Q and A episode 2: Your Questions Answered

Join Dr. Regan for the second Q and A episode in which she answers listener questions related to CBT therapy, parenting, autism in the workplace, non epileptic seizures, and exercise goals

Topics covered in this episode -- 

askjan.org Workplace Accommodations

Time Timers. Link to physical timer here or you can search app stores for Time Timers

Regan blog post on non-epileptic seizures

Virtual Fitness Challenges

Dysregulation podcast series, episode 1

Momentum for Activities podcast series, episode 1

 

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 episode transcript here:

 

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Hello and welcome.

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This is Dr Theresa Regan.

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I'm a neuropsychologist,

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a certified autism specialist and the director of an adult diagnostic autism clinic in central Illinois.

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I am the author of books,

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a speaker and your host for autism in the adult podcast.

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Today we're going to continue our question and answer series.

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It's kind of a mini series.

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This is number two and will be our final part of the question and answer episodes for a bit of time.

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We're going to pause on those and in the future.

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We will bring back some more episodes.

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Today's questions that I'm going to be answering from listeners across the world

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are a little eclectic.

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So we're just gonna go through various topics and respond to those.

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the first question I'm going to tackle is about CBT therapy for those on the spectrum.

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And this stands for cognitive behavioral therapy.

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Um,

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what this refers to is a talk therapy where the individual in the sessions works with a therapist to identify their inner state and their outer state.

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So what are my thoughts and feelings and what are my behaviors?

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And those three things are linked sometimes they'll add kind of 1/4 category,

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which is what am I feeling physically in the moment.

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Um,

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so the basis of this therapy is to realize that when we feel angry or afraid,

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um,

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that a lot of times there are thoughts that we have our beliefs that we have that kind of trigger or feed into.

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Um,

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this outcome of having an emotion that feels difficult.

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So,

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if I am really believing and thinking in my head that nothing ever goes right for me.

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And let's say I have a flat tire on the way to work.

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And um,

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I just feel so discouraged and hopeless and I'm not really sure why it hit me that much that a flat tire would do that Well.

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In this type of therapy,

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the therapist would help the person say,

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well,

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what kinds of things were you thinking related to that emotion?

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So the person is trying to train themselves to become more aware of the thoughts that were linked with that emotion of hopelessness.

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And you know,

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maybe they realize that they are saying to themselves,

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this internal mantra of things are never going to get better.

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Nothing happens.

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Um,

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to give me a break,

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nothing goes right for me.

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So then,

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you know,

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the person can then challenge those thoughts and they can say,

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well,

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is it 100% true that nothing ever goes right for you?

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And it's not really that the therapy teaches you to replace negative thoughts with positive thoughts.

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It's that it teaches you to replace um,

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really skewed thoughts to be more realistic thoughts.

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So instead of nothing ever goes right for me,

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the therapist would challenge you to get a more realistic statement.

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And,

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and maybe the statement that you come up with is boy having a flat tire really is not what I wished would happen today.

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It is an inconvenience.

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Um,

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it will pass and there actually have been several good things that have happened lately as well,

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so that would be kind of this more realistic thought,

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which then affects our emotion to be one of more kind of mild discouragement without a tail spin down into a more despondent state.

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The listener was asking whether this approach to therapy can um,

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kind of treat the person as a collection of symptoms without a psyche and um being more of a person who's conditioned than behaviorally conditioned um,

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in their life experience.

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So,

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what I would say to that is that it's really quite a bit more complex than just behavioral conditioning.

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I know that,

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you know,

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if you studied skinner or read things about Pavlov's dog,

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you can get um,

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certainly a pretty extreme view of what conditioning um,

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kind of is made up of,

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but the CBT therapy really focuses more on helping you identify thought patterns and behavioral patterns that are just not very healthy to your well being and then adjusting those.

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Um,

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the listener was asking whether,

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I think this is a good um type of talk counseling for someone on the autism spectrum.

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So what happens is um,

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in the therapeutic world CBT is often um,

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it's really often recommended for everything.

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Um,

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it's considered a gold standard in various ways.

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Um insurance companies think highly of it and will reimburse for it.

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Um,

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in reality,

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when therapists use CBT therapy,

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they're probably mixing in a bit more eclectic approaches um,

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with regard to autism.

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I know there's even at least one book about CBT and autism,

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I I use it um intermittently with some of my clients as a piece of what we're layering in,

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but I would say it's not even making up 50% of maybe the approach that I would take.

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And my concern with it is this that it's really based on the premise that if we teach someone to retrain their thoughts that they will have a different thought and that then,

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you know,

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this will relieve their anxiety or this will relieve the depression that they're struggling with.

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And I think there's some value to that.

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Um my concern about using this and autism is that it doesn't really acknowledge that we're talking about a neurologic base and if you're assuming that you can shift every area of distress in a person's life by just having them think differently.

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Um,

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I think it really kind of sets up,

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um,

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expectations that aren't very realistic just by teaching someone to have a different intellectual thought.

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So,

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the neurology of our intellect and what we know as facts doesn't always hang together with that neurology of experience and what I can pull off in my daily life and there can be this great disconnect that's kind of enhanced in neurologic conditions where,

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yeah,

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I intellectually know but my nervous system is responding differently.

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It's still very heightened in its responses. It still overreacts to sound, you know... it still becomes overwhelmed in crowds... and changing the way I think about

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It is not going to be as effective as it might for you know the client with my other example I have a neuro typical neurology.

