Join Dr. Regan for the final episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on recognizing when an individual is attempting to regulate and using this information to partner toward the best outcome. New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Dr. Regan's Resources Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website Resources for Clinicians Transcript of Episode 1 00:00:00,340 -- 00:00:03,370 This is Dr Theresa Regan. 2 00:00:03,380 -- 00:00:10,830 I'm a neuropsychologist and I specialize in understanding the way that the brain is related to emotions, 3 00:00:10,830 -- 00:00:13,000 behavior, cognition -- 4 00:00:13,000 -- 00:00:16,430 thinking skills -- and also personality. 5 00:00:16,440 -- 00:00:18,910 I'm a certified autism specialist. 6 00:00:18,920 -- 00:00:24,060 I'm the director of an autism diagnostic clinic for adults in Illinois. 7 00:00:24,070 -- 00:00:26,650 And I'm the mother of a teen on the spectrum. 8 00:00:27,740 -- 00:00:35,960 This is our final episode of a four point series on regulation and dysegulation on the autism spectrum. 9 00:00:36,440 -- 00:00:37,640 In the first episode, 10 00:00:37,640 -- 00:00:39,800 we talked about what those words mean. 11 00:00:39,800 -- 00:00:49,130 So regulation has to do with the nervous system's ability to help us stay centered with alertness... 12 00:00:49,140 -- 00:01:02,480 whether we are able to wake up quickly and efficiently in the morning and are able to wind down to sleep in the evening ... that has to do with regulation of our alertness, 13 00:01:02,490 -- 00:01:04,900 Also regulation of attention... 14 00:01:04,900 -- 00:01:14,000 so sometimes we may feel spacey and inattentive and other times we may have too much hyper focus, 15 00:01:14,000 -- 00:01:19,350 too attentive to details that aren't really helping our situation. 16 00:01:19,360 -- 00:01:21,530 And also third, 17 00:01:21,530 -- 00:01:24,370 the regulation of emotions and behavior. 18 00:01:24,370 -- 00:01:35,970 And so this would be what we typically call fight, flight, or freeze modes when someone's overwhelmed and they may revert to an outburst or a meltdown, 19 00:01:35,980 -- 00:01:39,230 they may be an individual who has quieter struggle... 20 00:01:39,230 -- 00:01:41,930 So they may have flight reactions -- 21 00:01:41,930 -- 00:01:43,590 like I'm leaving school, 22 00:01:43,590 -- 00:01:46,580 I can't come out of my room, 23 00:01:46,580 -- 00:01:48,340 I'm withdrawing. 24 00:01:48,350 -- 00:01:52,880 I'm hiding ... psychologically or physically. 25 00:01:53,740 -- 00:01:57,440 And some people have freeze reactions that ... I'm physically present, 26 00:01:57,440 -- 00:01:59,430 but I'm really shut down. 27 00:01:59,430 -- 00:02:07,660 I'm not psychologically present ... and it may even take the form of a dissociative episode like this person is shut down... 28 00:02:07,670 -- 00:02:10,520 They don't remember this conversation later. 29 00:02:10,520 -- 00:02:14,360 They're really just not able to be fully present. 30 00:02:15,440 -- 00:02:18,590 Another form of freeze reaction 31 00:02:18,590 -- 00:02:25,130 could be this expression of psychological stress through the physical body. 32 00:02:25,140 -- 00:02:29,330 So a person who's having what we call nonepileptic seizures. 33 00:02:29,340 -- 00:02:39,150 Those are seizures that are expressions of psychological struggle rather than based in electrical changes in the brain. 34 00:02:39,160 -- 00:02:42,420 That would be in this category. 35 00:02:42,420 -- 00:02:49,150 People who have feelings of physical pain in the context of emotional pain. 36 00:02:49,540 -- 00:02:52,750 People who have headaches or stomachaches etcetera. 37 00:02:55,540 -- 00:03:02,510 So we talked about ways to prevent dysregulation in the second episode. 38 00:03:02,510 -- 00:03:06,960 How to reduce those episodes of feeling uncentered. 39 00:03:08,240 -- 00:03:09,490 In the third episode, 40 00:03:09,490 -- 00:03:26,260 we talked about how to recover once dysregulation occurs, because it will ... it does for every human and there are just times in our life when we have more difficulties slipping into these dysregulated states. 41 00:03:26,270 -- 00:03:27,850 And then once that happens, 42 00:03:27,850 -- 00:03:30,760 we need to have strategies to recover. 43 00:03:30,770 -- 00:03:33,360 And that was our third topic. 44 00:03:34,040 -- 00:03:52,950 This is our fourth and final topic, and it's about how to recognize when the person you are with ... or how to recognize in yourself ... when you are attempting to regulate, because a lot of what we do as humans is say to ourselves, 45 00:03:52,950 -- 00:03:53,310 "Gosh, 46 00:03:53,310 -- 00:03:55,540 why is this person behaving that way? 47 00:03:55,550 -- 00:03:57,150 What does it mean? 48 00:03:57,640 -- 00:03:59,980 Why is my kid doing this? 49 00:04:00,050 -- 00:04:01,770 What's their intention? 50 00:04:01,770 -- 00:04:02,820 What does that mean? 51 00:04:02,830 -- 00:04:06,790 Or why did my spouse say this or didn't say this? 52 00:04:06,790 -- 00:04:08,460 What is the meaning behind that?" 53 00:04:09,040 -- 00:04:15,620 And it's really important if someone has a behavior and an attempt to regulate, that 54 00:04:15,620 -- 00:04:19,740 we understand that's what this behavior means. 