Join Dr. Regan for the second episode in this series about how autistic characteristics may shift across the lifespan. This episode focuses on the life season of adolescence. Stay tuned for the next episodes in the series to hear about hormonal shifts in women and autism in the aging adult (50's and beyond). 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: 1 00:00:03,340 -- 00:00:08,560 Hello and welcome to this episode of Autism in the Adult podcast, 2 00:00:08,940 -- 00:00:10,030 I am your host, 3 00:00:10,040 -- 00:00:11,550 Dr Theresa Regan. 4 00:00:11,560 -- 00:00:13,980 I am a neuropsychologist. 5 00:00:13,990 -- 00:00:23,750 The director of an adult diagnostic autism clinic in central Illinois, and I'm the mother of a teen on the autism spectrum. 6 00:00:25,140 -- 00:00:45,660 We are starting the second episode of a four part series today and the series is about characteristics of autism that fluctuate or shift across the lifespan according to different seasons in life of the individual or changes in the environment. 7 00:00:46,340 -- 00:00:53,960 And our first episode in this series was that foundational information about shifting characteristics, 8 00:00:53,970 -- 00:01:06,460 shifts in how the individual experiences the characteristics and how those around them experience or are impacted by these autistic characteristics. 9 00:01:07,840 -- 00:01:08,500 Today, 10 00:01:08,500 -- 00:01:09,700 in the second episode, 11 00:01:09,700 -- 00:01:26,360 we're going to focus on the time period of adolescence in the lifespan and talk about why that can be such a huge shift and why there can be so many changes for the individual at that time. 12 00:01:27,540 -- 00:01:47,860 one of the things we covered last time is that the changes in how we experience ourselves and express ourselves are often impacted by characteristics of the person that would include their physical development, 13 00:01:47,860 -- 00:01:49,540 the development of the brain, 14 00:01:49,550 -- 00:01:56,220 the biochemistry of the body and the brain also... things like the environment. 15 00:01:56,230 -- 00:01:59,770 So what kinds of demands are in the environment, 16 00:01:59,770 -- 00:02:05,860 what kind of assistance and structure are within that environment at the time. 17 00:02:07,340 -- 00:02:18,860 Things that may shift may also include coping strategies that we've learned certain things we've learned to mask something or to cope with something and regulate ourselves better. 18 00:02:20,040 -- 00:02:24,360 Let's start with the physical person during adolescence. 19 00:02:25,240 -- 00:02:37,980 So one thing that happens of course is that the physical body has been developing and changing and during adolescence there's just a lot of acceleration in that we've got a lot more muscle mass, 20 00:02:37,980 -- 00:02:39,510 you've got a lot of height, 21 00:02:39,520 -- 00:02:41,560 the voice changes etcetera. 22 00:02:42,140 -- 00:02:48,110 And the person at the end of that whole cycle has a different body in many respects. 23 00:02:48,740 -- 00:03:09,660 And one of the things that clients on the spectrum have discussed with me is that for people who like consistency and predictability and who they are and what's happening sometimes this season of having a different body can really be frustrating and upsetting. 24 00:03:10,140 -- 00:03:13,100 And I've had clients say, 25 00:03:13,110 -- 00:03:14,240 you know, 26 00:03:14,250 -- 00:03:16,420 this is not my body. 27 00:03:16,430 -- 00:03:20,920 I really want my 10 year old body back because that was me. 28 00:03:20,930 -- 00:03:37,320 It felt like my internal person was connected to that physical person and to have so many things change without my permission so that I'm a different height and weight and I just don't feel like this is my body anymore. 29 00:03:37,320 -- 00:03:39,430 I just don't like it. 30 00:03:39,440 -- 00:03:44,090 I want to go back in time and to have my original body, 31 00:03:44,090 -- 00:03:46,650 the body that fits my personhood. 32 00:03:50,140 -- 00:03:55,270 Sometimes this will come out where people say I as an adult, 33 00:03:55,280 -- 00:04:04,660 focused a lot on staying at the weight of 118 because that's what my weight was when I stopped getting taller. 34 00:04:04,660 -- 00:04:07,190 So when I graduated from high school, 35 00:04:07,190 -- 00:04:13,440 I was 118 And I really can't tolerate being 120. 36 00:04:13,450 -- 00:04:16,770 I can't tolerate being 100 and 10. 