160 --> 00:06:21,200A daughter who is eight has been home from school with the stomach flu but is feeling better and is now running around the house in her tutu singing and spinning and waving her magic wand around an autistic son who is 11,
8300:06:22,160 --> 00:06:25,049is melting down while doing his math homework.
8400:06:25,070 --> 00:06:32,630And another son is 15 and is playing loud music in his room with the door shut.
8500:06:34,019 --> 00:06:35,790So the first approach,
8600:06:35,799 --> 00:06:41,040the one that is our most typical go to may look like this.
8700:06:41,549 --> 00:06:42,899Dad walks in.
8800:06:43,059 --> 00:06:46,480Mom is yelling at her two youngest kids to be quiet.
8900:06:46,660 --> 00:06:51,549She's juggling hot food in the kitchen while trying to get food ready for dinner.
9000:06:52,700 --> 00:06:58,130The youngest daughter runs up to dad and wants to show off her tutu and her magic wand.
9100:06:58,540 --> 00:07:03,549And dad hears the loud music coming from upstairs and mom is thinking,
9200:07:03,559 --> 00:07:06,059thank goodness he is home.
9300:07:06,220 --> 00:07:07,549I need some help.
9400:07:07,559 --> 00:07:14,130I need some relief and dad is thinking I can't wait to get out of here and go for my bike ride.
9500:07:16,299 --> 00:07:23,519So mom and dad get in a fight about how he comes home and goes off by himself and she's been there all day,
9600:07:23,529 --> 00:07:24,309et cetera.
9700:07:25,209 --> 00:07:28,279So dad feels the pressure to make things right.
9800:07:28,510 --> 00:07:30,950He yells at his oldest son saying,
9900:07:30,959 --> 00:07:34,070why don't you turn off your music and come down and help your mother.
10000:07:34,390 --> 00:07:40,850And he yells at the middle son and says that math really isn't that hard and he should stop crying.
10100:07:42,920 --> 00:07:55,970We all get that right like we are at the end of our rope and we just want to make the chaos stop and calm down and we want other people to do their part.
10200:07:58,119 --> 00:08:00,250Let's think about a second approach.
10300:08:01,019 --> 00:08:17,299This is increased awareness that all of these people have really legitimate needs and a realization that there needs to be a way to figure out what they are and then to try to work together to do something.
10400:08:19,170 --> 00:08:22,100Mom is overwhelmed with sensory inputs.
10500:08:22,109 --> 00:08:26,929She's drained from the whole day of being the only adult at home,
10600:08:27,079 --> 00:08:33,700which means that she has been the go to person for everyone's needs in the household.
10700:08:34,559 --> 00:08:37,588So she needs quiet alone time.
10800:08:37,838 --> 00:08:39,598She needs compliments,
10900:08:39,609 --> 00:08:41,059she needs support.
11000:08:41,900 --> 00:08:44,830The youngest daughter suddenly feeling better.
11100:08:45,239 --> 00:08:54,210She needs to run off some of her nonsick energy and be recognized as someone who's beautiful and magical with her wand.
11200:08:55,409 --> 00:08:59,330The middle son has also been very drained from the day.
11300:08:59,669 --> 00:09:06,080He gets overwhelmed with the social and sensory environment at school and he has a math learning disability.
11400:09:06,719 --> 00:09:17,369So he has gone from a draining environment to a draining environment and he's doing a task that he just knows he can't have success with.
11500:09:18,260 --> 00:09:21,840He's unable to get his bearings to calm,
11600:09:22,059 --> 00:09:23,469to reenter,
11700:09:23,479 --> 00:09:25,869he needs some regulation help.
11800:09:27,960 --> 00:09:39,880The oldest son is feeling the angst of being a teen and this comes with easy irritation thinking his parents don't know anything and the loud music releases some of his irritability.
11900:09:40,000 --> 00:09:43,450It establishes his identity as his own person.
12000:09:43,619 --> 00:09:46,969So that is a lot.
12100:09:49,590 --> 00:09:51,229In this case,
12200:09:51,900 --> 00:10:07,090it often helps to have some type of planned huddle uh between the couple or with the family about what is the status right now and what do you need?
12300:10:09,809 --> 00:10:18,659The huddle is just a coming together to talk briefly about what are we gonna do next?
12400:10:18,900 --> 00:10:20,820What's going on and what are we gonna do?
12500:10:21,979 --> 00:10:26,710The status is really high chaos for everyone in this family right now.
12600:10:27,979 --> 00:10:35,590And sometimes families make up kind of humorous labels for levels of chaos or crisis.
12700:10:35,880 --> 00:10:50,049One family might use a color code where a code red is the most chaos or sometimes a movie related code where the most chaos is the Lord of the Rings scene where the orcs come.
12800:10:51,070 --> 00:10:54,030The status could also be a factual description.
12900:10:54,190 --> 00:10:55,340Bad day at work,
13000:10:55,349 --> 00:10:57,619really drained or bad day at home,
13100:10:57,630 --> 00:10:58,539really drained.
13200:10:58,710 --> 00:11:02,919And I'm at my breaking point at the highest level of chaos.
13300:11:02,929 --> 00:11:05,309Both mom and dad really need alone time.
13400:11:05,669 --> 00:11:06,280Now,
13500:11:06,289 --> 00:11:07,820what do the kids need?
13600:11:08,450 --> 00:11:08,929Well,
13700:11:08,940 --> 00:11:11,000you may have a quick family huddle,
13800:11:11,320 --> 00:11:12,780what do you need?
13900:11:13,210 --> 00:11:21,960Or the parents may have a sense already of what the kids would probably need to regulate and regroup.
14000:11:22,349 --> 00:11:27,219One helpful thing in this scenario might look like the following.
14100:11:27,840 --> 00:11:36,130Dad could go on his bike ride but also take the 11 year old son who's on the autism spectrum on the ride as well.
14200:11:37,150 --> 00:11:42,070They both really feel better after they get some pressure input,
14300:11:42,080 --> 00:11:45,929that's proprioceptive input and movement input,
14400:11:45,940 --> 00:11:47,330vestibular input.
14500:11:47,669 --> 00:11:53,450You can see our episode about sensory inputs for regulation.
14600:11:54,070 --> 00:11:57,539And this is why the bike ride is so important.
14700:11:57,760 --> 00:12:03,200If we tell dad not to go on the bike ride because the house is in chaos,
14800:12:03,599 --> 00:12:07,409he's not going to be able to regulate himself.
14900:12:07,590 --> 00:12:09,849So we want a dad who comes back,
15000:12:09,859 --> 00:12:12,979regulated centered calm.
15100:12:13,239 --> 00:12:14,640Um not at,
15200:12:14,650 --> 00:12:15,890at the breaking point.
15300:12:16,539 --> 00:12:30,619This bike ride also gives time for their mind to settle and it's a kind of together activity where they actually don't have to talk So it's the thing they like to do and we're together,
15400:12:30,630 --> 00:12:36,780but we don't have to say anything and that's very calming and regulating for them.
15500:12:38,750 --> 00:12:40,349Perhaps in this scenario,
15600:12:40,359 --> 00:12:51,559mom chooses a bubble bath with headphones and music and gives the 15 year old a task to keep him busy and to acknowledge his independence.
15700:12:52,200 --> 00:13:01,650So there's a small corner store about three blocks away and she gives him $15 to walk to the corner store and to take the eight year old,
15800:13:03,049 --> 00:13:11,119the eight year old can spin and sing and walk with her wand and he gets to choose whatever he wants for,
15900:13:11,130 --> 00:13:13,539quote dessert for the family.
16000:13:14,460 --> 00:13:18,489He chooses lots of movie candy like now and laters,
16100:13:18,500 --> 00:13:21,059Mike and Ike and Swedish fish.
16200:13:21,070 --> 00:13:25,109And he lets his sister pick out a Princess Pez dispenser.
16300:13:25,700 --> 00:13:27,390Then they walk home,
16400:13:27,400 --> 00:13:29,330mom's done with their bath.
16500:13:29,340 --> 00:13:38,270Dad and son are home and this is a regrouping time that acknowledges as many people's needs as possible.
16600:13:38,609 --> 00:13:44,409And then there can be a huddle at that point about how the rest of the night might go.
16700:13:46,419 --> 00:13:54,750But we at least want to problem solve when as many people as possible are more centered and less close to the breaking point.
16800:13:57,289 --> 00:14:06,520So this focus and strategy is uh really pinpointing what other people need people in the household.
16900:14:06,869 --> 00:14:12,479And it uses the huddle concept to come together and make a plan.
17000:14:12,849 --> 00:14:14,979So it's a quick coming together.
17100:14:14,989 --> 00:14:16,690It's not like a family meeting,
17200:14:16,700 --> 00:14:18,739where we talk through things,
17300:14:18,859 --> 00:14:21,580it's what's going on and what do we need to do.
17400:14:23,190 --> 00:14:23,679Now,
17500:14:23,690 --> 00:14:26,760we all know that this doesn't make everything easy,
17600:14:26,780 --> 00:14:35,969but it often makes things better and it creates partnerships within the household rather than really strained relationships.
17700:14:40,070 --> 00:14:44,280Let's look at another approach to household culture.
17800:14:44,419 --> 00:14:51,020So the second one is focusing on tradition and structure in order to interact,
17900:14:52,859 --> 00:14:55,090individuals with autistic neurology,
18000:14:55,099 --> 00:15:04,099often prefer structured topic based activities rather than hanging out or sharing about their day or sharing about feelings.
18100:15:04,510 --> 00:15:10,869These are typically more enjoyable to them than just unstructured together time.
18200:15:12,219 --> 00:15:16,950It might involve harnessing their knowledge about something that they love.
18300:15:19,450 --> 00:15:25,099And once you know who in the family really likes this kind of interaction.
18400:15:25,109 --> 00:15:26,320And you can say,
18500:15:26,479 --> 00:15:29,049I know this is what we enjoy best.
18600:15:29,380 --> 00:15:35,059This awareness can help increase the number of nice family memories or interactions.
18700:15:35,380 --> 00:15:37,239So for example,
18800:15:37,250 --> 00:15:46,159let's take a family um who likes to socially connect at the dinner table by sharing about their day,
18900:15:46,380 --> 00:15:47,929how the practice went,
19000:15:47,940 --> 00:15:49,409how their soccer game?
19100:15:49,419 --> 00:15:53,669Did uh did your friend feel good about their science project?
19200:15:53,679 --> 00:15:56,809How is your boss's husband doing since his surgery,
19300:15:56,820 --> 00:15:57,510et cetera?
19400:15:58,900 --> 00:16:02,880In contrast to another family with neurodiversity,
19500:16:02,890 --> 00:16:03,359now,
19600:16:03,369 --> 00:16:10,299they may prefer something more structured and less about how people felt or responded,
19700:16:10,780 --> 00:16:14,119less open ended or broad questions about the day.
19800:16:14,340 --> 00:16:15,919So what might that look like?
19900:16:17,909 --> 00:16:25,080This family might start a tradition at the dinner table where they each share an interesting fact that they learned that day.
20000:16:25,159 --> 00:16:30,159So perhaps the eight year old learned that most fish don't have eyelids.
20100:16:30,580 --> 00:16:33,000The 15 year old learned that on average,
20200:16:33,010 --> 00:16:36,739every person on earth owns 86 Lego Bricks.
20300:16:40,210 --> 00:16:42,320Let's look at another example.
20400:16:42,330 --> 00:16:44,059Let's take a spouse.
20500:16:44,400 --> 00:16:56,059We're looking at a woman who feels dissatisfied because her husband doesn't engage in conversations during times like car rides or while at a restaurant and waiting on their meal.
20600:16:56,739 --> 00:17:03,609She's realized though that they can have a really good social interaction if it's structured about a topic.
20700:17:04,250 --> 00:17:12,939She's also noticed that they have a good time interacting if they take online quizzes or play trivia together during these times.
20800:17:13,660 --> 00:17:22,630So the passenger in the car can ask the driver trivia questions and then they can switch and she notices that they really end up laughing,
20900:17:22,640 --> 00:17:24,089they learn new things.
21000:17:24,099 --> 00:17:25,530It works out well.
21100:17:25,540 --> 00:17:28,380It's actually a really connecting time,
21200:17:28,689 --> 00:17:34,829uh much better than the silence of sitting together without interacting.
21300:17:37,680 --> 00:17:39,530Let's take a third family.
21400:17:39,619 --> 00:17:53,829This family has teens and it's been struggling because the kids are a bit more moody than they were as youngsters and they're too old for some of the things that they used to do as a family when they were younger.
21500:17:54,099 --> 00:17:54,380You know,
21600:17:54,390 --> 00:17:57,170they don't like going to the zoo anymore.
21700:17:58,119 --> 00:18:05,349This family realized that structuring some traditions for activities has worked better than small talk.
21800:18:05,359 --> 00:18:13,849Like how with school they might have a Friday night tradition of board games and pizza or they might rotate,
21900:18:13,859 --> 00:18:16,530who gets to pick the Friday night activity.
22000:18:16,979 --> 00:18:21,810One teen may pick a movie and chooses the snacks next week,
22100:18:21,819 --> 00:18:26,089another chooses a board game and challenges kids against parents.
22200:18:26,579 --> 00:18:31,229And the next week mom chooses a Lock Drew mystery for the family to solve together.
22300:18:32,780 --> 00:18:43,729So this approach harnesses the fact that individuals with autistic neurology may really enjoy each other within the context of some structure,
22400:18:43,739 --> 00:18:53,310topic and activity rather than these loose connecting moments or open ended questions like how is your day and what's going on in your life.
22500:18:56,209 --> 00:19:00,420There's so much that goes into the culture of a household.
22600:19:00,790 --> 00:19:18,670But these two tips of helping people get their needs met and coming together with structure and topic focused activities can be part of what helps shift things in a good direction for many families and it really protects those partnering kinds of relationships.
22700:19:19,989 --> 00:19:24,660Thank you for joining me today to talk about households and families,
22800:19:24,819 --> 00:19:27,060protecting the wellness of our family.
22900:19:27,069 --> 00:19:32,709Connections can help us feel more supported and resilient overall.
23000:19:33,530 --> 00:19:42,430And next time we will round out this series by focusing on adding meaning and growth to areas of special interest.
23100:19:42,619 --> 00:19:44,219I hope you can join me then.
-
Do you want to live with more intention to achieve your goals? In this 4th episode in a series on Intentional Living, Dr. Regan identifies ways to use communication to create connection and help you achieve the life goals you aim for.
Resources mentioned in the podcast:
Talking About Autism podcast series
The Science of Making Friends: book
Better Small Talk: book
Crucial Conversations: book
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:03,809 --> 00:00:04,659Hi there.
200:00:04,670 --> 00:00:06,679This is Doctor Theresa Regan.
300:00:06,969 --> 00:00:11,510I'm joining you for an episode of autism in the Adult podcast.
400:00:11,800 --> 00:00:13,619I'm a neuropsychologist,
500:00:13,859 --> 00:00:19,120the founder and director of an autism diagnostic clinic in Central Illinois.
600:00:19,290 --> 00:00:21,959And I'm the parent of a teen on the spectrum.
700:00:22,680 --> 00:00:27,440Did you know that I did a podcast series on talking about autism?
800:00:27,659 --> 00:00:30,420This was in February of 2022.
900:00:30,559 --> 00:00:43,909It had three episodes where I covered things like how to talk to other people about your journey to seek a diagnostic evaluation or how to tell people that you've received a new diagnosis of autism.
1000:00:44,340 --> 00:00:53,270We cover topics about how to process and navigate the emotions of other people during conversations about autism.
1100:00:53,909 --> 00:01:01,279And we also reviewed how to talk to someone that you are familiar with --someone in your family,
1200:01:01,290 --> 00:01:05,739someone that you know -- about the possibility that they are on the spectrum.
1300:01:06,089 --> 00:01:08,930Maybe they haven't thought about it that way,
1400:01:08,940 --> 00:01:12,319but you recognize some characteristics in them.
1500:01:13,010 --> 00:01:18,069I'm going to put a link to this series talking about autism in the show notes.
1600:01:18,599 --> 00:01:26,940But today you are joining me for episode number four in a series about intentional living on the autism spectrum,
1700:01:28,309 --> 00:01:33,629we all get into rhythms and routines that have a life of their own.
1800:01:33,900 --> 00:01:36,000Sometimes our schedules,
1900:01:36,010 --> 00:01:37,540what we typically do,
2000:01:37,550 --> 00:01:41,440what we don't do... things that crop up in our lives.
2100:01:41,449 --> 00:01:56,860They catch us up in their momentum and sometimes it's just nice to pause and to step back and really see if the life that we're living lines up with where we'd like to be in the future.
2200:01:57,389 --> 00:02:01,150Are we choosing this life?
2300:02:01,160 --> 00:02:07,860Are we being swept away without really pausing to make some choices and decisions?
2400:02:08,440 --> 00:02:14,639And certainly we can't have the final say in everything that our life entails.
2500:02:14,649 --> 00:02:22,020But we really will be able to capture more of our dreams and visions for the future
2600:02:22,029 --> 00:02:27,259if we pause and make choices that line up with those...
2700:02:27,690 --> 00:02:29,339those goals that we have.
2800:02:31,770 --> 00:02:38,740This need to pause and reevaluate our intentions and choices is a universal human need.
2900:02:39,470 --> 00:02:49,300But we're spending some time talking about this in the context of autism because sometimes the individual on the spectrum will struggle more with this,
3000:02:49,750 --> 00:03:03,759possibly because they have difficulty switching gears from the typical routine or maybe this individual has problems finding the energy or the momentum to get going with something new.
3100:03:04,820 --> 00:03:12,910This person may feel like it's challenging to get out of the hyper focus of the moment and to try to think long term.
3200:03:13,919 --> 00:03:16,889So in the first episode for this series,
3300:03:16,899 --> 00:03:25,009we talked about how to get to the point where you can actually choose a goal that is difficult in itself.
3400:03:26,360 --> 00:03:35,020We outlined several life categories that you could analyze to see if you would like to think of a goal in these categories.
3500:03:35,940 --> 00:03:36,190Now,
3600:03:36,199 --> 00:03:41,110the second episode was about how to make specific goals within a category.
3700:03:41,990 --> 00:03:50,080So we want the goal to help us shift from our current place and leave the boundaries of our comfort zone.
3800:03:50,440 --> 00:03:58,820But we don't want it to be overwhelming or self defeating because we picked a goal that's just too difficult,
3900:03:58,830 --> 00:03:59,720too big...
4100:03:59,960 --> 00:04:02,059feels insurmountable.
4200:04:03,929 --> 00:04:16,660The third episode in this series about living with intention had to do with strategies to reach goals within the area of health and wellness specifically with regulation.
4300:04:17,278 --> 00:04:25,069And this is often a good place to start in our lives when we're trying to grow and challenge ourselves.
4400:04:25,079 --> 00:04:29,028Because if we're setting goals,
4500:04:29,199 --> 00:04:34,989this is really us setting a goal to do difficult things.
4600:04:35,290 --> 00:04:39,399And if we're not regulated when we start these goals,
4700:04:39,410 --> 00:04:41,750if we're not feeling grounded,
4800:04:41,760 --> 00:04:42,859centered,
4900:04:42,869 --> 00:04:45,609calm and psychologically present,
5000:04:45,750 --> 00:04:47,880attentive and rested,
5200:04:48,480 --> 00:04:56,290it's really difficult to leave our comfort zone in any other area to really have intentional living.
5300:04:56,619 --> 00:05:04,480So it is often nice to make sure that we're really well regulated before we jump into any other goals.
5400:05:05,790 --> 00:05:16,679So now today you are listening to the fourth episode and we're going to focus on intentional living within communication and relationships.
5500:05:17,359 --> 00:05:21,399And you may be asking why do I need to have social goals?
5600:05:21,570 --> 00:05:22,010Well,
5700:05:22,019 --> 00:05:22,950you don't,
5800:05:23,149 --> 00:05:30,350your communication and your social network don't have to match any particular template that others use.
5900:05:30,420 --> 00:05:32,489But at the same time,
6000:05:32,500 --> 00:05:35,619if you have a vision for your future,
6100:05:36,269 --> 00:05:44,089you may need to grow in certain areas of communication or connection so that you can meet the goals that you do have.
6200:05:45,309 --> 00:05:46,640For example,
6300:05:46,649 --> 00:05:52,359one person may want to become a history teacher because they love history.
6400:05:52,959 --> 00:05:54,299That is a great goal.
6500:05:54,309 --> 00:05:59,600It's a way of sharing your love of a topic with other people.
6600:06:00,269 --> 00:06:04,579But you'll also need to have some skills for communication,
6700:06:04,589 --> 00:06:08,549updates with your work team and with your students and families.
6800:06:08,579 --> 00:06:11,079Maybe about projects or grades,
6900:06:11,350 --> 00:06:18,500you'll have to have communication skills to interact with people who are really upset with you or disagree with you.
7000:06:19,329 --> 00:06:26,329Maybe you'll be put in charge of a major project for the school and you'll have to present on the topic.
7100:06:27,269 --> 00:06:29,600If you already have these skills,
7200:06:29,609 --> 00:06:30,709that's super,
7300:06:30,720 --> 00:06:32,869you don't need to grow in this area.
7400:06:33,239 --> 00:06:43,220But if you don't focusing on this area of growth may help you in the future as you take your path toward your ultimate goals.
7500:06:44,989 --> 00:06:55,670Another example would be someone who's just retired and maybe they're finding it difficult to connect or get along with their partner now that they're both at home a lot.
7600:06:56,190 --> 00:07:01,600So perhaps this person has a goal to connect in a more effective way.
7700:07:01,709 --> 00:07:09,320She may have a goal for communication and connecting in the home with this new life season of retirement.
7800:07:11,369 --> 00:07:12,309In contrast,
7900:07:12,320 --> 00:07:15,920you may be someone who's all set in this area.
8000:07:16,170 --> 00:07:17,190But in the future,
8100:07:17,200 --> 00:07:26,429you may want to have some things tucked away for different tasks or goals that crop up along the way this episode may be for you.
8200:07:27,339 --> 00:07:39,309So let's focus on three things to keep in mind that may help you reach a goal for more effective communication and connection in a particular area of your life.
8300:07:40,220 --> 00:07:41,350And let's face it,
8400:07:41,359 --> 00:07:46,690you are probably already super good at communicating about topics,
8500:07:46,700 --> 00:07:47,929facts,
8600:07:47,940 --> 00:07:49,149details,
8700:07:49,380 --> 00:07:58,790things like teaching about history or telling your partner that we're out of milk and somebody's got to get this supply at the store.
8800:07:59,600 --> 00:07:59,910Well,
8900:07:59,920 --> 00:08:07,660the trickier area of communication more often shows up when we're in an interaction and we start thinking,
9000:08:07,670 --> 00:08:08,250wow,
9100:08:08,260 --> 00:08:10,339what just happened here?
9200:08:10,920 --> 00:08:16,299What did this person react to in this conversation?
9300:08:16,309 --> 00:08:18,799I'm not even sure where they're coming from.
9400:08:18,970 --> 00:08:21,399I don't know what this person wants from me.
9500:08:22,059 --> 00:08:23,109After all,
9600:08:23,119 --> 00:08:25,549I was right about what I said.
9700:08:26,040 --> 00:08:29,429So why all this emotion or all this up and down?
9800:08:30,100 --> 00:08:36,469Let's look at a few areas of focus that can balance out that connection piece.
9900:08:36,989 --> 00:08:38,070First of all,
10000:08:38,080 --> 00:08:42,669I want to introduce and bring more into your awareness,
10100:08:42,679 --> 00:08:45,349this focus on the other.
10200:08:46,200 --> 00:08:49,210So when you are communicating with someone,
10300:08:49,219 --> 00:08:51,409whether that is a history teacher,
10400:08:51,419 --> 00:08:55,380talking to a parent or a woman who's just retired,
10500:08:55,390 --> 00:08:56,710talking to her partner.
10600:08:57,080 --> 00:09:05,799There is a difference between communication that's factually correct and communication that is effective.
10700:09:07,400 --> 00:09:09,309It helps to be correct.
10800:09:10,020 --> 00:09:13,549But we also want communication that's more than correct.
10900:09:13,559 --> 00:09:15,630We want it to be productive,
11000:09:15,739 --> 00:09:16,489helpful,
11100:09:16,500 --> 00:09:18,710valuable and fruitful.
11200:09:19,380 --> 00:09:21,880So remember what your goals are,
11300:09:22,369 --> 00:09:36,729is your goal to strengthen your relationship with your partner? is your goal to be a history teacher? ...and all these other goals you might have where communication and connection are important to meet that goal.
11400:09:37,030 --> 00:09:52,440One way to improve the effectiveness of our communication is to be able to pause during an interaction and focus on the other person rather than on the topic.
11500:09:53,280 --> 00:09:55,710And sometimes to be honest,
11600:09:56,559 --> 00:10:03,530this whole interaction happens and we never pause and we're a bit surprised and taken aback.
11700:10:03,710 --> 00:10:08,690And we process things after that's OK too.
11800:10:09,489 --> 00:10:16,400The goal eventually will be able to pause and process a bit during the interaction to adjust.
11900:10:16,760 --> 00:10:22,270But we may start by analyzing and thinking through things after the fact,
12000:10:23,789 --> 00:10:26,580focus on the other person.
12100:10:26,590 --> 00:10:32,859So ask yourself things like what does this person need from me right now?
12200:10:33,369 --> 00:10:37,549Other than being correct about the facts,
12300:10:37,559 --> 00:10:38,150I'm saying,
12400:10:38,159 --> 00:10:44,359what do they need from me in the social conversation?
12500:10:46,299 --> 00:11:04,739Maybe they need to feel heard or they need you to understand how difficult their day has been or they need you to know and really recognize their contribution to the team even though you've decided to take the work project in another direction.
12600:11:05,359 --> 00:11:05,830Now,
12700:11:05,840 --> 00:11:11,169these kinds of wonderings and kind of exploring these questions,
12800:11:11,179 --> 00:11:17,400this could be something that we do in a counseling or therapy session really in depth,
12900:11:17,409 --> 00:11:17,979right?
13000:11:18,250 --> 00:11:24,849So if you are trying to um process your relationship with your partner,
13100:11:24,979 --> 00:11:29,270maybe you process interactions with a therapist.
13200:11:29,719 --> 00:11:38,489But there are also probably a few things to say during these interactions that might help um you focus on the other,
13300:11:38,669 --> 00:11:40,450the other person's needs.
13400:11:41,150 --> 00:11:43,260So you could say things like,
13500:11:43,510 --> 00:11:51,989tell me more about how you're doing and what I can do to help? if somebody has come up to you and they're upset,
13600:11:52,010 --> 00:11:53,450they're emotional,
13700:11:53,700 --> 00:11:56,630they're in really a confrontational moment.
13800:11:57,479 --> 00:12:05,929-- Letting them know that you'd like to know how they're doing and what you can do to help ... can be a connecting moment.
13900:12:07,650 --> 00:12:14,340What do you want me to know that you feel like I don't understand about what your experience is.
14000:12:15,489 --> 00:12:18,020What are your needs in this situation?
14100:12:18,030 --> 00:12:25,270Tell me what you need... or I really value you and I do want to be part of the solution,
14200:12:25,280 --> 00:12:26,530not the problem.
14300:12:28,989 --> 00:12:32,109Do you need to say these specific words?
14400:12:32,169 --> 00:12:32,840No,
14500:12:33,109 --> 00:12:40,169it's important to make them your own and to match them to the person that you're talking to in the context.
14600:12:40,179 --> 00:12:54,169But the sentiment is there that you want good things to come out of this conversation that you want to know where they're coming from and what you can do um to advance things,
14700:12:54,179 --> 00:12:54,849support them,
14800:12:54,859 --> 00:12:56,070make things better.
14900:12:58,150 --> 00:13:05,010The basic idea is to pause and to ask for input about what they need in this situation.
15000:13:05,380 --> 00:13:09,359And it doesn't mean you have to change your opinion or your decisions.
15100:13:09,369 --> 00:13:16,159But in the midst of factual things like projects and chores making plans,
15200:13:16,169 --> 00:13:23,619there's still value that is found in recognizing the needs of the other during these interactions.
15300:13:24,030 --> 00:13:31,809And that can help bridge the gap from conversation that is factual to conversation,
15400:13:31,820 --> 00:13:33,460that is effective.
15500:13:33,909 --> 00:13:36,419The second thing I'd like you to keep in mind.
15600:13:36,429 --> 00:13:45,219And this is also a way of focusing on connecting with the other is the use of compliments and gratitude.
15700:13:46,400 --> 00:13:55,640This is another way that we can attend to the person and set the stage for the communication and the relationship.
15800:13:56,309 --> 00:14:00,119So some would say this person's only doing their job,
15900:14:00,130 --> 00:14:03,520why do I have to compliment them or thank them?
16000:14:03,830 --> 00:14:05,400I don't need that.
16100:14:05,460 --> 00:14:06,460I don't want that.
16200:14:06,469 --> 00:14:07,859I don't even like that.
16300:14:09,039 --> 00:14:17,140But this is a relatively easy thing that helps attend to what the other person needs even if you don't need it.
16400:14:17,489 --> 00:14:22,489So it sets the stage for people to understand how you view them.
16500:14:23,099 --> 00:14:26,729And when difficult things do happen in the relationship,
16600:14:26,750 --> 00:14:33,030the way that we interpret those may have to do with how this stage has been set in the past.
16700:14:33,179 --> 00:14:34,150For example,
16800:14:34,159 --> 00:14:40,770if is this a person who really knows for multiple examples in the past that you value them.
16900:14:41,070 --> 00:14:45,000And therefore this glitch in communication or this disagreement,
17000:14:45,289 --> 00:14:46,669it's tough,
17100:14:47,150 --> 00:14:50,669maybe it's unpleasant but it's not monumental.
17200:14:51,500 --> 00:14:56,039Or is this someone who really doesn't know that you value them?
17300:14:56,049 --> 00:15:00,760And therefore every communication glitch is really a big deal.
17400:15:01,109 --> 00:15:04,580So compliments and gratitude set the stage.
17500:15:04,590 --> 00:15:07,260This is how I think about you.
17600:15:07,270 --> 00:15:09,419This is how I think about our team.
17700:15:09,479 --> 00:15:10,080Again,
17800:15:10,090 --> 00:15:11,140I see you,
17900:15:11,200 --> 00:15:16,099I value you and it doesn't have to be mushy and emotional.
18000:15:16,109 --> 00:15:18,840It should fit the context and the person.
18100:15:19,070 --> 00:15:19,789But again,
18200:15:19,799 --> 00:15:28,119just a very uh brief uh effective way of adding to that connection during communication.
18300:15:29,119 --> 00:15:32,179Let's talk about two levels of compliment.
18400:15:32,419 --> 00:15:40,890One is a compliment about a skill or achievement and one is a compliment about a personal attribute.
18500:15:41,530 --> 00:15:44,820So the second one is really a higher level.
18600:15:45,080 --> 00:15:52,830Um and it gives a stronger message that I see you and I value you,
18700:15:52,900 --> 00:15:56,789not only do I see your product and I appreciate the product,
18800:15:56,799 --> 00:16:00,590but I see the person that produced that and,
18900:16:00,599 --> 00:16:03,210and I value your contribution.
19000:16:04,179 --> 00:16:04,440Now,
19100:16:04,450 --> 00:16:11,880they're both powerful and you can choose the type that you use based on how well you know the person,
19200:16:11,890 --> 00:16:17,549what your goal is in that social interaction and what else is happening in the context.
19300:16:18,559 --> 00:16:19,530For example,
19400:16:19,539 --> 00:16:26,830a partner who's trying to improve his relationship with his spouse could either say this is a delicious dinner.
19500:16:26,840 --> 00:16:33,270It's great to come home after all these pressured meetings to a really pleasant meal.
19600:16:33,280 --> 00:16:35,549And I thank you so much for fixing it.
19700:16:36,700 --> 00:16:47,549That would be a really nice way to set the relationship stage that you see the work that went into this and you've enjoyed the meal and you're grateful.
19800:16:48,489 --> 00:16:48,900Now,
19900:16:48,909 --> 00:16:53,099if it's a partner use this next level of compliment,
20000:16:53,559 --> 00:17:04,060he may have said you are such a great cook and you seem to know just what would help me unwind from a long and pressured day at work.
20100:17:04,069 --> 00:17:06,140I so appreciate that about you.
20200:17:07,819 --> 00:17:14,420Compliments and thank yous this gratitude and acknowledgement of the other,
20300:17:14,739 --> 00:17:17,199what they've brought the skill sets,
20400:17:17,209 --> 00:17:19,609they have individual attributes.
20500:17:19,930 --> 00:17:27,670This can all help set the stage for a relationship that the other person feels safe and happy with.