55 00:04:19,740 -- 00:04:24,760 It's stemming, not from any personal issue between me and this person, 56 00:04:24,770 -- 00:04:48,260 It's stemming from an attempt to regulate and it's a sign ...it's revelation to the person and to those around him or her, that this is a person who's not feeling centered, and they're trying to get there and we all really want to support each individual's attempt to get to the center. 57 00:04:48,740 -- 00:05:04,560 And the first step is recognizing when someone is trying to do that and not interfering with their attempt to regulate unless we can offer them a better option for regulation and we'll talk about that in a little bit. 58 00:05:06,140 -- 00:05:18,160 One of the strategies that we talked about in previous episodes for regulating, whether that is alertness or attention or emotional calm, 59 00:05:19,240 -- 00:05:34,590 can have to do with the sensory system. The sensory inputs that people often use for adjusting that regulation state often has to do with pressure... 60 00:05:34,600 -- 00:05:40,460 So getting sensations of pressure, and that can be in the muscles or the joints. 61 00:05:40,940 -- 00:05:44,560 That's when we get what we call proprioceptive input. 62 00:05:44,940 -- 00:06:02,550 And that is why weighted blankets are calming for some people, that you have this pressure in the muscles and the nervous system gets these signals that it can kind of recenter, refocus, and get grounded. 63 00:06:02,840 -- 00:06:09,760 That's why yoga often is something that people gravitate toward for calming and centering, 64 00:06:09,940 -- 00:06:19,520 you often have these poses that you hold for a significant amount of time... enough that that pressure in the joint really gets settled in there. 65 00:06:19,530 -- 00:06:35,590 But there are a lot of other ways that people get pressure as well and we'll talk more about how to recognize that ... A lot of times the things people gravitate toward without really realizing why do I do this... 66 00:06:35,600 -- 00:06:42,930 There could be some sensory input part to it besides pressure... 67 00:06:42,930 -- 00:06:45,740 we're also going to be looking at movement. 68 00:06:45,750 -- 00:06:50,360 So that's when our brain receives vestibular input. 69 00:06:50,840 -- 00:07:00,690 So if person is riding their bike down through hills and down through neighborhoods, 70 00:07:00,700 -- 00:07:04,950 that person is getting vestibular input into their brain. 71 00:07:05,340 -- 00:07:18,240 And this kind of input is only present if the person is moving through space in the sense that they were in position one and now they're in position two... like they're down the street, 72 00:07:18,250 -- 00:07:23,660 that means the fluid in their ears starts to move and the brain gets this type of input... 73 00:07:24,440 -- 00:07:32,360 What doesn't give the brain vestibular movement input would be if the person is riding a stationary bike, 74 00:07:32,740 -- 00:07:37,920 they're moving their arms and legs and guess what ... they are getting proprioceptive input.... 75 00:07:37,920 -- 00:07:40,980 that pressure in their muscles and their joints... 76 00:07:41,020 -- 00:07:45,670 but they're not moving through the neighborhood, down the hill, 77 00:07:45,720 -- 00:07:53,560 they're not getting that sense of movement into the brain, and that can be why a lot of people -- and you know who you are -- 78 00:07:53,640 -- 00:07:56,650 will say, "I love running through the neighborhood, 79 00:07:56,650 -- 00:07:58,590 but I'm not going to run on a treadmill." 80 00:07:58,600 -- 00:07:59,580 You know, 81 00:07:59,590 -- 00:08:04,670 that is a clue that you are someone that needs that vestibular component, 82 00:08:04,680 -- 00:08:07,950 otherwise it just doesn't meet your sensory needs. 83 00:08:09,740 -- 00:08:25,450 Let me give some more examples of sensory strategies so that we recognize when someone around us may be using a sensory strategy. When kids or adults chew on things... 84 00:08:25,840 -- 00:08:27,110 pencils, 85 00:08:27,120 -- 00:08:28,170 shirts, 86 00:08:28,180 -- 00:08:29,910 chewing on gum, 87 00:08:29,920 -- 00:08:34,280 chewing on the tops or tabs of things. 88 00:08:34,280 -- 00:08:39,010 People put all kinds of things... like straws or tabs in their mouth. 89 00:08:39,020 -- 00:08:42,710 So our approach to correcting that is to say, 90 00:08:42,710 -- 00:08:42,900 "Hey, 91 00:08:42,900 -- 00:08:44,330 don't chew on your shirt, 92 00:08:44,330 -- 00:08:45,460 that's disgusting"... 93 00:08:45,740 -- 00:08:48,410 or don't chew on the pencil, 94 00:08:48,410 -- 00:08:49,850 it's not for chewing. 95 00:08:50,140 -- 00:08:54,580 Um but that kind of instruction doesn't really help. 96 00:08:54,590 -- 00:09:06,710 And the reason that in the long term the person kind of reverts back to that is it's probable that they actually are needing some pressure input through their jaw, 97 00:09:06,720 -- 00:09:09,680 through their uh the teeth into the jaw. 98 00:09:09,690 -- 00:09:19,950 And when you chew you get a lot of oral input and a lot of pressure input and that kind of input may be centering for that person. 