Reducing Dysregulation on the Autism Spectrum

Join Dr. Regan for the second episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on three strategies to help reduce the frequency and intensity of dysregulation episodes for the autistic individual.

Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan

Dr. Regan's Resources

Book: Understanding Autism in Adults and Aging Adults, 2nd ed

Audiobook

Book: Understanding Autistic Behaviors

Autism in the Adult website

Resources for Clinicians

1 00:00:03,540 --> 00:00:07,840 Hello everyone and welcome to this episode of the podcast,

2 00:00:07,850 --> 00:00:09,680 autism in the adult,

3 00:00:09,690 --> 00:00:10,910 I am your host,

4 00:00:10,910 --> 00:00:12,450 Dr Theresa Regan.

5 00:00:13,040 --> 00:00:14,870 I am a neuropsychologist,

6 00:00:14,870 --> 00:00:20,640 which means that I specialize in understanding how the brain impacts things like thinking,

7 00:00:20,640 --> 00:00:21,320 skills,

8 00:00:21,330 --> 00:00:22,410 emotions,

9 00:00:22,420 --> 00:00:24,560 behavior and personality.

10 00:00:25,160 --> 00:00:30,460 I'm the founder and director of an adult diagnostic autism clinic in central Illinois.

11 00:00:30,840 --> 00:00:40,560 And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum.

12 00:00:41,440 --> 00:00:42,960 In the first episode,

13 00:00:42,960 --> 00:00:51,080 we defined these terms where regulation is feeling just right in the area of alertness,

14 00:00:51,090 --> 00:01:03,630 attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions,

15 00:01:03,630 --> 00:01:11,960 they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down,

16 00:01:12,410 --> 00:01:19,850 they might include physical expressions of stress, or what we call dissociation.

17 00:01:20,540 --> 00:01:31,760 Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real.

18 00:01:33,640 --> 00:01:34,800 In the first episode,

19 00:01:34,800 --> 00:01:38,030 we also reviewed that within the autism spectrum,

20 00:01:38,030 --> 00:01:43,360 dysregulation is more common than for those with different neurology.

21 00:01:44,540 --> 00:01:46,760 In the second episode of this series,

22 00:01:46,760 --> 00:02:08,760 we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into.

23 00:02:10,520 --> 00:02:12,120 For our third episode,

24 00:02:12,120 --> 00:02:16,460 our focus will be on what to do when dysregulation hits.

25 00:02:16,940 --> 00:02:21,650 We all have dysregulated states... for the person on the spectrum,

26 00:02:21,650 --> 00:02:28,970 they may be more likely to have these and, even when we do all that we can do to support the nervous system,

27 00:02:29,440 --> 00:02:38,260 we're going to have periods where we're really not just right with regard to alertness or attention or emotional status.

28 00:02:38,840 --> 00:02:40,860 So when someone is dysregulated,

29 00:02:40,860 --> 00:02:47,170 they might appear to be sluggish or have difficulty getting going or unmotivated.

30 00:02:47,180 --> 00:02:53,360 That would be when their motor is running too low in the area of alertness and activation.

31 00:02:54,040 --> 00:03:04,330 This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism.

32 00:03:04,330 --> 00:03:10,290 And I will post the links to these episodes below today,

33 00:03:10,290 --> 00:03:15,530 We're going to focus on the dysregulation that looks like anxiety,

34 00:03:15,540 --> 00:03:17,310 upset, anger,

35 00:03:17,310 --> 00:03:18,360 restlessness.

36 00:03:18,930 --> 00:03:24,570 These things that may manifest in fight, flight, or freeze reactions.

37 00:03:28,540 --> 00:03:37,480 So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing.

38 00:03:37,480 --> 00:03:41,650 So we're gonna start with this category of what not to do.

39 00:03:42,040 --> 00:03:49,540 Many of the things that we have an instinct for when someone is dysregulated actually may make things worse.

40 00:03:49,550 --> 00:03:51,270 So what do we tend to do?

41 00:03:51,270 --> 00:03:51,470 Well,

42 00:03:51,470 --> 00:03:55,010 we might ask the person to talk about how they're feeling,

43 00:03:55,010 --> 00:03:56,760 why they're feeling that way,

44 00:03:56,760 --> 00:04:01,320 what triggered this really strong emotional reaction.

45 00:04:02,240 --> 00:04:08,560 We may reason with them about why they should be feeling or reacting differently.

46 00:04:08,940 --> 00:04:10,390 We might say things like,

47 00:04:10,390 --> 00:04:13,130 "Well they didn't mean it" or "it's not a big deal,"

48 00:04:13,130 --> 00:04:28,420 "don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better.