20600:17:32,109 --> 00:17:36,300The third way of adding to this communication,
20700:17:36,310 --> 00:17:49,010that's not only factual but also effective is to think about to identify and discuss topics and life events that are important to the other person,
20800:17:49,290 --> 00:17:51,800even when they are not important to you,
20900:17:51,810 --> 00:17:54,119you really honestly don't care about them.
21000:17:55,420 --> 00:17:56,170But again,
21100:17:56,180 --> 00:17:59,310we're looking for communication that's effective.
21200:17:59,349 --> 00:18:11,849And you're choosing those moments when you are really working toward your longer term goals that I do want to have a better work team relationship.
21300:18:11,859 --> 00:18:16,250I do want to be able to be an effective teacher.
21400:18:16,569 --> 00:18:29,770So listen for things that are important to the other person and this might be things about their family it's good to know with people that you see or work with on a regular basis.
21500:18:29,780 --> 00:18:31,449What's their partner's name?
21600:18:31,459 --> 00:18:32,829What are their kids' names?
21700:18:32,839 --> 00:18:35,770What family are they interacting with?
21800:18:35,780 --> 00:18:37,280Who do they live with?
21900:18:37,420 --> 00:18:41,880Maybe they're talking about taking their son to his soccer tournament this weekend.
22000:18:43,329 --> 00:18:47,650This may be topics that they're passionate about but you are not.
22100:18:48,040 --> 00:18:55,550Maybe they love sci-fi movies or quilting might even be milestones in their life.
22200:18:55,560 --> 00:18:59,459It could be that they've had a birthday recently or a marriage anniversary.
22300:18:59,910 --> 00:19:04,699Maybe they've moved into a new apartment or purchased their first home.
22400:19:05,670 --> 00:19:08,849Even though these things are not important to you,
22500:19:09,140 --> 00:19:18,819they are important to the other and connecting in a more effective way with this person is part of your intentional life choice.
22600:19:19,500 --> 00:19:27,630You may consider making an effort to interact with this person once a week or once a month just to ask about things that are important to them.
22700:19:28,849 --> 00:19:34,180You don't have to know about the topic in order to bring it up in conversation.
22800:19:34,329 --> 00:19:35,579So people will say,
22900:19:35,589 --> 00:19:36,119well,
23000:19:36,150 --> 00:19:39,599not only do I not know about sci-fi movies,
23100:19:39,609 --> 00:19:44,859but I'm really not at all interested and I don't know what I would say.
23200:19:45,969 --> 00:19:47,300Um That's ok,
23300:19:47,829 --> 00:19:49,219this is about them.
23400:19:49,229 --> 00:19:54,540The goal is not to add content and correct factual information.
23500:19:54,550 --> 00:20:03,560The goal is to connect effectively and to set the stage of connection and you can do that without any factual knowledge.
23600:20:04,680 --> 00:20:08,869So you could say I don't know much about that topic.
23700:20:09,329 --> 00:20:09,349Uh,
23800:20:09,359 --> 00:20:11,550what do you like most about it?
23900:20:11,729 --> 00:20:13,750What first got you interested in,
24000:20:14,270 --> 00:20:15,489in that area?
24100:20:16,180 --> 00:20:18,310What's coming up related to that topic?
24200:20:18,319 --> 00:20:18,410So,
24300:20:18,420 --> 00:20:22,829let's say this is the sci-fi lover and you might say,
24400:20:22,839 --> 00:20:23,369hey,
24500:20:23,510 --> 00:20:26,630any big movies coming up that you're gonna go see.
24600:20:27,290 --> 00:20:28,660I'm not,
24700:20:28,670 --> 00:20:28,920um,
24800:20:28,930 --> 00:20:30,920up on what's at the movie theater.
24900:20:31,260 --> 00:20:31,579Um,
25000:20:31,589 --> 00:20:42,010so then this invites them to talk about their favorite topic And then later you could ask them how the movie was or someone who has,
25100:20:42,020 --> 00:20:42,319um,
25200:20:42,329 --> 00:20:52,209a real love for fish tanks and fish and little um villages in the fish tank that they build.
25300:20:52,219 --> 00:20:53,170Um You could say,
25400:20:53,180 --> 00:20:53,420hey,
25500:20:53,430 --> 00:20:55,920any new fish in your fish tank lately,
25600:20:55,930 --> 00:20:57,229what if you got that's new?
25700:20:57,239 --> 00:20:58,510Do you have a picture?
25800:20:59,290 --> 00:21:04,520So the purpose is not to contribute to a topic.
25900:21:04,530 --> 00:21:06,969The purpose is not to be correct.
26000:21:07,000 --> 00:21:09,329The purpose is to say,
26100:21:09,339 --> 00:21:09,739hey,
26200:21:09,750 --> 00:21:10,500I see you.
26300:21:10,510 --> 00:21:11,500I hear you.
26400:21:11,839 --> 00:21:16,969Um And I'm really acknowledging what's important to you.
26500:21:17,359 --> 00:21:18,319You could say,
26600:21:18,329 --> 00:21:18,540hey,
26700:21:18,550 --> 00:21:21,260how did the move to your new apartment go this weekend?
26800:21:21,270 --> 00:21:22,959Did you get hit with the rain?
26900:21:24,160 --> 00:21:28,770You can acknowledge what a big job it is to move and say,
27000:21:28,780 --> 00:21:29,140hey,
27100:21:29,150 --> 00:21:31,209I hope you feel settled in soon.
27200:21:31,859 --> 00:21:33,250You could say,
27300:21:33,260 --> 00:21:35,650how did your son's soccer tournament go?
27400:21:35,969 --> 00:21:37,550Did he feel good about it?
27500:21:38,199 --> 00:21:41,689Did you get to visit any interesting places or?
27600:21:41,699 --> 00:21:44,109I'm so glad you guys have that opportunity.
27700:21:44,219 --> 00:21:45,790What a big commitment that is,
27800:21:45,800 --> 00:21:56,670but I'm sure you'll have lots of great memories and perhaps you set a goal where you're going to ask someone on your work team,
27900:21:56,680 --> 00:22:04,550a follow up question once a week or three times a week and you're gonna rotate people.
28000:22:05,400 --> 00:22:16,810This is a way to make the goal real and to keep that intentionality in mind while working toward the goals that you do have.
28100:22:17,229 --> 00:22:17,579Now,
28200:22:17,589 --> 00:22:22,260there is so much we could cover about communicating and connecting.
28300:22:22,599 --> 00:22:29,119But hopefully this episode gives you some concrete things to use today in your relationships.
28400:22:29,380 --> 00:22:36,319We've reviewed the importance of pausing during an interaction to think about or ask the person what they need.
28500:22:36,790 --> 00:22:45,790We reviewed types of compliments and ways of expressing gratitude and how these can set the stage for helping with future interactions.
28600:22:46,280 --> 00:22:57,229And we reviewed that acknowledging what topics and life events are important to the other person can also really increase the value and fruitfulness of an interaction.
28700:22:58,829 --> 00:23:03,979If you want to dive deeper into communication and connection topics,
28800:23:04,199 --> 00:23:06,560there are great resources out there.
28900:23:07,050 --> 00:23:07,420Now,
29000:23:07,430 --> 00:23:11,130I don't have any financial interest in any of these products.
29100:23:11,170 --> 00:23:16,859I'm just offering some ideas of things that have helped or helped my clients in the past.
29200:23:17,619 --> 00:23:25,219I've linked some of my favorites in the show notes and one is a great book called The Science of Making Friends,
29300:23:25,250 --> 00:23:30,760which highlights strategies from the peers program that's out of U C L A.
29400:23:31,160 --> 00:23:34,910And there are chapters on finding and choosing good friends,
29500:23:35,339 --> 00:23:37,579elements of good conversations,
29600:23:37,949 --> 00:23:39,680dealing with arguments,
29700:23:39,689 --> 00:23:41,290handling and addressing,
29800:23:41,300 --> 00:23:43,569teasing and cyberbullying,
29900:23:43,890 --> 00:23:48,239minimizing rumors and gossip and changing a bad reputation.
30000:23:48,589 --> 00:23:48,959Now,
30100:23:48,969 --> 00:23:53,699this is a book that's focused on an audience of teens and young adults.
30200:23:54,239 --> 00:24:00,270I like to take those kind of books and apply the basic concepts to whatever age group I'm working with.
30300:24:00,489 --> 00:24:03,550But if you really don't relate to books in that way,
30400:24:03,560 --> 00:24:09,130and it's going to be distracting if people in the examples are from a different generation,
30500:24:09,199 --> 00:24:10,989that book may not be for you.
30600:24:11,479 --> 00:24:16,920There are also well known books such as Better Small Talk by Patrick King,
30700:24:17,319 --> 00:24:25,550How To Win Friends and Influence people by Dale Carnegie and Crucial Conversations by multiple people,
30800:24:25,560 --> 00:24:27,959Joseph Granny Carri Patterson,
30900:24:28,000 --> 00:24:30,569Ron mcmillan and Switzer.
31000:24:31,390 --> 00:24:40,640This book is a great tool to expand your skills at persuasion without being abrasive and to engage in conversations.
31100:24:40,650 --> 00:24:44,439Even when emotions are really running high,
31200:24:44,770 --> 00:24:46,979we're gonna need to know how to do that.
31300:24:46,989 --> 00:24:51,859If we're gonna be in connecting relationships that are really fruitful.
31400:24:52,339 --> 00:24:58,449There are many other great sources out there as well and I encourage you to find some that speak to you.
31500:24:58,530 --> 00:24:58,839Well,
31600:24:58,849 --> 00:25:04,819thanks again for joining me for this fourth episode of The Living With Intention Series.
31700:25:04,849 --> 00:25:10,410If you have goals that require you to expand your repertoire for communicating and connecting,
31800:25:10,589 --> 00:25:15,030I hope these tips and resources are a great place to start.
31900:25:15,819 --> 00:25:22,310Join me next time as we continue this series about intentional living on the autism spectrum.
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Want to live with more intention in order to achieve your goals? You may wish to start with steps to improve your core resilience so you can challenge yourself in other life areas. In this third episode in a series on intentional living, Dr. Regan identifies ways to improve resilience by using physical inputs to calm and center the nervous system.
As referenced in the current episode:
Dr. Regan's Zur Institute courses for clinicians
Autism in the Adult regulation series- episode one
The Alert Program
The Alert Program: Your Best Self Online Course
Dr. Regan's Resources
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:05,710 --> 00:00:06,119Hi,
200:00:06,130 --> 00:00:06,800everyone.
300:00:06,809 --> 00:00:11,319This is Dr Regan, host of the podcast Autism in the Adult.
400:00:11,539 --> 00:00:13,239I'm a neuropsychologist,
500:00:13,250 --> 00:00:17,729a certified autism specialist and mom to a teen on the spectrum.
600:00:18,149 --> 00:00:25,360It's my great pleasure to direct an autism diagnostic clinic in Central Illinois for adolescents,
700:00:25,370 --> 00:00:27,360adults and aging adults.
800:00:27,790 --> 00:00:32,139If you are a clinician wanting to increase your knowledge of autism,
900:00:32,150 --> 00:00:34,259in order to better serve your clients,
1000:00:34,490 --> 00:00:38,250you may want to check out my courses at Zur Institute,
1100:00:38,349 --> 00:00:40,409Z U R Institute.
1200:00:40,759 --> 00:00:44,880The links will be in the show notes for this podcast episode.
1300:00:45,520 --> 00:00:48,130If you're a regular follower of the podcast,
1400:00:48,139 --> 00:00:54,569you will know that we are in the third episode in a series about living with intention on the spectrum.
1500:00:55,400 --> 00:01:00,009I would encourage you to listen to the first two episodes to get the most information.
1600:01:00,139 --> 00:01:03,849Although this episode can be stand alone as well.
1700:01:04,300 --> 00:01:04,750Today,
1800:01:04,760 --> 00:01:10,569we'll be talking about a goal within the area of health and wellness and specifically,
1900:01:10,580 --> 00:01:16,230we're going to focus on improving regulation using sensory inputs.
2000:01:16,389 --> 00:01:16,699Now,
2100:01:16,709 --> 00:01:21,449I have several other episodes about regulation and I'll link them in the show notes,
2200:01:21,900 --> 00:01:33,330but in short regulation refers to the ability to stay centered balanced to get that just right state to be both calm and attentive.
2300:01:33,339 --> 00:01:34,349At the same time,
2400:01:35,419 --> 00:01:38,050this regulation can look like a meltdown,
2500:01:38,059 --> 00:01:39,209a panic attack,
2600:01:39,220 --> 00:01:44,309an outburst or it could look like withdrawal from a place or activity.
2700:01:44,319 --> 00:01:45,230For example,
2800:01:45,239 --> 00:01:50,510I need to quit this conversation or I need to go to my room off by myself.
2900:01:50,519 --> 00:01:52,180I can't attend work today.
3000:01:52,190 --> 00:01:53,519I can't go to school.
3100:01:54,300 --> 00:01:56,809It can also look like freeze,
3200:01:57,209 --> 00:02:01,470like shutting down feeling offline or dissociating.
3300:02:02,309 --> 00:02:03,080And finally,
3400:02:03,089 --> 00:02:13,020disregulation can look like the experience of physical symptoms that are not rooted or at least not completely caused by a physical condition,
3500:02:13,250 --> 00:02:15,520injury or disease process.
3600:02:16,020 --> 00:02:21,479Individuals on the spectrum are more likely to struggle with dysregulation in some form.
3700:02:21,789 --> 00:02:30,639Although what the dysregulation looks like can be different from one person to the next and can also change over the lifespan of the individual.
3800:02:30,649 --> 00:02:52,699So we can see how important the wellness topic of regulation is and why we're talking about regulation as a goal first because for some people on the spectrum regulation needs to improve before they can experience enough resiliency to get out of their comfort zone in other areas of life,
3900:02:52,710 --> 00:02:58,130like relationships or working or other areas that we've discussed in the series.
4000:02:58,139 --> 00:02:58,860So far,
4100:02:59,470 --> 00:03:08,910the tricky thing is that there are often more limitations to the success of regulation strategies on the spectrum than for the neurotypical.
4200:03:09,089 --> 00:03:17,360And the go to strategies are often some combination of counseling or talking through the difficulty,
4300:03:17,369 --> 00:03:20,089maybe reasoning through problems,
4400:03:20,339 --> 00:03:27,479we might add medication for the support of regulation or use punishment and reward programs.
4500:03:28,350 --> 00:03:38,270It's not that there's anything wrong with these approaches and they can be helpful as part of a layer in an overall program to help with regulation.
4600:03:38,279 --> 00:03:39,470However,
4700:03:39,750 --> 00:03:42,919if these are the only approaches we're relying on,
4800:03:42,970 --> 00:03:46,100there are likely to be some pretty big limitations.
4900:03:47,050 --> 00:03:49,550So let's think about how the nervous system works.
5000:03:49,559 --> 00:03:52,699If an infant is screaming,
5100:03:52,710 --> 00:03:54,500relentlessly crying,
5200:03:54,509 --> 00:03:55,500very upset,
5300:03:55,509 --> 00:03:57,029can't calm down.
5400:03:57,320 --> 00:03:58,039In other words,
5500:03:58,050 --> 00:03:59,660they can't regulate.
5600:04:00,460 --> 00:04:05,610We don't try to reason with them about how they're completely safe.
5700:04:05,619 --> 00:04:07,509They've just been fed,
5800:04:07,520 --> 00:04:12,589they're not in any danger or that their crying is really too loud.
5900:04:12,600 --> 00:04:13,869It's bedtime.
6000:04:14,690 --> 00:04:17,260We don't go reasoning through all that.
6100:04:17,998 --> 00:04:23,368We don't give them medication for depression or for anxiety.
6200:04:23,959 --> 00:04:28,348We don't use rewards or punishments in the traditional sense.
6300:04:28,799 --> 00:04:29,239Again,
6400:04:29,248 --> 00:04:31,928it's not that I don't recommend these approaches.
6500:04:31,938 --> 00:04:34,588I think they can be very helpful at times.
6600:04:34,598 --> 00:04:40,098But I'm pointing out that there is another way for humans to regulate their nervous system.
6700:04:40,378 --> 00:04:43,428And if you picture what we do for the infant,
6800:04:44,070 --> 00:04:46,149we hold them.
6900:04:46,359 --> 00:05:02,649Sometimes we swaddle the infant in a blanket and the holding or swaddling gives them pressure inputs that gives them this snug hug and then what do we do?
7000:05:02,660 --> 00:05:02,920Well,
7100:05:02,929 --> 00:05:09,059typically we rack them and this gives their brain some movement to input.
7200:05:10,410 --> 00:05:13,260This isn't always a magic way of calming an infant.
7300:05:13,269 --> 00:05:18,619But it often helps quite a bit as an approach to help the infant regulate,
7400:05:18,630 --> 00:05:19,820to center,
7500:05:19,920 --> 00:05:21,470to feel calm.
7600:05:21,630 --> 00:05:26,179Because the infant relies on the adult for regulation.
7700:05:26,730 --> 00:05:29,140This approach of using pressure,
7800:05:29,420 --> 00:05:34,540which we call proprioceptive inputs and movement.
7900:05:34,579 --> 00:05:35,579In this case,
8000:05:35,589 --> 00:05:38,799I'm talking about vestibular inputs.
8100:05:39,170 --> 00:05:48,589This approach of getting these inputs into the nervous system helps people of all ages and with all variations of nervous connections,
8200:05:48,600 --> 00:05:49,859nervous systems,
8300:05:50,410 --> 00:05:53,359uh whether you are neurotypical,
8400:05:53,369 --> 00:05:55,850whether you are neuro diverse,
8500:05:55,859 --> 00:05:57,380it doesn't matter we do.
8600:05:57,390 --> 00:05:59,890This is how our nervous system works.
8700:06:00,049 --> 00:06:08,470That's why therapists working with little kids on regulation may have them do heavy work like carrying or pushing something heavy.
8800:06:08,690 --> 00:06:10,679That's for the pressure input.
8900:06:11,630 --> 00:06:15,489It's why some individuals like weighted blankets for calming,
9000:06:15,750 --> 00:06:17,679that's pressure as well.
9100:06:18,480 --> 00:06:22,820Other individuals like to ride their bike after work or go jogging.
9200:06:22,970 --> 00:06:23,279Well,
9300:06:23,290 --> 00:06:25,179that's movement input.
9400:06:25,290 --> 00:06:34,579So we all tap into some of these inputs without really realizing why we like them or what role they have in helping us feel centered.
9500:06:34,790 --> 00:06:35,309Today,
9600:06:35,320 --> 00:06:47,570we'll focus on increasing your awareness of what your nervous system may need as far as physical inputs to help with regulation as well as how and when to use them.
9700:06:48,450 --> 00:06:58,929One place to start can be to think about what you have historically been drawn to perhaps as a child or in school or most recently,
9800:06:59,600 --> 00:07:03,250you can get pressure in the muscles or the joints,
9900:07:03,260 --> 00:07:11,390proprioceptive inputs into the brain pressure in the muscles could be from a massage or laying in a hammock.
10000:07:11,399 --> 00:07:13,579You get that squeeze input,
10100:07:14,049 --> 00:07:16,429laying under a weighted blanket,
10200:07:16,779 --> 00:07:20,070draping over an exercise ball,
10300:07:20,679 --> 00:07:22,609curling up in a chair.
10400:07:22,619 --> 00:07:25,950When we say I just want to curl up and read a good book.
10500:07:26,320 --> 00:07:28,140That's when we're giving ourselves,
10600:07:28,149 --> 00:07:43,269that kind of squeeze input being in the fetal position helps us have that squeeze hugs or bear hugs can give us that input laying on the ground or flapping on the ground.
10700:07:43,869 --> 00:07:48,160Pressure into the joints could be from things like pushing,
10800:07:48,190 --> 00:07:49,000pulling,
10900:07:49,010 --> 00:07:49,950hanging,
11000:07:50,329 --> 00:07:54,200anything that offers resistance through the joints,
11100:07:54,829 --> 00:07:56,970hanging from a pull up bar,
11200:07:56,980 --> 00:07:58,559shoveling snow,
11300:07:58,709 --> 00:07:59,750swimming,
11400:08:00,019 --> 00:08:03,670stretching a Farrah band or resistance band,
11500:08:04,079 --> 00:08:08,959riding a bike pressure through the jaw by chewing,
11600:08:08,970 --> 00:08:14,140resistive foods can also be pressure input for the nervous system.
11700:08:14,459 --> 00:08:29,549Maybe somebody loves to attack some beef jerky or crunchy food or chew gum pressure through the hands or feet by using a stress ball or rolling your foot over a tennis ball.
11800:08:30,959 --> 00:08:34,729You'll get the most input for the nervous system.
11900:08:34,770 --> 00:08:37,530When you're doing whole body activities,
12000:08:37,539 --> 00:08:40,890then when you're using the jaw or hands and feet,
12100:08:41,119 --> 00:08:44,390but we can't always do whole body activities.
12200:08:44,789 --> 00:08:56,200Maybe we're in a classroom and all we can do is have some gum that we're gonna chew on and maybe squeeze a stress ball under the desk movement.
12300:08:56,210 --> 00:09:02,099Input like the rocking baby gives vestibular input into the brain,
12400:09:02,789 --> 00:09:08,140the brain does not get vestibular input when we move our arms and legs,
12500:09:08,150 --> 00:09:10,619but we stand or sit still.
12600:09:11,049 --> 00:09:13,049There's no vestibular input.
12700:09:13,059 --> 00:09:14,479When we're on a treadmill,
12800:09:14,489 --> 00:09:15,590for example,
12900:09:15,880 --> 00:09:18,700or we're using a stationary bike,
13000:09:19,299 --> 00:09:22,369the fluid in our ears has to be moving.
13100:09:22,559 --> 00:09:24,739So when we're moving through space,
13200:09:24,750 --> 00:09:26,719like running through the neighborhood,
13300:09:26,729 --> 00:09:29,450swinging or riding a bike outside,
13400:09:29,530 --> 00:09:32,059then we're getting vestibular input.
13500:09:32,849 --> 00:09:34,700So those who say,
13600:09:34,710 --> 00:09:34,900oh,
13700:09:34,909 --> 00:09:36,539I love riding my bike,
13800:09:36,549 --> 00:09:39,349but I will not ride a stationary bike.
13900:09:39,520 --> 00:09:44,690What they may be saying is that their nervous system really needs that movement,
14000:09:44,700 --> 00:09:47,890that vestibular input through space.
14100:09:48,950 --> 00:09:53,469There are three types of vestibular input linear.
14200:09:54,030 --> 00:09:57,369So going in a relatively straight line,
14300:09:57,380 --> 00:10:00,690like if you're jumping up and down on a trampoline,
14400:10:00,840 --> 00:10:06,750swinging front and back or rocking left and right or front to back,
14500:10:07,650 --> 00:10:10,919rotary is spinning or twirling.
14600:10:10,929 --> 00:10:14,020That's the second kind of vestibular input.
14700:10:14,710 --> 00:10:19,919And the third kind are inversions which involves being upside down,
14800:10:19,929 --> 00:10:21,840like hanging upside down,
14900:10:21,849 --> 00:10:26,429doing a forward bend or doing a down dog position.
15000:10:26,440 --> 00:10:27,080In yoga.
15100:10:27,900 --> 00:10:31,719The movement inputs can be alerting or calming,
15200:10:31,859 --> 00:10:35,929intense or gentle as an individual.
15300:10:35,940 --> 00:10:40,390You can see what helps your nervous system at any given time.
15400:10:40,799 --> 00:10:45,210Someone who wants to feel calm or may want to rock in a rocking chair,
15500:10:45,940 --> 00:10:57,330sometimes people like to ride in the car and that just helps them feel centered and calm babies or little kids might fall asleep in the car.
15600:10:57,340 --> 00:11:01,530Even when they were so upset when they were actually getting in the car,
15700:11:01,809 --> 00:11:07,580another person may really feel calmer when they've been swinging again.
15800:11:07,590 --> 00:11:15,320We have the swings for infants that they can rock in and get that gentle front and back motion.
15900:11:17,619 --> 00:11:24,390Someone who wants to feel more alert and activated like I need energy,
16000:11:24,400 --> 00:11:26,809I need momentum to get going.
16100:11:27,169 --> 00:11:31,609They may want to ride their bike down a hill or jump on a trampoline.
16200:11:31,940 --> 00:11:35,349That vigorous movement input is often more alerting.
16300:11:35,909 --> 00:11:37,250So someone might say,
16400:11:37,260 --> 00:11:37,630oh,
16500:11:37,640 --> 00:11:38,820now,
16600:11:38,900 --> 00:11:40,669now I'm really awake.
16700:11:41,099 --> 00:11:46,719Every nervous system though responds a bit uniquely to these different kinds of inputs.
16800:11:46,809 --> 00:11:57,619So it's really important to know your own system to try different things safely and to gradually develop your own insight about what you need.
16900:11:57,630 --> 00:12:03,809And when there are some activities that provide both pressure and movement input,
17000:12:04,169 --> 00:12:09,510riding a bike gives pressure through the joints as well as movement through space.
17100:12:10,119 --> 00:12:10,890Climbing,
17200:12:10,900 --> 00:12:18,349a rock wall provides really intense pressure in the joints as well as gentle movement up the wall,
17300:12:19,200 --> 00:12:22,619swimming provides resistance through the joints.
17400:12:22,640 --> 00:12:32,409Some mild pressure on the muscles from the water pressure and some movement which could be mild or more intense depending on the speed of movement.
17500:12:32,419 --> 00:12:35,530Whether the person is going upside down.
17600:12:35,570 --> 00:12:39,450Are they diving off of a height or going down a water slide?
17700:12:39,700 --> 00:12:43,289If you think back to what you have really loved to do,
17800:12:43,869 --> 00:12:47,750you may get clues about what your nervous system prefers.
17900:12:48,280 --> 00:12:54,820One person may have a history of a love for diving and they've been on the swim team during school,
18000:12:55,140 --> 00:12:59,880but maybe they don't have any source of inputs since they graduated.
18100:13:00,510 --> 00:13:05,349They haven't even realized how important these inputs were to their regulation.
18200:13:06,130 --> 00:13:09,520Another person may have a love of roller coasters,
18300:13:09,530 --> 00:13:10,880fast motorcycles,
18400:13:10,890 --> 00:13:11,989skydiving,
18500:13:12,150 --> 00:13:15,780their system loves intense vestibular inputs.
18600:13:16,440 --> 00:13:18,479Another may love weightlifting,
18700:13:18,489 --> 00:13:20,289cracking their knuckles.
18800:13:20,489 --> 00:13:25,159This is another source of joint pressure and heavy work,
18900:13:25,169 --> 00:13:26,219like yard work,
19000:13:26,229 --> 00:13:26,799gardening,
19100:13:26,809 --> 00:13:30,750household projects involving a lot of lifting of supplies.
19200:13:31,570 --> 00:13:34,270If you can pinpoint what your system has liked,
19300:13:34,280 --> 00:13:35,260historically,
19400:13:35,359 --> 00:13:40,359you may have a place to start in experimenting with what your system needs.
19500:13:40,369 --> 00:13:44,599Now also take into account your current health,
19600:13:44,609 --> 00:13:49,640your physical abilities or restrictions and your doctor's advice.
19700:13:49,690 --> 00:13:53,020If you can't pinpoint what you've liked in the past,
19800:13:53,030 --> 00:13:57,380start making a list of things to try a little bit at a time.
19900:13:58,010 --> 00:14:00,520Perhaps some waits on one day,
20000:14:00,530 --> 00:14:03,979a walk through nature the next or swinging at the park.
20100:14:04,760 --> 00:14:09,630Once you identify an area of inputs that your system benefits from.
20200:14:09,859 --> 00:14:10,429And again,
20300:14:10,440 --> 00:14:12,690the benefit is feeling more centered,
20400:14:12,700 --> 00:14:16,710calm and fully present than before the activity,
20500:14:16,849 --> 00:14:18,380then start thinking,
20600:14:18,390 --> 00:14:21,510how else could I get inputs like this?
20700:14:22,090 --> 00:14:23,549If you love bike riding,
20800:14:23,559 --> 00:14:27,130perhaps try swinging for movement and pressure.
20900:14:27,489 --> 00:14:32,530If you love a way to blanket over you while rocking in a rocking chair,
21000:14:32,630 --> 00:14:44,960you may want to investigate a whole body swing that can be hung from the ceiling and just envelops you like a cocoon in the fabric while you move gently or vigorously.
21100:14:45,330 --> 00:14:47,799It can even spin in rotation.
21200:14:48,840 --> 00:14:50,289If you like weights,
21300:14:50,299 --> 00:14:53,820you might wanna try rock climbing for intense joint pressure.
21400:14:54,159 --> 00:15:03,729Some people who like vestibular input like to join aerial fitness gyms that allow them to hang upside down in a safe and controlled environment.
21500:15:04,440 --> 00:15:11,190Be creative and develop some awareness of what your system responds positively toward and again,
21600:15:11,200 --> 00:15:12,010make sure you know,
21700:15:12,020 --> 00:15:13,140your own body,
21800:15:13,150 --> 00:15:17,669your limitations and any recommendations from your own physician.
21900:15:18,309 --> 00:15:19,960So let's regroup.
22000:15:19,969 --> 00:15:20,719So far,
22100:15:20,729 --> 00:15:23,570you've learned about pressure and movement inputs,
22200:15:24,140 --> 00:15:30,710the variations of intensity and exercise versus restorative based inputs.
22300:15:30,979 --> 00:15:34,809So exercise could be something like riding a bike,
22400:15:35,000 --> 00:15:35,919restorative,
22500:15:35,929 --> 00:15:40,580could be something like laying in a hammock swing or a hammock.
22600:15:42,780 --> 00:15:46,979You've considered what you have liked or not liked historically.
22700:15:46,989 --> 00:15:52,630And perhaps you have a list of things to try in order to build up a repertoire of options.
22800:15:53,479 --> 00:16:03,950The next key to growing in the area of regulation is this don't wait to do the activities until you feel like you need it.
22900:16:04,440 --> 00:16:05,950This is crucial.
23000:16:06,200 --> 00:16:06,770Now,
23100:16:06,780 --> 00:16:14,489this doesn't mean that you shouldn't listen to your body if you're ill or injured and not able to do a specific activity that day.
23200:16:14,909 --> 00:16:18,929But what often happens for the autistic is that they feel great,
23300:16:18,940 --> 00:16:19,500great,
23400:16:19,510 --> 00:16:20,330great.
23500:16:20,609 --> 00:16:23,299And then they feel really off center.
23600:16:23,309 --> 00:16:26,880And a lot of times they'll say I just did not see that coming.
23700:16:27,359 --> 00:16:32,650So by the time they use their as needed inputs,
23800:16:32,919 --> 00:16:35,169they're already deregulated.
23900:16:35,489 --> 00:16:37,250So that's not the goal,
24000:16:37,260 --> 00:16:53,179the goal is to do the activities and give regular nervous system inputs that are regulating so that the episodes of disregulation decrease in number and they're easier to recover from.
24100:16:53,919 --> 00:17:01,450So think about ways to give yourself centering inputs multiple times a day and that will be individual to you.
24200:17:02,090 --> 00:17:04,979Some people might do this three times a day,
24300:17:04,989 --> 00:17:06,239maybe at the beginning,
24400:17:06,250 --> 00:17:07,300middle and end,
24500:17:07,660 --> 00:17:16,099they may need some pressure and movement in the morning to wake up to become energized and to also feel calm and attentive,
24600:17:16,780 --> 00:17:20,349they may need inputs over the lunch hour or midday.
24700:17:20,359 --> 00:17:21,689And then again at night,
24800:17:22,069 --> 00:17:26,869perhaps restorative inputs like a rocking chair or a weighted blanket,
24900:17:27,050 --> 00:17:28,910maybe some nighttime yoga.
25000:17:30,459 --> 00:17:34,349Then when you do become deregulated on any given day,
25100:17:34,359 --> 00:17:39,810think ahead of time about what your as needed inputs might be.
25200:17:40,310 --> 00:17:43,000So when you're in the moment of disregulation,
25300:17:43,010 --> 00:17:46,089it's really difficult to figure out what you need.
25400:17:46,760 --> 00:17:50,150So you may be able to think to yourself ahead of time.
25500:17:50,489 --> 00:17:50,829You know,
25600:17:50,839 --> 00:17:52,619when I get dis regulated,
25700:17:52,630 --> 00:17:55,239this is what that looks and feels like.
25800:17:55,459 --> 00:17:59,160And when I start to see myself in that place,
25900:17:59,170 --> 00:18:08,060I can try these handful of things to see if it helps in that moment of crisis or kind of surprise.