99 00:09:20,440 -- 00:09:30,240 We even now ...at least in the United States, when there's an individualized educational plan for a student with attention problems or other difficulties in school, 100 00:09:30,250 -- 00:09:47,750 it may be written in their program that they're allowed to chew gum during class because it can help with focus and concentration and centering to have some pressure through the jaw and through the the teeth into the jaw. 101 00:09:49,240 -- 00:10:09,850 Another way that you might see people trying to get proprioceptive input would be that kid that is rolling on the ground, is crashing into people or things, and seems to like that.... um impact of hitting something or tackling in football, 102 00:10:10,240 -- 00:10:16,260 that kind of thing is going to give them pressure in their muscles and joints. 103 00:10:16,940 -- 00:10:34,400 Kds who like to run and jump into someone's lap or jump into a bear hug might really be wanting to get that pressure input ... for people who like to work on a laptop or on a project while they're laying on their stomach, 104 00:10:34,400 -- 00:10:38,360 you're getting a lot of pressure throughout your... 105 00:10:38,740 -- 00:10:56,460 the length of your body. When people are sitting and they're um kind of swinging their legs and they're hitting their ankles onto the the leg of the chair. 106 00:10:56,940 -- 00:11:00,960 Uh that gives pressure into the ankle joint there. 107 00:11:01,440 -- 00:11:04,360 People who like to go barefoot, 108 00:11:04,370 -- 00:11:22,550 you get a lot more proprioceptive input from the floor that way... by going barefoot rather than having a shoe on. Other people shuffle or drag their feet and they might be corrected by a parent and saying pick up your feet... 109 00:11:23,440 -- 00:11:34,020 the individual who sleeps with a ton of blankets or stuffed animals or really likes to be swaddled into something to sleep 110 00:11:34,030 -- 00:11:39,250 might be seeking pressure input. For people seeking vestibular input, 111 00:11:39,640 -- 00:11:45,970 you get that movement input ... and it may be riding the bike as I had talked about, 112 00:11:45,980 -- 00:11:54,330 It could be jumping on a trampoline (that also gives you pressure in your joints or when you flop on the bed of the trampoline). 113 00:11:54,340 -- 00:11:55,010 So you, 114 00:11:55,020 -- 00:12:00,260 you might be seeing that the person is getting both of those ... 115 00:12:02,240 -- 00:12:06,720 people who love roller coasters, who like to ride a motorcycle, 116 00:12:07,140 -- 00:12:07,910 Um, 117 00:12:07,920 -- 00:12:20,790 even just we can see that some people like to go for a ride in the car, and that clears their mind and it may be that there's some component of quiet that they find there, 118 00:12:20,790 -- 00:12:27,260 but they're also maybe just this predictable linear movement that might be calming. 119 00:12:28,440 -- 00:12:30,980 I want to tell you a story in particular. 120 00:12:30,990 -- 00:12:35,480 I saw a mother and her... 121 00:12:35,490 -- 00:12:52,510 I would say the son was probably about 10 years old, and it was one of those situations where unfortunately we were all in line to sign up for something that was related to a kids activity. 122 00:12:52,520 -- 00:12:57,890 And so there were parents in this long line and um, 123 00:12:57,900 -- 00:13:01,930 some parents had their kids with them and the line, 124 00:13:01,940 -- 00:13:07,550 I think it was raining outside and the interior of the office... 125 00:13:07,740 -- 00:13:23,220 it was just very winding and it was like you could fit one person in this little hallway and then it it just um meandered like a snake around this whole building and so you didn't see any windows and you were kind of... 126 00:13:23,230 -- 00:13:25,900 it really was loud and claustrophobic, 127 00:13:25,900 -- 00:13:29,460 it was very difficult for me to wait in that line. 128 00:13:30,340 -- 00:13:33,720 And the boy who was next to me, 129 00:13:33,730 -- 00:14:07,460 I could hear his mom talking to another mom in line ...and she was talking about how her boys loved to ride down this a really, really steep hill by their house, and she she just worries about them a bit because it's so steep and they do things like you know riding on their handlebars and ...they just are so driven to go down this hill that she hasn't been able to figure out a way to keep them from doing that. 130 00:14:08,540 -- 00:14:14,270 And in my mind I'm thinking "oh those are kids that need a lot of vestibular input, 131 00:14:14,270 -- 00:14:20,750 they need that ... they're trying to regulate and that's the way that they found that really serves that purpose. 132 00:14:21,340 -- 00:14:35,820 And interestingly, the next thing that happened was the boy next to me started shaking his head back, back, back, back, back, back, back and forth... vigorously and then he'd stop and then he'd shake, 133 00:14:35,820 -- 00:14:36,060 shake, 134 00:14:36,060 -- 00:14:36,290 shake, 135 00:14:36,290 -- 00:14:36,510 shake, 136 00:14:36,510 -- 00:14:36,780 shake, 137 00:14:36,780 -- 00:14:37,010 shake, 138 00:14:37,010 -- 00:14:50,930 shake his head and then he'd stop... and in my head, I thought "oh that's a great way for this kid to try to regulate in a hallway, because there's no way he's riding his bike down this hallway," 139 00:14:50,940 -- 00:14:52,730 but by shaking his head, 140 00:14:52,730 -- 00:14:54,150 he's standing still, 141 00:14:54,150 -- 00:15:02,300 he's not making any noise and he's getting vestibular input because his head is shaking and that fluid in the ears is moving. 