49 00:04:28,440 --> 00:04:31,000 So we may say to them calm down,

50 00:04:31,010 --> 00:04:32,180 don't yell,

51 00:04:32,190 --> 00:04:43,490 look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system.

52 00:04:43,500 --> 00:04:52,360 It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed.

53 00:04:54,040 --> 00:04:56,530 For the person on the spectrum,

54 00:04:56,530 --> 00:05:02,300 it's already going to be effortful for them to figure out what their emotions are,

55 00:05:02,310 --> 00:05:09,250 what triggered them, and to talk about them face to face and eye to eye with another person.

56 00:05:10,040 --> 00:05:18,350 And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves.

57 00:05:18,940 --> 00:05:26,280 Um and so it's probably not only not realistic for them to be able to do that when overwhelmed,

58 00:05:26,840 --> 00:05:33,750 but talking to the individual who's overwhelmed also just adds stimulus,

59 00:05:33,760 --> 00:05:35,150 It adds demand,

60 00:05:35,150 --> 00:05:36,860 it adds noise.

61 00:05:37,740 --> 00:05:45,750 And so to the extent that talking is just adding stimulus to the situation,

62 00:05:46,540 --> 00:05:50,490 I really would recommend being calm,

63 00:05:50,490 --> 00:05:51,840 being quiet.

64 00:05:52,340 --> 00:05:59,360 Not necessarily engaging with the person in the moment that they are overwhelmed.

65 00:06:00,540 --> 00:06:21,560 So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time

66 00:06:24,440 --> 00:06:34,060 Other things that I would recommend not doing would be ... I would not take away possessions from them at this time.

67 00:06:34,540 --> 00:06:37,820 So don't try to take something out of their hands.

68 00:06:37,830 --> 00:06:43,810 Don't try to take something away from their space or their room...

69 00:06:43,820 --> 00:06:51,070 the place where maybe they find comfort. Objects are often very important to the individual on the spectrum.

70 00:06:51,070 --> 00:06:55,530 And when someone's dysregulated and overwhelmed,

71 00:06:55,530 --> 00:07:01,660 it's often not a good time to try to separate them from something that's that important to them.

72 00:07:03,640 --> 00:07:09,120 Likewise touching them or wrestling with them ...kind of getting into their space.

73 00:07:09,130 --> 00:07:16,060 Um It's generally again going to add stimulus to what they're trying to process.

74 00:07:16,070 --> 00:07:26,660 So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state.

75 00:07:27,640 --> 00:07:35,830 Again just kind of thinking how much information is coming at this individual who's already overwhelmed.

76 00:07:35,830 --> 00:07:46,660 So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them...

77 00:07:48,520 --> 00:07:50,970 So during a period of dysregulation,

78 00:07:50,970 --> 00:08:09,650 the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ...

79 00:08:09,660 --> 00:08:12,090 adding your speech, adding...

80 00:08:12,090 --> 00:08:13,990 being in in their space,

81 00:08:14,000 --> 00:08:17,080 taking away things that are comforting to them...

82 00:08:17,080 --> 00:08:20,860 that's likely to increase the dysregulated state.

83 00:08:23,440 --> 00:08:36,660 Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion.

84 00:08:37,440 --> 00:08:45,220 So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum.

85 00:08:45,220 --> 00:09:06,420 And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed.

86 00:09:08,040 --> 00:09:14,760 I would recommend staying very calm and even and predictable.

87 00:09:17,240 --> 00:09:27,650 I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process.

88 00:09:28,240 --> 00:09:31,670 If you do approach the person with high reactivity,

89 00:09:31,680 --> 00:09:43,970 you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own.

90 00:09:43,980 --> 00:09:52,760 And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated.

91 00:09:55,840 --> 00:10:08,350 The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated.

92 00:10:10,040 --> 00:10:26,190 We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual.

93 00:10:26,240 --> 00:10:38,930 The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs.

94 00:10:38,940 --> 00:10:43,950 And we talked about some of the strategies for this during the last episode.

95 00:10:44,440 --> 00:10:53,160 But, for example, an individual on the spectrum may really like pressure inputs or movement inputs.

96 00:10:53,730 --> 00:11:06,880 So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub,

97 00:11:06,890 --> 00:11:09,660 they feel a lot more centered after that.

98 00:11:10,240 --> 00:11:13,360 Some people recenter by lifting weights,

99 00:11:13,360 --> 00:11:14,330 doing yoga,

100 00:11:14,330 --> 00:11:26,460 swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding.

101 00:11:28,340 --> 00:11:30,830 Those experiences may be calming,

102 00:11:30,840 --> 00:11:38,750 they may be centering for the individuals so if you can add calming and centering inputs without talking,

103 00:11:39,440 --> 00:11:43,250 this can really help getting back to a regulated state.