26000:18:08,119 --> 00:18:08,260Uh,
26100:18:08,270 --> 00:18:09,579off centering,
26200:18:10,239 --> 00:18:11,290you may say,
26300:18:11,300 --> 00:18:11,729ok,
26400:18:11,739 --> 00:18:14,099I've had a particularly intense day.
26500:18:14,109 --> 00:18:16,609I'm feeling more off center than usual.
26600:18:16,699 --> 00:18:26,630I'm going to walk around my work building three times or I'm going to do forward bends and shake my head back and forth or listen to music with my headphones.
26700:18:26,910 --> 00:18:30,449This can be what as needed inputs look like.
26800:18:30,880 --> 00:18:34,569So you can see that like with the music and headphones,
26900:18:34,579 --> 00:18:41,739sometimes the regulating inputs could be also um a sensory input from another domain.
27000:18:41,770 --> 00:18:43,790What do you like to listen to?
27100:18:43,800 --> 00:18:46,810What scent do you like to smell like?
27200:18:46,819 --> 00:18:48,550Lavender or vanilla?
27300:18:48,920 --> 00:18:54,790But usually the big regulating inputs will involve movement and pressure.
27400:18:56,229 --> 00:18:57,680So today,
27500:18:57,689 --> 00:19:02,069we have chosen a growth area within health and wellness.
27600:19:02,099 --> 00:19:16,849This may be a good place for you to start as you live life with intention because feeling more grounded can help you feel more resilient as you try to stretch your comfort zone in other areas.
27700:19:17,270 --> 00:19:18,060Remember,
27800:19:18,069 --> 00:19:23,439the general approach we discussed in episode two when developing this program.
27900:19:23,900 --> 00:19:28,569So try to set up small reachable steps forward,
28000:19:28,859 --> 00:19:31,849use strategy to find your momentum.
28100:19:32,339 --> 00:19:37,130And once you've integrated the physical inputs into your daily routine,
28200:19:37,469 --> 00:19:41,599that momentum will kick in and it'll help you.
28300:19:41,609 --> 00:19:45,550Um not feel that this whole thing is effortful.
28400:19:45,560 --> 00:19:49,010It'll be just what you do on a regular basis.
28500:19:49,599 --> 00:19:54,290You'll also reap the benefits of having a more regulated nervous system.
28600:19:55,109 --> 00:19:57,050Be sure to check out the show notes,
28700:19:57,060 --> 00:20:01,969I have various links that we've mentioned here in the episode.
28800:20:02,020 --> 00:20:06,089One is a link to the Z Institute courses,
28900:20:06,099 --> 00:20:11,619Z U R for clinicians to learn more about autism in adolescents,
29000:20:11,630 --> 00:20:13,489adults and aging adults.
29100:20:14,020 --> 00:20:21,680I also have links to my podcast episodes about regulation if you'd like to do a deeper dive.
29200:20:22,030 --> 00:20:39,989And I'm also including links to the alert program put together by occupational therapists who have expertise in teaching people about using sensory inputs like movement or pressure to help regulate the nervous system,
29300:20:40,000 --> 00:20:42,310to feel calmer and more attentive.
29400:20:43,599 --> 00:20:51,569There's also a link specifically for their for All Program alert program four.
29500:20:51,579 --> 00:20:52,880That's the number four,
29600:20:52,890 --> 00:20:57,469not the word all dot com alert program for all dot com.
29700:20:57,800 --> 00:20:59,890That is a self guided study.
29800:20:59,900 --> 00:21:05,400You can purchase for a deeper dive into your own nervous system,
29900:21:05,410 --> 00:21:08,469figuring out what kind of inputs help you regulate.
30000:21:08,890 --> 00:21:13,630And I will have all four of those links in the show notes.
30100:21:15,270 --> 00:21:17,359Thank you for joining me today.
30200:21:17,489 --> 00:21:34,439I hope you will be able to enjoy the benefits of a more regulated nervous system and be sure to listen to our next episode as we continue this series on living with intention making goals and leaving our comfort zone.
-
You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this second episode in a series on intentional living, Dr. Regan identifies ways to create steps toward a goal, identify strategies, and monitor success.
As referenced in the current episode:
First Episode in Momentum for Behavior series
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript below:
100:00:01,830 --> 00:00:02,250Hi,
200:00:02,259 --> 00:00:02,960everyone.
300:00:02,970 --> 00:00:04,380This is your host,
400:00:04,389 --> 00:00:04,829Dr.
500:00:04,840 --> 00:00:05,980Theresa Regan,
600:00:06,250 --> 00:00:11,579introducing this next episode of autism in the adult podcast.
700:00:11,939 --> 00:00:13,779I'm a neuropsychologist.
800:00:13,789 --> 00:00:20,729So I specialize in understanding how the health of the brain and the connections of the brain impact,
900:00:20,739 --> 00:00:21,370thinking,
1000:00:21,379 --> 00:00:22,020skills,
1100:00:22,030 --> 00:00:22,700emotions,
1200:00:22,709 --> 00:00:23,319behavior,
1300:00:23,329 --> 00:00:24,569and personality.
1400:00:24,790 --> 00:00:30,540I've worked in hospitals for over 30 years and I'm the mother of a teen on the spectrum.
1500:00:31,649 --> 00:00:39,250And did you know that I have a series of three podcast episodes about momentum for activity.
1600:00:39,619 --> 00:00:43,869One is about exhaustion and finding balance in momentum.
1700:00:44,189 --> 00:00:53,000One of the episodes is about how to gain momentum for activity and the third is how to keep momentum for activity.
1800:00:53,430 --> 00:00:59,430You can find these three episodes as episodes number 21,
1900:00:59,650 --> 00:01:04,489and 23 In September and October of 2021.
2000:01:05,000 --> 00:01:07,410I'll put the link in the show notes.
2100:01:09,010 --> 00:01:09,449Today,
2200:01:09,459 --> 00:01:23,959we have our second episode of a series about finding some intentionality in um areas of our life where we'd like to grow and maybe challenge ourselves.
2300:01:23,970 --> 00:01:42,660Sometimes life is so fast and furious and we get in survival mode or we just get used to living a certain way that we realize we're not really making choices in all the areas of where we put our attention,
2400:01:42,989 --> 00:01:46,269uh whether we wanna grow or shift gears.
2500:01:46,650 --> 00:01:56,300So the previous episode was this introduction of thinking about where are we in our life right now?
2600:01:56,650 --> 00:02:02,059And if you can identify areas where you would like to find more meaning,
2700:02:02,449 --> 00:02:04,260uh a bit more challenge.
2800:02:04,269 --> 00:02:06,160If you'd like to change direction,
2900:02:06,370 --> 00:02:10,770then we're going to focus together on living intentionally.
3000:02:11,520 --> 00:02:23,789The first episode covered a few things and one is that I think the first step toward being intentional is having this increased self-awareness.
3100:02:24,149 --> 00:02:37,429And I feel like that's one of the greatest blessings of understanding our neurology and going through the diagnostic process about autism to see what,
3200:02:37,440 --> 00:02:41,460how am I wired and what does my system need?
3300:02:41,779 --> 00:02:43,649How do I interact with people?
3400:02:43,660 --> 00:02:46,210What do I find uh joy in,
3500:02:46,220 --> 00:02:46,770in life?
3600:02:46,779 --> 00:02:54,289What drains me and we have this elevated understanding of ourselves.
3700:02:54,300 --> 00:02:57,289Um That is part of that process.
3800:02:58,300 --> 00:03:02,229So I think after that process of self awareness,
3900:03:02,699 --> 00:03:09,410if we do identify areas where we would like to grow or expand in some way,
4000:03:09,919 --> 00:03:11,309one way to do that.
4100:03:11,320 --> 00:03:17,339And we covered this in the initial episode is to think of categories in our life.
4200:03:17,380 --> 00:03:24,490And I invited you to do this um to see where you might want to shift.
4300:03:26,479 --> 00:03:32,490One of the categories we talked about was within the area of a special interest.
4400:03:33,270 --> 00:03:37,470The second was within the area of health and wellness.
4500:03:38,250 --> 00:03:40,559The third was regulation,
4600:03:40,889 --> 00:03:46,699that means the ability to stay centered with things like alertness,
4700:03:46,889 --> 00:03:49,880attention and emotions.
4800:03:50,809 --> 00:03:53,380We also talked about 1/4 category,
4900:03:53,389 --> 00:03:54,729relationships.
5000:03:55,169 --> 00:04:04,6991/5 as everyday tasks kind of like staying on top of those chores and daily things that can be hard to get a rhythm for.
5100:04:05,130 --> 00:04:10,600And the sixth would be something like family and household culture.
5200:04:10,880 --> 00:04:14,130So if you're living in a household with other people,
5300:04:14,350 --> 00:04:19,170and these are people who are wired differently than each other.
5400:04:19,179 --> 00:04:26,690Sometimes focusing on the culture of the household can be a rewarding area of growth.
5500:04:29,399 --> 00:04:30,410Today,
5600:04:30,420 --> 00:04:38,470I would like you to bring your thoughts of what areas you would like to find more meaning in and to have more intention for.
5700:04:38,730 --> 00:05:01,500And we're going to talk about some basic um guidelines for making goals that you can stick with and that you can see change um in these areas without feeling overwhelmed and without kind of stopping in the middle and like our um New Year's resolutions.
5800:05:01,510 --> 00:05:01,980We don't want to,
5900:05:02,059 --> 00:05:03,109to be like that,
6000:05:03,440 --> 00:05:12,369but we want you to have this intention towards something and to give you some structure of how big should the goal be and,
6100:05:12,779 --> 00:05:16,399and how quickly should I work toward it and all of these things,
6200:05:16,410 --> 00:05:20,869I just want to give you some framework to see if this framework helps you.
6300:05:21,730 --> 00:05:26,579The first thing I'd like you to do is to take stock of where you are now.
6400:05:27,059 --> 00:05:30,279So if you chose a health and wellness goal,
6500:05:30,290 --> 00:05:33,709if you chose a household culture goal,
6600:05:33,799 --> 00:05:40,970I just want you to think about where you are right now in this area.
6700:05:41,260 --> 00:05:45,100So don't focus on the end goal.
6800:05:45,109 --> 00:05:47,350Let's just focus on where you are.
6900:05:49,690 --> 00:05:53,500Someone may say for health and wellness.
7000:05:53,510 --> 00:05:53,980Well,
7100:05:53,989 --> 00:06:00,299where I'm at is that I probably walk 10 minutes after work twice a week.
7200:06:00,989 --> 00:06:13,000Another person in the area of everyday tasks may want to really stay on top of bill paying and financial management.
7300:06:13,010 --> 00:06:14,989And so they may say,
7400:06:15,000 --> 00:06:15,279well,
7500:06:15,290 --> 00:06:26,760where I'm at right now is that I tend to um go overboard and spend more than I have in my bank account about four times a month.
7600:06:26,989 --> 00:06:38,209So we're just taking stock whatever your category is for growth and meaning maybe take stock of where you are now.
7700:06:39,250 --> 00:06:47,000And um knowing that you would like to be in a different spot at some point in the future.
7800:06:48,059 --> 00:06:55,269The next step is to create a goal where you're just going to take that one step forward.
7900:06:56,130 --> 00:07:02,420Um What we want to do is to make this goal really achievable.
8000:07:02,429 --> 00:07:05,779We want to set ourselves up for success.
8100:07:05,790 --> 00:07:13,829We want to be able to see the end of the goal and we want the goal to be on the lower side of effort.
8200:07:14,720 --> 00:07:23,880One way to create this type of goal is to think about time spent toward your ultimate destination.
8300:07:26,269 --> 00:07:27,730For example,
8400:07:27,739 --> 00:07:32,179in the area of movement and exercise.
8500:07:32,190 --> 00:07:44,149Someone may realize that they're walking a certain amount after work every week and they may add time to that current routine.
8600:07:44,700 --> 00:07:50,730So someone who wants to have more movement in their life or to get outdoors more frequently,
8700:07:50,869 --> 00:07:52,529perhaps they say,
8800:07:52,540 --> 00:07:52,869well,
8900:07:52,880 --> 00:08:04,049I'm going to add 15 minutes a week to my current routine of being outside or of walking in the neighborhood and moving.
9000:08:04,290 --> 00:08:04,570Um,
9100:08:04,579 --> 00:08:06,829just getting that movement in,
9200:08:06,839 --> 00:08:08,549maybe that's their goal.
9300:08:10,040 --> 00:08:16,630Another person who wants to work toward achieving skills in a certain area,
9400:08:16,640 --> 00:08:26,850maybe they're working toward a promotion or they would like to learn a new skill for fun within perhaps within their special interests.
9500:08:27,929 --> 00:08:35,580The goal may be to spend a certain amount of time per week learning this new skill.
9600:08:36,440 --> 00:08:39,690If they're currently not learning anything about it,
9700:08:39,700 --> 00:08:42,750they might want to start with 20 minutes a week.
9800:08:43,030 --> 00:08:45,190If they're already doing 20,
9900:08:45,200 --> 00:08:48,049they might want to increase by 15,
10000:08:48,849 --> 00:08:54,260whatever the stepwise time goal might be for you,
10100:08:54,270 --> 00:08:57,780that would make sense in your area of interest.
10200:08:58,530 --> 00:09:02,979That may be a way that you'd like to construct what your actual goal is.
10300:09:04,049 --> 00:09:13,780You can also think of it as doing a certain fraction or a certain percentage of the work toward the ultimate goal.
10400:09:14,739 --> 00:09:20,969If someone would like to have intentionality in the area of their special interest,
10500:09:21,580 --> 00:09:22,479publishing,
10600:09:22,489 --> 00:09:32,570some of their short stories may be a goal where they're at currently is they have a collection of 50 short stories,
10700:09:33,049 --> 00:09:36,549most of which are within a science fiction genre.
10800:09:37,950 --> 00:09:45,770They've never taken a class on creative writing or on marketing for their own business.
10900:09:46,549 --> 00:09:58,960What they might do is sit down with a friend and talk about all the steps that they might want to take to make this publishing goal most successful.
11000:10:00,289 --> 00:10:02,719They may identify 10,
11100:10:02,729 --> 00:10:03,46015,
11200:10:03,469 --> 00:10:04,76020 steps.
11300:10:05,460 --> 00:10:10,059One might be taking a free online course in creative writing.
11400:10:11,330 --> 00:10:20,020Another might be joining a local writers group in their community to become part of a network for writers.
11500:10:22,270 --> 00:10:29,919Another goal might be learning how to create a website or how to publish their own material online.
11600:10:30,919 --> 00:10:35,179They would want to take one of these multiple steps.
11700:10:35,239 --> 00:10:37,679So if they've identified 20,
11800:10:38,179 --> 00:10:49,909they may just want to take one goal then they'd have to figure out is this goal small enough that I can see the end.
11900:10:50,270 --> 00:11:05,979I know I can have success and it doesn't feel too effortful if they're going to sign up for a free online class in creative writing that may feel super easy or it may feel too big.
12000:11:07,239 --> 00:11:08,880If it's too big,
12100:11:09,049 --> 00:11:13,400you would want to break that task down.
12200:11:13,739 --> 00:11:23,239So the first step might be to investigate some free online options to choose from.
12300:11:25,359 --> 00:11:37,309If someone has a goal to participate in additional community activities or to get out of the house a bit more often,
12400:11:38,000 --> 00:11:57,130they may make a goal to attend one community event per month uh with a friend Or they may make a goal to spend 15 minutes at a community event before they decide whether they want to come home.
12500:11:57,559 --> 00:12:00,200This just gives a bit of structure,
12600:12:00,309 --> 00:12:12,630but the whole process is meant to just help make one step forward and not to have a goal that's too big or too effortful.
12700:12:12,679 --> 00:12:14,849So we should be able to see the end.
12800:12:14,859 --> 00:12:19,989We should know that it takes some effort that it takes us out of our comfort zone,
12900:12:20,000 --> 00:12:23,359but that we also are set up for success.
13000:12:24,559 --> 00:12:27,710The next step would be thinking of a timeline.
13100:12:29,359 --> 00:12:41,849If someone has a goal in the area of regulation and they identify that they would like to be more intentional about their sleep wake cycle.
13200:12:43,400 --> 00:12:50,000They may determine that they'll watch how they do with their goal across two weeks.
13300:12:50,690 --> 00:12:58,320Perhaps their goal is to get up at the same time every day and after two weeks,
13400:12:58,330 --> 00:13:10,919they can evaluate how easy or difficult that goal was to achieve for someone who's wanting to stay on top of the dishes every day.
13500:13:11,250 --> 00:13:24,380They may also pick a week or two weeks as a time frame that they can monitor their success or stop and reevaluate if the stepwise goal feels like it's been too difficult.
13600:13:24,880 --> 00:13:32,059But here comes the most important step we've looked at creating that step forward goal,
13700:13:32,710 --> 00:13:34,520creating a time frame.
13800:13:35,140 --> 00:13:43,190And this third part I would say is the most important this is picking a strategy to have success.
13900:13:44,140 --> 00:13:47,270What does not work is just saying,
14000:13:47,280 --> 00:13:47,630well,
14100:13:47,640 --> 00:13:48,880I'm going to do it.
14200:13:49,159 --> 00:13:50,630I've made the goal,
14300:13:50,640 --> 00:13:54,690I'm intentional about the goal and I have this time frame.
14400:13:54,700 --> 00:13:56,710I'm just going to do it this time,
14500:13:57,039 --> 00:13:59,890even though it's been really hard in the past.
14600:14:00,559 --> 00:14:04,690What happens with that is that we're able to spurt towards some goal,
14700:14:04,700 --> 00:14:05,919success there,
14800:14:05,929 --> 00:14:08,090but it's very difficult to maintain.
14900:14:09,590 --> 00:14:12,719So what I'd like you to do when you have a goal,
15000:14:12,729 --> 00:14:14,099you have a time frame,
15100:14:14,109 --> 00:14:16,359you have a little chunk that you're gonna work on.
15200:14:17,320 --> 00:14:18,630Say to yourself,
15300:14:18,640 --> 00:14:22,549what's my strategy for accomplishing this goal?
15400:14:23,780 --> 00:14:26,390Never move forward without a strategy.
15500:14:26,659 --> 00:14:28,349If you can't think of one,
15600:14:28,359 --> 00:14:30,710ask a friend or a family member,
15700:14:34,210 --> 00:14:42,869one strategy could be in the area of remembering how can I remember to take my supplies to school?
15800:14:42,979 --> 00:14:46,979How can I remember to do the dishes before I go to bed?
15900:14:48,650 --> 00:14:53,409Another strategy may have to do with adding fun to the task.
16000:14:53,770 --> 00:14:56,340How can I make this task less,
16100:14:56,349 --> 00:14:57,260boring,
16200:14:57,270 --> 00:14:58,750less mundane?
16300:14:59,320 --> 00:15:04,469Maybe I could do it while music is playing or an audio book,
16400:15:04,760 --> 00:15:11,419maybe I could make a race out of it to see if I can get it done within a certain amount of time.
16500:15:12,340 --> 00:15:22,229Perhaps there are ways that I could use a strategy to make the task easier learning about how to streamline the task,
16600:15:22,289 --> 00:15:26,640looking at other ways people do the task to make it easier,
16700:15:26,650 --> 00:15:28,140take up less time.
16800:15:30,210 --> 00:15:35,460Another strategy I could use is offering myself a reward for success.
16900:15:36,200 --> 00:15:40,710Maybe I say if I'm successful for eight weeks in a row,
17000:15:40,969 --> 00:15:46,030I get to buy myself this thing that is not too expensive,
17100:15:46,039 --> 00:15:47,179but usually,
17200:15:47,340 --> 00:15:47,630you know,
17300:15:47,640 --> 00:15:49,510that would be off limits for me.
17400:15:49,520 --> 00:15:54,429But I'm gonna reward myself after I reach this time frame.
17500:15:55,450 --> 00:15:57,719After you've chosen a strategy,
17600:15:58,099 --> 00:15:59,659you have a time frame,
17700:15:59,669 --> 00:16:03,179you have a small goal that you're set up for success with.
17800:16:03,190 --> 00:16:08,789Then it's time to put your plan into action after the week or two weeks.
17900:16:08,799 --> 00:16:15,830What you're going to do is to kind of have an evaluation and debriefing with yourself.
18000:16:15,840 --> 00:16:21,020The first part of the evaluation is I achieve my goal.
18100:16:21,190 --> 00:16:36,049Also think about how effortful was it to achieve what I did achieve if you achieve the goal and you were consistent about it across two weeks and it did not feel too hard or effortful.
18200:16:36,229 --> 00:16:42,700You may decide that you're ready to add another step forward goal to your momentum.
18300:16:43,010 --> 00:16:47,739If you did 10% of the small task toward your goal,
18400:16:47,750 --> 00:16:58,530you could add on another 10% goal or you could add on another 15 minutes of the type of task you were doing to meet your goal.
18500:16:58,539 --> 00:17:05,660Remember to keep a strategy if you need to shift based on your new goal,
18600:17:05,670 --> 00:17:07,530your new step forward goal,
18700:17:07,540 --> 00:17:08,949be sure to do that.
18800:17:12,650 --> 00:17:16,459If you achieved your goal,
18900:17:16,699 --> 00:17:23,500but you pulled it off and are really tired and don't know if you could do that again,
19000:17:24,098 --> 00:17:30,218then you probably need to evaluate whether the goal is small enough,
19100:17:30,229 --> 00:17:37,869whether it's easy enough in the sense that we all have areas of our life that we would say,
19200:17:38,509 --> 00:17:39,088you know,
19300:17:39,098 --> 00:17:40,489for whatever reason,
19400:17:40,499 --> 00:17:42,909this area really wipes me out.
19500:17:42,918 --> 00:17:48,759I just have a huge struggle in this category of my life.
19600:17:48,769 --> 00:17:51,568Maybe you need to start in a different category.
19700:17:52,280 --> 00:17:55,569But if you can make the step forward goal easier,
19800:17:55,930 --> 00:17:56,930do that.
19900:17:57,510 --> 00:18:00,780If you can use a strategy that will help you more,
20000:18:00,849 --> 00:18:02,089go ahead and do that,
20100:18:05,170 --> 00:18:18,390you wouldn't want to add on to your plan until you got that goal achieved in a way that starts to feel pretty effortless like I'm doing this because this is what I do.
20200:18:18,560 --> 00:18:19,979I have momentum for it.
20300:18:19,989 --> 00:18:27,150It's built into my routine and then you don't have to effort as much to keep it going.
20400:18:27,479 --> 00:18:30,609That's when you add just a little bit more to it.
20500:18:32,439 --> 00:18:35,170What do you do if you did not meet your goal?
20600:18:35,209 --> 00:18:35,530Well,
20700:18:35,540 --> 00:18:36,859that's fine too.
20800:18:37,020 --> 00:18:42,079You would step back and evaluate why you may ask yourself.
20900:18:42,089 --> 00:18:46,449Did I use the strategy that I created for this goal?
21000:18:46,459 --> 00:18:52,020If you did and you were not successful with the goal,
21100:18:52,089 --> 00:19:00,119you probably have to reevaluate the strategy or you may need to add another strategy on top of that.
21200:19:01,040 --> 00:19:04,150Maybe you used a remembering goal,
21300:19:04,310 --> 00:19:06,969but that wasn't enough to give you the momentum.
21400:19:06,979 --> 00:19:12,750You need to just get that new behavioral set into your repertoire.
21500:19:13,130 --> 00:19:15,849Maybe you also need to make it easier,
21600:19:15,859 --> 00:19:19,030make it fun or give yourself a reward.
21700:19:19,500 --> 00:19:21,829Maybe you need someone to be accountable to,
21800:19:21,839 --> 00:19:23,589maybe that's your strategy.
21900:19:24,430 --> 00:19:26,130You should also ask yourself,
22000:19:26,140 --> 00:19:28,089did I use my strategy?
22100:19:28,859 --> 00:19:30,949If I didn't reach my goals?
22200:19:30,959 --> 00:19:38,089Maybe it was because I had the intention of using reminders or making it fun.
22300:19:38,209 --> 00:19:41,680But I didn't actually follow through with that.
22400:19:43,589 --> 00:19:44,130Well,
22500:19:44,140 --> 00:19:46,849then you would evaluate that as well.
22600:19:47,130 --> 00:19:49,209Is this strategy too hard?
22700:19:49,910 --> 00:19:54,449Is it too complex and involved in energy draining?
22800:19:54,800 --> 00:19:57,290What other strategies could you think of?
22900:19:57,599 --> 00:20:03,280Do you need to layer something in or do you have to scrap the first strategy and try again?
23000:20:04,209 --> 00:20:08,239What strategies do other people use or find successful?
23100:20:08,869 --> 00:20:12,020What ideas can you glean from other people?
23200:20:12,030 --> 00:20:16,920You're always able to say no to someone's suggestion of a strategy,
23300:20:16,949 --> 00:20:19,640but only if you have a counter offer.
23400:20:19,800 --> 00:20:21,000If your boss says,
23500:20:21,010 --> 00:20:21,260hey,
23600:20:21,270 --> 00:20:22,839this still isn't working.
23700:20:22,959 --> 00:20:25,199I'd like you to try this strategy.
23800:20:25,619 --> 00:20:26,540You can say no,
23900:20:26,550 --> 00:20:28,660I'd rather not use that strategy,
24000:20:28,670 --> 00:20:31,339but only if you have a counter offer.
24100:20:32,189 --> 00:20:37,089If you can say I've thought of this other strategy,
24200:20:37,099 --> 00:20:38,729then you can run with that.
24300:20:39,609 --> 00:20:40,020Now,
24400:20:40,030 --> 00:20:49,469the nice thing about this process is you're learning not only perhaps a new skill that is your goal.
24500:20:49,479 --> 00:20:54,829Um learning how to create a family culture that works in your home.
24600:20:55,229 --> 00:20:59,780Uh Learning how to stay regulated in a way that matches you.
24700:21:00,430 --> 00:21:02,199You're not only learning those things,
24800:21:02,209 --> 00:21:06,890but you're learning this process of growth.
24900:21:07,150 --> 00:21:12,650So I wish I were in a different place in this area of my life.
25000:21:13,739 --> 00:21:17,280How can I start that shift?
25100:21:17,290 --> 00:21:22,510How can I think about doing it without feeling overwhelmed or like,
25200:21:22,520 --> 00:21:24,689I just can't get any,
25300:21:25,069 --> 00:21:25,939um,
25400:21:26,219 --> 00:21:30,790I can't get any forward momentum toward change.
25500:21:30,910 --> 00:21:31,410Well,
25600:21:31,420 --> 00:21:38,089this is a way that you can practice a process for living with more intention.
25700:21:38,510 --> 00:21:40,420Where would I like to be?
25800:21:40,430 --> 00:21:42,500Where am I right now?
25900:21:42,819 --> 00:21:47,060How can I make small steps forward to guarantee that?
26000:21:47,069 --> 00:21:48,959I know I can have success.
26100:21:49,459 --> 00:21:56,979How can I create strategy and timelines and then evaluate what needs to be shifted?
26200:21:57,729 --> 00:22:03,819And what you'll notice too is you may get a great momentum for your goal.
26300:22:03,829 --> 00:22:10,810Maybe you are doing the dishes every night or you're moving for 15 minutes after work every day.
26400:22:11,079 --> 00:22:17,500What will happen is you'll have momentum for that for maybe a long period of time.
26500:22:18,290 --> 00:22:19,839Then at some point,
26600:22:19,849 --> 00:22:31,000something in your life will change and you'll realize that now the strategies you were using aren't really gonna work quite as well anymore.
26700:22:31,170 --> 00:22:34,630And that's really part of that normal human process too.
26800:22:34,920 --> 00:22:36,369And because you know,
26900:22:36,380 --> 00:22:49,859the process of creating strategies of evaluating things of making these small steps forward that can be successful when you do need to reevaluate and get back on board with the goal.
27000:22:50,290 --> 00:23:00,040That's something that you can go back to that skill in itself is something you keep with you and you can use in lots of different areas of life.
27100:23:00,050 --> 00:23:03,780We will continue to talk about living with intention,
27200:23:03,790 --> 00:23:09,844meaning growth and having success with all steps forward.
27300:23:09,954 --> 00:23:17,564Next time when we talk more about strategies and goals within these different categories,
27400:23:17,574 --> 00:23:20,025we mentioned special interests,
27500:23:20,035 --> 00:23:22,135health and wellness regulation,
27600:23:22,194 --> 00:23:23,255relationships,
27700:23:23,265 --> 00:23:26,785everyday tasks and family and household culture.
27800:23:27,255 --> 00:23:28,785I hope you'll join me then.
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You may feel dissatisfaction or discomfort in some realm of life that you want to shift. But where to start and how to succeed? In this first episode in a series on intentional living, Dr. Regan identifies ways to plan the foundation of change so that you experience growth without becoming overwhelmed.
As referenced in the current episode:
adultandgeriatricautism.com
Autism and Regulation podcast episode #1
Dr. Regan's online presentations with Zur Institute March, 2023:
Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses
Autism Assessment: The Seven Diagnostic Criteria Brought to Life
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript:
100:00:06,040 --> 00:00:08,590Hello and welcome to the podcast,
200:00:08,600 --> 00:00:10,190autism in the adult.
300:00:10,200 --> 00:00:11,540I am your host,
400:00:11,550 --> 00:00:13,160Dr Theresa Regan.
500:00:13,170 --> 00:00:15,630I am a neuropsychologist,
600:00:15,640 --> 00:00:25,930the mom of a teen on the spectrum and I'm a certified autism specialist. For more information about my offerings and background,
700:00:25,940 --> 00:00:31,020please see my website at adultandgeriatricautism.com.
800:00:31,030 --> 00:00:32,830You can see the link below in the show notes.
900:00:33,450 --> 00:00:33,920Today,
1000:00:33,920 --> 00:00:41,420we are starting a new series that I am calling autism and intentional living.
1100:00:41,430 --> 00:00:54,410So living with intention rather than feeling that were just plodding along day to day or that there's a tidal wave of things happening and we are along for the ride.
1200:00:55,700 --> 00:01:03,000I think every human has seasons of life where we just try to recenter... regroup,
1300:01:03,010 --> 00:01:16,430figure out if we're really living with intention and meaning. We're going to focus on the intersection of that kind of season with autistic neurology.
1400:01:16,960 --> 00:01:35,810Today we're going to have just a foundational and introductory session on this topic and we're going to start with the question of why would someone on the spectrum really need to consider living with intention.
1500:01:35,820 --> 00:01:48,350A lot of living in this with this mindset has to do with setting goals and thinking about shifts in your life if you want to change direction,
1600:01:48,350 --> 00:01:51,460if you want to grow in any particular area.
1700:01:51,470 --> 00:01:53,570And some might feel like,
1800:01:53,570 --> 00:01:54,230well,
1900:01:55,320 --> 00:02:08,380a really nonjudgmental approach is just to support people where they are at and I completely agree... if the person is doing well,
2000:02:08,390 --> 00:02:15,000if they're happy and healthy and they don't have goals to shift gears or adjust.
2100:02:15,010 --> 00:02:16,970That is completely fine.
2200:02:17,340 --> 00:02:26,160But many of us really do best when we have some type of momentum toward a goal,
2300:02:26,170 --> 00:02:31,680a momentum toward growing in a particular area...
2400:02:31,690 --> 00:02:40,360but sometimes it's hard to figure out ...what should these goals be and how do I make a goal that's going to stick?
2500:02:40,370 --> 00:02:44,500How do I make a goal that is challenging and I can grow,
2600:02:44,500 --> 00:02:46,190but it's not overwhelming...
2700:02:46,360 --> 00:02:49,810I'm not going to be in this kind of never ending,
2800:02:49,820 --> 00:02:57,030trying to crawl out of this huge weight on my shoulders that I've taken on with this goal.
2900:02:57,040 --> 00:03:14,710So this series is for people who would like to be mindful of ways in which they might like to stretch themselves or go out of their comfort zone and would like to have a topic about how to do that,
3000:03:14,710 --> 00:03:16,000how to think through it,
3100:03:16,190 --> 00:03:20,400and some of the plans and supports that might help along the way.
3200:03:21,230 --> 00:03:36,380Let's talk about a first step to thinking with this intentionality and to be to become more aware of ways in which you might like to grow.
3300:03:36,390 --> 00:03:37,400Um,
3400:03:37,410 --> 00:03:50,430one of the best things I think about a correct diagnosis of autism is the increased self awareness that ... should come from this diagnosis.
3500:03:50,430 --> 00:03:50,620So,
3600:03:50,620 --> 00:03:53,900if you've ever had that aha moment,
3700:03:53,910 --> 00:03:55,710that's what I'm talking about,
3800:03:55,710 --> 00:04:00,460because things fall into place and you say,
3900:04:00,470 --> 00:04:02,780oh my goodness,
4000:04:02,780 --> 00:04:05,250this makes more sense.