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I tend to think extreme negative thoughts about myself and my circumstance and I happen to have a flat tire.

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Well that's different than the student who um can't tolerate being in the school building because it's so neurologically overwhelming and asking them to think differently about how overwhelming it is I think would be inappropriate.

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So an example of looking at cognitive distortions and C.

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B.

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T.

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Therapy would be for example that a therapist might point out to a client that they have black and white thinking.

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So this experience was all bad and this experience was all good and that's not really capturing reality very well.

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So let's think of something that's really um not all good or all bad but in the middle.

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Well in the autistic client that's a bit of a problem because their neurology does lean toward black and white thinking or categorical thinking.

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Uh this is all good.

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This is all bad or this was a success and this was a failure and there are degrees to which individuals with the autistic neurology can consider more abstract and complicated kinds of um beliefs and thoughts but in general that's going to be very likely neurologically difficult.

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And so when you get in that area,

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it's kind of like sending someone to change their thought process uh to help them see colors better.

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So,

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um,

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you're not very good at color recognition.

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We're gonna examine all your thoughts and try to get you back on track with your peers when in actuality this person is color blind.

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Well,

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you're not going to improve color blindness with cognitive behavioral therapy.

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You're not going to improve diabetes with cognitive behavioral therapy.

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You may be able to work on some of their thoughts about their health, the way they react and engage in diet and that kind of thing.

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But um,

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you know,

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I think if we're using cognitive behavioral therapy,

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we should be very aware of its strengths.

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Again,

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I do use that at times and then also its limitations within different um,

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patient groups.

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So that would be my thought about that.

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So I would focus more in therapy on helping people recognize their neurologic patterns,

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increasing that self awareness,

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creating strategies that will help the neurology kind of move forward in those areas.

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So what are strategies that you can calm your nervous system with?

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For example,

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that was a great question.

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I appreciate that.

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Um,

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I also had a question from a mother who asked,

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um,

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you know,

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what could I do when my young adult child with a diagnosis is really resisting talking about autism and feeling categorized and kind of pigeonholed.

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Um,

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if that discussion comes up feeling sick of everything being described through the autistic lens and therefore dehumanized.

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So this is such an individualized,

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um,

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internal state,

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right?

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We all have kind of different reactions of what we can take in and process how we feel about things.

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And essentially this person seems to be saying that they don't really feel seen and heard.

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Um,

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and that's an awful feeling.

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Um,

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even if people around them feel like,

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yes,

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I do see you.

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I do hear you.

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Um,

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you know,

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that internal feeling is still difficult.

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I think the best outcomes usually are when we allow people the freedom and space to process things differently than we are.

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Um,

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I have to say that I don't,

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um,

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you know,

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listeners who've been with me for a while probably know that I have an adolescent son on the spectrum and I have to say that I don't really talk about autism that much at home as far as using that word.

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So maybe this will help.

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Um,

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I don't think we have to bring up the term all the time,

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but um,

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it certainly is something people are free to talk about.

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So we give them that freedom.

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But what we tend to talk about more in our household is,

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you know,

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what do you need today?

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What does your system need?

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And I talk about what my system needs.

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And then I ask,

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you know,

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my husband,

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how,

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how have things gone for you,

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what do you need?

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And we try to learn that kind of talk as a family and what my son needs is going to be different than what my husband needs and what I need just because we're individuals and his individuality,

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My son's includes the autistic neurology.

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It also includes other things.

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He's at a different season of life than I am.

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His,

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um,

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school and peer kind of demands on him are different.

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The pace of his day is different.

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His physical state is different.

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And so,

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uh,

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we kind of process it that way that,

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um,

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we're each individuals,

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um,

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and how we're doing is important and how can we work as a group to help each other get what each person needs.

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And then there will be some things that,

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you know,

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are just important to discuss.

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We can't shy away from something that's really important for their health or wellness because we don't want to process things about autism.

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But um,

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a lot of times we can just talk about each person's individuality.

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Like,

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um,

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it looks to me like you've had a really rough day,

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would it feel better to talk about it?

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Or do you need alone time?

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Or you could say,

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you know,

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we have a lot of stuff coming up,

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You've got college applications,

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You've got some job interviews.

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It's really important to nail some of this down.

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But I'm wondering whether you'd like to process that face to face,

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whether you'd like to email together about it and you can put together some thoughts.

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Um,

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you know,

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so sometimes again you can process and say this topic is kind of non negotiable,

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we have to figure something out,

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but how could we talk about this in a way that meets where you're at.

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Um,

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and also just being sure to talk about a lot of things not related to the nervous system that um,

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we give each other compliments,

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like you're really good at this and I just I wish I had your eye for detail.

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I wish I was as artistic as you are.

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I wish um I had some of the spunk that I see in you,

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I really love that and this helps them know that we are seeing them as a whole person and we do love them and value them.

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Um,

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so those can be a few ways that we can round out what you don't want to do is sometimes when someone shuts down or resist or walks away,

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what you don't want to do is then have some chasing after them.

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This is a really difficult family dynamic and I see it in couples and families and in the workplace,

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it's just a very um common thing if someone becomes quiet that we're trying to talk to and they withdraw.

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We can have some chasing behaviors whether that's actually physically following them,

245
00:17:18,850 --> 00:17:20,350
whether it's saying,

246
00:17:20,740 --> 00:17:21,180
you know,

247
00:17:21,190 --> 00:17:21,660
no,

248
00:17:21,660 --> 00:17:23,240
you have to talk about this,

249
00:17:23,240 --> 00:17:24,360
this is important.