142 00:15:02,540 -- 00:15:03,230 And I thought, 143 00:15:03,230 -- 00:15:03,490 wow, 144 00:15:03,490 -- 00:15:05,660 that's a really great strategy for him. 145 00:15:06,240 -- 00:15:08,180 And the mom though, 146 00:15:08,190 -- 00:15:17,060 didn't realize what was happening, and she saw that as bad behavior and she said "stop that." 147 00:15:18,240 -- 00:15:23,480 And that's really the purpose of this episode... that if we don't understand, 148 00:15:23,520 -- 00:15:24,180 you know, 149 00:15:24,180 -- 00:15:32,630 here is someone who is struggling to stand still in a winding hallway, 150 00:15:32,630 -- 00:15:34,040 that's not moving, 151 00:15:34,050 -- 00:15:35,740 the line's not moving, 152 00:15:35,750 -- 00:15:37,290 people are talking, 153 00:15:37,290 -- 00:15:39,160 it's a very close space. 154 00:15:39,640 -- 00:15:42,360 Um and he's not able to move at all. 155 00:15:43,040 -- 00:15:47,060 So here he comes up with this great strategy, 156 00:15:47,060 -- 00:15:48,570 I'm sure unconsciously, 157 00:15:48,570 -- 00:15:49,550 it's not like he thought, 158 00:15:49,550 -- 00:15:51,060 how can I get movement input? 159 00:15:51,070 -- 00:15:54,120 But his body helped him out by saying, 160 00:15:54,120 -- 00:15:54,350 hey, 161 00:15:54,350 -- 00:15:55,210 do this. 162 00:15:55,740 -- 00:15:57,670 And mom said no, 163 00:15:57,680 -- 00:16:02,770 and so what we can really do, if we recognize what is this behavior... 164 00:16:02,770 -- 00:16:03,920 we could say, 165 00:16:03,930 -- 00:16:06,450 "oh that's a great strategy, 166 00:16:07,030 -- 00:16:15,000 Does that feel good to move your head like that" -- and we can help the person identifying themselves, 167 00:16:15,000 -- 00:16:17,160 what feels calming and what they need. 168 00:16:17,840 -- 00:16:18,470 Now, 169 00:16:18,480 -- 00:16:25,930 if she felt like that was too disruptive or if he were somehow banging his head into people, 170 00:16:25,940 -- 00:16:28,400 she very well could say something like, 171 00:16:28,410 -- 00:16:31,510 oh I really see that your body has that itch 172 00:16:31,520 -- 00:16:32,250 to move, 173 00:16:32,250 -- 00:16:33,940 it really needs to move, 174 00:16:33,950 -- 00:16:36,190 That's kind of hard to do in here. 175 00:16:36,190 -- 00:16:42,160 But would you like to go to the indoor pool after we're done? 176 00:16:42,160 -- 00:16:53,240 So you can get some of that movement that you really need... so that she's offering an alternative, and she's acknowledging that that actually serves a very important need for him, 177 00:16:53,250 -- 00:17:08,950 that he needs a lot of movement throughout the day and offering him more opportunity to do that again in a way that is safe and healthy and doesn't disrupt other people is a much better strategy than saying "don't do that." 178 00:17:09,140 -- 00:17:11,620 So once she understands that, 179 00:17:11,630 -- 00:17:18,080 they'll get along well with it, once we have a detective's hat on and we can say, 180 00:17:18,080 -- 00:17:18,520 wow, 181 00:17:18,520 -- 00:17:21,240 I wonder if X, 182 00:17:21,240 -- 00:17:22,480 y and Z. 183 00:17:22,490 -- 00:17:22,890 You know, 184 00:17:22,890 -- 00:17:28,960 I wonder if this behavior that you're showing really serves a function for you that's important. 185 00:17:29,440 -- 00:17:40,060 Then our solution can be to help the person realize what's happening, to support their attempts to regulate, and to create more opportunities for good regulation. 186 00:17:42,540 -- 00:17:50,170 It also breaks up this adversarial stance between people where if I'm correcting this person and saying, 187 00:17:50,180 -- 00:17:50,960 um, 188 00:17:50,970 -- 00:17:51,440 you know, 189 00:17:51,440 -- 00:17:52,380 pick your feet up, 190 00:17:52,380 -- 00:17:55,740 don't drag your feet, and don't shake your head, and don't talk. 191 00:17:55,750 -- 00:18:18,890 It gets into this very constant kind of adversarial situation where I've established a relationship with the person where I'm making sure they fit into a very small space, and they feel like their needs aren't getting met ... and she's asking, let's take the son who likes to move or needs movement, 192 00:18:18,900 -- 00:18:22,030 She's asking him to be still and be quiet. 193 00:18:22,030 -- 00:18:25,830 So she's asking him to regulate in the hallway. 194 00:18:25,840 -- 00:18:29,560 But she's asking him not to use regulation strategies. 195 00:18:29,570 -- 00:18:31,560 So that's where the problem is. 196 00:18:31,560 -- 00:18:43,910 He can either stay in the line and tolerate it by moving his head -- or he might then become more disruptive. 197 00:18:43,910 -- 00:18:48,450 Like then "I just can't stay in the line if I can't use the movement." 