4100:04:05,260 --> 00:04:07,350This has come together.
4200:04:07,360 --> 00:04:24,430It really has made a lot of things feel unified and meaningful and like I have a way to understand and express what makes me tick. And this self awareness,
4300:04:24,430 --> 00:04:43,920this increase in self awareness, is often the first step to thinking about... in what ways do I want to just stay centered where I am and in what areas of my life might I like to shift or grow or again kind of go out of that comfort zone.
4400:04:44,810 --> 00:04:47,920So when you have the self awareness,
4500:04:47,930 --> 00:05:01,510that is often the first step toward making some goals and being mindful of where you're at and where you'd like to be after self awareness.
4600:05:01,520 --> 00:05:08,500One thing that can be helpful in goal setting is to think in categories of your life,
4700:05:08,510 --> 00:05:13,130you may already know what your goal is or what you'd like to shift,
4800:05:13,140 --> 00:05:16,650but there may be people who are saying,
4900:05:16,660 --> 00:05:21,800I guess I should probably have a goal to be a better person or to...
5100:05:22,850 --> 00:05:23,930you know,
5200:05:23,940 --> 00:05:26,320become better in some way,
5300:05:26,320 --> 00:05:26,820but I don't...
5400:05:26,830 --> 00:05:30,110I just really don't know where to start.
5500:05:30,120 --> 00:05:31,620It could be everything.
5600:05:31,620 --> 00:05:33,430Maybe it could be nothing.
5700:05:33,440 --> 00:05:35,040So here,
5800:05:35,050 --> 00:05:36,700here's a way to start.
5900:05:36,710 --> 00:05:39,050We're going to think about categories.
6000:05:40,790 --> 00:05:48,960One thing that some people that I work with who are on the autism spectrum,
6200:05:49,760 --> 00:05:53,340one thing they think about as a category in their life,
6300:05:53,350 --> 00:05:57,150could be their special interest. Their...
6400:05:57,150 --> 00:05:58,790the things they love.
6500:05:58,800 --> 00:06:03,400Sometimes people will take that as a category and they will,
6600:06:03,410 --> 00:06:04,720will say,
6800:06:05,890 --> 00:06:07,730how...
6900:06:07,740 --> 00:06:11,750what kind of place does this have in my life right now,
7000:06:11,760 --> 00:06:15,730and am I satisfied with that?
7100:06:15,740 --> 00:06:21,310Or do I have this special interest,
7200:06:21,310 --> 00:06:29,320but I'd like to grow in a way that makes it more functional or meaningful for a broader audience.
7300:06:29,330 --> 00:06:30,140So,
7400:06:30,140 --> 00:06:32,660one way to think about it is,
7500:06:32,670 --> 00:06:33,850oh,
7600:06:33,850 --> 00:06:35,880I love, for example,
7700:06:35,880 --> 00:06:41,100if the special interest is creative writing and I have these characters,
7800:06:41,110 --> 00:06:47,030I have these narratives and plots in my head,
7900:06:47,030 --> 00:06:51,450and I think about what this character would say to that character,
8000:06:52,420 --> 00:06:55,390or I love history,
8100:06:55,400 --> 00:07:01,860and I combine these characters with historical timelines or science fiction themes.
8200:07:02,460 --> 00:07:02,930You know,
8300:07:02,930 --> 00:07:05,070this person may say,
8400:07:05,670 --> 00:07:08,200I have loved this for a long time,
8500:07:08,200 --> 00:07:19,880and I've gotten to the point where I've developed characters and themes perhaps a way to stretch myself in this area of strength is to say,
8600:07:20,420 --> 00:07:29,870do I want to have a goal to publish something perhaps to share it with other people who might enjoy it,
8700:07:29,880 --> 00:07:37,390perhaps to make some additional income from my writing,
8800:07:37,400 --> 00:07:40,140perhaps to grow as a writer.
8900:07:40,150 --> 00:07:40,770You know,
9000:07:40,770 --> 00:07:44,780this person may have this love of creative writing,
9100:07:44,790 --> 00:07:47,270but they may not have a degree in writing.
9200:07:47,270 --> 00:07:49,780They may not have taken classes.
9300:07:50,300 --> 00:07:51,620So,
9400:07:51,630 --> 00:07:56,320one category to think about is your interest.
9500:07:56,330 --> 00:08:01,150And in what ways might you want to grow in that area,
9600:08:01,160 --> 00:08:03,140you may take a course,
9700:08:03,150 --> 00:08:05,440You may create a product,
9800:08:05,450 --> 00:08:07,400you may create a website.
9900:08:07,410 --> 00:08:10,450Perhaps you want to publish fan fiction,
10000:08:10,450 --> 00:08:13,820Perhaps you want to publish an e book.
10100:08:13,830 --> 00:08:14,490Um,
10200:08:14,500 --> 00:08:18,140the publishing options are really broad right now.
10300:08:18,860 --> 00:08:24,250Another individual on the spectrum may love athletic pursuits.
10400:08:24,250 --> 00:08:30,140Perhaps they run and run and they just love that movement.
10500:08:30,140 --> 00:08:31,680They love to be outside.
10600:08:31,690 --> 00:08:33,570It's one of their special interests.
10700:08:33,570 --> 00:08:37,160They read a lot of running magazines,
10800:08:37,170 --> 00:08:40,780they read about nutrition for the runner and stretching.
10900:08:41,660 --> 00:08:46,950And this has been really a love that they've had for several years.
11000:08:46,960 --> 00:08:55,720This person may wish to think about whether they would like to broaden what they're doing with running.
11100:08:55,730 --> 00:09:06,770So their goal or their intention for growth might be that they'd like to train for a specific race or marathon.
11200:09:07,540 --> 00:09:09,730Another person may say,
11300:09:09,730 --> 00:09:10,230oh,
11400:09:10,240 --> 00:09:10,860you know,
11500:09:10,860 --> 00:09:15,070I don't know if I want to do that or maybe I've already done it,
11600:09:15,080 --> 00:09:23,930but they may say I would like to meet some new people to connect with the community and to give back uh,
11700:09:23,930 --> 00:09:25,210and bless other people.
11800:09:25,210 --> 00:09:38,790So I think I'm going to see if I could coach some track or cross country in the community and teach other people what I love and what I'm good at.
11900:09:39,470 --> 00:09:49,610So you can see that one category for growth and intention and momentum can be a special interest and something that you love,
12000:09:49,620 --> 00:09:51,170you've researched,
12100:09:51,170 --> 00:10:02,450you've done it and you'd like to expand that.
Another category I'd like you to consider is health and wellness.
12200:10:03,370 --> 00:10:11,920There are so many different areas... that this part of life can feel overwhelming. For the autistic though.
12300:10:11,920 --> 00:10:14,300If you want to think about health and wellness,
12400:10:14,310 --> 00:10:22,690you might think about areas that are particularly easy or particularly difficult for you.
12500:10:23,590 --> 00:10:38,610One person on the spectrum may have a love of nutrition and cooking and again that can be combined with the last category where they're gonna start to teach other people about that.
12600:10:39,250 --> 00:10:39,940However,
12700:10:39,940 --> 00:10:46,900another person on the spectrum may really find it difficult to expand
12800:10:46,910 --> 00:10:49,500the range of what they eat.
12900:10:49,510 --> 00:10:51,980They might say to themselves.
13200:10:54,130 --> 00:10:59,130I would like to expand my palate.
13300:10:59,550 --> 00:11:04,750This is not to say that they must eat every food.
13400:11:04,760 --> 00:11:05,200No,
13500:11:05,200 --> 00:11:09,260it's just saying if I go out of my comfort zone,
13600:11:09,270 --> 00:11:10,590how could I do that?
13700:11:10,600 --> 00:11:12,650Or maybe the individual says,
13800:11:12,650 --> 00:11:13,180you know what,
13900:11:13,190 --> 00:11:21,170I don't think I'm going to expand my palate but I do want to focus on... within the foods I can eat comfortably...
14000:11:21,180 --> 00:11:25,020How could I get better nutrition.
14100:11:25,420 --> 00:11:52,120So this person might say I'm going to try adding a protein powder to my smoothie that I have every day or I'm going to try some supplements because I really can do pretty well with swallowing pills or capsules, and I want to make sure I'm getting all the vitamins that I need... or all the minerals.
14200:11:52,800 --> 00:12:03,600Another person in the area of health and wellness may realize that they spend a lot of their time doing seated work.
14300:12:03,610 --> 00:12:11,150Maybe they love to do video games or they have a youtube channel that they keep up and they really enjoy that.
14400:12:11,520 --> 00:12:18,890Perhaps the part of health and wellness that they choose to move forward with might be movement.
14500:12:18,900 --> 00:12:19,790You know,
14600:12:19,790 --> 00:12:22,700a lot of times the nervous system,
14800:12:32,250 --> 00:12:43,450particularly for those on the spectrum might need close attention to... how much movement and pressure does their nervous system need. Pressure,
14900:12:43,450 --> 00:12:46,740meaning pressure in the muscles,
15000:12:46,750 --> 00:12:50,930like a weighted blanket OR pressure in the joints.
15100:12:50,930 --> 00:12:52,530Like lifting weights,
15200:12:52,540 --> 00:12:53,640yoga.
15300:12:54,020 --> 00:13:02,670A lot of times these sensory inputs are regulating and calming for well always for any human,
15400:13:02,670 --> 00:13:08,380but the person on the spectrum may really need that need that intentionality,
15500:13:08,390 --> 00:13:16,090that purposefulness where they really increase that during their daily routine.
15600:13:17,080 --> 00:13:23,250This person may start with saying I really need more movement.
15700:13:23,260 --> 00:13:30,610Therefore I'm going to walk the dog in the morning or I'm going to get a rocking chair and rock.
15800:13:30,620 --> 00:13:35,830Uh it's not exercise but it gives the nervous system movement input.
15900:13:35,840 --> 00:13:42,130And that can be for some people regulating where they feel more centered if they get to rock,
16000:13:42,560 --> 00:13:44,540another person may feel like,
16100:13:44,550 --> 00:13:47,440gosh I need more pressure input.
16200:13:47,450 --> 00:13:52,680Um I'm going to get a hammock so I can lay in the hammock,
16300:13:52,690 --> 00:13:54,860I'm going to get a weighted blanket.
16400:13:54,870 --> 00:14:02,510There's lots of ways to think about health and wellness as a category.
16500:14:03,260 --> 00:14:07,130Speaking of sensory regulation techniques,
16600:14:07,130 --> 00:14:10,180let's talk about regulation as a category,
16700:14:10,190 --> 00:14:17,930you can see past series that talk through a lot of detail about regulation.
16800:14:18,700 --> 00:14:24,990Every individual on the spectrum will find some challenges in the area of regulation.
16900:14:25,000 --> 00:14:32,420And here let's talk about regulation of emotions and of the internal motor,
17000:14:32,420 --> 00:14:37,670how activated someone feels or how sluggish.
17100:14:37,680 --> 00:14:46,060So for the autistic individual they may have difficulty staying centered,
17200:14:46,070 --> 00:14:47,350calm,
17300:14:47,660 --> 00:14:48,960attentive,
17400:14:48,970 --> 00:14:55,330and that they find that just right spot where they don't feel anxious,
17500:14:55,340 --> 00:14:56,450angry,
17600:14:56,450 --> 00:14:58,600overwhelmed or frozen,
17700:14:59,150 --> 00:15:12,650where they're aware and they're centered. There are strategies for regulation and I will put the link to that regulation series in the show notes.
17800:15:12,660 --> 00:15:17,580Someone may think of this category of regulation and say,
17900:15:18,120 --> 00:15:19,020you know,
18000:15:19,030 --> 00:15:32,710I would like to stay more even, I would like to feel more steady in my own person ...that I can feel resilient toward the day.
18100:15:32,710 --> 00:15:44,070And so my area for growth that I choose is to live with some intention about how to regulate myself
18200:15:44,520 --> 00:15:48,330the best that I can across time every day.
18300:15:49,250 --> 00:15:55,490Another great area for consideration would be relationships and communication.
18400:15:57,870 --> 00:16:00,880Not everyone needs a goal in this area,
18500:16:00,890 --> 00:16:07,400but the self awareness of the categories can help us think through again with intention.
18600:16:07,410 --> 00:16:13,180Like is this the place I'd like to be in my relationships and if you're in that place,
18700:16:13,190 --> 00:16:14,390super.
18800:16:14,400 --> 00:16:17,610If you would like to improve some area,
18900:16:17,610 --> 00:16:23,540you might consider whether you want to be intentional about some goals in that area.
19000:16:24,620 --> 00:16:53,320One individual may feel like they really have relationships that work well for them and they have this already established way of communicating this rhythm together and they just want to keep and maintain that -- another person may want to figure out how to get some extra social time and and kind of add to their relationships in a way that feels really satisfying to them.
19100:16:53,330 --> 00:17:07,520Like what type of person would I like to connect with and what kind of activities do I actually like to do with people... again in a way that feels really satisfying and filling to that individual.
19200:17:08,030 --> 00:17:11,680Another person may have a communication goal,
19300:17:11,750 --> 00:17:13,240they might say,
19400:17:13,250 --> 00:17:13,630you know,
19500:17:13,630 --> 00:17:18,650I'm super good at presenting facts and details at work,
19600:17:18,660 --> 00:17:21,090I like going on conference calls,
19700:17:21,090 --> 00:17:24,040I know what to say when it's my turn to talk,
19800:17:24,050 --> 00:17:31,610but I really get overwhelmed with conflict and I can shut down,
19900:17:31,610 --> 00:17:40,640I can freeze and at some point I might just kind of blow up and go too far trying to get my point across,
20000:17:40,650 --> 00:18:02,220I might want there to be justice in this situation and it's really difficult for me to know how to have effective communication without shutting down or blowing up in a case where there's a lot at stake ... where there's high emotion. That might be your area of growth this season,
20100:18:03,660 --> 00:18:05,490An additional category,
20200:18:05,500 --> 00:18:08,050may be everyday life tasks.
20300:18:08,060 --> 00:18:11,840We all have these kind of mundane,
20400:18:11,850 --> 00:18:13,770repetitive,
20500:18:13,780 --> 00:18:20,000really uninspiring things that have to get done in our everyday life.
20600:18:20,010 --> 00:18:25,380We have to pay bills... we need to take the car to get an oil change.
20700:18:26,060 --> 00:18:31,060We're really due to go to the dentist,
20800:18:31,060 --> 00:18:31,480you know,
20900:18:31,480 --> 00:18:35,970appointments and tasks and chores... these kinds of things.
21000:18:35,980 --> 00:18:46,780This may be an area where someone wants to push themselves this season and kind of get in a better rhythm. For one person.
21100:18:46,780 --> 00:18:51,200It may be tackling how to really clean their environment.
21200:18:51,210 --> 00:18:55,160... more frequently or ...or less frequently.
21300:18:55,170 --> 00:19:05,870How to declutter. For people on the spectrum who have great collections and love different objects perhaps related to their interest,
21400:19:05,880 --> 00:19:18,070they may feel they've gotten to the point where there's just not enough space... or they've spent too much money and they want to figure out how to balance out how many collections they have.
21500:19:19,110 --> 00:19:24,660Another person may feel like they want to figure out a better rhythm for budgeting.
21600:19:25,340 --> 00:19:29,730It's really tough to balance.
21700:19:29,740 --> 00:19:31,420you know...
21800:19:31,420 --> 00:19:33,400I've got to pay these bills first.
21900:19:33,400 --> 00:19:46,240But then this unexpected bill came and also I have these things related to my interests that I would really really love to invest my money in as well.
22000:19:46,250 --> 00:19:51,140There's also this executive function piece to money management of,
22100:19:51,390 --> 00:19:54,710have I set up all these automatic accounts?
22200:19:54,720 --> 00:19:57,130Have I forgotten to pay something.
22300:19:57,130 --> 00:20:03,980Have I not realized that my check didn't land in my account properly.
22400:20:03,990 --> 00:20:14,150So organization, planning, details and being able to wait to perhaps get something that you really love.
22500:20:14,160 --> 00:20:22,650Those things might be this category for you of tackling daily tasks a little differently.
22600:20:23,800 --> 00:20:29,060And someone else may want to work on how to get out there in the community,
22700:20:29,070 --> 00:20:30,830navigate their community,
22800:20:30,830 --> 00:20:33,890Perhaps they have a license to drive,
22900:20:33,890 --> 00:20:34,630they have a car,
23000:20:34,630 --> 00:20:37,310but it is not their favorite thing to do.
23100:20:37,320 --> 00:20:41,710Perhaps strategies related to...
23300:20:43,310 --> 00:20:52,340how do I maintain getting out of the house and connecting with people when driving is really kind of draining for me.
23400:20:53,500 --> 00:20:58,370A final category you might want to think about is the family culture.
23500:20:58,370 --> 00:21:01,980So if you live in a household with other people,
23600:21:01,990 --> 00:21:06,990you might want to think about how the culture works.
23700:21:07,000 --> 00:21:10,180This is part of self awareness and intentionality.
23800:21:10,180 --> 00:21:20,430Because what happens in any household is that we get into this just rhythm of what needs to be done.
23900:21:20,430 --> 00:21:21,010Who said
24000:21:21,010 --> 00:21:21,430what?
24100:21:21,430 --> 00:21:21,840Who did
24200:21:21,840 --> 00:21:22,360what,
24300:21:22,630 --> 00:21:25,990Who's irritating which person?
24400:21:26,000 --> 00:21:30,720Um and the culture can very easily drift into,
24500:21:30,730 --> 00:21:34,550hey don't do that or why didn't you do this?
24600:21:34,560 --> 00:21:44,960A lot of telling people how they're falling short ...having them know what our expectation is that they behave differently,
24700:21:44,960 --> 00:21:51,760that they do different tasks... and that can be a very draining kind of culture when we drift into that.
24800:21:52,000 --> 00:22:00,140So a different culture might be again focusing on this intentionality and awareness...
24900:22:00,150 --> 00:22:08,350To introduce the culture where our thought process is "this is what I need today."
25100:22:09,380 --> 00:22:17,450Maybe you're working on regulation and you need to take certain things into account to get better centered or more centered,
25200:22:17,460 --> 00:22:26,340but you have this culture emerging at home where you realize that other people may have a different need.
25300:22:26,340 --> 00:22:29,960So we say "this is what I need today,
25400:22:29,970 --> 00:22:31,850what is it that you need?"
25500:22:33,090 --> 00:22:34,600And then we say,
25600:22:34,610 --> 00:22:37,110how can we both get our needs met?
25700:22:37,780 --> 00:22:41,530And there are times when yeah,
25800:22:41,540 --> 00:22:43,910everybody can't get all their needs met.
25900:22:43,920 --> 00:22:57,240But this culture of trying to protect other people's needs and bring them out into the open and negotiate about those is really nice,
26000:22:57,250 --> 00:22:58,360it's really fun,
26100:22:58,380 --> 00:22:59,270freeing,
26200:22:59,280 --> 00:23:03,580It changes us from adversaries to partners.
26300:23:03,590 --> 00:23:28,360So if a dad is super sound sensitive and just had a rough day on a zoom call with his boss and he comes in and his five year old daughter is in her ballerina costume and she's singing and twirling and jumping and she jumps into his arms.
26400:23:28,860 --> 00:23:29,890You know,
26500:23:29,900 --> 00:23:33,030he may have this strong reaction like,
26600:23:33,040 --> 00:23:34,990oh my gosh,
26700:23:35,000 --> 00:23:36,370this house is a mess,
26800:23:36,370 --> 00:23:41,430this child is spinning all around and it's so loud,
26900:23:41,440 --> 00:23:42,590so loud,
27000:23:42,590 --> 00:23:44,210I'm so sound sensitive,
27100:23:44,220 --> 00:23:46,080I need my own space.
27200:23:46,090 --> 00:23:48,260I mean my own quiet.
27300:23:48,270 --> 00:23:57,350Um and he could very easily react to this and say stop,
27400:23:57,360 --> 00:23:58,770go to your room.
27500:23:59,280 --> 00:24:05,740Um but a shift in culture may look like look at you,
27600:24:05,750 --> 00:24:07,450you are all dressed up.
27700:24:07,460 --> 00:24:08,950Does that feel good?
27800:24:08,960 --> 00:24:13,920It looks like you'd really love to spin and sing today.
27900:24:13,930 --> 00:24:16,390I really need quiet.
28000:24:16,390 --> 00:24:17,680My ears are hurting.
28100:24:17,680 --> 00:24:19,940They're kind of sensitive today.
28200:24:20,980 --> 00:24:27,320If you're wanting to sing and dance and I need quiet and rest,
28300:24:27,330 --> 00:24:29,740how could we both get our needs met?
28400:24:31,520 --> 00:24:33,140And then dad could say,
28500:24:33,150 --> 00:24:33,660hey,
28600:24:33,660 --> 00:24:53,030I wonder if you could sing and dance in the basement, and I could have some rest and quiet time in the backyard ...and then we could meet back here and you can tell me more about your dancing that would represent a shift in culture.
28700:24:53,040 --> 00:24:59,780How does this household handle the needs of others when they conflict?
28800:24:59,790 --> 00:25:00,990Um,
28900:25:01,000 --> 00:25:08,800so that maybe this area of growth that you might want to focus on for a season today,
29000:25:08,800 --> 00:25:20,090we've talked about the way that an autism diagnosis creates some freedom and openness by increasing self awareness.
29100:25:20,100 --> 00:25:21,710This is how I work.
29200:25:21,710 --> 00:25:23,500This is what makes me tick.
29300:25:23,510 --> 00:25:36,090This is what I need and that in itself is an expanding out of the smaller place that you might have felt you existed in before.
29400:25:36,100 --> 00:25:39,060So with this expansion of self awareness,
29500:25:39,070 --> 00:26:06,450we can either kind of go back to life as usual or we can ride the tidal wave of all our daily activities and things that we're used to doing or we can pause and kind of restock and think about if I want to live intentionally and perhaps I want to grow,
29600:26:06,460 --> 00:26:08,880I want to go out of my comfort zone,
29700:26:08,880 --> 00:26:13,570I want to have goals and momentum toward those goals,
29800:26:13,570 --> 00:26:15,780but I don't want to be overwhelmed.
29900:26:16,870 --> 00:26:17,320You know,
30000:26:17,320 --> 00:26:20,230this is a way to approach that.
30100:26:20,240 --> 00:26:25,220If you would like to take some journey with me during the series,
30200:26:25,230 --> 00:26:42,050take some time this month to say which of these categories might fit where I'm at and where I'd like to have some growth now I do not want you to make goals in every category.
30300:26:42,060 --> 00:26:42,890No,
30400:26:42,900 --> 00:26:51,220this is about being intentional without um kind of running ourselves into the ground.
30500:26:51,230 --> 00:27:02,010We don't want to make so many goals that we just um can't keep up the momentum because we're weighted down.
30600:27:02,020 --> 00:27:07,860So just pick a category and pick one little goal,
30700:27:07,870 --> 00:27:46,540one area of growth within that category to start and then in the future you can redo other categories but be mindful think about intention and what you would like to think through as an area of growth and then join me back next time because what we're going to talk about in the second session of the series is how to take an area within a category and think about it in more specific ways in order to make a goal.
30800:27:46,550 --> 00:27:52,190Many clients that I have come in and say I'd like to grow in this area,
30900:27:52,190 --> 00:28:04,490but I have no idea how what kind of goal I can have success with or what kind of goal is reasonable for me at this time of my life,
31000:28:04,500 --> 00:28:07,310I feel lost about how to make a goal,
31100:28:07,310 --> 00:28:08,490how to choose a goal,
31200:28:08,500 --> 00:28:10,120how to choose an area of....
31300:28:10,490 --> 00:28:31,410So next episode will be about that topic and then in the future will have additional episodes of this series that takes some of these categories and break them down even more with some strategies that might help you create more growth and wellness in any of these categories of life.
31400:28:32,270 --> 00:28:32,860So,
31500:28:32,860 --> 00:28:34,590food for thought for this month,
31600:28:34,600 --> 00:28:44,950I'm so glad you joined me and I hope that you come back again with some thoughts about where you would like to have more intention in your living.
-
Join Dr. Regan for this episode on the neurodiversity movement, autism affirming services, and the importance of allowing for complexity in our understanding of autism.
Dr. Regan's online presentations with Zur Institute March, 2023:
Is my Client on the Spectrum? Dispelling Myths About Autism Diagnoses
Autism Assessment: The Seven Diagnostic Criteria Brought to Life
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:07,050 --> 00:00:10,400Welcome to the podcast Autism in the Adult.
200:00:10,540 --> 00:00:12,310I'm Dr Theresa Regan,
300:00:12,320 --> 00:00:14,060a neuropsychologist,
400:00:14,100 --> 00:00:16,150the mother of a teen on the spectrum,
500:00:16,160 --> 00:00:22,680and the founder and director of an autism diagnostic clinic in Central Illinois for adolescents,
600:00:22,690 --> 00:00:24,720adults and aging adults.
700:00:26,490 --> 00:00:32,300Sometimes I get emails from people asking if I perform autism assessments for adults.
800:00:32,310 --> 00:00:33,080And indeed,
900:00:33,080 --> 00:00:35,030that's my full time job.
1000:00:35,040 --> 00:00:36,850So I go to work every day.
1100:00:36,850 --> 00:00:42,730I see patients and clients in a medical setting for evaluations and recommendations.
1200:00:44,260 --> 00:00:58,920Then I also have other things that I've chosen to do in the topic area of autism because I'm passionate about the people impacted and the positive things that can happen when we understand more about the autistic neurology.
1300:01:00,000 --> 00:01:12,240I do have a few online presentations coming up through Zur Institute which is a continuing education program for professionals.
1400:01:12,250 --> 00:01:20,970I'll include a link in the podcast show notes to these programs so you can look at the descriptions and registration links.
1500:01:21,340 --> 00:01:26,440And the first one is Tuesday March 7th 2023.
1600:01:26,440 --> 00:01:27,740For one hour.
1700:01:27,760 --> 00:01:34,100The presentation covers information about the basic foundational rules of the autism.
1800:01:34,100 --> 00:01:45,750Diagnostic criteria Will be dispelling myths about the foundations and requirements that may prevent people from being referred for assessment appropriately.
1900:01:45,870 --> 00:01:48,740And the second presentation is on Saturday,
2000:01:48,750 --> 00:01:50,210March 25,
2100:01:50,220 --> 00:02:02,410that's for two hours and this presentation will highlight the seven diagnostic criteria what they mean and also what they look like in a clinical case of a young adult female,
2200:02:02,410 --> 00:02:05,580just to illustrate some of the concepts.
2300:02:05,900 --> 00:02:08,860So if you are a clinician or you know,
2400:02:08,870 --> 00:02:13,420of professionals in your area who are wanting to learn more about autism,
2500:02:13,430 --> 00:02:16,420this may be a good resource opportunity.
2600:02:16,940 --> 00:02:22,020The topic of the podcast today is actually not the topic that I had been working on.
2700:02:22,030 --> 00:02:23,860Uh to record,
2800:02:23,870 --> 00:02:29,120I've had multiple interactions about a different topic over the last few weeks.
2900:02:29,120 --> 00:02:35,460And it really struck me as perhaps something that would be timely to talk about or helpful to process.
3000:02:35,470 --> 00:02:37,090And so in this episode,
3100:02:37,090 --> 00:02:47,760I wanted to talk about neurodiversity and autism affirming approaches to serving those on the spectrum.
3200:02:47,770 --> 00:02:54,790I'm gonna talk about three things within the context of this episode.
3300:02:54,790 --> 00:02:57,480One is just what are we talking about?
3400:02:57,480 --> 00:03:01,050What's the definition when we talk about neuro diversity?
3500:03:01,060 --> 00:03:11,630The second is what kinds of conditions or characteristics might we want to include under the umbrella of neuro diversity?
3600:03:11,640 --> 00:03:30,220And the third has to do with a viewpoint that some put forward that says that only individuals who have diagnoses of neuro divergence should be offering services to those on the spectrum.
3700:03:30,230 --> 00:03:32,820When we talk about neuro diversity,
3800:03:32,830 --> 00:03:40,800we're basically talking about the idea that people experience and interact with the world around them in many different ways.
3900:03:40,810 --> 00:03:44,570And this concept of course,
4000:03:44,570 --> 00:03:47,450neuro being neurology and diversity,
4100:03:47,460 --> 00:03:48,760meaning diversity.
4200:03:48,760 --> 00:03:58,080So we all have variations in our neurologic wiring and there's no one quote right way of thinking,
4300:03:58,090 --> 00:04:05,700learning and behaving and that all neurologic differences should be appreciated as part of natural variation.
4400:04:06,370 --> 00:04:10,350And I explain those concepts,
4500:04:10,360 --> 00:04:16,990knowing and wanting to communicate that people will defined neuro diversity differently.
4600:04:16,990 --> 00:04:23,630And so I'm trying to use phrases that are commonly used um in describing what that means,
4700:04:23,640 --> 00:04:25,750one person can say that,
4800:04:25,760 --> 00:04:26,230you know,
4900:04:26,230 --> 00:04:31,060that isn't really what it means to me and that's completely fine.
5000:04:31,070 --> 00:04:39,020It's such a complex topic that getting it right as everyone would define it is difficult.
5100:04:39,020 --> 00:04:40,260But basically,
5200:04:40,270 --> 00:05:06,220it is this understanding that there's variations on our wiring and there's this emphasis that there's not one right way to be connected neurologically um at its best when we're talking about neuro diversity as a concept and autism affirmation as a concept.
5300:05:06,230 --> 00:05:29,960It really helps ward against an approach to intervention that may focus on correcting or fixing behaviors in the neuro diverse individual only because the behaviors are unusual or atypical. When a therapist is neuro diversity affirming or autism affirming,
5400:05:29,970 --> 00:05:44,310this is often used to emphasize that they understand that neuro divergence itself is not a flaw or an illness that needs to be fixed or corrected.
5500:05:44,640 --> 00:05:47,820And we're gonna talk about this a little bit more later.
5600:05:47,820 --> 00:05:52,640But neuro divergence often refers to autism,
5700:05:52,640 --> 00:05:56,030but it is a much larger umbrella right now.
5800:05:56,030 --> 00:05:58,020And so we'll talk about that as well.
5900:05:58,800 --> 00:06:02,940However,
6000:06:04,180 --> 00:06:05,410at the same time,
6100:06:05,410 --> 00:06:23,080we hope that the autism affirming therapist can also acknowledge some parts of autism that really may create a lot of difficulty or pain for the person that's presenting for care.
6200:06:23,090 --> 00:06:25,230So at its best,
6300:06:25,230 --> 00:06:39,420we really hope there's this balance of understanding of the gifts and strengths in the autistic experience in the struggles and difficulties that someone may really inherently experience,
6400:06:39,430 --> 00:06:43,960not because of the attitudes of society or,
6500:06:43,970 --> 00:06:44,690or anything,
6600:06:44,690 --> 00:06:51,640but because this neurologic piece is really giving them difficulty. At it's extreme,
6700:06:52,260 --> 00:07:24,600there may be some in the autism affirming community or the neuro divergence community that really emphasize that the autistic experience is very positive in its essence that the diverse experience should always be emphasized as strength and the variation doesn't involve any inherent struggle.
6800:07:25,560 --> 00:07:28,740I think that when
6900:07:28,740 --> 00:07:32,970we get to that categorical kind of description,
7000:07:32,980 --> 00:07:39,740whether someone is talking about the autistic experience is all bad... or all good,
7100:07:40,010 --> 00:07:40,430you know,
7200:07:40,430 --> 00:07:49,340I think we're missing the complexity of the human experience and specifically here,
7300:07:49,340 --> 00:07:51,210the autistic experience.
7400:07:51,220 --> 00:08:05,430So what I would say about the movement and the concept of neuro diversity is it's really best when we're able to stay centered in the complexity... in the center,
7500:08:05,430 --> 00:08:07,550not those two extreme categories,
7600:08:07,550 --> 00:08:18,990but in the center of this mix of good and difficult where most often the truth lies in that center in that complexity.
7700:08:19,990 --> 00:08:24,140Let me explain what the DSM 5,
7800:08:24,140 --> 00:08:32,620that's the diagnostic manual for many of the conditions that people refer to as neurodivergent...
7900:08:32,630 --> 00:08:39,240I want to talk about the criteria they use for when something is called a diagnosis.
8000:08:39,240 --> 00:08:41,880So this is not specific to autism.
8100:08:41,890 --> 00:08:46,040This could include learning disability,
8200:08:46,050 --> 00:08:47,250autism,
8300:08:47,260 --> 00:08:48,360psychosis,
8400:08:48,360 --> 00:08:49,400depression,
8500:08:49,410 --> 00:08:50,960lots of different things.