250
00:17:26,240 --> 00:17:30,570
That kind of chasing in the relationship usually just makes things worse.

251
00:17:30,600 --> 00:17:31,460
So,

252
00:17:31,840 --> 00:17:34,960
um I would focus more on strategy.

253
00:17:34,960 --> 00:17:42,850
Like I can see this conversation is really tough um how and when would you like to process this?

254
00:17:45,540 --> 00:17:46,350
Other than that,

255
00:17:46,350 --> 00:17:58,010
it may just be helpful for the family or the parent or the individual to have a counselor that they can process individualized recommendations with.

256
00:17:58,010 --> 00:17:59,110
That's a tough one.

257
00:17:59,220 --> 00:18:03,270
It's a tough season and difficult things to talk about.

258
00:18:05,540 --> 00:18:09,930
Um the next question from a listener is kind of related,

259
00:18:09,930 --> 00:18:14,660
it's about parenting and this time it's about parenting in neuro diverse couples,

260
00:18:14,660 --> 00:18:20,120
which means that One of the parents is on the spectrum and one is not.

261
00:18:20,130 --> 00:18:22,710
So um you know,

262
00:18:22,710 --> 00:18:28,950
there are differences in their nervous systems and and what they lean toward what their strengths are,

263
00:18:29,340 --> 00:18:33,270
what kinds of things challenge them.

264
00:18:34,040 --> 00:18:41,780
And so this listener is asking this as a parent and part of a couple.

265
00:18:41,780 --> 00:18:46,670
So they're trying to parent their kids and their spouse,

266
00:18:46,680 --> 00:18:49,750
I'm not sure who is who,

267
00:18:49,750 --> 00:18:55,620
but one of them has that autistic neurology and the person is pointing out that,

268
00:18:55,620 --> 00:18:56,480
you know,

269
00:18:56,500 --> 00:19:01,230
parenting is a lot of just loud,

270
00:19:01,230 --> 00:19:02,600
chaotic,

271
00:19:02,610 --> 00:19:03,710
messy,

272
00:19:03,720 --> 00:19:06,700
unexpected things going on.

273
00:19:06,700 --> 00:19:10,460
You've got the need to communicate as parents.

274
00:19:10,840 --> 00:19:13,300
Um the need to be consistent.

275
00:19:13,310 --> 00:19:15,670
You've got sensory overload in the house,

276
00:19:15,670 --> 00:19:19,170
you've got distractions and changes to routine.

277
00:19:19,170 --> 00:19:30,560
So that is a great point that if anything is going to kind of challenge um the neuro diverse couple this,

278
00:19:30,570 --> 00:19:33,430
this is really difficult.

279
00:19:33,440 --> 00:19:38,620
And so my brief answer is I would say a couple of things.

280
00:19:38,620 --> 00:19:49,070
One is what I just talked about for the other listener that sometimes really being direct and forthright about where are you at today?

281
00:19:49,070 --> 00:19:50,060
What do you need?

282
00:19:50,440 --> 00:19:52,140
Or boy,

283
00:19:52,140 --> 00:19:56,560
it looks like this kid is really melting down a lot.

284
00:19:56,940 --> 00:19:58,440
That's the state they're in.

285
00:19:58,440 --> 00:20:00,960
How are we going to get this?

286
00:20:01,340 --> 00:20:05,520
Kids needs met and this other one has homework to do.

287
00:20:05,520 --> 00:20:06,450
How are we gonna?

288
00:20:06,460 --> 00:20:11,470
So kind of taking a survey of the land and we all need to do that,

289
00:20:11,470 --> 00:20:19,990
but sometimes we forget to do it kind of explicitly... we think our spouse will see what needs to be done or agree with us.

290
00:20:19,990 --> 00:20:26,630
And sometimes when couples go to counseling and maybe they're talking about parenting strategies,

291
00:20:27,040 --> 00:20:30,820
um you kind of get the sense that one of the partners is saying,

292
00:20:30,830 --> 00:20:33,010
why can't you be like me?

293
00:20:33,020 --> 00:20:33,590
You know,

294
00:20:33,590 --> 00:20:35,470
why can't you parent like me?

295
00:20:35,470 --> 00:20:41,180
Why can't you see what needs to be done and kind of do it the way I would do it.

296
00:20:41,670 --> 00:20:49,270
So part of that of success and that kind of role is having this increased self awareness.

297
00:20:49,740 --> 00:20:50,370
Okay,

298
00:20:50,370 --> 00:20:51,810
I really get that,

299
00:20:51,810 --> 00:20:54,030
your neurology is different,

300
00:20:54,090 --> 00:20:55,860
these are your strengths,

301
00:20:56,240 --> 00:21:12,460
these are the things that challenge you and that's different from my neurology and so sometimes what can help once you have this increasing awareness and these open discussions about how you each work differently.

302
00:21:13,040 --> 00:21:19,350
Um one of the things that can help is to have a huddle in the morning and in the evening by huddle,

303
00:21:19,350 --> 00:21:25,770
I just mean like there's kind of a brief checking in about the status quo,

304
00:21:26,240 --> 00:21:26,860
like,

305
00:21:27,240 --> 00:21:28,070
what's your day,

306
00:21:28,070 --> 00:21:29,150
like today?