37 00:04:16,780 -- 00:04:34,080 I need to be kind of that same foundational number that I associate with my body and I don't want it to change as you can predict by thinking about the lifespan of the individual. 38 00:04:34,740 -- 00:04:42,370 This stress related to unexpected or unplanned changes in the body, 39 00:04:42,380 -- 00:04:45,460 can really happen across lots of life seasons. 40 00:04:45,940 -- 00:04:49,750 So adolescence is certainly a big one, 41 00:04:49,760 -- 00:04:51,790 pregnancy is a big one, 42 00:04:51,800 -- 00:04:53,270 aging is a big one. 44 00:04:54,060 -- 00:05:00,960 we can all relate to wanting our younger body back and for the individual on the spectrum, 45 00:05:01,340 -- 00:05:14,160 the angst of feeling disconnected with their personhood when their body changes may maybe even more acute that this really has happened without my permission and I do not like it. 46 00:05:15,440 -- 00:05:20,340 The brain also has been doing a lot of development during this period of time. 47 00:05:20,350 -- 00:05:22,800 And as we talked about in the first episode, 48 00:05:22,800 -- 00:05:30,110 the brain itself does not stop developing as a part of the body until about 20, 21, 49 00:05:30,480 -- 00:05:33,010 that early adulthood phase. 50 00:05:33,020 -- 00:05:36,310 So the brain is not grown, 51 00:05:36,310 -- 00:05:44,260 is not fully developed until the person is really out of high school and starting that young adulthood phase, 52 00:05:45,640 -- 00:05:51,760 This development of the brain includes things like thinking at a different level, 53 00:05:51,770 -- 00:05:55,260 challenging what you've always been told, 54 00:05:55,640 -- 00:06:01,250 trying to graduate into more abstract ways of thinking conceptualized thinking. 55 00:06:01,740 -- 00:06:14,260 So there's a lot of changes in the brain itself and the anatomy and the connections and that can impact how autism feels or is expressed during that time. 56 00:06:15,440 -- 00:06:19,070 The chemistry of the body and the brain also shifts. 57 00:06:19,080 -- 00:06:21,300 And so we talked about this before, 58 00:06:21,300 -- 00:06:31,990 that hormones are meant to change the body and the brain and they do and the impact can really feel quite dramatic, 59 00:06:31,990 -- 00:06:33,850 especially during adolescence, 60 00:06:34,440 -- 00:06:44,320 where sometimes that's just this period of the perfect storm for the most centered individual. 61 00:06:44,330 -- 00:06:44,720 You know, 62 00:06:44,730 -- 00:06:56,240 every person probably has stories about adolescents when they were tearful or yelling or or stomping off, 63 00:06:56,250 -- 00:06:57,620 jumping on their bike, 64 00:06:57,620 -- 00:07:03,530 riding away whatever the drama of that period of time may have been for you, 65 00:07:03,540 -- 00:07:17,120 you can relate to that feeling that this hormonal storm for someone that already has some dysregulation difficulty can also be pretty profound. 66 00:07:17,130 -- 00:07:21,260 So it's even harder for me to stay centered. 67 00:07:21,270 -- 00:07:41,150 It's even harder for me to keep my emotions in check or to um focus or get rid of that anxiety or sleep well that this regulation and you can go ahead and listen to the series on regulation that was not too long ago, 68 00:07:41,150 -- 00:07:44,640 a four part series if you want to know more about that. 69 00:07:44,640 -- 00:07:53,760 But the ability to stay centered and even it's just more difficult once those hormones kick in. 70 00:07:54,140 -- 00:07:58,660 And even more so for the person who struggled to begin with, 71 00:07:59,440 -- 00:08:05,040 it's also true that the body and the brain become sexualized during that time. 72 00:08:05,050 -- 00:08:17,850 And so there are even these additional layers of emotion and physical response related to the sexualization of the body that the person has to navigate. 73 00:08:18,540 -- 00:08:19,290 You know, 74 00:08:19,300 -- 00:08:20,960 it's just not. 75 00:08:21,440 -- 00:08:25,960 this is the time of life anymore when please, thank you, and sorry 76 00:08:25,960 -- 00:08:29,610 was going to help you connect with people around you. 77 00:08:29,620 -- 00:08:39,860 There's this really complicated social environment now and that also includes this sexualization of some relationships, 78 00:08:42,440 -- 00:08:44,470 a psychological task. 79 00:08:44,470 -- 00:08:48,150 So we're still talking about the individual at this moment, 80 00:08:48,150 -- 00:08:56,400 but I want to stop and talk about not the physical piece but the psychological task of much of adolescence. 