198 00:18:50,640 -- 00:19:11,790 I want to give you another example I witnessed of someone who is using vestibular input to regulate, and that was a preschooler who I observed the class was walking in their single file line behind the teacher. One of the students that had a lot of difficulty regulating 199 00:19:11,790 -- 00:19:15,480 -- I already knew from past observations -- 200 00:19:15,490 -- 00:19:21,740 He was spinning while walking down in line. 201 00:19:21,750 -- 00:19:23,940 This kind of took a lot of coordination, 202 00:19:23,940 -- 00:19:27,150 but he was spinning in his own personal space, 203 00:19:27,150 -- 00:19:31,260 but while moving in a single file... line and again, 204 00:19:31,260 -- 00:19:34,520 that was something that he got reprimanded for. 205 00:19:34,530 -- 00:19:36,050 But it's a big revelation. 206 00:19:36,050 -- 00:19:37,050 It's a big clue. 207 00:19:37,340 -- 00:19:38,410 And if we can say, 208 00:19:38,410 -- 00:19:38,890 wow, 209 00:19:38,890 -- 00:19:40,350 that's a clue, 210 00:19:40,360 -- 00:19:46,240 maybe I should put this kid on a swing and and let him go before we go back into the classroom, 211 00:19:46,250 -- 00:19:48,770 then we can use that information. 212 00:19:51,140 -- 00:19:54,130 The person who wants to chew on everything. 213 00:19:54,140 -- 00:19:59,030 Maybe they can chew gum instead of chewing on pencils or ruining their shirts. 214 00:19:59,040 -- 00:20:06,770 Um maybe they can chew on a pencil topper ... so they make different things you can chew on that you could put on top of a pencil. 215 00:20:07,040 -- 00:20:17,890 Another strategy that sometimes works for kids to kind of give them another source of regulation is to have them do their homework or um you know, 216 00:20:17,890 -- 00:20:23,940 for an adult to do their projects, while sitting on an exercise ball because when you're doing that, 217 00:20:23,940 -- 00:20:30,350 you're getting more pressure into your seat and you have the opportunity to move and get that vestibular input as well. 218 00:20:30,350 -- 00:20:39,660 And sometimes that reduces the need for chewing because you're actually getting some pressure and movement and feel more centered. 219 00:20:43,840 -- 00:20:48,020 Another way that people tend to seek regulations... 220 00:20:48,020 -- 00:20:58,150 so we've talked about sensory inputs... and another way that people seek regulation is when they want to engage in their pleasurable activities. 221 00:20:58,160 -- 00:21:00,640 So for the individual on the spectrum, 222 00:21:00,640 -- 00:21:07,010 this might include something like sorting or patterning objects in their collections. 223 00:21:07,340 -- 00:21:11,590 So they may take time to sort and organize their colored pencils, 224 00:21:11,590 -- 00:21:13,060 they're playing cards, 225 00:21:13,070 -- 00:21:16,140 they may take out items to look at that 226 00:21:16,150 -- 00:21:24,350 ... they have that are figurines that are ornaments, that are books in a collection with special covers signed by the author. 227 00:21:25,940 -- 00:21:31,930 It may be that this person is wanting to read their favorite book, 228 00:21:31,930 -- 00:21:33,830 watch their favorite tv show, 229 00:21:33,840 -- 00:21:38,970 eat their favorite meal ... and this is their attempt to regulate. 230 00:21:38,970 -- 00:21:42,500 So they're gonna like ... their pleasurable, 231 00:21:42,500 -- 00:22:02,420 go-to activities ... and they're also going to tend to like things that are familiar. And one of the biggest problems I encounter for families is when they misinterpret why the person is trying to grasp at these familiar and pleasurable things. 232 00:22:02,430 -- 00:22:12,260 So let's take the example of a teenage girl who comes home from school and she is exhausted, 233 00:22:12,640 -- 00:22:14,910 it's loud at school, 234 00:22:14,920 -- 00:22:17,520 she was previously homeschooled, 235 00:22:17,520 -- 00:22:21,340 so the high school environment is a big difference. 236 00:22:21,350 -- 00:22:24,860 And after school she gets off the bus, 237 00:22:24,860 -- 00:22:34,600 she comes in and she breaks the family rule about using mom's iPad. 238 00:22:34,600 -- 00:22:41,910 So she is allowed to use mom's ipad for a certain number of minutes a day, 239 00:22:42,440 -- 00:22:47,770 and it is not until she has done her homework that she's able to start with it. 240 00:22:48,240 -- 00:23:05,170 But she goes right in to get the iPad, and she goes to her closet and she sits in the dark with the iPad, um with the closet door closed and mom finds her in there and ... really, 241 00:23:05,170 -- 00:23:08,550 really gets upset! Like this... 242 00:23:08,560 -- 00:23:10,870 these kind of things have happened before. 243 00:23:10,880 -- 00:23:16,900 And mom really views her as being very defiant, 244 00:23:16,910 -- 00:23:29,670 even though she intellectually knows the rules. She interprets her sitting in the closet in the dark with the ipad as "I know I'm not supposed to be doing this and I'm doing it anyway" 245 00:23:29,670 -- 00:23:36,200 and that feels very, very intentionally willful and defiant to mom. 246 00:23:36,200 -- 00:23:40,450 And so she um takes a very hard stance about it... 247 00:23:40,450 -- 00:23:43,960 she starts to yell and get upset, 248 00:23:43,960 -- 00:23:50,320 she grabs the ipad and physically takes it out of her daughter's hands. 