307
00:21:29,160 --> 00:21:31,950
Uh do you have everything you need,

308
00:21:32,440 --> 00:21:34,950
this kid needs to be picked up,

309
00:21:34,960 --> 00:21:35,190
blah,

310
00:21:35,190 --> 00:21:35,800
blah blah.

311
00:21:35,810 --> 00:21:36,280
So,

312
00:21:36,290 --> 00:21:40,340
so there's this coming together in the morning to say,

313
00:21:40,340 --> 00:21:40,700
you know,

314
00:21:40,700 --> 00:21:41,060
again,

315
00:21:41,060 --> 00:21:42,770
like in a sports analogy,

316
00:21:42,780 --> 00:21:52,170
um huddle is this image of um the sports players getting together on the field and saying this is the play we're going to use.

317
00:21:52,560 --> 00:22:00,430
It's so funny because I remember one of our um high school friends at a reunion and he was saying,

318
00:22:00,440 --> 00:22:01,340
you know,

319
00:22:01,350 --> 00:22:04,950
once you go from two kids to three kids,

320
00:22:04,960 --> 00:22:05,570
you know,

321
00:22:05,580 --> 00:22:08,150
it's like you have to go to a zone defense,

322
00:22:08,160 --> 00:22:11,460
you can't be one parent on one kids anymore,

323
00:22:11,470 --> 00:22:13,060
so that's the kind of thing,

324
00:22:13,060 --> 00:22:13,970
like in the morning,

325
00:22:13,970 --> 00:22:15,260
what's our game plan?

326
00:22:15,740 --> 00:22:17,960
How are we going to divide this up?

327
00:22:18,740 --> 00:22:21,250
Um and then in the evening as well,

328
00:22:21,250 --> 00:22:23,960
and sometimes in the evening it's even more important,

329
00:22:24,340 --> 00:22:31,930
so you've had this whole day of experience and you're coming together and there's these things that need to be done.

330
00:22:31,940 --> 00:22:34,960
So part of the evening huddle can be,

331
00:22:35,740 --> 00:22:51,990
my day at work was unexpectedly horrible and I feel like I'm about to collapse and I also see that the kids are laying on the floor screaming and somebody's drawing on the wall with crayons and you,

332
00:22:52,000 --> 00:22:54,670
you're crying and um,

333
00:22:55,140 --> 00:22:57,580
so what,

334
00:22:57,590 --> 00:22:58,930
let's triage,

335
00:22:58,940 --> 00:23:05,600
what is the most important thing we have to do and what do you need?

336
00:23:05,610 --> 00:23:09,370
This is what I need And then getting a game plan,

337
00:23:09,430 --> 00:23:16,670
like I need 20 minutes of no touching and talking and anything and then I'm going to come back out,

338
00:23:17,340 --> 00:23:20,010
you take the kids for a ride and I'm gonna clean,

339
00:23:20,020 --> 00:23:20,740
you know,

340
00:23:20,750 --> 00:23:23,880
so that kind of thing also,

341
00:23:23,880 --> 00:23:27,430
I think that a lot of times when we have this increase of awareness,

342
00:23:28,240 --> 00:23:38,850
we can assign tasks based on the person's strengths rather than hoping that everybody does all of the stuff.

343
00:23:39,340 --> 00:23:40,290
So,

344
00:23:40,300 --> 00:23:40,970
you know,

345
00:23:40,980 --> 00:23:50,960
one spouse may love doing laundry and organizing and throwing things away and this feels really satisfying to them,

346
00:23:51,340 --> 00:23:55,150
but they really have a tough time giving the kids a bath,

347
00:23:55,150 --> 00:23:57,140
like it's sensory overload.

348
00:23:57,140 --> 00:23:59,260
They struggle a lot.

349
00:23:59,740 --> 00:24:02,620
So if there is a way to integrate in,

350
00:24:03,040 --> 00:24:03,680
you know,

351
00:24:03,690 --> 00:24:05,770
one parent might say,

352
00:24:06,240 --> 00:24:06,750
you know,

353
00:24:06,760 --> 00:24:11,570
giving the kids a bath is not hard for me at all.

354
00:24:11,580 --> 00:24:13,210
So I'll do that,

355
00:24:13,220 --> 00:24:14,500
you do what,

356
00:24:14,510 --> 00:24:17,930
what you connect with and then these other stuff,

357
00:24:17,940 --> 00:24:18,230
you know,

358
00:24:18,230 --> 00:24:19,670
the other things that we both,

359
00:24:20,140 --> 00:24:20,970
hey,

360
00:24:20,980 --> 00:24:25,560
we'll just try to share the load and get through some of the stuff we hate.

361
00:24:26,940 --> 00:24:30,770
Um another way is to reduce talking.

362
00:24:31,140 --> 00:24:34,860
I think one of the pieces of advice that I give,

363
00:24:35,740 --> 00:24:41,950
um family members the most is to talk less.

364
00:24:42,640 --> 00:25:00,350
Um I think our go to strategy for improving things is often talking about it again and again or asking or questioning or um nagging or talking and a lot of times for the autistic that makes a difficult situation like more overwhelming.

365
00:25:00,740 --> 00:25:04,660
So you want me to do this and I have to socially communicate about it.

366
00:25:04,660 --> 00:25:05,880
That's really dreaming.