8600:08:50,960 --> 00:09:01,810And there are two things that they really focus on as being present in order for a diagnosis to be relevant.
8700:09:01,810 --> 00:09:04,760And so one is that the condition,
8800:09:04,770 --> 00:09:19,440the constellation of characteristics, is statistically atypical ... that it's not the most common constellation that we see in the daily human experience.
8900:09:19,450 --> 00:09:23,410It's not the most common state.
9000:09:24,060 --> 00:09:24,340Now,
9100:09:24,340 --> 00:09:33,970the second thing though is that the atypical constellation of characteristics must cause some form of difficulty for the individual,
9200:09:33,980 --> 00:09:34,490you know,
9300:09:34,490 --> 00:09:36,500does it work against their physical health?
9400:09:36,500 --> 00:09:39,580Does it reduce their safety in some situations?
9500:09:39,590 --> 00:09:43,320Is it associated with internal distress,
9600:09:43,320 --> 00:09:46,810does it prevent the person from reaching goals for daily living,
9700:09:46,810 --> 00:09:48,290like maintaining work?
9800:09:48,550 --> 00:09:51,660Is it associated with pain and relationships?
9900:09:51,660 --> 00:10:01,860So it has to have some functional impact that has worked against the well being of this individual.
10000:10:01,870 --> 00:10:02,490So,
10100:10:02,490 --> 00:10:08,070both things according to the diagnostic manual must be present for a diagnosis.
10200:10:08,080 --> 00:10:11,530There has to be this atypical constellation,
10300:10:11,530 --> 00:10:20,590but there also has to be ... that this atypical constellation has been the root of some functional struggle.
10400:10:21,450 --> 00:10:31,440So if there are individuals who have the autistic neurology and it has never been a source of functional difficulty,
10500:10:31,450 --> 00:10:36,950they actually don't meet the criteria for a diagnosis as defined in the in the manual.
10600:10:36,960 --> 00:10:40,710So when we're talking about having an official diagnosis,
10700:10:40,720 --> 00:10:42,010that would be part of it,
10800:10:42,010 --> 00:10:43,540that in some season,
10900:10:43,540 --> 00:10:44,700in some way,
11000:10:44,710 --> 00:10:50,130there's really been a struggle associated with those neurologic characteristics.
11100:10:50,790 --> 00:10:51,680And this is why,
11200:10:51,680 --> 00:10:52,560for example,
11300:10:52,560 --> 00:10:57,680depression is a diagnosis as well. It's not rare,
11400:10:57,690 --> 00:11:00,650but ... it's not the most typical mood state.
11500:11:00,650 --> 00:11:04,600And when people get stuck in that atypical mood state,
11600:11:04,610 --> 00:11:08,230it causes these functional areas of difficulty.
11700:11:08,230 --> 00:11:09,330It's hard to get up,
11800:11:09,330 --> 00:11:10,470it's hard to go to work,
11900:11:10,470 --> 00:11:12,660it's hard to maintain relationships.
12000:11:12,850 --> 00:11:22,610And so that's where we shift from saying something is diverse to something that
12100:11:22,620 --> 00:11:29,740we're calling a diagnosis... that rather than just being mood-diversity where gosh,
12200:11:29,740 --> 00:11:31,410I've had a bad day,
12300:11:31,930 --> 00:11:37,590but it's really not impacted functionally how I'm doing across time...
12400:11:37,600 --> 00:11:48,460but when I get stuck in this mood state and it's really interfering with wellness in my daily life,
12500:11:48,460 --> 00:11:50,440that's when it's a diagnosis.
12600:11:51,270 --> 00:11:51,660Now,
12700:11:51,660 --> 00:12:01,130autism as a diagnosis does require that difficulty at some point in your life that you've really had the autistic neurology,
12800:12:01,140 --> 00:12:07,590making it hard to function in a way that's comfortable where you're achieving your goals.
12900:12:08,030 --> 00:12:08,440Now,
13000:12:08,440 --> 00:12:13,360autism as a diagnosis occurs in 2% of individuals,
13100:12:13,370 --> 00:12:15,290they would meet the full criteria.
13200:12:15,300 --> 00:12:27,890The neurologic characteristics hang together in those individuals because they hang together anatomically and they have also impacted the individual's well being their goals,
13300:12:27,890 --> 00:12:29,390their functional life.
13400:12:29,910 --> 00:12:30,170Now,
13500:12:30,170 --> 00:12:36,400does this mean that the neurology of autism causes pain or distress in every way?
13600:12:36,410 --> 00:12:37,870Absolutely not.
13700:12:37,880 --> 00:12:43,160Does it mean that the difficulty is constant throughout the whole lifespan?
13800:12:43,580 --> 00:12:44,440No.
13900:12:44,450 --> 00:12:46,100So in my viewpoint,
14000:12:46,110 --> 00:12:52,160all humans have characteristics that work for them in some ways and against them in some ways.
14100:12:52,170 --> 00:12:54,870And this is true in autism as well.
14200:12:54,880 --> 00:12:55,870For example,
14300:12:55,870 --> 00:13:00,570the attention to detail can be a great strength in some work projects.
14400:13:00,570 --> 00:13:08,360Whereas it can really create difficulty when the ultimate goal is speed and generalization rather than detail.
14500:13:09,070 --> 00:13:22,980So much of the benefit for the autistic individual and those who love them is this increased awareness of how their characteristics may work for them or against them in different contexts or across life seasons?
14600:13:23,510 --> 00:13:23,790Now,
14700:13:23,790 --> 00:13:25,180having said that again,
14800:13:25,180 --> 00:13:40,460remember that individuals who meet that full criteria by definition have had a level of neurologic difference that really increases the risk of difficulty and a lot of these functional areas compared with someone with a different neurology,
14900:13:41,100 --> 00:13:45,930we know that every human will have this mix of gifts and weaknesses,
15000:13:45,930 --> 00:13:47,270strengths and struggles,
15100:13:47,280 --> 00:13:49,510abilities and limitations.
15200:13:49,520 --> 00:13:51,510And for one person,
15300:13:51,520 --> 00:13:52,070you know,
15400:13:52,070 --> 00:13:57,780he may excel in athletics but struggle to read at functional levels.
15500:13:57,790 --> 00:14:05,040So he can't read a contract or release or a medical form without struggling and getting taken advantage of,
15600:14:05,040 --> 00:14:09,390that's a neurologic difference in that reading comprehension.
15700:14:09,790 --> 00:14:18,050Another person may be able to produce wonderful needlework that requires really good fine motor skills appreciation of color
15800:14:18,050 --> 00:14:18,770palettes,
15900:14:18,770 --> 00:14:20,660creativity and design.
16000:14:20,670 --> 00:14:21,450However,
16100:14:21,450 --> 00:14:30,420they might struggle to keep blood sugar levels even and their pancreas just isn't helping them with this task as much as we would wish.
16200:14:30,430 --> 00:14:33,810And maybe they take insulin shots because of this.
16300:14:34,400 --> 00:14:39,960I bring these examples up just to say that in our human form,
16400:14:39,970 --> 00:14:48,650we all have gifts and strengths and triumphs and skill sets.
16500:14:48,660 --> 00:14:59,580And we also will have some form of limitation or struggle at some part in our life and my struggle,
16600:14:59,580 --> 00:15:03,850my limitation in my human form may be different than yours.
16700:15:04,100 --> 00:15:12,010But I know that the commonality of the human experience is that you also will have some strength,
16800:15:12,010 --> 00:15:16,520some gift in your human form and some limitation,
16900:15:16,520 --> 00:15:19,500some struggle in that human form.
17000:15:19,510 --> 00:15:27,980And for some their area of gift and struggle may involve aspects of this autistic neurology.
17100:15:29,200 --> 00:15:34,380I think we do best for each other when we appreciate all sides of our humanity,
17200:15:34,420 --> 00:15:36,550that these are my strengths,
17300:15:36,550 --> 00:15:38,030these are my limitations,
17400:15:38,030 --> 00:15:39,710this is my humanity,
17500:15:39,870 --> 00:15:43,840this mix of good and difficult and strong and weak.
17600:15:43,850 --> 00:15:55,770And I'll always have a mix of this and this is what it is to be human and to truly show honor and respect and appreciation to the personhood of each individual.
17700:15:55,780 --> 00:16:00,960We allow all those things in the mix to be viewed and discussed.
17800:16:01,030 --> 00:16:04,340There's no reason to only talk about easy things,
17900:16:04,340 --> 00:16:05,120bright things,
18000:16:05,120 --> 00:16:06,220successful things.
18100:16:06,220 --> 00:16:13,630We can talk about all the messiness of each of our humanity and still affirm that every single person,
18200:16:13,640 --> 00:16:15,420no matter their age,
18300:16:15,430 --> 00:16:16,030culture,
18400:16:16,030 --> 00:16:17,340health abilities,
18500:16:17,340 --> 00:16:18,580spirituality,
18600:16:18,590 --> 00:16:19,340gender,
18700:16:19,340 --> 00:16:20,880any of these things,
18800:16:20,890 --> 00:16:38,020every single person is filled with inherent value and is deserving of honor and respect because that is inherent to their personhood and having a gift does not make them any more valued in having limitations.
18900:16:38,020 --> 00:16:41,120Does not take away any of their value.
19000:16:41,550 --> 00:16:44,140When someone is celebrating and rejoicing,
19100:16:44,140 --> 00:16:47,220we can come alongside and celebrate too.
19200:16:47,420 --> 00:16:49,440And when someone is grieving,
19300:16:49,450 --> 00:16:54,530when someone is struggling with something or coming across their own limitations,
19400:16:54,530 --> 00:16:58,540we also come alongside them in this as well.
19500:16:58,550 --> 00:17:00,860We can acknowledge the struggle,
19600:17:00,870 --> 00:17:03,640we can offer community assistance,
19700:17:03,650 --> 00:17:10,640anything that we can bring to the table in this moment of of humanity and coming together.
19800:17:10,650 --> 00:17:13,890So let's talk about the second topic,
19900:17:13,890 --> 00:17:25,000which is What kinds of diagnoses or characteristics do we want to consider as under that neuro diversity umbrella.
20000:17:25,010 --> 00:17:38,640So the neuro diversity movement began in the 90s as a way of talking about autism and sometimes attention deficit and the real benefit of it was that it,
20100:17:38,650 --> 00:17:56,780it championed the humanity of everyone with neuro diverse characteristics and made sure that they weren't being looked at as less than or somehow not as valued in society.
20200:17:57,410 --> 00:18:07,690Examples of conditions that are currently considered under the neuro diversity umbrella often include in addition to autism and attention deficit,
20300:18:07,700 --> 00:18:10,370things like obsessive compulsive disorder,
20400:18:10,370 --> 00:18:11,680bipolar disorder,
20500:18:11,680 --> 00:18:13,020dyslexia,
20600:18:13,030 --> 00:18:14,800and dyspraxia.
20700:18:15,870 --> 00:18:16,950But now,
20800:18:16,960 --> 00:18:18,640even though in the beginning,
20900:18:18,640 --> 00:18:26,350we often would talk about autism or attention deficit as being a large part of neuro diversity.
21000:18:26,360 --> 00:18:27,010Now,
21100:18:27,010 --> 00:18:43,020there's a much bigger umbrella that people um talk about as involving these kinds of conditions and it's kind of growing all the time and there's not an inherent difficulty with that,
21200:18:43,020 --> 00:19:02,280but there are some challenges with having the umbrella be very narrow or having it be really um inclusive because neuro diversity at its most inclusive is anything that has diverse neurology as part of its definition.
21300:19:02,290 --> 00:19:03,510So,
21400:19:03,710 --> 00:19:08,910if we're going to expand it beyond autism and attention deficit,
21500:19:08,910 --> 00:19:18,120that we're really going to um be expanding it to include everything with diverse neurology.
21600:19:18,120 --> 00:19:23,850And so that's going to include things like spinal cord injury,
21700:19:23,860 --> 00:19:24,710stroke,
21800:19:24,720 --> 00:19:25,970cerebral palsy,
21900:19:25,970 --> 00:19:28,150parkinson's traumatic brain injury,
22000:19:28,150 --> 00:19:29,230encephalitis,
22100:19:29,240 --> 00:19:30,430brain tumor,
22200:19:30,430 --> 00:19:31,750multiple sclerosis,
22300:19:31,750 --> 00:19:32,820hydrocephalus,
22400:19:32,830 --> 00:19:34,020Alzheimer's disease,
22500:19:34,020 --> 00:19:35,920and all other forms of dementia,
22600:19:35,930 --> 00:19:37,980all learning difficulties,
22700:19:37,990 --> 00:19:40,880intellectual disability and so on.
22800:19:41,500 --> 00:19:46,300If we're going to use the umbrella to be all inclusive of neurologic diversity,
22900:19:46,310 --> 00:19:51,090we are essentially going to be talking about all neurologic conditions.
23000:19:51,340 --> 00:19:52,170In which case,
23100:19:52,170 --> 00:19:56,240we really kind of lost the meaning of the term itself.
23200:19:56,250 --> 00:20:01,010So I'm not sure that it's as powerful a term or meaningful a term.
23300:20:01,800 --> 00:20:04,120But if that's what we prefer,
23400:20:04,120 --> 00:20:05,900we certainly can do this.
23500:20:05,910 --> 00:20:07,620I just think at some point,
23600:20:07,620 --> 00:20:15,560we'll need to decide what meaning do we want the term to include and to be specific,
23700:20:15,560 --> 00:20:28,640knowing that there are a lot of neuro diverse conditions that would have to be under the umbrella if we're going to be all inclusive for neuro diverse conditions.
23800:20:29,480 --> 00:20:29,910So,
23900:20:29,910 --> 00:20:30,620in summary,
24000:20:30,620 --> 00:20:31,600so far,
24100:20:31,610 --> 00:20:38,470I would suggest that we think about what kind of meaning we want the term to have as far as neurology.
24200:20:38,470 --> 00:20:48,170And then also are we able to approach autism in a way that acknowledges all the strengths and the struggles that each individual presents with?
24300:20:48,180 --> 00:20:51,240Always understanding that in all of this mix,
24400:20:51,250 --> 00:21:06,870every person is filled with inherent value and you are important and your importance is never defined by strengths or limitations and you will always have a mix of both because you are human.
24500:21:07,660 --> 00:21:08,000Now,
24600:21:08,000 --> 00:21:23,280in this final section will be addressing an opinion that some have put forth that states that it's really not okay for individuals without an autism diagnosis or some form of neurodivergent diagnosis.
24700:21:23,290 --> 00:21:23,700Again,
24800:21:23,700 --> 00:21:25,270this is ill defined,
24900:21:25,460 --> 00:21:34,370but it's not all right for these individuals to provide services or input to autistic individuals essentially,
25000:21:34,370 --> 00:21:38,750only autistic providers should serve those on the spectrum.
25100:21:38,760 --> 00:21:40,780Uh For example,
25200:21:40,780 --> 00:21:51,550there are some workplaces that serve neurodivergent clients and only hire those with neurodivergent diagnoses.
25300:21:52,110 --> 00:21:57,940I think my response to this is similar to my response to the topics that we've covered so far,
25400:21:57,940 --> 00:22:12,740which is basically that I think the truth and the life and the best outcomes are often found in the center rather than um at either categorical opinion.
25500:22:13,020 --> 00:22:17,950So anytime we're tempted to go for that uh kind of simple,
25600:22:17,950 --> 00:22:18,870straightforward,
25700:22:18,880 --> 00:22:21,550only this and never that kind of thought process,
25800:22:21,550 --> 00:22:28,380we're really limiting the truth and limiting the good that we'll find in the complex middle.
25900:22:29,030 --> 00:22:30,200And in this case,
26000:22:30,200 --> 00:22:44,190I think the wonderful thing about this approach is it does emphasize uh welcoming all kinds of diverse inputs to discussion services and program development as far as they do go,
26100:22:44,200 --> 00:22:51,260which is neuro diversity that we bring together the neuro diverse to serve the neuro diverse.
26200:22:52,500 --> 00:22:53,030Now,
26300:22:53,030 --> 00:22:55,620I love to hear people's stories,
26400:22:55,630 --> 00:22:56,580their opinions,
26500:22:56,580 --> 00:23:01,170their perspectives and whether those are from the autistic individual,
26600:23:01,170 --> 00:23:01,940their friends,
26700:23:01,940 --> 00:23:03,320their family members,
26800:23:03,330 --> 00:23:07,320whether those are from individuals and a helping profession,
26900:23:07,320 --> 00:23:08,550anyone,
27000:23:08,560 --> 00:23:12,350it enriches me over and over and over again.
27100:23:13,700 --> 00:23:14,390However,
27200:23:14,390 --> 00:23:24,700I think saying that only autistic providers should come alongside the autistic to provide input is limiting in a way that would work against the greatest good.
27300:23:24,710 --> 00:23:31,330Not because the autistic providers viewpoint is not valid or in some way less than others viewpoint.
27400:23:31,340 --> 00:23:44,400But because the breadth of specialization and experience that benefits individuals is so huge that no one group of individuals can ever cover all of that information.
27500:23:44,410 --> 00:23:54,020And I think if we tap into our diverse knowledge and experience that we will have the richest information to share.
27600:23:54,030 --> 00:23:59,240So having occupational therapists and neurologists and neuropsychologist,
27700:23:59,250 --> 00:24:02,290experts in academic learning and nutrition,
27800:24:02,300 --> 00:24:05,200all of these things are so beneficial,
27900:24:05,210 --> 00:24:13,150such richness of knowledge and experience that it's the exchange here that brings the blessing.
28000:24:13,160 --> 00:24:18,030It's increasing the diversity of input that brings the blessing.
28100:24:18,490 --> 00:24:27,720And some of these individuals in their specialization will be on the spectrum and some will not in other examples.
28200:24:27,730 --> 00:24:28,200You know,
28300:24:28,200 --> 00:24:36,470if I had multiple sclerosis and I would only receive care from a neurologist who had the same diagnosis.
28400:24:36,480 --> 00:24:41,670I would be limiting some of my um options.
28500:24:41,670 --> 00:24:43,740There may not be someone available.
28600:24:43,750 --> 00:24:47,690Uh This person may not be as experienced as someone else.
28700:24:47,700 --> 00:24:52,030Um I may be limiting where I could have a whole team of people.
28800:24:52,030 --> 00:24:53,090Maybe I'm saying no,
28900:24:53,090 --> 00:24:54,870I just want this one person.
29000:24:55,300 --> 00:24:59,490It would get even more difficult if I had two conditions,
29100:24:59,490 --> 00:24:59,930right?
29200:24:59,930 --> 00:25:04,870That I have multiple sclerosis and congestive heart failure.
29300:25:04,880 --> 00:25:05,390Now,
29400:25:05,390 --> 00:25:12,550do I have to find a provider that has both or I can see a heart provider that also has congestive heart failure?
29500:25:13,230 --> 00:25:22,290It's not that there's not value in getting input from others who share characteristics about your life and have walked in your shoes and get it.
29600:25:22,300 --> 00:25:25,220I think that's really valuable.
29700:25:25,700 --> 00:25:32,230But there's also value in getting input from those who don't share the same characteristics,
29800:25:32,230 --> 00:25:40,150but they have areas of expertise that they can offer some input that you wouldn't get in other places.
29900:25:40,250 --> 00:25:41,190Essentially,
30000:25:41,190 --> 00:25:46,240we're talking about the benefits of diversity and getting diverse input.
30100:25:46,240 --> 00:25:50,810When you have some struggles or limitations in any form of your life,
30200:25:51,140 --> 00:25:57,930then you get to take in the perspectives of all those other people and you decide what's helpful to you.
30300:25:57,940 --> 00:26:03,160But you have a lot of diverse input and rather than limiting the input,
30400:26:03,160 --> 00:26:04,140you're getting,
30500:26:04,150 --> 00:26:11,020you get to take in this information process it and say this has really helped me.
30600:26:11,030 --> 00:26:17,290This is not helpful to me and you get to be the filter for what you take into your own life.
30700:26:17,810 --> 00:26:20,720This is a really complex topic.
30800:26:20,730 --> 00:26:23,220There's a lot of emotions involved.
30900:26:23,230 --> 00:26:24,410I think in the end,
31000:26:24,410 --> 00:26:38,470what I'm saying is just that being able to be in the center of complexity helps me the most to understand the good and the difficult,
31100:26:38,480 --> 00:26:43,220the strength and the struggle of all kinds of human experience.
31200:26:43,230 --> 00:26:54,750And I would emphasize that the inherent value of the person is in their personhood and that never changes.
31300:26:54,760 --> 00:27:02,820So whether we're working with someone on something that they're celebrating or something that they're grieving,
31400:27:02,830 --> 00:27:07,200we can come along either way and say you are important,
31500:27:07,580 --> 00:27:09,110your personhood,
31600:27:09,120 --> 00:27:11,300you have this inherent value.
31700:27:11,310 --> 00:27:13,600I value that you've come,
31800:27:13,610 --> 00:27:21,320I value your story and your input and let me come alongside you and add what I can to your journey.
31900:27:22,070 --> 00:27:31,790I'm glad that you joined me today and that you're part of this podcast community and I hope you join me next time for another great topic.
-
Join Dr. Regan for this episode on the quest for balance on the autism spectrum. Whether it's emotional regulation, attention, sleep, social interactions, task initiation, finances and more, finding the "just right" state is difficult for many on the spectrum.
Book: The Science of Making Friends
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the Transcript Here:
100:00:07,240 --> 00:00:11,610Hello and welcome back to the podcast Autism in the Adult.
200:00:11,620 --> 00:00:12,730I am your host,
300:00:12,730 --> 00:00:14,390Dr Theresa Regan,
400:00:14,400 --> 00:00:16,120a neuropsychologist,
500:00:16,130 --> 00:00:18,470a certified autism specialist.
600:00:18,480 --> 00:00:23,930The director of an autism diagnostic clinic for adolescents,
700:00:23,940 --> 00:00:29,590adults and aging adults in central Illinois and the mother of a teen on the spectrum.
800:00:30,660 --> 00:00:48,140I'm glad you're joining me today for this episode that I'm going to call autism and "just right." This is actually a great topic that was suggested by a listener from Finland and I hope that I am pronouncing the name correctly.
900:00:48,140 --> 00:01:07,680I think it's Maya ... Maya wrote about questions and struggles within the topic of balance in life when you have that autistic neurology,
1000:01:07,690 --> 00:01:09,270Maya wrote this.
1100:01:09,670 --> 00:01:23,030I would so much love to hear what you have to say about autistic people and the struggle we have with striking a balance in situations where we have to create an appropriate view on or understanding of things?
1200:01:23,040 --> 00:01:29,350I am convinced that this is the major autistic difficulty that I personally struggle with.
1300:01:30,110 --> 00:01:34,570It shows up in different forms for me and on many levels.
1400:01:35,700 --> 00:01:39,890I could take a few examples so that you understand what I mean?
1500:01:39,900 --> 00:01:44,520Because most often this is not linked to intelligence,
1600:01:44,530 --> 00:01:46,350for example,
1700:01:46,350 --> 00:01:47,490is this person,
1800:01:47,500 --> 00:01:50,100a friend who respects me or not,
1900:01:50,740 --> 00:01:53,230am I too skinny or even to fat?
2000:01:53,240 --> 00:01:58,050Should I contact a doctor because of this thing that I'm feeling right now.
2100:01:58,570 --> 00:02:01,470How far should I stand by this person's side?
2200:02:01,660 --> 00:02:04,500How much should I help him or her?
2300:02:05,210 --> 00:02:10,820Exactly how well should I perform in this university course in order to pass.
2400:02:11,910 --> 00:02:15,030I want to thank Maya for writing about that.
2500:02:15,040 --> 00:02:29,300Um this is something I've thought about as well and I think it's one of those really great ways to conceptualize autism aside from specific details.
2600:02:29,310 --> 00:02:34,510So sometimes to get the most meaning out of what you're feeling,
2700:02:34,510 --> 00:02:47,890it can help to step back and say how is it that all these little pieces of the autistic experience hang together in some ways it can feel so granular,
2800:02:47,900 --> 00:02:51,500like so many things are impacted.
2900:02:51,510 --> 00:02:59,120Why do these things happen at the same time and when we have ways of conceptualizing it?
3000:02:59,480 --> 00:03:02,450Um I think it brings meaning.
3100:03:02,460 --> 00:03:10,290It helps these little pieces come together as why do I have trouble with these 12 things?
3200:03:10,300 --> 00:03:11,380Well,
3300:03:11,390 --> 00:03:19,090these 12 things have a thread that go through and when we can step back and see that thread that joins things,
3400:03:19,100 --> 00:03:23,020I think it really makes things more meaningful.
3500:03:23,030 --> 00:03:26,210Um and so that's what I want to do with this topic.
3600:03:26,210 --> 00:03:32,870Today I call this the just right state.
3700:03:32,880 --> 00:03:35,570So she was talking about balance.
3800:03:35,570 --> 00:03:38,230That's another great way to term it.
3900:03:38,240 --> 00:03:43,950Um A lot of times with the neurology that we're talking about,
4000:03:43,950 --> 00:03:55,770somebody will have difficulty finding that just right spot of balance where whatever they're attempting is not too much or too little.
4100:03:56,130 --> 00:04:24,560And ideally our neurology should help us flow in these areas that we can flow and adjust and we have this innate sense of where we should land to be just right for this context for this person for this topic and we can shift because just right will look different in one setting that it will in another setting or across time.
4200:04:25,100 --> 00:04:30,320So there's a lot of innit nous and flow in this ability to find just right.
4300:04:31,650 --> 00:04:35,920We've talked about difficulty with regulation in a very broad sense.
4400:04:35,920 --> 00:04:47,530We did a series on regulation issues having to do with alertness and attention and emotions and getting to that just rate state in those areas.
4500:04:47,540 --> 00:04:59,270But I think what Maya is pointing out is that regulation and balance and just right is a thread that goes through a lot of other areas with autism as well.
4600:04:59,280 --> 00:05:04,170So let's take a few areas and see how this just right.
4700:05:04,400 --> 00:05:08,330Uh this quest for just right is difficult.
4800:05:08,950 --> 00:05:10,990Let's take the social area.
4900:05:11,590 --> 00:05:19,020So some things that were struggling with that would capture this difficulty with just right would be,
5000:05:19,030 --> 00:05:22,400how much should I be speaking right now to this person?
5100:05:22,410 --> 00:05:24,690How much detail should I be giving?
5200:05:24,700 --> 00:05:27,830How much personal information should I share?
5300:05:27,840 --> 00:05:34,660What is the just right intensity and level of excitement for this context or person?
5400:05:35,020 --> 00:05:41,240What is just right as I'm interacting with a boss versus an acquaintance?
5500:05:41,250 --> 00:05:43,090How much eye contact?
5600:05:43,100 --> 00:05:44,700Too much or too little?
5700:05:44,710 --> 00:05:55,420How much emotional expression should I be using without looking false or like I'm putting on a show or that I don't care at all.
5800:05:56,380 --> 00:05:57,410For example,
5900:05:57,420 --> 00:06:01,380opening gifts without looking just flat or board,
6000:06:01,390 --> 00:06:07,660but without looking like an actor that's pretending to be happy with a gift.
6100:06:08,690 --> 00:06:11,720How much should I give this person?
6200:06:12,830 --> 00:06:15,130How long should I stand by them?
6300:06:15,140 --> 00:06:17,200How much money should I loan them?
6400:06:17,210 --> 00:06:20,490How many times should I give them a ride or a lift?
6500:06:20,500 --> 00:06:24,040How much leeway should I give in a relationship?
6600:06:24,050 --> 00:06:25,270For example,
6700:06:25,280 --> 00:06:31,540I know people are complex and I can be friends with people who do things that I don't agree with.
6800:06:31,550 --> 00:06:34,120But at what point do I say?
6900:06:34,120 --> 00:06:34,420Yeah,
7000:06:34,420 --> 00:06:37,970this is really not a healthy relationship for me.
7100:06:37,970 --> 00:06:40,130I need to end this relationship.
7200:06:41,290 --> 00:06:44,200How close should I make this relationship?
7300:06:44,210 --> 00:06:52,470And how soon what is the just right closeness and the timing of a relationship?
7400:06:52,480 --> 00:07:03,690So some people on the spectrum struggle because they really want some definition to the relationship quickly because this in between state,
7500:07:03,690 --> 00:07:06,770this undefined state feels really uncomfortable.
7600:07:07,600 --> 00:07:08,600So they might say,
7700:07:08,600 --> 00:07:20,770well let's just get married right away because we know we're right for each other and in essence defining and structuring the relationship feels better than this.
7800:07:20,770 --> 00:07:21,300Huh?
7900:07:21,310 --> 00:07:23,600I don't know what's gonna happen with this relationship.
8000:07:23,610 --> 00:07:27,070It feels safer and more defined and more predictable.
8100:07:28,080 --> 00:07:36,130Others will break up a relationship because they don't want to be in that undefined spot that in between place.
8200:07:36,140 --> 00:07:42,420Um So how much is just right as far as closeness in a relationship.
8300:07:43,810 --> 00:07:52,850What is the just right number of times to text or phone someone if they don't call you back or to extend an invitation to someone.
8400:07:52,860 --> 00:07:58,530Now sometimes there are rules of thumb for something like that.
8500:07:58,540 --> 00:08:06,670There's a nice book that I like called the Science of Making Friends that I'll link in the show notes that talks about,
8600:08:06,680 --> 00:08:06,970you know,
8700:08:06,970 --> 00:08:14,120you don't text or call again once you've done so twice without a return text or call.
8800:08:17,250 --> 00:08:28,880I once worked with a couple and we were trying to really increase his ability to bring some nurturance and emotional content to the relationship.
8900:08:28,890 --> 00:08:38,330And I worked with him on being aware that one way to show his wife love is to compliment her.
9000:08:38,340 --> 00:08:40,960So we kind of worked on that as a goal,
9100:08:40,960 --> 00:08:41,780practiced it,
9200:08:41,780 --> 00:08:45,090role played it and he put it into action.
9300:08:45,820 --> 00:08:48,310The problem was then his wife said,
9400:08:48,310 --> 00:08:50,820well now he's complimenting me too much.
9500:08:53,000 --> 00:08:54,570It is the difficulty,
9600:08:54,570 --> 00:08:55,820isn't it?
9700:08:55,870 --> 00:08:58,880Like I can learn a strategy,
9800:08:58,890 --> 00:09:02,390I can apply new knowledge,
9900:09:03,300 --> 00:09:08,690but the getting the just right amount,
10000:09:08,690 --> 00:09:09,880the just right moment,
10100:09:09,880 --> 00:09:11,970the just right compliment boy.
10200:09:11,970 --> 00:09:13,510That's really difficult.
10300:09:13,520 --> 00:09:15,260It's difficult for anyone.
10400:09:15,270 --> 00:09:16,010Uh,
10500:09:16,010 --> 00:09:18,580and even more so on the spectrum,
10600:09:20,830 --> 00:09:24,280let's look at finances for that just right state.
10700:09:25,130 --> 00:09:39,340It seems common for individuals on the spectrum to either lean toward spending too much perhaps on their special interests or other things that cut their eye or to spend too little.
10800:09:40,490 --> 00:09:41,090Um,
10900:09:41,100 --> 00:09:56,050there are people that have lots of money in a savings account or other type of account but they don't want to withdraw anything to fix the roof or to buy an updated phone.
11000:09:57,660 --> 00:10:01,970What is the amount of spending that is just right.
11100:10:02,830 --> 00:10:12,100There are guides for budgeting but it can still feel really elusive to get just right in specific personal situations.
11200:10:12,110 --> 00:10:13,490So yeah,
11300:10:13,490 --> 00:10:14,840this is the principle,
11400:10:14,840 --> 00:10:16,080this is the guideline,
11500:10:16,080 --> 00:10:17,750this is the percentage,
11600:10:17,760 --> 00:10:25,380but it is hard to have to look that framework up and not have a sense,
11700:10:25,380 --> 00:10:29,070an innate sense like yeah,
11800:10:29,070 --> 00:10:33,180I really need to get this roof repaired some will say,
11900:10:33,190 --> 00:10:33,730yeah,
12000:10:33,730 --> 00:10:35,960I know that I can ask for advice,
12100:10:35,960 --> 00:10:41,950I know that I can use this budget but I wish I had this innate sense of yeah,
12200:10:41,950 --> 00:10:46,440I really need to update this in my home or boy,
12300:10:46,440 --> 00:10:51,570I've spent too much on this area and not enough on this other area.
12400:10:53,460 --> 00:10:54,240They'll say,
12500:10:54,240 --> 00:10:54,540you know,
12600:10:54,540 --> 00:11:02,840it's difficult to have a feel for it instead of having to stick to some type of formula and maybe feeling like,
12700:11:02,850 --> 00:11:09,360well what would that rule of thumb look like in this situation and how would it apply to this other case.