81 00:08:56,590 -- 00:09:05,180 If you're familiar with Erik Erickson and his work with the tasks that we all have at different seasons of life. 82 00:09:05,190 -- 00:09:12,560 He would say that the adolescent's job is to navigate this journey of identity. 83 00:09:12,940 -- 00:09:14,260 Who am I? 84 00:09:14,640 -- 00:09:21,410 Who am I as separate from my parents or from my family history and I'm my own person. 85 00:09:21,410 -- 00:09:21,930 If so, 86 00:09:21,930 -- 00:09:26,360 what does that look like and how can I connect with my tribe? 87 00:09:26,370 -- 00:09:27,310 Where is my, 88 00:09:27,320 -- 00:09:28,160 my people, 89 00:09:28,160 -- 00:09:42,090 my tribe... peer relationships really are an important piece of the connection at that time where I switch from not so much having my best friend be mom or dad anymore or Joey down the street, 90 00:09:42,090 -- 00:09:49,260 but I really switched toward a lot more peer companionship that I'm going to connect with... 91 00:09:49,640 -- 00:09:51,170 A romantic peer... 92 00:09:51,170 -- 00:09:57,440 I'm going to connect with peer groups at my school or in my neighborhood or at my part time job. 93 00:09:57,450 -- 00:10:01,220 And these people may have different values than my parents had. 94 00:10:01,230 -- 00:10:05,960 And I may explore all these different ways of being and thinking. 95 00:10:06,240 -- 00:10:10,860 And my parents no longer seemed to have all the rules, 96 00:10:11,040 -- 00:10:11,380 uh, 97 00:10:11,380 -- 00:10:13,240 and all the keys to life. 98 00:10:13,250 -- 00:10:17,940 And so this process of navigating life, 99 00:10:17,950 -- 00:10:20,640 navigating the social environment, 100 00:10:20,650 -- 00:10:23,060 navigating all of the um, 101 00:10:23,940 -- 00:10:32,360 the reasoning and facts and cognitive pieces that a person might think throw as far as what do I believe? 102 00:10:32,740 -- 00:10:39,380 Do I believe the same thing my parents do and where can I connect? 103 00:10:39,390 -- 00:10:43,460 Where can I belong and find connection with other people? 104 00:10:45,540 -- 00:11:00,550 What we see in the autism community is that there can be a lot of gender diversity that overlaps here and part of it can be this feeling that this is not my body. 105 00:11:00,940 -- 00:11:01,370 Um, 106 00:11:01,380 -- 00:11:09,510 I don't feel connected to the community of people who were born female or born male, 107 00:11:09,510 -- 00:11:11,060 whatever the case may be. 108 00:11:11,070 -- 00:11:13,360 I don't identify as that. 109 00:11:13,360 -- 00:11:14,730 It's not my identity. 110 00:11:14,730 -- 00:11:16,310 I don't feel connected to that. 111 00:11:16,310 -- 00:11:19,060 I can't connect with the peer group in that way. 112 00:11:19,740 -- 00:11:23,510 And in the case of this emerging sexuality as well, 113 00:11:23,510 -- 00:11:26,300 that I'm looking for my identity, 114 00:11:26,300 -- 00:11:27,760 I'm looking for my group. 115 00:11:28,140 -- 00:11:33,660 And there's this gender diversity journey for some people on the spectrum. 116 00:11:34,440 -- 00:11:41,200 So a lot of the research shows that although we would expect to see two um, 117 00:11:41,210 -- 00:11:45,430 autism within any group throughout the world, 118 00:11:45,430 -- 00:11:47,980 whether it's a um, 119 00:11:47,990 -- 00:12:02,160 type of nation that we're looking at or whether it's a city or That about 2% of people in any particular area would be on the spectrum and within the gender diverse community that's higher. 120 00:12:02,640 -- 00:12:11,870 So the research says about 5-8 % of the gender diverse community maybe on the spectrum, 121 00:12:11,870 -- 00:12:14,560 I suspect it's somewhat higher than that. 122 00:12:15,140 -- 00:12:15,490 Um, 123 00:12:15,490 -- 00:12:21,180 but certainly there's that process of understanding the physical body, 124 00:12:21,180 -- 00:12:23,510 understanding the peer group connection, 125 00:12:23,510 -- 00:12:36,190 seeking that out and this who am I kind of journey in addition to changes in the person that can make, 126 00:12:36,200 -- 00:12:36,630 um, 127 00:12:36,630 -- 00:12:40,060 some added stress during a life season. 128 00:12:40,840 -- 00:12:51,020 There are also a lot of changes to the environment of the individual who's in that adolescent period within autism. 129 00:12:51,020 -- 00:13:03,450 What we see is that the autistic individual has more difficulty than their peers with things like independent daily activities and behavior. 