367
00:25:07,540 --> 00:25:10,860
So one way to reduce talking,

368
00:25:11,340 --> 00:25:15,520
you can have a code word that if a person,

369
00:25:15,520 --> 00:25:18,860
one of the parents is about to just meltdown,

370
00:25:18,860 --> 00:25:20,270
they're in dire straits,

371
00:25:20,270 --> 00:25:26,890
they need to stop this conversation or they need to stop being in the room with the kids.

372
00:25:27,060 --> 00:25:28,960
You guys can use a code word.

373
00:25:29,340 --> 00:25:32,330
So you could pick something that's funny,

374
00:25:32,330 --> 00:25:39,450
you can pick something that's um an inside memory or something and if someone says that word,

375
00:25:40,040 --> 00:25:41,660
you don't have to talk it through.

376
00:25:41,660 --> 00:25:45,560
Everybody just knows that that person needs to leave and regroup.

377
00:25:46,140 --> 00:25:48,100
So it could be pineapple,

378
00:25:48,100 --> 00:25:56,770
it could be hawaii or whatever has meaning and then you can cut down some of that talking in the moment.

379
00:25:57,940 --> 00:26:02,690
Also a way to reduce talking is to use refrigerator magnets.

380
00:26:02,700 --> 00:26:08,230
So sometimes people and families will want to know how everyone's doing,

381
00:26:08,230 --> 00:26:12,010
but this conversation about how I'm doing and how are you doing?

382
00:26:12,010 --> 00:26:13,410
That's really draining.

383
00:26:13,420 --> 00:26:15,520
So for instance,

384
00:26:15,520 --> 00:26:23,890
you could use Refrigerator magnets that are from 1 to 10 and you can have it represent anything.

385
00:26:23,890 --> 00:26:31,110
So maybe it's your stress level that everybody has a column on the fridge where they can put their number.

386
00:26:31,120 --> 00:26:47,760
And so if someone comes home from school and they walk in and they don't talk and they pass mom or dad and they put that Number seven out of 10 on there and walk to their room and shut the door.

387
00:26:48,080 --> 00:26:54,160
That is a way of communicating that my day was really overwhelming and I need to be alone.

388
00:26:54,740 --> 00:26:58,360
So the parents feel like they have a sense of what just happened.

389
00:26:58,740 --> 00:27:00,560
There's some communication,

390
00:27:00,570 --> 00:27:03,810
but we don't have to sit down and socially communicate,

391
00:27:03,810 --> 00:27:05,360
which is also draining.

392
00:27:07,140 --> 00:27:07,510
Um,

393
00:27:07,510 --> 00:27:11,210
and also just thinking about as a couple,

394
00:27:11,220 --> 00:27:13,170
you can't always plan,

395
00:27:13,640 --> 00:27:14,400
um,

396
00:27:14,410 --> 00:27:17,190
all the things that happen in a family.

397
00:27:17,190 --> 00:27:17,660
And,

398
00:27:18,040 --> 00:27:19,570
but sometimes,

399
00:27:19,580 --> 00:27:20,280
you know,

400
00:27:20,290 --> 00:27:21,670
when you're together,

401
00:27:21,670 --> 00:27:22,730
newly as a couple,

402
00:27:22,730 --> 00:27:24,060
you can talk about,

403
00:27:24,540 --> 00:27:24,880
oh,

404
00:27:24,880 --> 00:27:26,280
you want six kids.

405
00:27:26,280 --> 00:27:26,900
Well,

406
00:27:27,140 --> 00:27:27,960
I want,

407
00:27:28,340 --> 00:27:29,860
I'm thinking I would want one,

408
00:27:29,860 --> 00:27:33,250
I think it would be really overwhelming for me,

409
00:27:33,260 --> 00:27:33,720
uh,

410
00:27:33,720 --> 00:27:44,760
and and to try to make plans for your family that take into account everyone's temperament and personality and nervous system.

411
00:27:49,240 --> 00:27:53,460
Another listener asked about things related to the workplace.

412
00:27:53,940 --> 00:27:54,540
Um,

413
00:27:54,550 --> 00:27:56,740
one question was about,

414
00:27:56,750 --> 00:27:57,220
you know,

415
00:27:57,220 --> 00:28:07,480
it's really difficult to know how to negotiate about raises or other issues in the workplace because I feel like I'm not sure if I'm being taken advantage of,

416
00:28:07,480 --> 00:28:14,270
I'm not sure if I'm asking for too much or too little and I don't know how far to push things or how to say it.

417
00:28:14,940 --> 00:28:16,440
Um and you know,

418
00:28:16,440 --> 00:28:19,530
this person feels like as an autistic individual,

419
00:28:19,530 --> 00:28:19,820
it,

420
00:28:19,830 --> 00:28:25,990
it feels harder to um just get a feel for the room like what is politics,

421
00:28:25,990 --> 00:28:26,650
what is,

422
00:28:26,660 --> 00:28:29,950
what should not be said in this room?

423
00:28:29,960 --> 00:28:32,270
Um and you know,

424
00:28:32,270 --> 00:28:35,030
that is a really good point.

425
00:28:35,040 --> 00:28:40,850
A lot of negotiation is getting a feel for how hard to push.

426
00:28:42,140 --> 00:28:42,610
You know,

427
00:28:42,610 --> 00:28:53,860
I think taking advantage of all the data approaches that are available in this age of technology can really help in that regard.