104 00:11:44,140 --> 00:11:55,150 And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them.

105 00:11:55,740 --> 00:11:58,480 So thinking about this individual,

106 00:11:58,480 --> 00:12:01,210 what do they lean towards doing ... that

107 00:12:01,210 --> 00:12:04,050 they seem to find rejuvenating.

108 00:12:05,240 --> 00:12:17,860 Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos,

109 00:12:18,840 --> 00:12:28,460 another person may love sorting through their collections or sorting through images on Pinterest,

110 00:12:28,840 --> 00:12:36,510 looking at various colors that are so ... they're just so compelled by these colors,

111 00:12:36,520 --> 00:12:40,760 they capture their attention and it's almost like they just fill,

112 00:12:40,770 --> 00:12:45,290 fill this person up ... and they feel so rejuvenated.

113 00:12:46,240 --> 00:12:53,980 A third person may love to listen to history podcasts or to watch a favorite movie,

114 00:12:53,990 --> 00:12:57,870 even one that they've watched 100 times,

115 00:12:57,880 --> 00:13:04,560 It may be their go-to movie when they want to regroup and settle back to the center.

116 00:13:05,540 --> 00:13:10,020 In these moments of being uncentered and wanting to recenter,

117 00:13:10,030 --> 00:13:17,640 it's very likely that familiar things will be more calming than new things.

118 00:13:17,640 --> 00:13:24,650 So um a lot of times if people watch what they're drawn to on a difficult day,

119 00:13:24,740 --> 00:13:27,850 it may give them this information.

120 00:13:27,860 --> 00:13:38,590 This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment.

121 00:13:38,600 --> 00:14:05,300 And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far.

122 00:14:05,300 --> 00:14:35,050 We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time

123 00:14:35,640 --> 00:14:37,320 some type of game plan,

124 00:14:37,350 --> 00:14:53,130 a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?"

125 00:14:53,270 --> 00:14:53,690 You know,

126 00:14:53,690 --> 00:14:56,800 what should I do during this episode to feel better?

127 00:14:57,340 --> 00:15:10,650 So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time.

128 00:15:11,240 --> 00:15:13,260 People do it all different ways.

129 00:15:13,260 --> 00:15:23,230 Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered.

130 00:15:23,240 --> 00:15:24,200 Oh yes,

131 00:15:24,210 --> 00:15:24,590 you know,

132 00:15:24,590 --> 00:15:25,940 I wouldn't have thought of this,

133 00:15:25,940 --> 00:15:32,060 but I can take a walk outside of the weather permits and I actually do feel better then.

134 00:15:32,840 --> 00:15:41,890 Sometimes people make a box ahead of time of items in it that are soothing.

135 00:15:41,890 --> 00:15:46,070 They might have a lava lamp in there that they can just watch,

136 00:15:46,070 --> 00:15:47,960 they might have a stress ball.

137 00:15:48,440 --> 00:15:57,350 Uh there might be slime or different scents like lavender or vanilla that are soothing or calming.

138 00:15:59,140 --> 00:16:06,550 So this detective work ahead of time can be really helpful and then adding cues to the person

139 00:16:06,550 --> 00:16:09,000 either from familiar people who can say,

140 00:16:09,000 --> 00:16:09,280 hey,

141 00:16:09,280 --> 00:16:14,900 I wonder if it would feel good for you to do this or to have it in the environment,

142 00:16:14,900 --> 00:16:17,460 like a list or a box of items...

143 00:16:19,840 --> 00:16:27,240 Ideally the individual will have a sense over time of when a dysegulated state is coming on.

144 00:16:27,250 --> 00:16:28,660 So for example,

145 00:16:28,670 --> 00:16:37,060 if they lean toward starting to shut down or disassociate during difficult times or difficult conversations,

146 00:16:37,470 --> 00:16:43,520 they may start to catch themselves when their mind starts to go blank and they're talking to somebody.

147 00:16:44,540 --> 00:16:49,630 They also may have a sense over time of when this happens at home,

148 00:16:49,670 --> 00:16:55,320 it often helps me to do these kinds of things-- and when it happens in public,

149 00:16:55,330 --> 00:16:57,860 I've learned to do these other kinds of things.

150 00:16:59,140 --> 00:17:02,700 Being able to recognize dysregulation, know

151 00:17:02,700 --> 00:17:11,670 what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening...

152 00:17:11,680 --> 00:17:21,090 that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people,

153 00:17:21,100 --> 00:17:25,370 we can really stabilize these situations and these relationships.