130 00:13:04,040 -- 00:13:11,590 What that means is that this person may have this brilliant sense of math or music or art. 131 00:13:11,600 -- 00:13:15,460 Their head may be filled with facts and ideas. 132 00:13:15,470 -- 00:13:16,190 Um, 133 00:13:16,200 -- 00:13:20,990 but their ability to just kind of flow through the day and get things done. 134 00:13:20,990 -- 00:13:23,200 Like I'm going to take my shower, 135 00:13:23,200 -- 00:13:26,550 I'm going to throw my laundry in as a high school student, 136 00:13:26,550 -- 00:13:27,790 I'm going to learn to drive, 137 00:13:27,790 -- 00:13:30,140 I'm going to learn how to save money, 138 00:13:30,140 -- 00:13:31,530 I'm going to learn to cook. 139 00:13:31,540 -- 00:13:31,960 You know, 140 00:13:31,960 -- 00:13:34,280 that kind of stuff is just harder. 141 00:13:34,280 -- 00:13:37,690 Like I can name all these physics equations, 142 00:13:37,690 -- 00:13:44,400 but I just can't catch up with my peers in this area of being independent and, 143 00:13:44,410 -- 00:13:59,840 and this um kind of emerging into adulthood and this disconnect between the neuro typical peer and the individuals on the spectrum who's going through adolescent that gets bigger, 144 00:13:59,850 -- 00:14:00,660 wider, 145 00:14:00,660 -- 00:14:03,780 The gap gets wider with age. 146 00:14:03,790 -- 00:14:05,590 So as you know, 147 00:14:05,590 -- 00:14:07,190 a five year old, 148 00:14:07,200 -- 00:14:15,050 there's some gap there where neuro typical peers are doing more independently typically than the autistic individual, 149 00:14:15,440 -- 00:14:16,600 but you know, 150 00:14:16,600 -- 00:14:22,360 there's not a whole lot of independent things that a five year old is being asked to do. 151 00:14:22,840 -- 00:14:26,560 But when you get to middle school high school young adulthood, 152 00:14:26,570 -- 00:14:27,210 whoa, 153 00:14:27,210 -- 00:14:33,460 the independent demand just skyrockets and this gap becomes more and more visible. 154 00:14:33,840 -- 00:14:34,300 Um, 155 00:14:34,300 -- 00:14:39,150 and although the person may really be ahead with academic knowledge, 156 00:14:39,540 -- 00:14:44,670 this person may be really feeling the gap of cash, 157 00:14:44,670 -- 00:14:47,680 how do my peers get through life this way? 158 00:14:47,680 -- 00:14:49,170 This is really overwhelming. 159 00:14:49,170 -- 00:14:50,740 I have a lot of anxiety, 160 00:14:50,740 -- 00:14:54,250 I feel like I don't know how to navigate all these things. 161 00:14:55,840 -- 00:15:14,950 So the environment begins to demand more independence and the autistic individual going through this adolescent period starts to fall behind more and more with what's expected as far as independent daily behavior. 162 00:15:15,440 -- 00:15:24,460 So can you approach a teacher and ask a question or talk to your teacher about, 163 00:15:24,840 -- 00:15:25,090 hey, 164 00:15:25,090 -- 00:15:31,150 I think the reason I am falling behind in math is that I don't understand this core concept. 165 00:15:31,160 -- 00:15:36,790 Can you help me understand this or can they approach their peer and say, 166 00:15:36,790 -- 00:15:37,190 hey, 167 00:15:37,190 -- 00:15:41,230 do you want to go to the dance with me or hey, 168 00:15:41,240 -- 00:15:44,540 I think we had kind of a rough interaction back there. 169 00:15:44,540 -- 00:15:46,360 I really didn't mean to, 170 00:15:46,740 -- 00:15:47,540 um, 171 00:15:47,550 -- 00:15:48,010 you know, 172 00:15:48,010 -- 00:15:49,440 criticize you, 173 00:15:49,450 -- 00:15:51,860 I think it was a misunderstanding. 174 00:15:52,640 -- 00:16:05,850 So this increased demand for communication from the individual that mom is going to be calling the school less and the students going to be doing the talking more often than before. 175 00:16:09,330 -- 00:16:20,250 There are demands for independence in self care that all of this hygiene and grooming and eating independently and making sure you drink water and wear deodorant. 176 00:16:20,740 -- 00:16:27,820 These things start to become the person's responsibility instead of the parents' responsibility. 177 00:16:27,820 -- 00:16:34,790 And they're just can be a gap there where the expectation for independence is growing, 178 00:16:34,800 -- 00:16:38,950 but the person is struggling to keep up. 179 00:16:40,240 -- 00:16:45,170 There are increased demands with independence within what we call executive function. 180 00:16:45,200 -- 00:16:51,320 So that ability to plan and organize and multitask time management, 181 00:16:51,320 -- 00:16:57,850 These things that the person becomes more and more in charge of... these become harder and harder. 