249 00:23:50,840 -- 00:23:53,110 the daughter loses it, 250 00:23:53,190 -- 00:23:55,160 she starts screaming, 251 00:23:55,540 -- 00:23:58,540 she slams doors, 252 00:23:58,540 -- 00:24:03,560 she takes one of the doors ... not completely off the hinge, 253 00:24:03,560 -- 00:24:19,380 but kind of breaks and bends one of the hinges, and it just turned into a very loud screaming and property breaking kind of episode. 254 00:24:19,380 -- 00:24:29,700 And so this was unfortunate because I think mom's interpretation of what was going on was inaccurate. 255 00:24:29,720 -- 00:24:34,060 In my working with this teen, 256 00:24:34,540 -- 00:24:38,460 this is a teen with straight A's in school, 257 00:24:38,840 -- 00:24:43,760 she is very rule-oriented in school, 258 00:24:43,760 -- 00:24:47,860 which makes her mom feel very upset that she breaks the rules at home ... 259 00:24:48,640 -- 00:24:52,390 but she's just exhausted by the time she gets home, 260 00:24:52,400 -- 00:24:59,970 it's a complex academic, sensory, and social environment ...and she has not been used to it, 261 00:24:59,980 -- 00:25:05,320 she's back in a public school environment, and even the bus drive there and the bus drive home, 262 00:25:05,320 -- 00:25:06,570 that adds another, 263 00:25:06,580 -- 00:25:07,340 you know, 264 00:25:07,340 -- 00:25:15,330 hour to the day of being around all these people ...and it's very overwhelming to her. When she gets overwhelmed, 265 00:25:17,840 -- 00:25:32,000 what she wants to do is look at pictures of animals, and she wants to look up animal facts and topics and charts, and she wants to learn about a new animal and see pictures of the animal. 266 00:25:32,010 -- 00:25:54,060 And so all she's doing on the ipad is looking up animal facts and pictures and this is soothing to her. I do get where mom's coming from, that there are some households where the rule is you get to do fun things after you do your homework, 267 00:25:54,940 -- 00:26:04,740 but this person's nervous system really needs the opportunity to regroup before doing something again. 268 00:26:04,750 -- 00:26:05,550 That's hard. 269 00:26:06,340 -- 00:26:18,300 So she is at a breaking point when she comes home and it's actually her attempt to regulate that has her take this thing ... and I know she's hiding with it. 270 00:26:18,300 -- 00:26:26,360 But I also think that being in a dark, quiet space is also something she's trying to do to regulate as well. 271 00:26:29,140 -- 00:26:41,150 I think the misunderstanding is that mom feels that the daughter on the spectrum could easily comply and behave in a different way. 272 00:26:41,160 -- 00:26:51,480 And my view is that she's leaning toward trying to get her neurologic needs met and it breaks the household rule 273 00:26:51,480 -- 00:26:54,540 which puts everybody in a very tough position. 274 00:26:54,550 -- 00:27:00,810 So mom is essentially saying "I want you to regulate without doing your pleasant activities." 275 00:27:00,820 -- 00:27:06,970 And she is saying "I can't regulate if that's taken away from me." 276 00:27:06,980 -- 00:27:14,580 So mom's um kind of coming in and barging into the the bedroom area and the closet area, 277 00:27:14,580 -- 00:27:17,860 turning the lights on, physically taking away the 278 00:27:18,540 -- 00:27:30,270 ipad and raising her voice ... really added to this very overwhelming situation for her ... and then when she couldn't use flight... 279 00:27:31,040 -- 00:27:33,760 here she had come home and used flight right?... 280 00:27:33,760 -- 00:27:35,560 I'm going to go to the closet. 281 00:27:36,240 -- 00:27:36,440 Um, 282 00:27:36,440 -- 00:27:41,860 and her favorite activity to prevent a meltdown. 283 00:27:42,240 -- 00:27:44,310 Once that was taken away from her, 284 00:27:44,310 -- 00:27:48,350 then she did have a meltdown, and it wasn't in defiance... 285 00:27:48,360 -- 00:27:52,050 it was just that what she was using to regulate was taken away. 286 00:27:53,040 -- 00:27:58,300 I think there would have been a much better outcome if the parent had seen her in the closet and thought, 287 00:27:58,300 -- 00:27:58,720 wow, 288 00:27:58,730 -- 00:28:01,170 it looks like you had a really rough day. 289 00:28:01,740 -- 00:28:07,260 Does it feel good to be in a dark cozy space and looking at your animals? 290 00:28:07,740 -- 00:28:14,850 And this could have started a real dialogue about what her system needs and what she notices. 291 00:28:15,330 -- 00:28:23,200 And it can introduce this concept that we can partner together to make sure that you're safe and healthy, 292 00:28:23,200 -- 00:28:29,960 but that your needs also get met because you are important and how you're doing is important. 293 00:28:30,640 -- 00:28:30,990 Um, 294 00:28:30,990 -- 00:28:34,060 and it sets up this collaboration and this partnership. 295 00:28:35,740 -- 00:28:46,070 Maybe there could be flexibility in the iPad rule and maybe they discussed that mom really does want her to feel centered after a hard day at work. 296 00:28:46,080 -- 00:28:55,060 And one option might be that mom and daughter could sit in a dark room together after school and look at animal facts for 30 minutes. 297 00:28:55,540 -- 00:29:10,140 If the reason that mom is restricting the ipad is that she thinks that she must be in the closet because she's looking at unapproved sites ... or maybe they could decide that having animal books from the library 298 00:29:10,150 -- 00:29:10,880 299 00:29:10,880 -- 00:29:19,170 and the daughter could choose those books and go into an enclosed dark space and look at the books... 