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

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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