428
00:28:53,870 --> 00:28:57,690
I'm not sure about different countries or cultures,

429
00:28:57,690 --> 00:29:01,210
but In the United States there's been a big push,

430
00:29:01,210 --> 00:29:03,310
particularly over the last 10 years,

431
00:29:03,310 --> 00:29:13,540
I would say um to be very data oriented in um comparing salaries across the region,

432
00:29:13,540 --> 00:29:15,150
across the United States,

433
00:29:15,430 --> 00:29:17,770
there's more available on the internet.

434
00:29:18,740 --> 00:29:20,950
Um as far as benchmarking,

435
00:29:20,950 --> 00:29:22,360
what is common,

436
00:29:22,940 --> 00:29:27,460
um I really relate to this listeners challenge.

437
00:29:27,460 --> 00:29:29,800
I'm not really good um,

438
00:29:29,810 --> 00:29:31,130
at those things either.

439
00:29:31,130 --> 00:29:34,720
So what I tend to do is every five years,

440
00:29:34,720 --> 00:29:46,170
there's um an article published about common um benchmarks for neuropsychology salaries and then of course our workplace benchmarks,

441
00:29:46,170 --> 00:29:46,860
things.

442
00:29:46,940 --> 00:29:55,650
I'm hoping that in the future it will become even more transparent that when you see a job ad it will just have the salary in the ad.

443
00:29:55,650 --> 00:30:10,980
And again I don't know if other countries do that but there it's almost like a card game where you're not quite sure um what benchmark the employer might be using,

444
00:30:10,980 --> 00:30:13,970
they don't show all their cards necessarily.

445
00:30:13,980 --> 00:30:21,920
Um But it I do think that as a strategy it can help anyone,

446
00:30:21,920 --> 00:31:07,450
particularly someone that wants to go by data to kind of have data to put it in a proposal and to hand that in to your boss to say you know this is some data that I found and I wanted to talk about that with you and I would also suggest that you give data about yourself and so you can kind of think of um like a state of the union address where um you can give your boss a summary of all the things that you have accomplished um either that year or in the past five years and bosses know that in the moment.

447
00:31:07,460 --> 00:31:13,600
But I do find that giving the summary Snapchat and highlighting all the things you've done.

448
00:31:14,240 --> 00:31:23,850
Um That's data as well and sometimes you know your boss just cannot have all of that in their head.

449
00:31:23,860 --> 00:31:27,990
And they'll often say things like oh my gosh that's right,

450
00:31:27,990 --> 00:31:32,380
you did this and that and you know for someone in sales,

451
00:31:32,380 --> 00:31:36,450
they can say I earned the company this amount of money etcetera.

452
00:31:36,640 --> 00:31:44,300
So you can hand in data points both about salary benchmarking and also highlighting how you've benefited the company,

453
00:31:44,300 --> 00:31:46,350
what kinds of things you've accomplished.

454
00:31:46,360 --> 00:31:48,240
Um So I would start there,

455
00:31:48,250 --> 00:31:51,560
just try try a very data oriented approach.

456
00:31:53,240 --> 00:31:58,290
Another question was about how to pursue accommodations in the workplace.

457
00:31:58,300 --> 00:32:00,990
Um They seem so open ended,

458
00:32:00,990 --> 00:32:04,620
it's difficult to know what's reasonable as a request,

459
00:32:04,620 --> 00:32:05,480
who to talk to,

460
00:32:05,480 --> 00:32:06,160
etcetera.

461
00:32:06,840 --> 00:32:07,250
Um,

462
00:32:07,260 --> 00:32:15,950
so I would say a few things you I would look on the internet for common accommodations for autism or other things.

463
00:32:15,950 --> 00:32:21,750
And the site that I often go to to look is called ask Jan dot org.

464
00:32:21,840 --> 00:32:25,050
JAN stands for job accommodation Network.

465
00:32:25,060 --> 00:32:25,430
Again,

466
00:32:25,430 --> 00:32:27,170
this is in the United States.

467
00:32:27,640 --> 00:32:28,080
Um,

468
00:32:28,080 --> 00:32:29,930
and again,

469
00:32:29,930 --> 00:32:31,900
in the line of having data,

470
00:32:31,910 --> 00:32:40,340
this gives a lot of common accommodations that could be requested for a variety of conditions.

471
00:32:40,350 --> 00:32:47,950
So you would type in autism as you as the condition that you want to ask for accommodations under.

472
00:32:47,950 --> 00:32:57,060
So you have to have kind of a um something that's considered qualifying for that accommodation.

473
00:32:57,920 --> 00:33:03,820
And then what I would say is Jobs want these accommodations to be individualized.

474
00:33:03,820 --> 00:33:09,100
They don't want to just have a list of 200 accommodations that you want.

475
00:33:09,100 --> 00:33:24,570
So I would say look through those and think about your own self awareness and areas that are particularly easy or difficult for you and try try some of the strategies if you can.

476
00:33:24,580 --> 00:33:25,540
So,

477
00:33:25,550 --> 00:33:26,460
um,

478
00:33:26,840 --> 00:33:35,080
if you're going to ask for an accommodation to where noise canceling headphones in your cubicle while you're working,

479
00:33:35,090 --> 00:33:36,410
um you know,

480
00:33:36,410 --> 00:33:41,700
try some of that at home and see if those headphones really help you.

481
00:33:41,710 --> 00:33:43,760
So you can tie it into,

482
00:33:43,760 --> 00:33:48,830
let's say you've gotten feedback that you're really struggling with timeliness,

483
00:33:48,840 --> 00:33:50,850
that things are taking too long,

484
00:33:50,940 --> 00:33:53,600
and that's part of that executive function,

485
00:33:53,610 --> 00:33:55,330
piece of autism.