182 00:16:58,240 -- 00:17:14,450 These are things that are always difficult on the spectrum to some extent and the gap again becomes larger as the demand becomes larger. chores are things that the person is supposed to start doing. 183 00:17:14,450 -- 00:17:14,850 You know, 184 00:17:14,850 -- 00:17:23,770 can I start to do my laundry or I'm in charge of um caring for this pet that the family has or doing the dishes. 185 00:17:24,540 -- 00:17:32,350 Can I message my doctor through the electronic medical record and ask a question and then driving? 186 00:17:33,340 -- 00:17:33,700 You know, 187 00:17:33,700 -- 00:17:39,160 driving can be a milestone that feels overwhelming for the individual on the spectrum. 188 00:17:39,640 -- 00:17:47,830 And I looked this past year at the clinic patients I've seen across several years. 189 00:17:47,840 -- 00:17:55,800 I took ages 16 through 20 who individuals who had uh, 190 00:17:55,810 -- 00:17:57,860 no intellectual disability. 191 00:17:58,440 -- 00:18:16,270 And I saw that 80% of the clients I have seen in the clinic either did not do any driving by the age of 20 or they were significantly anxious about driving where I only drive to this one place and that's it. 192 00:18:17,340 -- 00:18:23,750 So there can be this kind of overwhelming sense that things happen too fast on the road. 193 00:18:23,750 -- 00:18:25,070 Things are overwhelming. 194 00:18:25,070 -- 00:18:27,650 Or what if I make the wrong choice? 195 00:18:27,660 -- 00:18:28,750 What if I crash? 196 00:18:28,750 -- 00:18:37,370 What if I hurt someone in the midst of this increasing demand for independence? 197 00:18:37,380 -- 00:18:43,350 There's also this reduction in structure or helpful support, 198 00:18:44,540 -- 00:18:46,470 as we said before, 199 00:18:46,480 -- 00:18:51,940 the person starts to be encouraged to be their own self advocate. 200 00:18:51,950 -- 00:18:54,690 And I don't know about where you live, 201 00:18:54,700 -- 00:19:05,170 but self advocacy is a word that's used more and more once you get into middle school and high school and college and even in the workplace, 202 00:19:05,840 -- 00:19:12,260 it means that the individual is in charge of doing their own talking to people. 203 00:19:12,840 -- 00:19:16,760 Self advocacy means that you can um, 204 00:19:16,770 -- 00:19:18,610 look at your situation, 205 00:19:19,840 -- 00:19:30,760 think about why it is that you're struggling and what you need to make a plan for improvement and approach someone in your situation and talk to them about it. 206 00:19:31,240 -- 00:19:33,800 So I approach my guidance counselor, 207 00:19:33,800 -- 00:19:35,440 I approach my professor, 208 00:19:35,450 -- 00:19:44,080 I approach my boss and I initiate this discussion and we come to an agreement about what a good plan would be for. 209 00:19:44,090 -- 00:19:48,540 Let's say for me to arrive on time for me to get my work in on time, 210 00:19:48,540 -- 00:19:49,270 et cetera. 211 00:19:49,540 -- 00:19:54,680 So parents start to play less of a role and the, 212 00:19:54,690 -- 00:20:05,070 so the structure and the support starts to be pared back while the demand is increased socially, 213 00:20:05,070 -- 00:20:07,960 things are more complex as well. 214 00:20:08,440 -- 00:20:19,010 So gone are the days where running around and chasing each other and playing tag and hiding things is really a great social interaction. 215 00:20:20,240 -- 00:20:32,660 I remember talking to some parents who were saying what great socialization their child had as a youngster and that when they would go to the park, 216 00:20:33,140 -- 00:20:37,030 the child would play with other kids for example. 217 00:20:37,740 -- 00:20:54,870 But when I asked what kind of play it typically was it was that the child would chase other kids and other kids would chase the child and they would laugh and play and fall and which is good for that age group. 218 00:20:54,870 -- 00:20:55,770 That's fine. 219 00:20:56,340 -- 00:21:07,180 But it's also this kind of instinctual physical play that puppy dogs can play and little kids know how to play that and it's a fun game, 220 00:21:07,200 -- 00:21:23,160 but it doesn't really require the social skills and the social navigation that middle school relationships require right when you get from physical to play to this more relational connection, 221 00:21:23,180 -- 00:21:32,670 that's where you can see some of the social things really begin to be much more difficult and the person really can't navigate that? 222 00:21:33,140 -- 00:21:35,770 How do I start a relationship? 