12800:11:11,270 --> 00:11:16,490Let's look at just right as it relates to task completion on the spectrum.
12900:11:17,020 --> 00:11:22,400What is the just right amount of completion for some people on the spectrum,
13000:11:22,410 --> 00:11:30,960completion is very important but when is something complete and what is the just right amount of accuracy and detail?
13100:11:30,970 --> 00:11:44,080Some may feel like I need to finish one task before I start another task or I can't go to bed until I read all of these pages assigned from the class of the previous day.
13200:11:45,060 --> 00:11:49,120What is the right amount of detail?
13300:11:49,130 --> 00:11:51,290What is the right amount of speed?
13400:11:53,480 --> 00:11:57,100Have I done enough that this assignment is complete,
13500:11:57,140 --> 00:12:03,440especially when we get to adulthood tasks don't have a clear cut off.
13600:12:04,510 --> 00:12:16,370It's not like there are five math problems and we finish each one and we know the task is complete and maybe that we have a research paper or we have a software project.
13700:12:16,380 --> 00:12:16,830Well,
13800:12:16,840 --> 00:12:18,040when is it complete?
13900:12:18,040 --> 00:12:19,620When is it good enough?
14000:12:23,130 --> 00:12:25,020That difficulty knowing?
14100:12:25,020 --> 00:12:25,480Hey,
14200:12:25,480 --> 00:12:29,120I haven't attended a task B at all,
14300:12:29,120 --> 00:12:33,420but I've overworked on task A and how do I balance that?
14400:12:33,420 --> 00:12:35,030When do I know that?
14500:12:35,030 --> 00:12:36,560That's the difficulty.
14600:12:38,750 --> 00:12:50,450One person I worked with said I've always had the strong feeling that a newspaper needs to be read completely from cover to cover from every page that there,
14700:12:50,460 --> 00:12:53,030there is a completion that's important.
14800:12:53,840 --> 00:12:56,700You can't just read an article here and there.
14900:12:56,750 --> 00:12:58,630That's just not right.
15000:12:59,420 --> 00:13:06,680Another person may feel I have to finish this test completely before I start this other project.
15100:13:07,650 --> 00:13:18,980Even though the first task was something a coworker asked me about and this next one I have to complete is something my boss asked me to work on.
15200:13:22,510 --> 00:13:32,520It's difficult sometimes for the individual with that autistic neurology to understand that all details do not have the same importance.
15300:13:33,110 --> 00:13:38,970Um There are people um on the spectrum who feel like,
15400:13:38,980 --> 00:13:48,350well every detail is going to be important so it has to be included and the neurology there just isn't helping the person know like Yeah,
15500:13:48,350 --> 00:13:54,010but in this instance this part is not as important as this part,
15600:13:56,290 --> 00:14:06,880it can be really hard to get the neurology to shift uh to adjust if a task needs to be done quickly but does not need to be as accurate.
15700:14:07,390 --> 00:14:12,510So meeting deadlines might really be difficult if your boss says to you,
15800:14:12,510 --> 00:14:15,910hey this project needs to be done quickly.
15900:14:15,920 --> 00:14:21,720It doesn't really need to be detailed but I have to have it ready for a meeting tomorrow at noon.
16000:14:21,730 --> 00:14:24,990I just want to give a broad overview.
16100:14:25,000 --> 00:14:29,830Details are not important that can feel actually very stressful.
16200:14:29,840 --> 00:14:32,990Well what does a broad overview look like?
16300:14:33,000 --> 00:14:34,600And will,
16400:14:34,610 --> 00:14:41,230will I feel okay stopping when there are other details available.
16500:14:43,910 --> 00:14:49,200This is also related to the topic that maya brought up about working on a course,
16600:14:49,210 --> 00:14:50,780a university class.
16700:14:50,790 --> 00:14:57,460How much work do I need to do in order to do a good job?
16800:14:57,470 --> 00:15:00,290What if I could have done more?
16900:15:00,300 --> 00:15:01,820Could have done better.
17000:15:03,090 --> 00:15:06,500How many a's do I need to get to be a good student?
17100:15:06,500 --> 00:15:11,730How can I hit the mark of balance with accuracy and speed?
17200:15:12,910 --> 00:15:14,800How can I balance that?
17300:15:14,800 --> 00:15:18,460Everything doesn't have the same importance at the same time,
17400:15:20,530 --> 00:15:26,400something may be able to go undone while something else cannot wait another minute.
17500:15:26,400 --> 00:15:27,490So triaging,
17600:15:27,490 --> 00:15:32,400how do I triage quickly based on importance?
17700:15:33,210 --> 00:15:36,360How thorough do I need to be on this project?
17800:15:36,870 --> 00:15:41,420If the professor said I need to cite 10 sources,
17900:15:42,200 --> 00:15:44,070Can my brain let go?
18000:15:44,070 --> 00:15:52,440The other 25 sources I might be able to get and how can I just innately have a feel for?
18100:15:52,450 --> 00:15:53,360Okay,
18200:15:53,370 --> 00:15:54,250this is done,
18300:15:54,260 --> 00:15:58,120this is this project is finished and it's good to go.
18400:15:59,020 --> 00:16:11,500Maya also noted in her email that sometimes the approach to dealing with this difficulty is to get input from others about what might be just right in a situation,
18500:16:12,310 --> 00:16:15,570but that approach doesn't always feel practical.
18600:16:15,580 --> 00:16:23,180Like who could I ask or there's a deadline and people aren't around this just isn't practical.
18700:16:23,190 --> 00:16:25,520It also takes a lot of energy.
18800:16:25,530 --> 00:16:32,760And do I always bother the same person or how many times do I ask for input and who do I ask?
18900:16:34,050 --> 00:16:35,610So first of all,
19000:16:35,620 --> 00:16:40,850let's talk about that difficulty finding the just right state.
19100:16:41,510 --> 00:16:46,470So this could be within alertness and behavioral activation,
19200:16:46,480 --> 00:16:49,310it can be within attention.
19300:16:49,320 --> 00:16:52,790Like what is the just right amount of attention.
19400:16:52,800 --> 00:16:56,210It's somewhere between distractible and hyper focus.
19500:16:56,220 --> 00:17:08,840What is the just right space for our emotions while it's to be psychologically present and um clearheaded and calm.
19600:17:09,520 --> 00:17:12,010What is just right for test completion,
19700:17:12,010 --> 00:17:15,280finances working out nutrition,
19800:17:15,280 --> 00:17:17,130dieting all of these things.
19900:17:18,280 --> 00:17:26,470Let me give you an example for my own life that has to do with another physical just rate dilemma.
20000:17:27,400 --> 00:17:35,250So one of the things that I think about that I think also highlights this is that personally,
20100:17:35,260 --> 00:17:42,950it's kind of a joke in my family that I have really bad depth perception and again,
20200:17:42,950 --> 00:17:51,470it's kind of a joke because at some point you just have to laugh and luckily I always think I have less room.
20300:17:51,480 --> 00:17:55,770So it's not that I go around hitting things with the car,
20400:17:56,070 --> 00:17:57,870but you know,
20500:17:57,880 --> 00:18:01,350there's lots of room left and it does get kind of funny,
20600:18:02,960 --> 00:18:12,470I wish so in the back of my mind that I could learn to compensate for that because I do get tired of laughing at myself and having to be a good sport about this,
20700:18:12,490 --> 00:18:18,620just silly thing that I've parked so far away from where I could have parked,
20800:18:20,790 --> 00:18:29,250I realized that I always leave two ft from where I could have pulled up.
20900:18:29,780 --> 00:18:37,640So there's this remarkable consistency for me in that area that I can't tell what's just right,
21000:18:37,650 --> 00:18:42,600but somehow I'm always two ft from where I probably should be.
21100:18:42,600 --> 00:18:43,650So I thought,
21200:18:43,660 --> 00:18:45,100okay,
21300:18:45,110 --> 00:18:57,570well I will compensate for this difficulty with just right by going an extra two ft because I actually think I can Gauge what two ft would be.
21400:18:59,020 --> 00:19:06,830So I started to do that and lo and behold I that just does not work.
21500:19:06,840 --> 00:19:16,110I cannot compensate to get to intellectually get to the where the just right status.
21600:19:16,120 --> 00:19:31,770So as you can imagine I'm either to end up touching the wall or the um edge of the parking space with my car or I end up still being well below where I could be.
21700:19:33,350 --> 00:19:48,420So for me that's just another example that if my eyes in my brain are not able to show me the just rate state,
21800:19:50,120 --> 00:19:54,700there's not much I can do about that unfortunately.
21900:19:55,990 --> 00:20:02,700Um And even though I intellectually think of a strategy to compensate,
22000:20:02,710 --> 00:20:06,940it still doesn't mean that I can hit the just right spot.
22100:20:06,950 --> 00:20:08,680Well I should do this more,
22200:20:08,680 --> 00:20:10,140I should do this less.
22300:20:10,150 --> 00:20:29,430Um So I actually believe and in my experience with clients I think that ability that flow for that feel for the just rate state is something that is very difficult to compensate for.
22400:20:29,440 --> 00:20:33,770And I'm not sure that there are great ways to do that.
22500:20:34,900 --> 00:20:46,350I think what we typically do is we suggest intellectual compensations kind of like what I tried to do for my uh driving and parking.
22600:20:46,360 --> 00:21:15,230Um And I think those things are helpful in some ways but there's still this gap between where we would want to be as far as having a flow and an efficiency a feel for that would be so great rather than having to try to gauge to hit that spot a little bit better.
22700:21:17,430 --> 00:21:23,400Some of the compensations that are helpful would be,
22800:21:23,410 --> 00:21:24,330um,
22900:21:24,340 --> 00:21:28,280I think having the self awareness is helpful.
23000:21:28,290 --> 00:21:29,750So for example,
23100:21:29,760 --> 00:21:33,660I know that I have this difficulty,
23200:21:33,660 --> 00:21:36,480so if I have a passenger in the car and they're like,
23300:21:36,480 --> 00:21:37,040you know,
23400:21:37,050 --> 00:21:42,450you can pull up some more because I have that self awareness.
23500:21:42,460 --> 00:21:45,850I have a place for that to integrate that comment.
23600:21:45,850 --> 00:21:47,070And I can say,
23700:21:47,800 --> 00:21:49,080oh yeah,
23800:21:49,080 --> 00:21:50,320I probably can,
23900:21:50,330 --> 00:21:51,520I can't really tell you,
24000:21:51,520 --> 00:21:52,840tell me when to stop.
24100:21:53,470 --> 00:21:54,000Um,
24200:21:54,010 --> 00:21:57,510so I'm able to say yes to that comment.
24300:21:57,520 --> 00:21:58,060Like,
24400:21:58,070 --> 00:21:58,480oh yeah,
24500:21:58,480 --> 00:21:59,640I have a place for that.
24600:21:59,640 --> 00:22:00,680That makes sense.
24700:22:00,690 --> 00:22:01,900I have that awareness.
24800:22:01,900 --> 00:22:05,930I have that understanding of myself and I can't compensate myself.
24900:22:05,940 --> 00:22:09,010But if you're here and you're willing to help,
25000:22:09,010 --> 00:22:09,940let's do that.
25100:22:11,310 --> 00:22:14,460So having a place to put comments like,
25200:22:14,470 --> 00:22:15,650um,
25300:22:15,660 --> 00:22:16,350you know,
25400:22:16,350 --> 00:22:25,390you don't have to call me so many times or um I really don't think that person is mad at you.
25500:22:25,400 --> 00:22:25,840You know,
25600:22:25,840 --> 00:22:27,590when we get feedback like that,
25700:22:27,590 --> 00:22:30,950it it does help us to have a place where we say,
25800:22:30,960 --> 00:22:31,650oh,
25900:22:32,250 --> 00:22:33,400I didn't realize that,
26000:22:33,400 --> 00:22:39,570but I do know I can make errors in that in that area sometimes.
26100:22:40,420 --> 00:22:41,170Um,
26200:22:41,810 --> 00:22:47,440I also think that the awareness can be about what we lean toward.
26300:22:47,450 --> 00:22:50,780So if we have trouble finding the just right spot,
26400:22:50,780 --> 00:23:03,780sometimes we lean toward going toward too much or too little and in my case I lean toward uh leaving too much room or thinking I don't have enough room.
26500:23:03,780 --> 00:23:05,790So I lean in the same direction.
26600:23:07,100 --> 00:23:07,800Um,
26700:23:07,810 --> 00:23:17,440in the case of autism and the categories that we've talked about sometimes that's true for individuals in those categories as well.
26800:23:17,450 --> 00:23:28,640So I have clients that always lean toward thinking that they haven't done enough or they always lean toward thinking,
26900:23:28,900 --> 00:23:29,500um,
27000:23:29,510 --> 00:23:36,160someone's mad at them or thinking that they shouldn't spend money on something.
27100:23:36,170 --> 00:23:40,680So they have a way that they lean so they can say to themselves,
27200:23:40,690 --> 00:23:46,090I realize about myself that when I am off of just right,
27300:23:46,090 --> 00:23:48,780I'm usually in this direction in this category.
27400:23:50,230 --> 00:23:51,840That's also helpful.
27500:23:51,850 --> 00:23:52,600Um,
27600:23:52,610 --> 00:23:54,780because I do think again,
27700:23:54,780 --> 00:23:56,510it gives us a place to put things.
27800:23:56,510 --> 00:24:06,800So let's say that someone is working on a university project and there's nobody there to guide them through and they're thinking,
27900:24:08,050 --> 00:24:14,600I've checked all these specific boxes that the professor asked for,
28000:24:14,610 --> 00:24:17,390but I just have this feeling that I should do more.
28100:24:17,390 --> 00:24:19,290I know I could do more,
28200:24:19,300 --> 00:24:21,910at least they're able to say to themselves,
28300:24:21,910 --> 00:24:22,590you know,
28400:24:22,600 --> 00:24:26,720when I'm uncertain about whether I've done enough,
28500:24:26,720 --> 00:24:29,410usually I've already done too much.
28600:24:29,420 --> 00:24:30,060Um,
28700:24:30,060 --> 00:24:34,730so that can be a guide for them of sorts where they could say,
28800:24:34,730 --> 00:24:35,150okay,
28900:24:35,150 --> 00:24:36,170I'm gonna,
29000:24:36,180 --> 00:24:38,730I'm gonna complete this task,
29100:24:38,730 --> 00:24:42,370I'm gonna call it completed because um,
29200:24:43,210 --> 00:24:47,890I know I lean in that direction and I feel like I've ticked the basic boxes.
29300:24:52,170 --> 00:24:58,140Another thing that can be helpful then is to have some way to communicate.
29400:24:58,150 --> 00:25:06,210Maybe some uh sentences or phrases or ways of putting things that you've practiced ahead of time,
29500:25:06,890 --> 00:25:13,520that communicate to others about your difficulty finding just right in a specific area.
29600:25:15,040 --> 00:25:17,880So let's take some examples.
29700:25:17,890 --> 00:25:26,920And this could be communication beforehand or uh in the midst or after something has happened,
29800:25:27,960 --> 00:25:29,720an example would be,
29900:25:29,730 --> 00:25:42,750let's say someone is starting a new romantic relationship and they have the self awareness that sometimes when they come home from work,
30000:25:42,750 --> 00:25:48,130they are really shut down psychologically and they're in their own head,
30100:25:48,140 --> 00:25:48,780you know,
30200:25:48,780 --> 00:25:53,590that they don't talk a lot to their partners,
30300:25:53,590 --> 00:25:59,110they don't interact much and sometimes partners need something that they aren't,
30400:25:59,120 --> 00:26:00,180aren't giving.
30500:26:00,190 --> 00:26:02,410So with that awareness,
30600:26:02,420 --> 00:26:06,300they could say to the partner ahead of time,
30700:26:06,930 --> 00:26:07,640hey,
30800:26:07,640 --> 00:26:17,420I'm I've been learning about myself uh and one of the things I've learned is that I guess I tend to be shut down after work when I come home.
30900:26:17,430 --> 00:26:20,940So if you need help with something,
31000:26:20,950 --> 00:26:23,620if you um you know,
31100:26:23,620 --> 00:26:27,580want to tell me a specific story or something that's happened,
31200:26:27,580 --> 00:26:39,820you might really just have to um have me look you in the eye and tell me exactly what you need because I might not read the situation very well on my own.
31300:26:40,550 --> 00:26:43,360So that would be a case where,
31400:26:43,370 --> 00:26:44,020you know,
31500:26:44,020 --> 00:26:45,950you have difficulty finding just right,
31600:26:45,950 --> 00:26:49,600you're not going to be able to compensate after work,
31700:26:49,600 --> 00:26:52,210you're already kind of offline,
31800:26:52,220 --> 00:27:02,410but you could explain a bit of the context even though you can't compensate yourself or shift that you could give some context.
31900:27:03,990 --> 00:27:08,890I think the value of that is not only giving the person that information,
32000:27:08,890 --> 00:27:15,040but I think telling people that you're trying to learn more about yourself,
32100:27:15,050 --> 00:27:19,350I think is just a really good thing to communicate.
32200:27:19,360 --> 00:27:32,340People value that we all know we're imperfect humans and we're learning about ourselves and we're growing and that we're open to feedback.
32300:27:32,350 --> 00:27:33,350So,
32400:27:33,360 --> 00:27:33,830you know,
32500:27:33,830 --> 00:27:36,280if feel free to give me feedback,
32600:27:36,280 --> 00:27:49,630if I'm if I'm offline and and I can try to adjust an example of communicating after the fact or maybe in the midst of a fact.
32700:27:49,640 --> 00:27:52,540So let's take a different example.
32800:27:52,540 --> 00:28:06,350We're going to take the example of being at work and there is a project that you've been put in charge of and you miss the deadline and your boss is gonna do coaching with you about that.
32900:28:07,400 --> 00:28:15,290Um So you get feedback from your boss who is frustrated that the deadline was missed.
33000:28:15,860 --> 00:28:16,890That you know,
33100:28:16,890 --> 00:28:25,660he he really needs to be able to count on someone that can meet deadlines because these are very important to the bottom line of their department.
33200:28:25,670 --> 00:28:30,540And if you can't be a team player and get those deadlines done,
33300:28:30,540 --> 00:28:34,670then the whole team suffers again.
33400:28:34,670 --> 00:28:39,980This would be an opportunity for you to say in your head,
33500:28:39,990 --> 00:28:40,380you know,
33600:28:40,380 --> 00:28:43,970to think uh here here,
33700:28:43,970 --> 00:28:44,860this comes up.
33800:28:44,860 --> 00:28:53,530I know that I do tend to focus on accuracy more than speed and I didn't realize it,
33900:28:53,530 --> 00:28:58,300but uh that's come into play here and so out loud to your boss,
34000:28:58,310 --> 00:29:01,140you could say a similar thing,
34100:29:01,140 --> 00:29:02,330you could say,
34200:29:03,230 --> 00:29:04,700you know,
34300:29:04,710 --> 00:29:07,410I'm really sorry that that happened,
34400:29:07,420 --> 00:29:31,260I've been learning about myself that I really do tend toward getting into the detail and sometimes I sacrifice speed without really meaning to and what I realize helps me is and then you can give a specific thing that you would like.
34500:29:31,270 --> 00:29:36,870Um so one of the things an employee might ask for would be,
34600:29:36,880 --> 00:29:55,720it would help me if I could set uh deadlines for parts of the project rather than the completion so that I really stay on pace and what I'd like to do for this next project you've given me is break it into six parts and I'm going to,
34700:29:55,730 --> 00:29:56,390you know,
34800:29:56,390 --> 00:30:04,290give you dates for my deadlines for each of these parts and you can tell me if the deadlines need to be adjusted.
34900:30:04,800 --> 00:30:11,090Um so what you're doing is saying I have this self awareness and I'm growing in this area,
35000:30:11,630 --> 00:30:19,600you're showing that you're open to feedback and then you're also showing that you're going to try a new strategy.
35100:30:20,650 --> 00:30:31,310So sometimes there can be ways of trying to um navigate this difficulty with just right,
35200:30:31,320 --> 00:30:38,760we talked before about how another navigation tool might might be rules of thumb or general principles.
35300:30:38,760 --> 00:30:40,900So here's my budget,
35400:30:40,900 --> 00:30:50,230this is what I'm supposed to spend or not spend or um rules of thumb for completing a university course.
35500:30:51,540 --> 00:31:10,790But I think the truth of that struggle of not having that innate feel for just right really is something core in the autism neurology that I haven't found um a way to shift.
35600:31:10,790 --> 00:31:20,690I think that's really a core neurologic piece that I'm either too much or too little and if I hit just right,
35700:31:20,700 --> 00:31:21,590that's great.
35800:31:21,590 --> 00:31:23,760But I have such a hard time staying there.
35900:31:25,490 --> 00:31:39,900I want to thank my again for that insight and um I think even when there aren't answers to correct a challenge or to kind of make it easier over time,
36000:31:39,910 --> 00:31:46,180I think that awareness that conceptualization that oh why do I do this?
36100:31:46,180 --> 00:31:48,650Why am I really good at detail?
36200:31:48,650 --> 00:31:50,590But I really struggle with deadlines.
36300:31:50,600 --> 00:31:54,390Well this all hangs together neurologically,
36400:31:54,390 --> 00:32:05,120it's part of that difficulty finding just right and I do think that that conceptualization that self awareness is important in and of itself.
36500:32:05,130 --> 00:32:10,960Um and I do think the understanding that that crosses over categories,
36600:32:10,970 --> 00:32:21,170social and task completion and sleep and attention and all of these other things that are really difficult to balance.
36700:32:22,410 --> 00:32:26,960Thank you Maya and I hope you all join me for our next episode
-
Join Dr. Regan for this episode on neurodiversity and holiday celebrations. Sometimes the most memorable moments come from holding tightly to our foundations and releasing other things that don't fit our season of life or individual needs.
Planning a Merry Holiday on the Autism Spectrum, podcast episode 2020
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:03,870 --> 00:00:09,800Hello and I'm glad you're joining me today for this episode of Autism in the Adult podcast.
200:00:09,810 --> 00:00:12,790I am your podcast host,
300:00:12,800 --> 00:00:14,430Dr Theresa Regan,
400:00:14,440 --> 00:00:16,530a neuropsychologist.
500:00:16,540 --> 00:00:25,010I am the founder and director of an autism diagnostic clinic in central Illinois for adolescents,
600:00:25,020 --> 00:00:27,830adults and geriatric patients.
700:00:27,840 --> 00:00:32,780I'm a certified autism specialist and the mother of a teen on the spectrum.
800:00:33,790 --> 00:00:37,770Today we are going to talk about the holiday season.
900:00:37,780 --> 00:00:41,460If you are listening to this shortly after its release,
1000:00:41,470 --> 00:00:45,980you may be within a holiday season as well.
1100:00:45,990 --> 00:01:01,120There are many different meaningful celebrations going on at this time of year across the world and those look different across families and countries and backgrounds and faith experiences.
1200:01:01,470 --> 00:01:07,150But many of us are celebrating a yearly,
1300:01:07,160 --> 00:01:09,310meaningful
1400:01:09,320 --> 00:01:12,910moment in our lives and that can get hectic.
1500:01:12,920 --> 00:01:24,980It can get exciting ... and we're going to talk about how to do that with intention and meaning and hopefully a bit more peace,
1600:01:24,990 --> 00:01:33,490particularly in light of the neuro diversity that may be within your home or your extended family.
1700:01:34,960 --> 00:01:49,930I published one other holiday episode two years ago and re ran that last year. I will link that in the show notes in case you're wanting even more ideas or information about holiday seasons.
1800:01:51,580 --> 00:02:00,770What I wanted to talk to you about today is really something that impacts everyone regardless of generation,
1900:02:00,770 --> 00:02:06,720regardless of region that you're from or what you're celebrating.
2000:02:07,260 --> 00:02:26,270It impacts those on the autism spectrum and impacts neurotypicals... it's something that also is not specific to holidays that really these are concepts I want to talk about related to anything that we celebrate and re celebrate,
2100:02:26,270 --> 00:02:33,050that we have some kind of tradition for ... this meaningful moment or life season.
2200:02:33,510 --> 00:02:40,420And this could pertain to how we celebrate birthdays or the birth of a child,
2300:02:40,430 --> 00:02:42,290the death of a family member,
2400:02:42,300 --> 00:02:43,320a wedding,
2500:02:43,320 --> 00:02:44,570a graduation.
2600:02:44,580 --> 00:02:47,570You know that in addition to holidays,
2700:02:47,570 --> 00:02:52,450these are events that often have some tradition to them.
2800:02:52,450 --> 00:02:55,880Like this is how we
2900:02:55,890 --> 00:02:57,510remember this person.
3000:02:57,510 --> 00:02:59,590This is how we celebrate this event.
3100:02:59,600 --> 00:03:02,190This is this is our tradition.
3200:03:02,190 --> 00:03:10,420And what happens in these moments is that we have reproducible
3300:03:10,430 --> 00:03:13,290items to how we approach this season.
3400:03:13,290 --> 00:03:17,340So we reproduce the birthday celebration.
3500:03:17,340 --> 00:03:22,740We reproduce the holiday celebration... that this is what we do every year.
3600:03:22,740 --> 00:03:24,050This is our tradition.
3700:03:24,050 --> 00:03:35,950This is our expression of joy or meaning or sorrow in the celebration in addition to having a lot of reproduced elements.
3800:03:35,960 --> 00:03:47,990These are also times with heightened emotion and intensity and whether those emotions are joyous or sorrowful or complicated,
3900:03:48,000 --> 00:03:53,010they are there and particularly for the holiday season,
4000:03:53,020 --> 00:03:57,700I think a lot of times there's this feeling of "This year,
4100:03:57,700 --> 00:03:59,920we're going to heighten that excitement.
4200:03:59,930 --> 00:04:05,240We're going to heighten the anticipation and it will be the best holiday ever!"
4300:04:05,250 --> 00:04:14,580And whether we're doing that for ourselves or for kiddos in our household or why we're doing it ... a lot of times.
4400:04:14,580 --> 00:04:23,330there's this quest to reproduce and one-up the last time we celebrated these things.
4500:04:25,050 --> 00:04:39,440It's important to understand that the same adrenaline that feels exciting to many people during these events can also feel overwhelming.
4600:04:39,450 --> 00:04:48,360Adrenaline can feel like anxiety to someone particularly with a sensitive nervous system.
4700:04:48,360 --> 00:04:53,940So someone on the autism spectrum may experience that anticipation,
4800:04:53,940 --> 00:04:54,890the unknown,
4900:04:54,890 --> 00:04:56,580the surprises...
5100:04:57,670 --> 00:05:03,690and this heightened emotion and intense schedule as pretty overwhelming.
5200:05:03,690 --> 00:05:05,190Whereas someone else might say,
5300:05:05,200 --> 00:05:05,700oh,
5400:05:05,710 --> 00:05:06,590I love it.
5500:05:06,600 --> 00:05:09,910It's this anticipation,
5600:05:09,920 --> 00:05:11,440the emotion in the air,
5700:05:11,440 --> 00:05:14,720all the memories... I dive in.
5800:05:14,730 --> 00:05:16,840It's one of my favorite things.
5900:05:16,850 --> 00:05:27,540So here we see that different nervous systems are going to process these moments and celebrations and meaningful events differently.
6000:05:27,550 --> 00:05:31,050And that's one of the things we'll talk about today.
6100:05:34,130 --> 00:05:36,330I'm going to talk about some things that
6200:05:36,340 --> 00:05:56,420I'll invite you to try this holiday season ... or next birthday or next graduation celebration. And one is that I'd really like to invite you to pause and become really psychologically present.
6300:05:56,930 --> 00:06:04,280I think one thing that can happen particularly with the holidays that there is this momentum that comes,
6400:06:04,290 --> 00:06:18,100it's almost like a tidal wave or a tsunami of events and all of a sudden you are kind of just automatically riding this wave of things that are coming at you.
6500:06:18,640 --> 00:06:20,080Again,
6600:06:20,080 --> 00:06:21,500they may be fun things.
6700:06:21,500 --> 00:06:22,820They may be exciting things,
6800:06:22,820 --> 00:06:26,230but often there's really no moment to say,
6900:06:26,240 --> 00:06:26,800okay,
7000:06:26,800 --> 00:06:31,240let's pause and think about what's going on,
7100:06:31,250 --> 00:06:32,300what we need,
7200:06:32,300 --> 00:06:33,570what we'd like to do.
7300:06:33,580 --> 00:06:34,110Um,
7400:06:34,120 --> 00:06:39,040It's just kind of seeing what's coming at us next and riding the wave...
7600:06:40,000 --> 00:06:46,120So I do want to invite us to pause and realize,
7700:06:46,130 --> 00:06:48,130kind of what season we're in,
7800:06:48,340 --> 00:06:51,030what our celebration is about.
7900:06:51,040 --> 00:06:53,830And as we're pausing,
8000:06:53,830 --> 00:06:57,430I would like you to think about ...
8100:06:58,350 --> 00:07:02,230what the season is this year.
8200:07:02,240 --> 00:07:24,080One of the best things that I learned at a time in my life that I guess I needed to hear it was that it's okay for every holiday season to be different ... because it will be we reproduce these events and that's fine.
8300:07:24,080 --> 00:07:26,550But everything won't be reproducible.
8400:07:26,560 --> 00:07:37,680And so one person or family may have a different holiday season this year because they've lost a family member or they've gained family members.
8500:07:37,690 --> 00:07:42,510It may be different for health reasons or financial reasons.
8600:07:42,520 --> 00:07:47,280And sometimes it's not even an individual difference.
8700:07:47,290 --> 00:07:47,840It's
8900:07:48,450 --> 00:07:50,290throughout the whole world,
9000:07:50,290 --> 00:07:50,640you know...
9200:07:51,020 --> 00:07:58,370when we were in the midst of covid and that really just impacted
9300:07:58,380 --> 00:07:59,190everyone.
9400:07:59,200 --> 00:08:28,990And so we have this ability to then pause and become a bit more self aware of what is happening this season that may be a bit different ... and to realize that it's okay to give space to that and to think about how we might want to engage a bit differently this year given these circumstances.
9600:08:30,690 --> 00:08:48,590I think that the intense desire to reproduce and to one-up the greatness and happiness of past holiday seasons can again be the only driving force.
9700:08:48,600 --> 00:08:51,770So if we take a moment and pause and think,
9800:08:51,770 --> 00:08:55,660what is this holiday season going to be like?
9900:08:55,660 --> 00:08:59,260What's what's the reality like in my household,
10000:08:59,270 --> 00:09:00,450in my personal life,
10100:09:00,450 --> 00:09:03,180my work life, in our region,
10200:09:03,190 --> 00:09:07,350in my faith system, in the country...
10300:09:07,360 --> 00:09:11,320And let me become aware of that for a moment.
10500:09:15,230 --> 00:09:27,680in addition to noticing that the seasons of life change... and that there may be different ways that we want to engage in the holiday season.
10600:09:27,690 --> 00:09:28,200(again,
10700:09:28,210 --> 00:09:29,510other birthdays,
10800:09:29,510 --> 00:09:30,310anniversaries,
10900:09:30,310 --> 00:09:31,160etcetera)
11000:09:31,810 --> 00:09:45,270there are also differences in people... that one person in your household is going to need something different than another person.
11100:09:45,620 --> 00:09:49,470And pausing and thinking about that can be really helpful.
11200:09:49,470 --> 00:09:49,850Again,
11300:09:49,850 --> 00:09:59,700the drive to reproduce all of these elements the same way the same year for all people around you...
11400:09:59,700 --> 00:10:01,460That's really difficult.
11500:10:01,470 --> 00:10:05,630And it often doesn't make this season as meaningful.
11600:10:06,830 --> 00:10:09,180So for example,
11700:10:09,180 --> 00:10:10,650one person,
11800:10:10,660 --> 00:10:19,480like we said in the beginning may love surprises and that may be the best part of the holiday season,
11900:10:19,480 --> 00:10:25,670that there are all these little surprises and gifts and wow moments like,
12000:10:25,680 --> 00:10:29,610oh look at this recipe that this person made,
12100:10:29,610 --> 00:10:31,010how new,
12200:10:31,010 --> 00:10:32,000how interesting,
12300:10:32,000 --> 00:10:43,750how exciting ...another person may really want peace and maybe internal introspection or alone time.
12400:10:43,750 --> 00:10:51,110And maybe they want the "silent night" of the Christmas carol ... or
12500:10:51,120 --> 00:10:57,320they want to know ahead of time what will happen because they enjoy the experience
12600:10:57,330 --> 00:11:01,080but they don't like the excitement or the surprise,
12700:11:01,090 --> 00:11:05,720They want to calm down that intensity and that's where the autism piece comes in,
12800:11:05,980 --> 00:11:17,910that someone with a heightened neurology or a different neurology may have different desires and needs and to reproduce everything the same year and
12900:11:17,920 --> 00:11:20,200for every different person,
13000:11:20,210 --> 00:11:26,970I think that takes away some of the real meaning and good memories that we could have.