154 00:17:25,380 --> 00:17:26,850 So for example,

155 00:17:26,850 --> 00:17:33,770 if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown,

156 00:17:34,140 --> 00:17:40,530 it's generally very acceptable and professional in most work settings to step out...

157 00:17:40,540 --> 00:17:49,670 if you offer some type of explanation... walking out of the room without explanation would not be considered okay or professional,

158 00:17:50,040 --> 00:17:55,250 but someone may use a very generic explanation and just say,

159 00:17:55,260 --> 00:17:55,870 "You know,

160 00:17:55,880 --> 00:17:58,340 I'm starting to not feel very well,

161 00:17:58,340 --> 00:18:13,360 I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work.

162 00:18:14,940 --> 00:18:17,480 So in that case the person might say,

163 00:18:17,480 --> 00:18:17,840 "You know,

164 00:18:17,840 --> 00:18:21,450 I can see that I'm really feeling passionate about this topic,

165 00:18:21,840 --> 00:18:29,660 but I also want to be able to hear what you have to say and ways in what your opinion is different from mine.

166 00:18:29,670 --> 00:18:34,050 And I think I just need to step out to regroup for a few minutes,"

167 00:18:34,740 --> 00:18:45,960 or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate.

168 00:18:46,440 --> 00:18:48,310 They may say to their boss,

169 00:18:48,320 --> 00:18:48,720 "You know,

170 00:18:48,720 --> 00:18:52,890 I can feel myself getting really passionate about my own opinion,

171 00:18:52,890 --> 00:18:55,920 but I know that your perspective is important too,

172 00:18:55,920 --> 00:19:08,140 and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized.

173 00:19:08,260 --> 00:19:11,440 I'd really love for you to hear them,

174 00:19:11,440 --> 00:19:14,320 but I also would like to read your thoughts.

175 00:19:14,320 --> 00:19:15,960 If you could send them to me.

176 00:19:15,970 --> 00:19:32,670 I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps.

177 00:19:33,940 --> 00:19:39,360 Then I would like to come back and talk more about our opinions and talk them through."

178 00:19:40,340 --> 00:19:51,640 Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things.

179 00:19:51,650 --> 00:19:55,330 So this could be a technique that's done in a workplace,

180 00:19:55,340 --> 00:20:06,600 in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on.

181 00:20:06,600 --> 00:20:07,970 But it's very important,

182 00:20:07,970 --> 00:20:08,290 you know,

183 00:20:08,290 --> 00:20:17,670 being able to have time and space to process before you come back together can help stabilize that interaction.

184 00:20:20,940 --> 00:20:35,920 It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you,

185 00:20:35,920 --> 00:20:38,430 even though you disagree with it.

186 00:20:38,440 --> 00:20:46,530 Um that it kind of helps show that you want there to be a good exchange.

187 00:20:46,540 --> 00:20:48,000 If you're walking out,

188 00:20:48,000 --> 00:20:52,110 sometimes people feel like they're not even committed to a good exchange.

189 00:20:52,110 --> 00:20:54,950 So what ... what good is this partnership?

190 00:20:54,960 --> 00:21:09,600 But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now.

191 00:21:09,610 --> 00:21:16,260 Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work.

192 00:21:18,540 --> 00:21:28,670 That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ...

193 00:21:29,440 --> 00:22:07,960 what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time.

194 00:22:08,640 --> 00:22:14,960 So we've talked now about several ways to approach periods of dis regulation.

195 00:22:15,340 --> 00:22:31,060 One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation,

196 00:22:31,140 --> 00:22:38,260 but all I can say certainly is that these are general things I've noticed that do help or don't help.

197 00:22:40,120 --> 00:22:44,630 Focus should also always be on the person's safety in that moment,

198 00:22:44,630 --> 00:22:47,690 if there's something unsafe that needs to be stopped,

199 00:22:47,700 --> 00:22:52,260 that's really something to immediately intervene with.

200 00:22:53,340 --> 00:23:01,460 But in general reducing stimuli and demand and increasing soothing inputs can be really helpful.

201 00:23:03,840 --> 00:23:12,810 I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life.

202 00:23:12,810 --> 00:23:36,960 So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing.

203 00:23:37,440 --> 00:23:48,800 So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial --

204 00:23:48,800 --> 00:23:54,860 so that goals with some challenge can be added once regulation has improved.

205 00:23:57,640 --> 00:24:05,670 Now our next episode will be the final in our four episode series on regulation and dysregulation.

206 00:24:07,140 --> 00:24:09,360 In the 4th and final episode,

207 00:24:09,360 --> 00:24:19,670 we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations.

208 00:24:20,740 --> 00:24:28,060 So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.