486
00:33:55,340 --> 00:33:58,220
And you can say,

487
00:33:58,230 --> 00:33:58,870
you know,

488
00:33:58,870 --> 00:34:02,860
I realize um that this has been a struggle for me.

489
00:34:02,860 --> 00:34:14,300
I really listen to that feedback and I want to improve that the strategy that I'd like to pursue as to where these noise canceling headphones,

490
00:34:14,310 --> 00:34:17,210
because it really helps me focus.

491
00:34:17,220 --> 00:34:22,490
Um I don't have to be processing through all of the noise around me.

492
00:34:22,500 --> 00:34:25,780
Uh and then um you know,

493
00:34:25,790 --> 00:34:30,220
if they say yes,

494
00:34:30,220 --> 00:34:31,130
that's great,

495
00:34:31,140 --> 00:34:37,060
you can talk to them about why it kind of just depends on what kind of relationship you have there.

496
00:34:37,440 --> 00:34:39,230
If they just come back with,

497
00:34:39,230 --> 00:34:39,410
well,

498
00:34:39,410 --> 00:34:41,730
that's not part of our dress code.

499
00:34:41,740 --> 00:34:47,960
Uh then you can present documentation of your diagnosis and just say,

500
00:34:47,960 --> 00:34:53,750
how could I get this formalized that I'm formally asking for this accommodation.

501
00:34:54,840 --> 00:35:00,660
They'll probably send you through to HR to human resources and you can do it that way.

502
00:35:04,160 --> 00:35:09,670
There was a question about preventing seizure episodes that are non epileptic.

503
00:35:10,240 --> 00:35:20,660
Um Non epileptic means that the seizures look like seizures when people are watching and observing,

504
00:35:21,040 --> 00:35:25,610
um but they're not electrical so that when the person is hooked up to the E.

505
00:35:25,610 --> 00:35:25,730
E.

506
00:35:25,730 --> 00:35:26,180
G.

507
00:35:26,180 --> 00:35:28,580
And they see the manifestation of the seizure,

508
00:35:28,580 --> 00:35:32,170
they can see that it's not electrically generated through the brain.

509
00:35:32,540 --> 00:35:43,060
And what that means is that it's non epileptic and these are things that are triggered by stress and really being overwhelmed or traumatized.

510
00:35:43,070 --> 00:35:46,760
And um I do have a blog post on that.

511
00:35:46,770 --> 00:35:56,390
Um So I will put the link in the show notes and also I would recommend listening to the podcast episodes.

512
00:35:56,400 --> 00:36:07,350
We have some series about how to help people with regulation and that's how I would address these non epileptic seizures that these are signs.

513
00:36:07,350 --> 00:36:12,240
These are clues that the person is dis regulated that they're overwhelmed.

514
00:36:12,430 --> 00:36:15,790
So rather than trying to talk them through,

515
00:36:15,790 --> 00:36:24,160
I would use the recommendations in the regulation series and I will link to the first of those series.

516
00:36:24,530 --> 00:36:29,150
I think there's four in that podcast series here in the notes.

517
00:36:31,530 --> 00:37:01,440
Um It should be noted too if it interests you that this phenomenon of non epileptic seizures is more common for autistics than for those who are you're a typical Finally there was a question about why diet and motivation for exercise can become harder with age for the autistic who's entering um Their 40's or 50s.

518
00:37:01,830 --> 00:37:16,210
Um I think that that's really tied in a lot with the executive function issue we talked about where um and I guess I'm referring to the podcast series on behavioral motivation,

519
00:37:16,220 --> 00:37:18,320
exhaustion getting going.

520
00:37:18,330 --> 00:37:27,660
So the center and front part of the brain is in charge of executive function that's always somewhat impacted or involved in autism.

521
00:37:27,930 --> 00:37:32,170
And part of that has to do with what's called behavioral initiation.

522
00:37:32,180 --> 00:37:37,000
So how do I get started from this stopped state?

523
00:37:37,000 --> 00:37:38,240
It's really hard.

524
00:37:38,830 --> 00:37:45,870
Not only is the individual probably likely to have difficulty with the getting going part of behavior anyway,

525
00:37:45,880 --> 00:37:50,320
but executive function can become more difficult.

526
00:37:50,330 --> 00:37:50,650
Um,

527
00:37:50,650 --> 00:37:53,950
less efficient and easy with age.

528
00:37:54,330 --> 00:37:58,760
We talked about this in our aging episode where um,

529
00:37:58,770 --> 00:38:03,920
executive function is always going to be a bit harder as people age.

530
00:38:03,920 --> 00:38:06,650
So their thought process might feel slower.

531
00:38:06,660 --> 00:38:08,840
They can't multitask as well.

532
00:38:08,840 --> 00:38:16,340
Some of the details of their memory gets harder and also this behavioral activation can also be impacted.

533
00:38:17,520 --> 00:38:26,170
Another thing I think that makes this difficult and autism is that for many people on the spectrum,

534
00:38:26,250 --> 00:38:32,460
it's difficult to think abstractly about likely outcomes.

535
00:38:32,920 --> 00:38:33,340
Um,

536
00:38:33,350 --> 00:38:40,330
if you ask someone intellectually what's likely to happen if you don't take your medicine or if you don't exercise,

537
00:38:40,720 --> 00:38:43,360
sometimes they can recite a bunch of facts,

538
00:38:43,360 --> 00:38:49,640
but it doesn't really feel real unless they've actually already experienced it.