223 00:21:36,340 -- 00:21:38,580 How do I maintain this relationship? 224 00:21:38,580 -- 00:21:42,520 How do I understand this relationship? 225 00:21:42,520 -- 00:21:43,770 What just happened? 226 00:21:44,740 -- 00:21:46,960 Why did this relationship end? 227 00:21:47,540 -- 00:21:49,920 Why did they misinterpret me? 228 00:21:49,920 -- 00:21:51,770 Because that's not what I meant. 229 00:21:52,740 -- 00:22:07,160 So there there becomes a lot more at stake and a lot more complexity when you're navigating not physical play and not play dates that your mom organized, 230 00:22:08,140 -- 00:22:13,770 but you're really navigating your own emerging adult relationships. 231 00:22:14,840 -- 00:22:24,160 Another thing that happens is that life becomes less predictable. 232 00:22:24,940 -- 00:22:27,590 It's not your life in a box anymore. 233 00:22:27,620 -- 00:22:30,320 You know when you're in first grade, 234 00:22:30,320 -- 00:22:35,500 you know that next year you go to second grade and the next year you go to third grade, 235 00:22:35,500 -- 00:22:43,530 fourth grade and life has this very predictable rhythm where you know where you go next. 236 00:22:43,540 -- 00:22:47,910 Now you don't know what classes will be like or what your teacher will be like, 237 00:22:47,920 -- 00:22:52,240 but you're going to the same school or you're switching schools, 238 00:22:52,250 -- 00:22:55,560 but you have the structure ahead of you. 239 00:22:55,940 -- 00:23:00,430 There's still something that propels you along and when you get to the next place, 240 00:23:00,430 -- 00:23:07,960 there's a structure in place for you and someone will tell you where you're going to be next. 241 00:23:10,040 -- 00:23:12,260 When you get to the end of high school, 242 00:23:12,640 -- 00:23:14,580 at least in the United States? 243 00:23:14,590 -- 00:23:17,440 What happens is that people start to say to you, 244 00:23:17,440 -- 00:23:19,060 what are you going to do next? 245 00:23:20,640 -- 00:23:23,530 What are you going to be when you quote grow up, 246 00:23:23,540 -- 00:23:24,860 what do you want to be? 247 00:23:25,340 -- 00:23:39,850 And they'll say things like you can be anything you want to be the whole world is your oyster and you start to see that your peers are no longer following the same path as every other peer, 248 00:23:39,850 -- 00:23:43,460 that everyone is kind of making their own path. 249 00:23:44,240 -- 00:23:46,970 And the person on the spectrum can feel like, 250 00:23:46,970 -- 00:23:47,450 well, 251 00:23:48,140 -- 00:23:49,710 what am I supposed to do? 252 00:23:49,710 -- 00:23:49,910 What, 253 00:23:49,920 -- 00:23:52,060 what is my life supposed to look like? 254 00:23:53,240 -- 00:23:54,600 Where is the path? 255 00:23:54,610 -- 00:23:56,870 Show me the path and I'll follow the path. 256 00:23:56,880 -- 00:24:00,200 But to forge my own path, 257 00:24:00,200 -- 00:24:04,360 may not actually feel that empowering or exciting. 258 00:24:04,940 -- 00:24:08,770 I kind of like to know that I'm on the correct path. 259 00:24:08,780 -- 00:24:11,800 I like to know how to meet people's expectations. 260 00:24:12,240 -- 00:24:14,910 I like to know that I'm not getting lost. 261 00:24:15,180 -- 00:24:18,860 I like to know that I'm not taking a risk that it's not unsafe. 262 00:24:20,140 -- 00:24:24,060 So the future becomes more self propelled. 263 00:24:25,340 -- 00:24:35,680 And this can also be a task of young adulthood that is daunting to the person with neurology that likes to know, 264 00:24:35,680 -- 00:24:36,060 like, 265 00:24:36,840 -- 00:24:38,570 did I get an A on that, 266 00:24:38,670 -- 00:24:39,000 you know, 267 00:24:39,000 -- 00:24:40,230 did I do it right. 268 00:24:40,370 -- 00:24:42,060 Is this where I'm supposed to be? 269 00:24:43,140 -- 00:24:49,260 So here we have the picture during adolescence that the internal self, 270 00:24:49,740 -- 00:24:52,400 the psychological biochemical, 271 00:24:52,400 -- 00:24:56,050 physical self and the external life, 272 00:24:56,540 -- 00:24:58,570 the supportive structure, 273 00:24:58,630 -- 00:25:06,170 the demands on the individual are creating this sense of just a lot less stability. 274 00:25:07,140 -- 00:25:07,550 You know, 275 00:25:07,550 -- 00:25:09,730 my internal self is less stable. 276 00:25:09,730 -- 00:25:11,680 I feel all over the place. 277 00:25:11,690 -- 00:25:14,080 I'm crying one minute I'm laughing. 278 00:25:14,080 -- 00:25:15,700 One minute I'm throwing something. 