13100:11:29,070 --> 00:11:36,290What I'd like to invite you to do is to think about what your reality is this year.
13200:11:36,300 --> 00:11:39,710What has gone on this year in your personal life,
13300:11:39,710 --> 00:11:40,680your family life,
13400:11:40,680 --> 00:11:44,070what's the reality for people in your home?
13500:11:45,080 --> 00:11:53,630And I'd also like you to take a personal inventory and to check in with the people that you're closest with,
13600:11:53,640 --> 00:12:08,910that you will be doing the holidays with, and see where they're at and what they need and to take this intentional pause and to ask for everybody's individual needs.
13700:12:08,920 --> 00:12:18,740... I think really helps the holiday season run more smoothly and helps for better connection and more meaning.
13800:12:21,910 --> 00:12:34,120Part of the way that an individual is going to respond will be based on their neurologic makeup and part will be based on their own life story this year,
13900:12:35,900 --> 00:12:45,790invite people to pick 1, 2, ... 3 things that really are the most meaningful for them during a holiday season.
14000:12:45,800 --> 00:12:55,390So you could conceptualize it as what do you want to hold tightly to and what could you hold loosely,
14100:12:56,140 --> 00:13:02,900what do you want to be your foundational holiday experience like ...this is meaningful,
14200:13:02,900 --> 00:13:03,840I love this.
14300:13:03,840 --> 00:13:07,400I look forward to this every year... and what could be,
14400:13:07,410 --> 00:13:08,420you know,
14500:13:08,420 --> 00:13:10,580something you enjoy and you've done,
14600:13:10,580 --> 00:13:13,040but you could hold loosely to it...
14700:13:13,050 --> 00:13:26,770you could release it this year and still feel OK. And when everyone has those one or two things and is able to come together,
14800:13:26,930 --> 00:13:41,160I would invite you to share that together and see what kinds of things come up that are most meaningful and important to people in this framework.
14900:13:41,670 --> 00:14:05,400There is a need to be able to release some things and I think if we are holding on to every reproducible piece of every holiday season tightly because we don't want to miss out or we don't want the kids to miss out or it wouldn't be Christmas without everything going on or Hanukkah,
15000:14:05,410 --> 00:14:10,540... it wouldn't be a birthday if we didn't do this again,
15100:14:10,540 --> 00:14:21,880I'd invite you to pause and think about whether we're doing all of those things out of fear that people will miss out on something.
15200:14:22,460 --> 00:14:31,100And if so maybe we could release that this year and maybe we could pause and make a few more meaningful choices.
15300:14:32,500 --> 00:14:45,060I cannot tell you the number of times I've talked to families in crisis who have a neuro diverse family ... and they're in crisis because you know,
15400:14:45,070 --> 00:14:51,190one or more of them is really having a lot more meltdowns and anxiety. And yet when they leave,
15500:14:51,190 --> 00:14:52,170they talk about
15600:14:52,180 --> 00:14:57,900"oh and we're going to this concert and we're going out of state to visit this relative and we're..."
15700:14:57,910 --> 00:15:00,090and I kind of think,
15800:15:00,850 --> 00:15:01,690you know,
15900:15:01,690 --> 00:15:06,660I think that's an example of where we don't even kind of stop to think like,
16000:15:06,660 --> 00:15:11,850does that match where we're at this year in this family unit?
16100:15:11,850 --> 00:15:17,190And does it match the nervous system for people who are in the family?
16200:15:21,510 --> 00:15:33,510I want to give you an example of a family that went on this journey just to make it come alive and give you some ideas and encouragement to
16300:15:33,520 --> 00:15:39,350focus on this pause and intentionality this year in some way,
16400:15:40,730 --> 00:15:46,320This is a family with a couple who have been married 20 plus years.
16500:15:46,330 --> 00:15:48,610They are now empty nesters.
16600:15:48,610 --> 00:15:58,570They have three young adult Children and one of their adults kids is not going to be home for the holidays this year,
16700:15:58,570 --> 00:15:59,430which is different.
16800:15:59,430 --> 00:16:03,450So that's a piece of their life that is in transition.
16900:16:03,460 --> 00:16:05,780What is this holiday to them?
17000:16:05,780 --> 00:16:05,980Well,
17100:16:05,980 --> 00:16:08,470one of their loved ones won't be there...
17300:16:09,740 --> 00:16:14,770the gentleman in this couple lost his mother this year,
17400:16:14,770 --> 00:16:16,110she passed away.
17500:16:16,700 --> 00:16:17,240Um,
17600:16:17,250 --> 00:16:24,110they each work and they each have had some personal struggles and challenges at work.
17700:16:24,120 --> 00:16:26,530They've had some financial changes.
17800:16:26,540 --> 00:16:28,190Um,
17900:16:28,200 --> 00:16:41,030one of the two kids who is going to be home for the holiday season is doing really well and another of their adult kids whose coming home is struggling,
18000:16:42,110 --> 00:16:44,320their family is neuro diverse.
18100:16:44,330 --> 00:17:08,970And the gentleman in the couple has been diagnosed on the spectrum for a couple of years and the one individual who is actually doing well and really in a good place is also on the spectrum and they have extended family members that they suspect to have qualities or perhaps undiagnosed autism.
18200:17:10,490 --> 00:17:21,770So one of the things that they were invited to do as a couple that started off with the couple kind of focusing on the holiday season,
18300:17:21,780 --> 00:17:28,340They were invited to have this pause and awareness of what's going on in the family.
18400:17:29,000 --> 00:17:35,860What's the context for this year's holiday season and to become more aware of that.
18500:17:35,870 --> 00:17:43,100And they were invited to do this within the context of counseling because they really had had just um,
18600:17:43,110 --> 00:17:48,100about a rough year and a half of relationship issues.
18700:17:48,110 --> 00:17:49,290Um,
18800:17:49,300 --> 00:17:50,590it was complex,
18900:17:50,590 --> 00:17:55,640some of it had to do with empty nest issues and,
19000:17:55,650 --> 00:17:58,370and now that they didn't have the kids there,
19100:17:58,370 --> 00:18:03,270they wanted to rely on each other more for emotional support and companionship.
19200:18:03,270 --> 00:18:04,340And uh,
19300:18:04,350 --> 00:18:06,730there were some rough spots there,
19400:18:06,740 --> 00:18:09,520they had each had their own stressors.
19500:18:09,520 --> 00:18:13,060And so that impacted their ability to connect as well.
19600:18:14,260 --> 00:18:22,730So they were really hurting in their relationship and that was why they went to counseling and that is why the counselor brought up,
19700:18:22,740 --> 00:18:32,950what is this holiday season for you guys where you at in your life and how might the holiday season connect with all of this complexity.
19800:18:33,680 --> 00:18:38,010And that ended up being a really good pause for them.
19900:18:38,020 --> 00:18:39,170Um,
20000:18:39,180 --> 00:18:51,340and they were able to review all of these life events and to think about this concept of whether everything needed to be reproduced um,
20100:18:51,350 --> 00:18:54,590in their life this year again for the holidays.
20200:18:54,590 --> 00:18:57,260They were very active people.
20300:18:57,270 --> 00:19:00,070They both worked full time.
20400:19:00,080 --> 00:19:04,900They there were various volunteer things they did over the holiday season.
20500:19:04,910 --> 00:19:14,780They also hosted more than one holiday gathering at their home for extended family and also for a community organization.
20600:19:15,260 --> 00:19:16,000Uh,
20700:19:16,010 --> 00:19:16,800they just,
20800:19:16,810 --> 00:19:18,170they were busy people.
20900:19:18,170 --> 00:19:19,850They decorated their house.
21000:19:19,860 --> 00:19:23,780So kind of a lot of the normal stuff in there.
21100:19:23,790 --> 00:19:24,460Um,
21200:19:24,470 --> 00:19:32,390geographic region they participated in when they became more self aware,
21300:19:32,390 --> 00:19:41,120they tried to go through this process of what do I want to hold tightly to and what can I hold loosely?
21400:19:41,130 --> 00:19:43,790And they did have this initial reaction like,
21500:19:43,800 --> 00:19:44,060oh,
21600:19:44,060 --> 00:19:46,120I don't want to give this part up.
21700:19:46,130 --> 00:19:46,790Um,
21800:19:46,790 --> 00:20:04,090and they felt increased pressure to make it the best holiday ever because they were struggling that that almost made it more dire for them to make this wonderful.
21900:20:04,280 --> 00:20:11,730And there was the voice in the back of their head that felt like if we can't even make the holidays work.
22000:20:11,740 --> 00:20:12,920Uh,
22100:20:12,930 --> 00:20:13,400you know,
22200:20:13,400 --> 00:20:15,450is there hope for our relationship,
22300:20:15,450 --> 00:20:20,830Can we make other things work if we can't do this kind of very reproducible,
22400:20:20,830 --> 00:20:22,760happy kind of celebration.
22500:20:23,780 --> 00:20:26,270So they thought about that for a while.
22600:20:26,280 --> 00:20:33,140Um and they had a whole list of things they didn't feel like they could release,
22700:20:33,660 --> 00:20:36,360but then you know,
22800:20:36,360 --> 00:20:37,670with a bit more pause,
22900:20:37,670 --> 00:20:40,300they decided that this year they would try it,
23000:20:40,310 --> 00:20:45,660they would try to see and if next year they wanted to do the whole shebang,
23100:20:45,660 --> 00:20:47,180they really could do that.
23200:20:49,930 --> 00:20:58,360An interesting thing for them as a couple to was that they had recently had a really nice personal moments.
23300:20:58,370 --> 00:21:05,840Um they lived in a warm climate and they had this kind of slider um,
23400:21:05,850 --> 00:21:07,790it's kind of like a porch swing,
23500:21:07,790 --> 00:21:31,150but I guess it was on a slider kind of mechanism and they would be in the backyard in that slider swing kind of thing and they've had some nice conversations out there and that was not always the case for them in the season of their life and they both said those were moments recently that were really good.
23600:21:32,400 --> 00:21:48,570Now interestingly the therapist in working with them could see that the gentleman on the spectrum really sought a lot of the stimulator input and that is movement input and that was calming and regulating to his nervous system.
23700:21:48,580 --> 00:21:52,210He was an avid long distance cycler.
23800:21:52,220 --> 00:22:17,880Um he had done other things like downhill skiing and he was really drawn toward movement to feel centered and this was a way that he could get some gentle rocking input while having a conversation that had the potential to have kind of an emotional elevation or difficulty.
23900:22:18,810 --> 00:22:35,870Another thing that the therapist notice that probably made that swing a nice place for them to talk and connect was that there is not a social expectation that you're going to face each other and have this long extended eye contact.
24000:22:35,880 --> 00:22:39,260So when you're in this kind of swing mechanism,
24100:22:39,270 --> 00:22:50,950it's expected that you'll sit side to side and for him that was enough to reduce some of the intensity of the experience to a point where he felt more regulated.
24200:22:50,960 --> 00:22:54,140So this was actually a good place for them.
24300:22:54,140 --> 00:23:01,120And even though there's no reason they can't have a conversation in the house getting away from the house,
24400:23:01,120 --> 00:23:08,740psychologically felt like they were kind of leaving behind and and coming away together.
24500:23:08,940 --> 00:23:09,760Um,
24600:23:09,770 --> 00:23:16,520so that felt like a separating a part that was good for them to have those conversations.
24700:23:16,530 --> 00:23:30,180They also had a pagoda type set up in the backyard with comfy chairs and that was also just a nice place of respite for them both individually and as a couple.
24800:23:31,380 --> 00:23:42,380So in talking through what was going on in their life and what was most meaningful to them that they wanted to hold onto during the holiday season.
24900:23:42,390 --> 00:23:43,020Uh,
25000:23:43,030 --> 00:23:54,510the wife said that lights were really part of the holiday that brought her the most joy and she wouldn't want to not have lights in the house or christmas,
25100:23:54,510 --> 00:24:02,530lights in in what they were doing and so what they decided to do was not to decorate the whole house,
25200:24:02,540 --> 00:24:07,570they decided to put white lights all over the pagoda,
25300:24:07,580 --> 00:24:23,360all over the um swing mechanism chair and to have a little festive area in the back that they could retreat to and kind of connect in that space.
25400:24:23,370 --> 00:24:27,270And that ended up being um,
25500:24:28,000 --> 00:24:32,650both a really nice celebration of the holiday.
25600:24:32,660 --> 00:24:35,150It ended up bringing them together.
25700:24:35,160 --> 00:24:45,610So they worked together to create this space that was meaningful and pleasant and they were able to protect that space where they could communicate.
25800:24:45,620 --> 00:24:51,560And so that felt like a good exchange that a lot of the decorations were released,
25900:24:51,570 --> 00:24:57,510but they did focus on this nice space and on the lights that were important to her.
26000:24:59,590 --> 00:25:12,090Now the husband said that one of the things that was most important to him about the holidays that he wouldn't want to release is he had a whole list of dishes.
26100:25:12,100 --> 00:25:16,840Uh he liked to cook and she was never the cook in the home.
26200:25:16,840 --> 00:25:17,330He,
26300:25:17,340 --> 00:25:26,920he was always the cook and he really liked to reproduce uh family dishes and traditional dishes during the holiday season.
26400:25:27,250 --> 00:25:35,700The difficult thing about that though is that oftentimes because of the way the holiday schedule works.
26500:25:35,710 --> 00:25:36,350You know,
26600:25:36,350 --> 00:25:42,080you end up having to produce all this food in a very short period of time.
26700:25:42,090 --> 00:25:43,490You're having guests,
26800:25:43,490 --> 00:25:46,780you're having a celebration on a particular day.
26900:25:47,300 --> 00:25:53,030So what he held onto were 10 of those dishes?
27000:25:53,550 --> 00:26:03,580Uh he let some go and then he also released having to have these nice meals on a particular day.
27100:26:03,590 --> 00:26:09,450So what they did is they took Multiple weeks out of the season.
27200:26:09,450 --> 00:26:21,730So prior to their thanksgiving that they were celebrating through the Christmas season through the new year and they made 1-2 of those important dishes every week.
27300:26:22,380 --> 00:26:25,810And what they did was they also made them together.
27400:26:25,820 --> 00:26:27,720So now that the kids were gone,
27500:26:27,720 --> 00:26:34,160she actually was interested in learning not to cook mundane meals,
27600:26:34,160 --> 00:26:34,680but she,
27700:26:34,690 --> 00:26:38,700she kind of really did want to get in there and learn some fun stuff.
27800:26:38,710 --> 00:26:42,330So this became a good um,
27900:26:42,340 --> 00:26:52,140couples moment as well and they also had a nice time just having a calm meal together,
28000:26:52,350 --> 00:27:00,550having some of these fun traditional dishes and it offered them the opportunity to reminisce as well.
28100:27:00,560 --> 00:27:05,360And so he could tell his stories again about childhood and this is grandma,
28200:27:05,360 --> 00:27:05,630so,
28300:27:05,630 --> 00:27:08,550and so's recipe and um,
28400:27:08,560 --> 00:27:09,800some of these facts,
28500:27:09,800 --> 00:27:14,350she knew before and some were new and that felt like a meaningful,
28600:27:14,350 --> 00:27:17,380enjoyable thing that they did.
28700:27:17,380 --> 00:27:19,640And for some of these dishes,
28800:27:19,650 --> 00:27:22,020um their kids were home,
28900:27:22,020 --> 00:27:26,670the two kids and they were able to kind of have that family moment as well.
29000:27:28,380 --> 00:27:33,680So there were other things that they did things that each of their kids wanted or needed.
29100:27:33,690 --> 00:27:40,800But this story I think highlights the potential of a couple of things.
29200:27:40,800 --> 00:27:44,090One is realizing what the,
29300:27:44,100 --> 00:27:50,320the life season is for you during a particular birthday season,
29400:27:50,320 --> 00:27:51,840holiday season.
29500:27:51,850 --> 00:27:53,990What is your life season?
29600:27:53,990 --> 00:28:14,390How does that connect also who are the individuals that are in the celebration or this meaningful, reproduced event and what are their specific needs ... and that may be related to their age,
29700:28:14,390 --> 00:28:16,050to their neurology.
29800:28:16,060 --> 00:28:20,550Um lots of different things can impact what a person needs.
29900:28:21,710 --> 00:28:27,340Having this self awareness and pause of those two elements,
30000:28:27,350 --> 00:28:31,910the life season and the individuals that's really helpful.
30100:28:33,440 --> 00:28:41,190It also teaches us to have increased self awareness a lot of times.
30200:28:41,190 --> 00:28:41,800As I said,
30300:28:41,800 --> 00:28:46,280there's this tidal wave about this is what the season is,
30400:28:46,280 --> 00:28:51,040regardless and it it teaches us to be more aware of what we need.
30500:28:51,050 --> 00:28:58,500It encourages people around us to be aware of what they need and to communicate that that's huge.
30600:28:58,500 --> 00:29:00,130We can use that every day.
30700:29:00,330 --> 00:29:03,290This is a household where people have different needs,
30800:29:03,300 --> 00:29:15,600what do you need and let me tell you what I need and how can we bring together a moment and a celebration and a season that is life giving for the people in this home.
30900:29:17,300 --> 00:29:29,330It does require us to hold fast and strong to some foundational things and to release things and the releasing can feel hard,
31000:29:29,340 --> 00:29:36,850but I challenge you to do that this season and to see if there's joy and peace that comes from this.
31100:29:36,860 --> 00:29:39,280Um in a meaningful way.
31200:29:39,900 --> 00:29:42,030Every season can be different.
31300:29:42,040 --> 00:29:44,600You can go back to the whole shebang,
31400:29:44,610 --> 00:29:53,900You can pick different things next season but never feel that you have to go along with the tidal wave just because it's there.
31500:29:55,120 --> 00:30:15,520I hope you have a blessed and meaningful holiday season if you are in the midst of one and that all of your life moments that you celebrate and you pause to add meaning to that these come together to really be a calm and peaceful place in relationship building.
31600:30:16,420 --> 00:30:23,700I'm going to take the rest of the holiday season off and I will see you again for the next episode in january.
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Join Dr. Regan for the final episode in this series on autism misdiagnosis. This episode focuses on anxiety-related conditions and when their diagnosis may mean that autism is never considered. Wrapping up this series, Dr. Regan also discusses that after all assessments are concluded, there will be instances when no diagnosis of autism can or should be made.
Previous episode -- Abuse, Neglect, and Relational Pain on the Autism Spectrum
Dr. Regan's Resources
Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:06,730 --> 00:00:07,190Hello,200:00:07,190 --> 00:00:09,130this is Dr Theresa Regan.300:00:09,140 --> 00:00:11,790I am the host of this podcast,400:00:11,800 --> 00:00:13,320autism in the adult.500:00:13,330 --> 00:00:15,480I'm a neuropsychologist,600:00:15,490 --> 00:00:23,650the director of an adult diagnostic autism clinic in central Illinois and a certified autism specialist.700:00:24,330 --> 00:00:32,480You are joining me for the 4th and final episode of a series on autism and misdiagnosis.800:00:32,490 --> 00:00:36,480The first episode covered foundational information.900:00:36,490 --> 00:00:39,320Why does misdiagnosis occur?1000:00:40,390 --> 00:00:47,110That is, why is autism missed while other conditions may be diagnosed Instead.1100:00:48,040 --> 00:01:02,860The next episode focused on personality disorders and we specifically reviewed information about borderline personality and narcissistic personality as potential misdiagnoses for autism.1200:01:03,640 --> 00:01:12,730The 3rd episode covered information about bipolar disorder and depression and today's episode will focus on anxiety.1300:01:14,620 --> 00:01:25,760I should say that we could continue this misdiagnosis series for quite some time and cover other really common areas of misdiagnosis ... like schizophrenia,1400:01:25,760 --> 00:01:27,390psychotic conditions,1500:01:27,400 --> 00:01:34,810dementia and those involving behavioral dysregulation things like oppositional defiant disorder.1600:01:35,930 --> 00:01:52,250I'm not going to dive into all the possible categories because I feel like we've covered several common misdiagnoses and also because the main goal of the series has been to just introduce the concept that misdiagnosis does occur.1700:01:52,260 --> 00:02:08,990And also to illustrate why ... essentially to point out what kinds of elements in the neurology of autism may lead to diagnoses describing these single points but missing the big picture diagnosis of autism.1800:02:12,090 --> 00:02:32,480So we covered the possible misdiagnosis of depression last episode and we're going to talk about anxiety today ... and so I'll share with you my own thoughts based on my personal experiences that anxiety seems to stem at least in part from the neurobiology of autism.1900:02:33,040 --> 00:02:39,560Whereas depressed mood as I would define it with this component of emotional struggle,2000:02:39,570 --> 00:02:40,790hopelessness,2100:02:40,790 --> 00:02:41,520helplessness,2200:02:41,520 --> 00:02:42,540worthlessness,2300:02:42,550 --> 00:02:44,950loss of pleasure in activities.2400:02:44,960 --> 00:02:51,540This seems to be more reactive in the autistic individual to difficult life circumstances.2500:02:52,320 --> 00:02:59,000It seems to me that most individuals on the spectrum do experience difficulty with anxiety,2600:02:59,010 --> 00:03:07,470although the strength of this anxiety and how much it impacts their daily life can vary across life seasons.2700:03:10,860 --> 00:03:34,090There is research that has attempted to capture information on the prevalence of anxiety disorders and autism and there are such wide ranging findings that it is a little difficult to really come to a conclusion about the percentage of autistic individuals who do experience noticeable anxiety.2800:03:34,970 --> 00:03:43,560One thing about the research is that many studies focus on individuals who meet full criteria for a certain anxiety disorder.2900:03:43,570 --> 00:03:54,510So, many individuals who experience anxiety and are impacted by this may not meet full criteria and may not be counted in the studies. Also,3000:03:54,510 --> 00:03:59,620I find that it's really common for some individuals to have significant anxiety,3100:03:59,630 --> 00:04:01,920but it looks like something else.3200:04:01,930 --> 00:04:03,160For example,3300:04:03,160 --> 00:04:08,990meltdowns and outbursts are often triggered by anxiety in the autistic,3400:04:09,000 --> 00:04:13,460but they're interpreted as opposition or conduct disorders.3500:04:14,360 --> 00:04:18,000A flight reaction or a freeze reaction...3600:04:18,190 --> 00:04:24,260These are often so quiet that the anxiety piece of the reaction gets missed.3700:04:25,840 --> 00:04:26,490So,3800:04:26,500 --> 00:04:33,850my experience is that anxiety is more prevalent than it might at first seem in autism and it's also true,3900:04:33,850 --> 00:04:34,290however,4000:04:34,290 --> 00:04:40,860that I should keep in mind that people do seek appointments with me when they have a season of struggle,4100:04:40,870 --> 00:04:49,150they're coming to a clinic setting because something has really hit them at a time that they need input.4200:04:49,370 --> 00:04:59,050And so it's certainly true that my point of view might be skewed as far as working in this particular setting.4300:04:59,050 --> 00:05:05,660Now, rather than going through each anxiety disorder separately as listed in the diagnostic manual,4400:05:05,670 --> 00:05:10,610let's consider the grouping of generalized anxiety disorder,4500:05:10,620 --> 00:05:12,720social anxiety disorder,4600:05:12,720 --> 00:05:16,160separation anxiety, and agoraphobia together.4700:05:18,530 --> 00:05:28,900It's easy to see that individuals who have this baseline anxiousness, and as I said...4800:05:28,910 --> 00:05:33,790some of which seems to be neurobiological degenerated,4900:05:34,360 --> 00:05:37,680that "my system really leans toward anxiety,"5000:05:37,710 --> 00:05:43,870that this could easily be diagnosed as generalized anxiety disorder.5100:05:44,470 --> 00:05:46,530The social anxiety disorder.5200:05:46,530 --> 00:05:47,250Again,5300:05:47,260 --> 00:05:59,170very understandable why the individual on the spectrum may have anxiety related to social interactions and possibly being evaluated negatively.5400:05:59,180 --> 00:06:09,960Many people on the spectrum have a fear of being misunderstood and they don't feel solid enough in their interactions and their comprehension of what's going on... to feel like,5500:06:09,970 --> 00:06:10,300"Yeah,5600:06:10,300 --> 00:06:11,290that really went well,5700:06:11,290 --> 00:06:16,430I feel calm and confident about my social interaction."5800:06:16,440 --> 00:06:21,440So that can lead to this anxiety that brings them in for assistance.5900:06:22,370 --> 00:06:27,920Separation anxiety again could be seen in the autistic individual.6000:06:27,930 --> 00:06:36,280It's often the case that the person on the spectrum would really love to feel safe and connected with someone who's supportive.6100:06:36,290 --> 00:06:49,760This might be a parent in younger years, it could also be a particular friend or a sibling that they don't want to go out you know unless they're paired with them, and it could also be a spouse.6200:06:50,710 --> 00:06:56,820And agoraphobia is also something that could be diagnosed for the person on the spectrum.6300:06:56,820 --> 00:07:01,270In the sense that this could be a person who doesn't like to leave their home,6400:07:01,280 --> 00:07:03,110feels overwhelmed in crowds,6500:07:03,110 --> 00:07:08,800wants to be in their own space and just have time alone in their own setting.6600:07:11,060 --> 00:07:20,680So we can see how an individual with autistic neurology may acquire one or more of these diagnoses based on a few elements of their experience.6700:07:20,690 --> 00:07:26,120The problem ends up being not that those features aren't present.6800:07:26,120 --> 00:07:28,830For example there is a social anxiety,6900:07:28,830 --> 00:07:30,230there is an agoraphobia.7000:07:30,230 --> 00:07:31,270However,7100:07:31,280 --> 00:07:37,890once those are diagnosed the diagnostic picture stops.7200:07:37,900 --> 00:07:46,170So um, they don't say "hey, we should also look for autism." And that's the piece that's difficult.7300:07:46,180 --> 00:07:50,230We want autism to be in that differential at the beginning.7400:07:51,970 --> 00:07:55,740For more information on differentials and what that means.7500:07:55,750 --> 00:07:58,520See the first episode in this series.7600:07:58,530 --> 00:08:06,090But essentially what we're saying is that if someone is being evaluated for a diagnosis of generalized anxiety,7700:08:06,100 --> 00:08:07,250social anxiety,7800:08:07,250 --> 00:08:16,090separation anxiety, or agoraphobia ... there should be a trigger in our minds that also puts autism in that assessment process.7900:08:18,400 --> 00:08:23,960The current edition of the diagnostic manual does not include PTSD or OCD8200:08:24,420 --> 00:08:26,500under anxiety disorders.8300:08:26,510 --> 00:08:37,930Instead the manual gives these their own sections including trauma and stress or related disorders, and obsessive compulsive and related disorders.8400:08:38,610 --> 00:08:39,660However,8500:08:39,670 --> 00:08:42,770for the cohesiveness of our talk,8600:08:42,770 --> 00:08:47,280I am going to include them in this episode on anxiety.8700:08:48,680 --> 00:08:50,780With regard to PTSD,8800:08:50,790 --> 00:08:57,500you may wish to refer to my previous episode entitled Abuse, Neglect, and Relational Pain8900:08:57,500-> 00:09:01,700On the Autism Spectrum in May of 2021.9000:09:02,600 --> 00:09:18,890I'll link the episode in the show notes today. In summary, trauma is a more frequent experience for those on the spectrum than for neurotypical and there are a lot of reasons that this probably occurs. For one,9100:09:18,900 --> 00:09:31,280some infants and children on the spectrum really have difficulty regulating ...and what that means is their ability to feel steady and calm and safe.9200:09:31,860 --> 00:09:37,400This difficulty can be quite a struggle and it can be very externalized.9300:09:37,410 --> 00:09:41,350So the child may be crying and not sleeping.9400:09:41,360 --> 00:09:52,500They might have frequent or prolonged meltdowns, may struggle with everyday aspects of life like wearing socks or eating food. Because of these high levels of needs,9500:09:52,500 --> 00:09:58,480the caregivers of the child may also struggle to get enough sleep, to stay calm...9600:09:58,490 --> 00:10:05,470This may lead to difficult interactions both emotionally and psychologically ... and sometimes physically,9700:10:06,820 --> 00:10:14,370The individual on the spectrum may also struggle to recognize risk interpersonally... when they do encounter this.9800:10:14,370 --> 00:10:15,830So for example,9900:10:15,840 --> 00:10:28,330many females on the spectrum report that they've been in dating situations and really haven't realized the sexual overtures until they found themselves in a really sexually traumatic situation.10000:10:29,390 --> 00:10:38,420There are other reasons that individuals on the spectrum may experience trauma. And PTSD may not be a misdiagnosis at all.10100:10:38,430 --> 00:10:45,900However many times once this diagnosis is entered in someone's chart,10200:10:45,900 --> 00:10:48,170once it's made... a lot of times,10300:10:48,180 --> 00:11:00,150everything about the person is attributed to trauma reactions and there's been no investigation done to see if the underlying neurologic framework for autism can be detected.10400:11:01,460 --> 00:11:09,290Now ... sometimes the trauma has been so extensive that trauma and neurology just can't be teased apart very easily.10500:11:10,010 --> 00:11:14,480But more often there has never even been a consideration of autism.10600:11:14,480 --> 00:11:30,770Nobody has tried to make this distinction, and there's been this overall conclusion that everything the person experiences and the way they react has to do with the trauma experience. And finally, obsessive compulsive disorder.10700:11:32,150 --> 00:11:38,330Now there are seven diagnostic criteria for autism and the first three are social in nature.10800:11:38,370 --> 00:11:46,340They all must be met. And the last four are described as restricted and repetitive patterns of behavior.10900:11:46,350 --> 00:11:48,490Only two of those need to be met.11000:11:49,080 --> 00:11:55,420Now these criteria include elements of thoughts and behaviors that can be labeled as OCD11300:11:55,900 --> 00:11:58,250if someone's not looking at the big picture.11400:11:59,170 --> 00:12:13,910Examples of these kinds of behaviors or elements might include scrupulosity. For example, being very particular about details, thinking in a black and white manner about what's good and what's bad,11500:12:13,910 --> 00:12:15,400what's right and wrong.11600:12:16,110 --> 00:12:18,590This can include literal thinking.11700:12:18,600 --> 00:12:20,470For those on the spectrum.11800:12:20,480 --> 00:12:27,300They may correct others when they're wrong about something and get upset when people break the rules.11900:12:27,310 --> 00:12:30,310They might want to get all the details correct12000:12:30,320 --> 00:12:33,930rather than being able to move on to more important things.12100:12:35,160 --> 00:12:46,160These individuals may repeat certain sequences of movements or speech and they may want objects lined up and arranged in particular patterns or a particular order.12200:12:46,470 --> 00:12:49,280They may care about symmetry and repetition.12300:12:49,880 --> 00:12:54,480So this focus on repetition and ritual can resemble OCD12600:12:55,310 --> 00:13:00,190Which can mean that the diagnosis of autism is never explored.12700:13:01,310 --> 00:13:02,240So now,12800:13:02,240 --> 00:13:06,250if we step back and we think about all the episodes in this series,12900:13:06,260 --> 00:13:11,550we can see how an individual who presents with a history of multiple diagnoses,13000:13:11,640 --> 00:13:14,740let's say social anxiety disorder,13100:13:14,740 --> 00:13:16,090bipolar disorder,13200:13:16,090 --> 00:13:17,780borderline personality.13300:13:17,790 --> 00:13:18,380Well,13400:13:18,380 --> 00:13:25,840they may actually have one diagnosis that has never even been considered and that is autism.13500:13:27,700 --> 00:13:28,170Now,13600:13:28,170 --> 00:13:30,490before we end this series entirely,13700:13:30,490 --> 00:13:41,920let me add a caveat to balance out this information. Because autism often doesn't get enough attention with clinicians when they're performing assessments,13800:13:41,920 --> 00:13:44,330particularly those perhaps with adults,13900:13:44,350 --> 00:13:54,250I do focus a lot on the importance of autism assessment and also the fact that these diagnoses can be specifically included in a differential.14000:13:55,400 --> 00:13:59,910Since I've emphasized evaluation and differential diagnosis so much,14100:13:59,920 --> 00:14:10,880I also want to say that in reality there will be times when a skilled clinician will not be able to identify whether autism is present or not.14200:14:12,670 --> 00:14:12,990Now,14300:14:12,990 --> 00:14:19,840autism is identified by a specific pattern in the results and for many reasons,14400:14:19,840 --> 00:14:28,710there will be subsets of patients who present without a clear pattern of features and this may reflect how complex their background is,14500:14:28,720 --> 00:14:30,680how much distress they're in.14600:14:30,690 --> 00:14:35,910But if an autistic pattern is not present or it's obscured by other issues,14700:14:35,930 --> 00:14:41,130then the clinician will not be able to rule in or out the diagnosis of autism.14800:14:41,140 --> 00:14:43,640And rightly so. Now,14900:14:43,640 --> 00:14:44,340ultimately,15000:14:44,340 --> 00:14:51,040our first goal needs to be that autism is included in the differential assessment process.15100:14:51,150 --> 00:14:55,440The second goal is that everyone has a correct diagnosis,15200:14:55,450 --> 00:14:57,470whether that's bipolar,15300:14:57,480 --> 00:14:59,990social anxiety, or autism...15400:15:01,350 --> 00:15:01,660Now,15500:15:01,670 --> 00:15:04,690if the autism pattern is not clearly present,15600:15:04,700 --> 00:15:07,770a diagnosis can't and shouldn't be given.15700:15:08,430 --> 00:15:18,080Some individuals will receive feedback that the autism pattern is clearly not present and this is an important piece of information for them.15800:15:18,790 --> 00:15:22,600Others will receive feedback that autism features are present,15900:15:22,600 --> 00:15:25,460but not all the criteria are met.16000:15:25,470 --> 00:15:28,000So a full diagnosis is not made.16100:15:29,030 --> 00:15:29,530Third,16200:15:29,530 --> 00:15:41,950there will be individuals who receive feedback that there are things obscuring any kind of pattern and figuring out how to untangle these things may really actually be impossible.16300:15:43,060 --> 00:15:43,900Lastly,16400:15:43,900 --> 00:15:50,190about 2% of individuals will receive the feedback that they meet full criteria for autism.16500:15:51,170 --> 00:15:57,850Whatever the conclusions are, dedication toward including neurology in the assessment process,16600:15:57,860 --> 00:15:58,900for example,16700:15:58,900 --> 00:16:09,220including autism in the differential ... it can add to the self awareness that clients receive and awareness is key to well-being and growth.16800:16:10,590 --> 00:16:23,270I thank you for joining me for this series on misdiagnosis, those times when people receive a diagnosis that's describing one little element of their presentation,16900:16:23,270 --> 00:16:25,160but not their whole experience.17000:16:25,170 --> 00:16:29,040And autism is one of those big picture diagnoses.17100:16:30,660 --> 00:16:32,420Thanks again for listening,17200:16:32,420 --> 00:16:34,490and I hope you join me next time.