300 00:29:19,180 -- 00:29:25,270 if the reason for the rule is that mom doesn't want electronics all day in front of the daughter. 301 00:29:26,540 -- 00:29:34,310 Perhaps they could even have a tradition where after her alone time looking at animal facts and books, 302 00:29:34,310 -- 00:29:37,810 she could come out and tell mom some animal information. 303 00:29:37,920 -- 00:29:42,660 What was the most interesting that she learned... and this could also bring them together. 304 00:29:43,140 -- 00:29:43,710 305 00:29:43,710 -- 00:29:44,930 once they have this, 306 00:29:44,940 -- 00:29:49,510 this better partnership and a tradition like 'this is how you unwind, 307 00:29:49,520 -- 00:29:51,060 this is how we connect'... 308 00:29:53,350 -- 00:29:56,450 And then once they figure out that that's helpful, 309 00:29:56,940 -- 00:30:03,780 they can talk about what else could we set up for you and give you access to that would help your system. 310 00:30:03,790 -- 00:30:04,330 You know, 311 00:30:04,330 -- 00:30:22,270 maybe this person needs a weighted blanket or a hammock or maybe laying in a bubble bath after school feels grounding, and they could come up with more ideas so that she has more access rather than less access to regulating activities. 312 00:30:24,140 -- 00:30:28,080 Consider an example of a husband who comes home from work 313 00:30:28,090 -- 00:30:34,350 to his wife and two preschool kids, and he walks straight to his home office, 314 00:30:34,350 -- 00:30:35,570 he shuts the door, 315 00:30:35,580 -- 00:30:47,870 he watches tv, plays games on his phone... and his kids had just thrown themselves at him when he came in the door only to be uh rejected and feel rejected. 316 00:30:47,880 -- 00:30:54,320 His wife is feeling like she's the one who needs to recharge because she's been with the kids all day. 317 00:30:54,320 -- 00:30:59,760 She hasn't seen another adult and she also feels ignored and rejected in her marriage. 318 00:31:00,940 -- 00:31:03,360 This again is a case of, 319 00:31:03,940 -- 00:31:04,300 um, 320 00:31:04,300 -- 00:31:13,160 an autistic adult who has given everything at work and comes in and actually does need some recentering time. 321 00:31:13,640 -- 00:31:19,670 And a discussion of this would probably be more fruitful 322 00:31:20,100 -- 00:31:27,860 than people talking about discontent with it, or telling him to do something different. 323 00:31:28,440 -- 00:31:28,840 Uh, 324 00:31:28,850 -- 00:31:42,760 it may be much more strategic to say "what do you need for these 30 or 40 minutes when you get home and then I'll tell you what I need and how can we get these things that we all need in the evening." 325 00:31:45,040 -- 00:31:55,720 Another strategy would be maybe he could start doing things at his office that would help him regulate during the day and then when he gets home, 326 00:31:55,730 -- 00:31:58,800 maybe he'd have a little bit more left. 327 00:31:58,800 -- 00:32:00,880 So maybe over a lunch break, 328 00:32:00,890 -- 00:32:04,450 he could eat his sandwich while he's walking around the block, 329 00:32:04,830 -- 00:32:08,300 Maybe he could listen to music when he's not in meetings. 330 00:32:08,740 -- 00:32:18,850 So this conscious working towards strategy helps us with the regulation piece. 331 00:32:19,850 -- 00:32:21,320 Then when he gets home, 332 00:32:21,720 -- 00:32:26,330 maybe he could go into his office and do some alone things for 30 minutes. 333 00:32:26,740 -- 00:32:31,770 And if wife needs alone time then or needs together time with him, 334 00:32:32,140 -- 00:32:38,390 they could pick maybe a restorative activity for the family... one that the kids never get to do. 335 00:32:38,400 -- 00:32:53,170 But they're going to pull this out in the evening because they really need something that's restorative and calm and so maybe they don't let let the kids watch movies or eat popcorn or eat anything in the living room. 336 00:32:53,440 -- 00:33:05,000 So maybe they could have a popcorn picnic or a pancake picnic in the living room while they put on a cartoon and they can turn off the lights. 337 00:33:05,060 -- 00:33:07,540 The kids might settle down in there, 338 00:33:07,540 -- 00:33:15,490 they can turn the volume down and then the parents could just cuddle on the couch and that level of activity 339 00:33:15,490 -- 00:33:22,450 may be something that he can regulate through and that actually is also restorative for them as a family. 340 00:33:23,740 -- 00:33:35,700 So once we recognize that the behavior is not intentionally defiant or manipulative at its core... and it doesn't represent a rejection of other people, 341 00:33:35,700 -- 00:33:38,860 we can problem solve and establish a partnership. 342 00:33:39,240 -- 00:33:42,550 And if you're the individual learning about yourself, 343 00:33:42,550 -- 00:33:48,500 you can say to the other person ... it looks like you have had a crazy day, 344 00:33:48,510 -- 00:33:50,390 I want to know what you need. 345 00:33:50,400 -- 00:33:58,060 Let me tell you what I think I need ... and so we can all grow in this self awareness and in these discussions about partnering. 