279 00:25:15,700 -- 00:25:19,710 One minute I have all these demands on me. 280 00:25:19,720 -- 00:25:21,920 People seem to be figuring this out, 281 00:25:21,920 -- 00:25:23,820 but I can't figure it out. 282 00:25:23,830 -- 00:25:25,020 I can't sleep, 283 00:25:25,020 -- 00:25:26,050 I'm anxious. 284 00:25:27,040 -- 00:25:35,560 Um And there's all this stuff that goes along with this less stable season. 285 00:25:37,140 -- 00:25:38,950 The person on the spectrum, 286 00:25:38,950 -- 00:25:40,820 as we said earlier, 287 00:25:40,830 -- 00:25:43,400 with relationship to regulation, 288 00:25:43,400 -- 00:25:48,450 they're more likely to get dis regulated just from a neurological perspective. 289 00:25:48,940 -- 00:25:57,860 And dis regulation looks like fight where it's any externalized expression of being unsent erred, 290 00:25:57,880 -- 00:25:59,410 I'm crying, 291 00:25:59,410 -- 00:26:00,730 I'm melting down. 292 00:26:00,730 -- 00:26:01,920 I'm screaming, 293 00:26:01,920 -- 00:26:03,080 I'm throwing something, 294 00:26:03,080 -- 00:26:06,460 I'm shouting and arguing at you and I'm slamming doors. 295 00:26:07,440 -- 00:26:09,060 You get flight. 296 00:26:09,740 -- 00:26:11,850 I can't go to school anymore. 297 00:26:11,920 -- 00:26:12,970 My stomach hurts. 298 00:26:12,970 -- 00:26:14,270 I need to come home. 299 00:26:14,840 -- 00:26:16,830 I'm staying in my room. 300 00:26:16,840 -- 00:26:18,810 I'm not going to eat at the table. 301 00:26:18,820 -- 00:26:19,950 I have homework to do. 302 00:26:19,950 -- 00:26:21,170 I'm not coming out. 303 00:26:21,940 -- 00:26:33,360 You get this social withdrawal and freeze is also part of this regulation that if you force me to I will sit sit here physically. 304 00:26:34,040 -- 00:26:36,640 But psychologically I'm offline. 305 00:26:36,650 -- 00:26:39,400 I can't process what's happening anymore. 306 00:26:39,410 -- 00:26:41,000 I'm checked out. 307 00:26:41,010 -- 00:26:42,820 I'm staring at the wall, 308 00:26:42,830 -- 00:26:46,470 I might be having a seizure that's not electrical. 309 00:26:46,480 -- 00:27:01,360 I might lose my memory for parts of the day and all of that is this dis regulation and the dis regulation of adolescents can be quite a bit more noticeable that there's this real crisis of regulation. 310 00:27:02,140 -- 00:27:09,760 But also what I see in the clients that I serve is that the regulation difficulty can all of a sudden look different. 311 00:27:10,140 -- 00:27:12,770 So that would not be unusual either. 312 00:27:13,140 -- 00:27:20,460 So what I see is that sometimes if little kiddos were under reactive to their environment, 313 00:27:20,470 -- 00:27:24,360 they were less reactive to what's going on around them, 314 00:27:25,740 -- 00:27:33,170 they may look really um compliant and passive and go with the flow. 315 00:27:33,640 -- 00:27:39,060 But what that really is is that they should have some response to what's going on in the environment. 316 00:27:39,060 -- 00:27:41,760 But instead they just lack a response. 317 00:27:41,770 -- 00:27:44,130 And if someone tells them to sit up, 318 00:27:44,130 -- 00:27:44,750 they set up. 319 00:27:44,750 -- 00:27:47,330 If someone tells them to go here or there, 320 00:27:47,330 -- 00:27:47,970 they do it. 321 00:27:47,980 -- 00:27:52,170 But they don't have a lot of reactivity to what's going on. 322 00:27:53,340 -- 00:27:54,440 And adolescence. 323 00:27:54,440 -- 00:28:03,820 This may be a person that flips into an over reactive state or an elevated reactive profile where oh my gosh, 324 00:28:03,820 -- 00:28:07,340 the littlest thing happens and I react to it now. 325 00:28:07,350 -- 00:28:17,230 So I have like this flip from passive to so elevated in my response or you can have vice versa. 326 00:28:17,240 -- 00:28:19,310 Where as a little kid, 327 00:28:19,310 -- 00:28:25,910 this person was melting down and rolling on the ground and biting people and now as an adolescent, 328 00:28:25,920 -- 00:28:33,030 they can't get out of bed and they're sluggish and they don't eat and they don't have momentum for activities. 329 00:28:34,040 -- 00:28:38,790 That could also be something that you see where there's this dis regulated state, 330 00:28:38,800 -- 00:28:40,410 but it looks different, 331 00:28:40,420 -- 00:28:49,170 but it's still dysregulation and it's still uh kind of falls within what we talked about in that past series. 332 00:28:52,540 -- 00:28:57,740 Some people feel like with biochemical and hormonal changes, 333 00:28:57,740 -- 00:29:00,960 that their anxiety really is elevated. 