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Join Dr. Regan for the third in this series on autism misdiagnosis. This episode focuses on the misdiagnosis of mood conditions for the autistic individual. Specifically bipolar disorder and depression are reviewed.
Exhaustion in Autism: Balancing Momentum for Daily Activities
Recognizing Dysregulation on the Autism Spectrum: Fight, Flight, Freeze
Dr. Regan's Resources
New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Audiobook
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the transcript here:
100:00:06,900 --> 00:00:07,470Hello,
200:00:07,470 --> 00:00:09,420this is Dr Theresa Regan.
300:00:09,430 --> 00:00:15,040I'm glad you're joining us for today's episode of autism in the adult podcast.
400:00:15,050 --> 00:00:25,570I am a neuropsychologist and the director and founder of a diagnostic autism clinic for adolescents through aging adults in central Illinois.
500:00:25,580 --> 00:00:26,940I am an author,
600:00:26,940 --> 00:00:30,600your podcast host, and the parent of a teen on the spectrum.
700:00:31,550 --> 00:00:41,780You are joining us for the third episode in our series on misdiagnosis for those on the spectrum, and, at a very basic level,
800:00:41,790 --> 00:01:02,980the diagnosis of autism is something that helps us distinguish whether the core emotions and behavioral patterns we see for an individual are the result of their neurology or the result of learning, life experiences, or willful behavior...
900:01:02,990 --> 00:01:07,290that "this is a decision for me to respond this way."
1000:01:08,530 --> 00:01:15,470This is a really important starting point to understand the basis for the patterns that we experience or express.
1100:01:15,480 --> 00:01:24,730And this distinction helps us make good goals and use strategies that are most likely to help us reach the best outcomes for well being.
1200:01:25,400 --> 00:01:25,820Now,
1300:01:25,820 --> 00:01:35,170of course it would be too simplistic to say that a behavioral pattern could be the result entirely of neurology or experience.
1400:01:35,180 --> 00:01:39,780But because we often miss that neurology piece,
1500:01:39,790 --> 00:01:42,280I am highlighting it in this episode.
1600:01:44,100 --> 00:01:44,390Now,
1700:01:44,390 --> 00:02:02,060one of the things that happens for individuals who receive mental health diagnoses is that there's never even a starting point in the diagnostic process where neurology is invited into consideration into the differential.
1800:02:02,070 --> 00:02:04,980So the differential process is when we say,
1900:02:04,990 --> 00:02:05,440okay,
2000:02:05,440 --> 00:02:10,040these features could be present and these five diagnoses.
2100:02:10,040 --> 00:02:18,090Now we're going to do our detective work to figure out which diagnosis really matches this individual.
2200:02:18,100 --> 00:02:21,170If neurology is not in that process,
2300:02:21,180 --> 00:02:22,010of course,
2400:02:22,010 --> 00:02:23,420we're not going to find it,
2500:02:23,430 --> 00:02:24,710we're not looking for it,
2600:02:24,710 --> 00:02:26,140we're not looking at it.
2700:02:28,140 --> 00:02:35,880The assumption is that the experience of the individual stems from their life experience from their choices.
2800:02:35,890 --> 00:02:43,440Uh and that putting diagnoses into two categories of neurologic versus experiential.
2900:02:43,450 --> 00:02:46,660Um although it's not that simple,
3000:02:46,670 --> 00:02:50,470it is a starting point for the beginning framework.
3100:02:50,480 --> 00:02:50,840So,
3200:02:50,840 --> 00:02:58,750I want to raise this idea of neurology being considered in the diagnostic process as really an important place to start,
3300:03:00,000 --> 00:03:06,830because autism often is not considered as a possibility and the initial diagnostic process.
3400:03:06,830 --> 00:03:09,640Many autistic individuals on the spectrum,
3500:03:09,640 --> 00:03:10,250really,
3600:03:10,260 --> 00:03:18,750particularly adults, are given mental health diagnoses that may capture pieces of the picture.
3700:03:19,140 --> 00:03:26,570Um but that are not the best description of the person's overall pattern of experience and behavior,
3800:03:26,570 --> 00:03:31,920and also really missing the point of describing the neurology.
3900:03:32,780 --> 00:03:33,180Now,
4000:03:33,180 --> 00:03:38,500if you have not listened to the first episode in this series on misdiagnosis,
4100:03:38,500 --> 00:03:40,070please do that.
4200:03:40,080 --> 00:03:59,860The foundation for understanding each of these subsequent episodes is really in that first offering. The second episode covered misdiagnosis of personality disorders, and we specifically spent time talking about borderline personality and narcissistic personality.
4300:03:59,880 --> 00:04:00,360Now,
4400:04:00,360 --> 00:04:05,330today we are going to cover diagnoses that have to do with mood.
4500:04:05,370 --> 00:04:09,990So specifically including bipolar disorder and depression.
4600:04:11,250 --> 00:04:11,550Now,
4700:04:11,550 --> 00:04:13,970as in all the episodes in this series,
4800:04:13,970 --> 00:04:20,300we will not be discussing how to distinguish autism from mood conditions.
4900:04:20,310 --> 00:04:30,740This really is an important thing to understand because it's something that would require a skilled clinician to do with lots of training.
5000:04:30,750 --> 00:04:38,270Um it's really on a very individualized basis and it's beyond the scope of anyone podcast episode.
5100:04:39,030 --> 00:04:39,690We will,
5200:04:39,690 --> 00:04:40,280however,
5300:04:40,280 --> 00:04:52,160be covering why a mood diagnosis might be assigned to the autistic individual incorrectly while the autism diagnosis gets missed.
5400:04:52,170 --> 00:04:56,290I think that's an important thing that all of us can understand,
5500:04:56,290 --> 00:04:57,650"why does this happen."
5600:04:57,660 --> 00:05:03,290and then we can start discussions about this with our providers or family...
5700:05:03,490 --> 00:05:12,120so that we're really trying to get at that ability to start with the neurology included in the differential.
5800:05:13,970 --> 00:05:16,370So let's start with bipolar disorder.
5900:05:16,380 --> 00:05:16,940Now,
6000:05:16,940 --> 00:05:17,920at a basic level,
6100:05:17,920 --> 00:05:21,790bipolar describes things like manic episodes,
6200:05:21,800 --> 00:05:26,120lability of mood and emotional expression. 'Lability'
6300:05:26,120 --> 00:05:34,190meaning that there's this quick change of emotional expression or these mood swings.
6400:05:35,100 --> 00:05:36,210Specifically,
6500:05:36,210 --> 00:05:39,670the following elements may be present in mania:
6600:05:39,680 --> 00:05:43,560inflated self esteem or grandiosity.
6700:05:43,570 --> 00:05:44,010So,
6800:05:44,010 --> 00:05:48,050feeling that the person really has a great knowledge,
6900:05:48,050 --> 00:05:50,460skill, and ability that other people don't.
7000:05:50,990 --> 00:05:52,980For some on the spectrum,
7100:05:52,990 --> 00:05:56,600there are qualities of categorical thinking,
7200:05:56,610 --> 00:06:04,770A love for facts and ideas and inventions, and difficulty understanding the perspectives of others.
7300:06:04,780 --> 00:06:05,230So,
7400:06:05,230 --> 00:06:07,810when these qualities are present,
7500:06:07,820 --> 00:06:27,390the individual may feel that their knowledge (particularly about their topics of greatest interest)... that their knowledge level or skill level is so exceptional that others really have a lot to learn from them... and as noted in the previous episode on personality,
7600:06:27,400 --> 00:06:37,410the individual on the spectrum with these characteristics might appear narcissistic or grandiose ... particularly regarding their
7800:06:38,330 --> 00:06:39,930particular interests.
7900:06:39,930 --> 00:06:48,140So let's say they love history and they dive in and perhaps they really...
8000:06:48,150 --> 00:06:57,460emphasize their skill level in this area and may feel that they are really well above people in their sphere...
8100:06:57,470 --> 00:07:08,640other people that they're interacting with. Another feature of mania that's recognizable to the clinician is a decreased need for sleep.
8200:07:08,650 --> 00:07:12,580So the person in the midst of a manic episode
8300:07:12,590 --> 00:07:15,380may be sleeping a lot less,
8400:07:15,390 --> 00:07:18,660may even stay up for a few days at a time.
8500:07:19,550 --> 00:07:26,130Sleep disturbance is a common characteristic in autism because the brain is in charge of sleep.
8600:07:26,140 --> 00:07:33,350So ... there is variability in what the sleep disturbance looks like for the autistic individual,
8700:07:33,360 --> 00:07:35,840including if it's present at all,
8800:07:35,850 --> 00:07:43,080but a common pattern for the autistic is this trouble falling asleep... very late
8900:07:43,090 --> 00:07:44,180sleeping,
9000:07:44,190 --> 00:07:48,350late waking, or sometimes even reversed sleep cycles.
9100:07:48,350 --> 00:07:52,810So I'm a person that goes to bed at two and wakes up at noon.
9300:07:53,730 --> 00:08:03,670There can even be at least seasons of time where this is an individual that will be up for two days at a time and just can't fall asleep for... three days.
9400:08:03,680 --> 00:08:13,580Sometimes they crash then from exhaustion and spend a lot of time in bed for a period before they're up and at it again.
9500:08:14,870 --> 00:08:16,110The decreased sleep,
9600:08:16,120 --> 00:08:23,140particularly if it's within a season of being even more difficult than usual for this individual...
9700:08:23,150 --> 00:08:23,690Again,
9800:08:23,690 --> 00:08:25,730staying up for days at a time...
9900:08:25,740 --> 00:08:32,930this can trigger concerns for mania in the individual who is actually on the autism spectrum.
10000:08:34,480 --> 00:08:43,840Another piece of mania that people can focus on when they meet someone on the spectrum (and again,
10100:08:43,840 --> 00:08:45,100miss that
10200:08:45,100 --> 00:08:48,830this could be part of autism) is increased talkativeness.
10300:08:49,920 --> 00:08:53,560So for the person with mania,
10400:08:53,570 --> 00:08:57,630they may have a very rapid speech pattern.
10500:08:57,640 --> 00:09:04,630They may not let the other person contribute to the conversation or slow down for the other person.
10600:09:04,640 --> 00:09:08,110It may be difficult to really follow.
10800:09:08,760 --> 00:09:14,010everything that's floating through their head and and coming out.
11000:09:14,450 --> 00:09:18,390so that the listener might feel lost in the case of mania.
11100:09:19,520 --> 00:09:20,000Now,
11200:09:20,000 --> 00:09:25,900for the person on the spectrum who loves to talk about really particular topics...
11400:09:27,000 --> 00:09:30,680they may dominate conversations without realizing it,
11500:09:30,690 --> 00:09:37,740or they may struggle to really understand when others need to stop or take a break or switch topics.
11600:09:37,750 --> 00:09:42,550They might resist talking about topics that they're not interested in.
11700:09:42,560 --> 00:09:50,470Perhaps where they're the listener and the other person is talking about things they enjoy,
11800:09:50,480 --> 00:09:55,580even though the autistic person really is not interested in that.
11900:09:57,080 --> 00:10:07,670And many people on the spectrum also feel like they have racing thoughts and it can be difficult to turn their brain off at night or when they have down time,
12000:10:07,680 --> 00:10:09,700that at least in seasons,
12100:10:09,710 --> 00:10:12,650racing thoughts can interfere with sleep,
12200:10:12,660 --> 00:10:21,530or they can't slow their thoughts down in order to pay attention to a class or a work project.
12300:10:22,520 --> 00:10:30,370And they may even dive deep into particular topics of interest to the extent that they seem obsessed with them in mania.
12500:10:32,950 --> 00:10:35,810You can picture the seasons of poor sleep,
12600:10:35,820 --> 00:10:38,270intense interest, racing thoughts,
12700:10:38,280 --> 00:10:50,290perhaps looking like a mania uh ... particularly if there's a season where these features are really emphasized, like...
12800:10:50,300 --> 00:10:50,530oh,
12900:10:50,530 --> 00:10:55,700I usually get a bit better sleep and now I'm just so into this topic,
13000:10:55,710 --> 00:10:57,790I've been up all night.
13100:11:00,510 --> 00:11:04,320The person with the mania may be distracted easily.
13200:11:04,330 --> 00:11:07,130So executive function...
13300:11:07,140 --> 00:11:17,730part of that is the ability to stay focused, to have flexible attention based on what's most important, to be able to concentrate well.
13400:11:17,730 --> 00:11:24,830Executive function is also an area of challenge for the autistic individual in some pattern.
13500:11:25,640 --> 00:11:32,470So the executive function difficulty for one person on the spectrum may look like distractibility.
13600:11:33,980 --> 00:11:41,170They may struggle with having too little attention for things that people want them to focus on,
13700:11:41,180 --> 00:11:49,720but also too much attention to other things that really capture their interest. Also within the bipolar realm,
13800:11:49,730 --> 00:11:56,240we can see this increase in goal directed activity or what's called psychomotor agitation,
13900:11:56,240 --> 00:11:56,710where,
14100:11:57,300 --> 00:11:59,480the person just can't stop...
14200:11:59,480 --> 00:12:02,790their motor is really running too high.
14300:12:03,710 --> 00:12:08,500The autistic individual who has a motor that's running too high.
14400:12:08,510 --> 00:12:11,140We call that dysregulation.
14500:12:11,150 --> 00:12:17,020And we talked about these concepts and issues when we focused on regulation.
14600:12:17,030 --> 00:12:25,690And one form of dysregulation in the neurologic sphere is when our internal motor is running too high...
14700:12:25,700 --> 00:12:30,490we're not centered in our activity level.
14800:12:30,710 --> 00:12:40,720And so this is an individual neurologically who may rock or pace or stay up all night researching fish tanks instead of sleeping.
14900:12:41,520 --> 00:12:50,970And this is dysregulation for the autistic individual that ...may look like a manic or a hypomanic episode.
15000:12:52,390 --> 00:13:04,030Another feature listed in the diagnostic manual for a manic episodes include engaging in activities that hold the potential for painful consequences.
15100:13:04,040 --> 00:13:09,000This would be things like ...purchasing lots of items,
15200:13:09,000 --> 00:13:10,200spending lots of money,
15300:13:10,200 --> 00:13:11,440for example.
15400:13:13,190 --> 00:13:16,980This characteristic may also be present for the autistic.
15500:13:16,990 --> 00:13:18,680If their executive function
15600:13:18,680 --> 00:13:30,040difficulty leads to poor planning of finances, and if their intense interests really lead to that hunger for more...
15700:13:30,050 --> 00:13:33,600"I want to add to my collection of interesting items,
15800:13:33,600 --> 00:13:36,200I want to add to my book series.
15900:13:36,200 --> 00:13:40,190I need to finish the series of things that I really love."
16000:13:42,820 --> 00:13:48,480Now... spending is not the only type of behavior that could lead to risk or consequences,
16100:13:48,480 --> 00:13:53,800but it's one example in this category of potentially risky activities.
16200:13:55,100 --> 00:14:07,750A characteristic of the bipolar individual may also be difficulty with emotional regulation which is called labile mood in bipolar ...where you have mood swings.
16300:14:07,760 --> 00:14:10,840So instead of being regulated,
16400:14:10,850 --> 00:14:16,100which again means centered with emotions,
16500:14:17,000 --> 00:14:23,060the individual with bipolar may experience difficulty with mood swings.
16600:14:23,070 --> 00:14:25,630So this ability to stay centered...
16800:14:27,620 --> 00:14:36,770and perhaps someone with dysregulation who has bipolar may become very upset or angry without much warning.
16900:14:38,670 --> 00:14:39,180Now,
17000:14:39,190 --> 00:14:44,450all individuals on the spectrum will struggle with emotional regulation.
17100:14:44,460 --> 00:14:50,810But the individual on the spectrum who leans toward externalized dysregulation...
17200:14:50,820 --> 00:14:55,880So "we let out all of this emotion"... a meltdown...
17300:14:55,890 --> 00:15:00,240this may be a person who rolls on the ground, or shouts, or throws
17400:15:00,240 --> 00:15:02,850things ... has crying spells.
17500:15:02,870 --> 00:15:04,960These are the external ...
17600:15:04,970 --> 00:15:07,160you know that... when they're dysregulated,
17700:15:07,170 --> 00:15:09,800it's very loud and noticeable.
17800:15:10,530 --> 00:15:11,060Well,
17900:15:11,060 --> 00:15:15,910this person on the spectrum who has externalized dysregulation,
18000:15:15,950 --> 00:15:20,010they are at risk of being misdiagnosed as bipolar.
18100:15:21,340 --> 00:15:21,640Now,
18200:15:21,640 --> 00:15:27,650the person who has quiet dysregulation... like I'm hiding,
18300:15:27,650 --> 00:15:30,230I'm retreating and withdrawing...
18400:15:30,240 --> 00:15:34,930That's the flight reaction. Or... I'm frozen.
18500:15:34,940 --> 00:15:36,000I'm shut down.
18600:15:36,000 --> 00:15:37,630I've dissociated.
18800:15:38,830 --> 00:15:40,940This is the freeze reaction.
18900:15:41,810 --> 00:15:47,990These individuals on the spectrum are not likely to be diagnosed with bipolar.
19000:15:48,050 --> 00:15:51,910They may be diagnosed with other things like depression,
19100:15:51,910 --> 00:15:53,540which we'll talk about in a bit.
19200:15:55,690 --> 00:15:56,040So,
19300:15:56,040 --> 00:16:10,430one thing to remember is that the type of dysregulation for this specific autistic individual may influence what misdiagnoses they may be likely to receive.
19400:16:10,440 --> 00:16:22,290So someone with externalized fight reactions when dysregulated may look bipolar to a clinician who's not looking at the big neurologic picture.
19500:16:24,540 --> 00:16:29,980It is possible for an individual to have both bipolar and autism.
19600:16:29,980 --> 00:16:30,900However,
19700:16:30,910 --> 00:16:34,160most of the time that I see bipolar present,
19800:16:34,170 --> 00:16:43,230it's a misdiagnosis or it's assigned by clinicians who don't understand that emotional dysregulation is expected in autism,
19900:16:43,240 --> 00:16:46,260it doesn't need a separate label.
20000:16:47,070 --> 00:16:47,750Um,
20100:16:47,760 --> 00:16:53,940If the dysregulation is not explained by the autism diagnosis,
20200:16:53,950 --> 00:17:08,460then you also diagnose bipolar. And I think I've diagnosed both in about two of my clients out of nearly 550 assessments.
20400:17:09,500 --> 00:17:12,600So that could be particular to my clinic,
20500:17:12,610 --> 00:17:18,260but it does show you that really it's not a very common overlap,
20600:17:18,270 --> 00:17:21,170that most of the time when there's overlap there...
20700:17:21,170 --> 00:17:26,810just describing the fact that there's an externalized dysregulation when someone's overwhelmed.
20900:17:27,720 --> 00:17:33,830But that is to be expected. For the people that I did diagnose,
21000:17:33,840 --> 00:17:48,900I really was able to work with them over a long period of time and I could see acute episodes of mania that really were not typical for autism and were very different from their baseline of autistic dysregulation.
21100:17:49,870 --> 00:17:55,170Another thing to note is that medications typically are not going to change
21200:17:55,180 --> 00:17:59,560if the diagnosis switches from bipolar to autism.
21300:18:00,510 --> 00:18:12,740The medication choices tend to be symptom based and therefore not really dependent on the specific diagnosis as much as the presentation of the characteristics.
21400:18:12,750 --> 00:18:16,630So there may still be a mood stabilizer,
21500:18:16,630 --> 00:18:17,730for example,
21600:18:17,740 --> 00:18:20,970prescribed for someone who has difficulty
21700:18:20,980 --> 00:18:23,400staying centered with emotions.
21800:18:24,620 --> 00:18:24,900Now,
21900:18:24,900 --> 00:18:27,530let's look at the diagnosis of depression,
22000:18:29,960 --> 00:18:38,360certainly the individual on the spectrum can have mood difficulties based on life struggles just as any human does.
22100:18:38,370 --> 00:18:39,190Um,
22200:18:39,190 --> 00:18:40,280in my experience,
22300:18:40,280 --> 00:18:46,400anxiety is much more inherent to the neurology of autism than depression,
22400:18:46,410 --> 00:18:50,360but depressed mood occurs secondary to struggles.
22500:18:51,440 --> 00:19:01,260Other characteristics that the autistic may have could be labeled as depression but appear to be a misdiagnosis ...
22600:19:01,270 --> 00:19:04,490trying to describe some neurologic characteristics.
22700:19:05,400 --> 00:19:08,140So if there's a misdiagnosis,
22800:19:08,140 --> 00:19:16,820what characteristics of autism would be likely misdiagnosed as part of a depressive episode or part of depression?
22900:19:17,450 --> 00:19:19,390Let's look at these examples.
23000:19:19,390 --> 00:19:19,980So,
23100:19:19,990 --> 00:19:22,760someone with a flat affect ...
23200:19:22,770 --> 00:19:29,730Affect is the emotions ... and in this case we're talking about emotions in the face and the voice.
23300:19:29,740 --> 00:19:33,010And for the individual on the spectrum,
23400:19:33,010 --> 00:19:39,510their neurology may be that there are muted expressions.
23500:19:39,520 --> 00:19:51,940There's a limited range of emotion that comes through the face and the voice so that there's a flatness or a lack of range in their nonverbal expression.
23600:19:51,940 --> 00:20:08,340And this can be part of what fits this criteria of nonverbal communication difficulties when there is not much emotional expression.
23700:20:08,350 --> 00:20:10,630Whether it's neurologic or not...
23800:20:10,640 --> 00:20:12,430another person may say,
23900:20:12,430 --> 00:20:12,850oh,
24000:20:12,850 --> 00:20:16,920this looks like the person is depressed.
24100:20:16,930 --> 00:20:21,990There could be this kind of hidden struggle inside,
24200:20:22,000 --> 00:20:24,750let's treat this person for depression,
24300:20:25,820 --> 00:20:28,050but this is an individual who says,
24400:20:28,050 --> 00:20:28,350gosh,
24500:20:28,350 --> 00:20:29,610I don't feel sad,
24600:20:29,620 --> 00:20:32,130I don't feel hopeless or helpless.
24700:20:32,140 --> 00:20:33,810I don't feel worthless.
24800:20:33,820 --> 00:20:35,750I don't feel discouraged.
24900:20:35,760 --> 00:20:37,100I feel fine,
25000:20:37,640 --> 00:20:39,920but people tell me I'm depressed.
25100:20:39,920 --> 00:20:41,720So I guess I must be...
25200:20:42,490 --> 00:20:46,010So that could be one person who's at risk for,
25300:20:46,020 --> 00:20:48,120misdiagnosis.
25400:20:48,120 --> 00:20:51,140And then of course the depression interventions,
25500:20:51,140 --> 00:20:59,200whether that's counseling or medication, are not going to change the neurology of that nonverbal expression.
25600:21:01,670 --> 00:21:02,890Also,
25700:21:02,900 --> 00:21:11,380there are a subset of individuals on the spectrum who struggle to consistently engage in things like self care...
25800:21:11,390 --> 00:21:12,930taking showers,
25900:21:12,940 --> 00:21:14,060brushing their teeth,
26000:21:14,060 --> 00:21:15,040wearing deodorant,
26100:21:15,050 --> 00:21:16,030eating regular...
26200:21:16,030 --> 00:21:17,280nutritious food,
26300:21:17,290 --> 00:21:20,310uh engaging in exercise,
26400:21:20,320 --> 00:21:21,270getting the sleep
26500:21:21,270 --> 00:21:23,390they need, cleaning the environment,
26600:21:23,400 --> 00:21:24,090working,
26700:21:24,090 --> 00:21:25,940engaging in relationships...
26800:21:26,760 --> 00:21:30,190If the individual rarely leaves the house,
26900:21:30,200 --> 00:21:31,450eats junk food,
27000:21:31,450 --> 00:21:32,960has a reversed sleep cycle,
27100:21:32,960 --> 00:21:34,120doesn't bathe,
27200:21:34,130 --> 00:21:36,140only plays video games...
27300:21:36,150 --> 00:21:39,710Others may conclude that this person is depressed,
27400:21:40,640 --> 00:21:43,880particularly if something in life has changed.
27500:21:43,890 --> 00:21:45,230For example,
27600:21:45,230 --> 00:21:50,540let's say the individual graduated from high school and really can't get going with life.
27700:21:53,150 --> 00:21:56,460The problem is that for the autistic individual,
27800:21:57,260 --> 00:22:10,330their neurology may struggle without structure and high school may have been that input that gave them a reason to get up in the morning, and to get going, and a place to go.
27900:22:10,340 --> 00:22:19,140And the removal of that structure could really lead to a loss of what we call behavioral momentum,
28000:22:19,150 --> 00:22:22,430which is neurologically based...
28100:22:24,410 --> 00:22:30,470creating their own structure and momentum (because of their neurology on the spectrum)...
28200:22:30,470 --> 00:22:32,320that can really be difficult.
28300:22:32,330 --> 00:22:36,120So, even in the absence of emotional struggle,
28400:22:36,130 --> 00:22:45,550you may see this real struggle to initiate behaviors and keep momentum for daily life.
28500:22:49,700 --> 00:22:50,070Now,
28600:22:50,070 --> 00:22:51,580speaking of momentum,
28700:22:51,580 --> 00:22:54,760the brain is in charge of this...
28800:22:54,770 --> 00:22:58,420The issue of getting started...
28900:22:59,230 --> 00:23:02,570let's get going with the task or behavior.
29000:23:02,590 --> 00:23:03,740Let's go,
29100:23:03,740 --> 00:23:04,670let's start,
29200:23:04,680 --> 00:23:09,370let's transition from a resting state to an active state.
29300:23:09,380 --> 00:23:12,770And in my book Understanding Autistic Behaviors,
29400:23:12,780 --> 00:23:16,020I have a chapter called The Physics of Behavior...
29500:23:16,050 --> 00:23:23,150just to explain these kinds of phenomenon where ... if we take the concept of inertia,
29600:23:23,160 --> 00:23:24,510for example,
29700:23:24,520 --> 00:23:27,870so this is a physics concept,
29800:23:27,880 --> 00:23:30,360that's something that is in a resting state
29900:23:30,370 --> 00:23:35,330tends to stay there unless there's energy put into moving it.
30000:23:35,330 --> 00:23:43,160So how do I get going from a resting state... from a stopped state?
30100:23:43,750 --> 00:23:47,240When the individual with autism is in a resting state,
30200:23:48,140 --> 00:23:52,700they may have difficulty getting going into a state of activity.
30300:23:54,410 --> 00:23:54,790Now,
30400:23:54,790 --> 00:23:55,800interestingly,
30500:23:55,810 --> 00:24:01,650the last section on mania describes the same difficulty of transitioning states,
30600:24:01,650 --> 00:24:04,300but this time it's in the opposite direction.
30700:24:04,310 --> 00:24:14,450So the brain should help us both start an activity and stop an activity depending on what's most meaningful,
30800:24:14,450 --> 00:24:16,040important, and healthy.
30900:24:16,050 --> 00:24:16,520Now.
31000:24:16,520 --> 00:24:19,520For the individual with autistic neurology,
31100:24:19,520 --> 00:24:29,390they may have difficulty neurologically doing this... so I can't get going, or when I'm going,
31200:24:29,400 --> 00:24:31,690I have not only momentum,
31300:24:31,690 --> 00:24:35,090but I'm accelerating and I can't stop.
31400:24:35,720 --> 00:24:36,030So,
31500:24:36,030 --> 00:24:40,150if you can't get going that can look like depression, and if you can't stop,
31600:24:40,160 --> 00:24:47,300that can look like mania ... and you can have these elements in the same person at different times.
31700:24:47,310 --> 00:24:56,750So the neurology has difficulty getting to the "just right state" of activity level. Fourth,
31800:24:56,750 --> 00:24:58,000and finally,
31900:24:58,010 --> 00:25:02,970the social withdrawal in autism can also be mistaken for depression.
32000:25:02,980 --> 00:25:19,210So the individual on the spectrum who is content to have alone time, to not leave the house for periods of time, to engage in solitary pursuits... may appear depressed to people who prefer a lot more social interaction and activity.
32100:25:20,060 --> 00:25:20,480Uh,
32200:25:20,490 --> 00:25:23,600So let's talk and visit and talk about our lives...
32300:25:23,610 --> 00:25:24,630Let's play games,
32400:25:24,630 --> 00:25:25,500Let's watch a movie.
32500:25:25,500 --> 00:25:33,060Let's have people over for dinner, and when the individual on the spectrum resists this level of interaction,
32600:25:33,070 --> 00:25:40,550others may wonder if there's a mood issue present and ... kind of at the root of this difficulty.
32700:25:42,590 --> 00:25:48,520So ...certain individuals on the spectrum can struggle significantly with depressed mood....
32800:25:48,530 --> 00:25:51,260But this section highlights,
33000:25:51,680 --> 00:26:18,020that depressed mood can also be misapplied ... and sometimes can prevent the person from getting a really accurate diagnosis of autism because there's this assumption that this must be depression. Now because we've talked about behavioral momentum and we've talked about getting going with activities.
33100:26:18,960 --> 00:26:24,870I'm going to link a few of our previous podcast series that cover these issues.
33300:26:26,710 --> 00:26:35,190I did a series on exhaustion in autism... and issues of gaining and keeping momentum for daily activities.
33400:26:35,200 --> 00:26:41,430This started in September of 2021, and I will put a link to that first episode.
33500:26:41,440 --> 00:26:43,950But there are a couple in that series
33600:26:43,950 --> 00:26:45,510you might want to review.
33700:26:46,210 --> 00:27:00,880I also did a series on dysregulation and autism... and what that can look like, and what to do to prevent dysregulation, to recover from dysregulation, and to recognize dysregulation...
33800:27:00,890 --> 00:27:05,130and that series started in January of 2022.
33900:27:05,140 --> 00:27:09,660I will also link the first episode down in the show notes.
34000:27:11,580 --> 00:27:16,020Thank you for joining me for this episode about mood and autism,
34100:27:16,030 --> 00:27:22,030and we are going to keep talking about this important subject of misdiagnosis in autism
34200:27:22,030 --> 00:27:26,600next time when we focus on anxiety based conditions,
34300:27:26,610 --> 00:27:28,020I hope you join me then.
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