346 00:33:59,940 -- 00:34:07,230 It's also important to note that flight can sometimes be an attempt to save regulation as well. 347 00:34:07,240 -- 00:34:09,320 And we talked about this a little bit. 348 00:34:09,320 -- 00:34:31,190 I just want to emphasize it before we end today ... that if someone leaves the room or if they shut down or if they stop the conversation and they are just going to leave ... one danger to chasing after them physically or psychologically, 349 00:34:32,040 -- 00:34:36,180 is that that flight may be the only thing 350 00:34:36,180 -- 00:34:39,720 saving them from melting down, 351 00:34:39,730 -- 00:34:41,350 that might be their strategy... 352 00:34:41,350 -- 00:34:43,160 flight might be their strategy. 353 00:34:43,170 -- 00:34:45,360 And so if it is, 354 00:34:46,440 -- 00:34:53,540 it often doesn't help to chase after the person and prevent them from flight. 355 00:34:53,550 -- 00:35:00,900 That's not to say that we don't want to work toward a more sustained level of communication. 356 00:35:01,340 -- 00:35:09,630 It's just that what doesn't seem to work -- and even though it's understandable ---is to go kind of in chase mode, 357 00:35:09,630 -- 00:35:11,770 like "I'm not going to let this go, 358 00:35:11,770 -- 00:35:12,600 this is important, 359 00:35:12,600 -- 00:35:13,860 we need to do this." 360 00:35:14,840 -- 00:35:16,080 Again, 361 00:35:16,080 -- 00:35:18,600 there are lots of caveats to all these, 362 00:35:18,600 -- 00:35:24,740 these are kind of general principles that I found helpful, 363 00:35:24,750 -- 00:35:30,960 but there may be times that you do block an activity or escape because of safety reasons. 364 00:35:31,340 -- 00:35:35,100 Um but most of the time when I see it happening, 365 00:35:35,100 -- 00:35:36,970 it's in frustration. 366 00:35:37,340 -- 00:35:42,170 Uh that ... I'm not gonna let you leave or I'm not gonna let you be defiant. 367 00:35:43,140 -- 00:35:48,360 Another approach that may work better in the flight mode issue is saying, 368 00:35:48,370 -- 00:35:51,750 I know that having this conversation is really tough for you, 369 00:35:52,240 -- 00:35:56,340 but it's also really important to me to communicate about this. 370 00:35:56,340 -- 00:36:01,250 And what would help you feel more centered and still be able to communicate. 371 00:36:02,130 -- 00:36:14,160 So some people may do better communicating about a sensitive topic when you're sitting in the dark so that they don't have to be face to face with you and they don't have to have eye contact. 372 00:36:14,630 -- 00:36:26,540 Another person may want to email about things for the same reason... that anything you can do to reduce the intensity of the conversation might make it more successful. 373 00:36:26,550 -- 00:36:29,390 So if they're overwhelmed enough that they want to leave, 374 00:36:29,400 -- 00:36:35,950 how can you reduce the intensity without reducing the core of what you want to accomplish? 375 00:36:36,230 -- 00:36:39,710 So maybe you can reduce the eye contact. 376 00:36:39,720 -- 00:36:49,960 Maybe you can reduce um you know turn down the lights or go in a quieter spot or schedule a time instead of having it spontaneous. 377 00:36:50,930 -- 00:37:05,450 So the bottom line summary of today's episode on recognizing when someone is attempting to regulate is that the way that we interpret someone's behavior ... 378 00:37:06,140 -- 00:37:07,850 you know, "what does this mean?" 379 00:37:08,430 -- 00:37:17,490 ... it ends up impacting a lot, and if we think the behavior means someone's being disrespectful, 380 00:37:17,490 -- 00:37:36,300 manipulative, defiant, rejecting us ... then we are often going to respond in a way that's less effective than if we recognize that "oh this is a person who is dysregulated and trying to regulate. 381 00:37:36,300 -- 00:37:37,950 They're trying to get back. 382 00:37:37,960 -- 00:37:47,010 ... this is a person who's overwhelmed ... then we can make better choices about how to respond in that situation to get the better outcome, 383 00:37:47,020 -- 00:37:55,580 the best outcome ... and that may include "wow it looks like you've had a rough day" or "it's really noisy in here isn't it?" 384 00:37:55,590 -- 00:38:01,670 Or "it seems like your system might need to move"... and really problem solving together. 385 00:38:03,130 -- 00:38:07,440 I hope this four part series on regulation has been helpful to you. 386 00:38:08,330 -- 00:38:15,550 It's certainly a topic that people often contact our clinic for ... for advice and education. 387 00:38:17,430 -- 00:38:22,840 Next time you join me it will be for the beginning of our next series, and I'm going to call it, 388 00:38:22,840 -- 00:38:24,450 Talking About Autism. 389 00:38:24,830 -- 00:38:28,140 This is a listener request, and I think it's a great one. 390 00:38:28,140 -- 00:38:30,140 It was sent in by several people, 391 00:38:30,150 -- 00:38:36,950 all wanting to really hear my input about how to talk about autism with each other. 392 00:38:37,630 -- 00:38:39,110 Hope you can join me then.

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

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