334 00:29:01,390 -- 00:29:09,260 Sometimes there are self harm behaviors that may look like cutting or um hitting yourself, 335 00:29:09,270 -- 00:29:10,460 biting yourself, 336 00:29:10,840 -- 00:29:12,850 banging your head on the wall. 337 00:29:14,340 -- 00:29:18,450 Sometimes there are elevated sensory concerns where, 338 00:29:19,040 -- 00:29:19,560 you know, 339 00:29:19,560 -- 00:29:24,290 this food never bothered me before or noise or whatever, 340 00:29:24,290 -- 00:29:29,110 but all of a sudden I just really can't tolerate the sensory environment, 341 00:29:29,110 -- 00:29:38,050 It's too much and that can be part of this physical and environmental season of dis regulation. 342 00:29:40,040 -- 00:29:57,310 Now I do wanna um say that this I think is a really good summary of what I tend to see during adolescence as far as shifts in the qualities of autism and people I do want to say however, 343 00:29:57,310 -- 00:30:00,570 that I work in a clinic. 344 00:30:00,580 -- 00:30:17,160 So people come to me during adolescence when they are struggling and so I really don't get to see folks that have improved through adolescence and are doing better and not needing to come through. 345 00:30:17,640 -- 00:30:36,360 So I'm fully aware of that piece as well and I have seen people in my community and in my personal life and in my friendships that have had a bit of a smoother course as well where the sensory issues have really come down by adolescents, 346 00:30:36,740 -- 00:30:39,490 there's a bit better social connection. 347 00:30:39,500 -- 00:30:40,570 Um, 348 00:30:40,580 -- 00:30:43,760 executive functions not that much of a problem. 349 00:30:44,440 -- 00:30:58,770 So you can certainly see this variety of individualized um kind of seasons and my purpose and talking about this isn't to say, 350 00:30:58,780 -- 00:30:59,880 oh gosh, 351 00:30:59,880 -- 00:31:01,350 when people get to adolescence, 352 00:31:01,350 -- 00:31:02,450 that's going to be rough. 353 00:31:02,840 -- 00:31:03,180 No, 354 00:31:03,180 -- 00:31:20,360 it's just to point out that it is an individualized season of life and that just because autism is neurologic in its base doesn't mean that there there aren't shifting seasons and how that feels or how that looks. 355 00:31:20,840 -- 00:31:25,990 And I think whenever that happens in your life or the life of those, 356 00:31:25,990 -- 00:31:26,860 you love that, 357 00:31:27,340 -- 00:31:27,880 um, 358 00:31:27,890 -- 00:31:28,330 you know, 359 00:31:28,330 -- 00:31:31,090 certainly it's likely to happen for you. 360 00:31:31,090 -- 00:31:34,180 It may be adolescents for someone else. 361 00:31:34,190 -- 00:31:34,580 Uh, 362 00:31:34,590 -- 00:31:34,950 you know, 363 00:31:34,950 -- 00:31:40,550 maybe pregnancy or menopause or even just life seasons that aren't physical, 364 00:31:40,550 -- 00:31:41,540 that oh, 365 00:31:41,540 -- 00:31:47,360 my parent dies and that's a season where my body is really responding differently. 366 00:31:49,240 -- 00:32:09,790 I hope this information gives you a context for recognizing when you're going through those ups and downs of season and normalizing that these kinds of things can shift If you would like to review strategies for regulation. 367 00:32:09,800 -- 00:32:22,560 I encourage you to go back to our regulation series not too long ago to look at strategies for centering and feeling better in your own skin. 368 00:32:23,640 -- 00:32:26,810 And I'm looking forward to the third episode. 369 00:32:26,810 -- 00:32:32,270 We're going to focus on next time and this is going to have to do with hormonal shifts. 370 00:32:32,740 -- 00:32:39,170 A lot of that will talk about the experience of females on the spectrum, 371 00:32:39,170 -- 00:32:41,540 just because they're tend to be, 372 00:32:41,540 -- 00:32:46,870 of course more discreet hormonal shifts in the lives of women. 373 00:32:47,540 -- 00:32:50,560 This will include menstrual cycles, 374 00:32:51,040 -- 00:32:51,980 pregnancy, 375 00:32:51,980 -- 00:32:52,920 breastfeeding, 376 00:32:52,920 -- 00:32:53,950 menopause. 377 00:32:54,340 -- 00:32:54,840 Um, 378 00:32:54,840 -- 00:33:03,360 so some of these hormonal shifts will also impact males on the spectrum and some will be more specific to females. 379 00:33:03,740 -- 00:33:14,360 But I really hope you can join us next time as we start rounding out this series on shifting characteristics in autism.

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

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