539
00:38:50,020 --> 00:38:52,860
So if I say that to someone,

540
00:38:52,870 --> 00:38:55,710
uh there may be an autistic individual who says,

541
00:38:55,710 --> 00:38:55,880
well,

542
00:38:55,880 --> 00:38:57,590
how would I know what would happen?

543
00:38:57,600 --> 00:38:58,950
It hasn't happened yet.

544
00:38:59,420 --> 00:39:03,000
Other people can state facts that they've learned,

545
00:39:03,010 --> 00:39:06,310
but in a lot of ways those feel fear radical,

546
00:39:06,310 --> 00:39:08,900
they don't really feel real.

547
00:39:08,910 --> 00:39:12,360
Um and for example,

548
00:39:12,370 --> 00:39:14,900
I have had patients who say,

549
00:39:14,900 --> 00:39:18,430
well I took cholesterol medication for a month,

550
00:39:18,440 --> 00:39:20,390
but I just stopped it.

551
00:39:20,400 --> 00:39:21,690
I didn't feel any better,

552
00:39:21,690 --> 00:39:22,980
I didn't feel anything.

553
00:39:22,990 --> 00:39:31,360
Um so this conceptual hypothesis that it's probably doing something important,

554
00:39:31,370 --> 00:39:35,030
even though you don't feel it or see it or experience it,

555
00:39:35,420 --> 00:39:35,740
you know,

556
00:39:35,740 --> 00:39:43,650
that can just be really difficult to grab hold of um a few suggestions if you want to try them.

557
00:39:44,020 --> 00:39:47,150
Um I love time timers,

558
00:39:47,160 --> 00:39:55,030
you can get the app or you can buy the physical time timer on places like amazon or other websites on the internet.

559
00:39:55,520 --> 00:39:57,580
A time timer is a visual timer.

560
00:39:57,580 --> 00:40:01,620
So if you have difficulty um with time management,

561
00:40:01,620 --> 00:40:06,700
if you have difficulty getting going or transitioning from one activity to another,

562
00:40:06,710 --> 00:40:11,130
like I'm not exercising now and I have to transition to exercise,

563
00:40:11,510 --> 00:40:28,730
um you can set that time timer and see the visual time disappear and for some reason it just feels very real and compelling and concrete in a way that looking at digits or a clock face doesn't quite feel.

564
00:40:28,810 --> 00:40:30,320
I love these,

565
00:40:30,330 --> 00:40:32,910
I use them in my workplace.

566
00:40:32,920 --> 00:40:34,830
Um I use them at home.

567
00:40:35,210 --> 00:40:44,140
Um so you could set the time timer for when you're gonna start the exercise and also for when you're going to end.

568
00:40:44,610 --> 00:40:57,930
So I only have to do this until the red disappears and then it's a very concrete achievable kind of goal as opposed to this feeling like,

569
00:40:57,940 --> 00:40:58,340
oh,

570
00:40:58,340 --> 00:40:59,890
I have to start this and when,

571
00:40:59,900 --> 00:41:20,020
when is it going to end another technique that I think can make things more concrete and doable is to um set up something that feels real instead of this concept that exercises in some way helpful.

572
00:41:20,030 --> 00:41:22,360
And of course as we age,

573
00:41:22,370 --> 00:41:29,620
we see the results of that less like we we exercise and exercise and eat right and gosh,

574
00:41:29,630 --> 00:41:34,410
my body still doesn't look the way that I would like it to and I'm not really sure what this is doing,

575
00:41:34,410 --> 00:41:37,110
but I have faith that it's good.

576
00:41:37,120 --> 00:41:45,650
Um so we can make it more concrete by using things like challenges um or prompts to move.

577
00:41:45,650 --> 00:41:47,980
So there's a lot of technology these days,

578
00:41:47,980 --> 00:41:50,300
like um smartwatches,

579
00:41:50,310 --> 00:41:57,180
they can vibrate once an hour just to remind us to move or get up and walk.

580
00:41:57,190 --> 00:42:02,590
Um there are challenges on the smartwatches,

581
00:42:02,600 --> 00:42:03,600
different ones,

582
00:42:03,600 --> 00:42:04,770
call them different things,

583
00:42:04,770 --> 00:42:06,420
but there can be games,

584
00:42:06,430 --> 00:42:17,990
there might be like a fitness bingo or these things where you get icons lit up if you walk a certain number of steps or have your heart rate going as active.

585
00:42:18,000 --> 00:42:21,430
So those kind of things can make it concrete and fun.

586
00:42:21,440 --> 00:42:24,510
Like I don't know if my cholesterol changed,

587
00:42:24,510 --> 00:42:25,810
but I got this,

588
00:42:25,820 --> 00:42:31,220
I won this game or I finished this challenge and that felt good.

589
00:42:31,900 --> 00:42:35,360
Um there are also since Covid in particular,

590
00:42:35,360 --> 00:42:39,420
a lot of virtual challenges that you can do with people around the world.

591
00:42:39,430 --> 00:42:52,200
So there are challenges where you can sign up to walk through a particular area of the world and people around the world are doing it with you and then you get a medal afterward and again.

592
00:42:52,200 --> 00:42:54,390
That that makes it feel concrete.

593
00:42:54,390 --> 00:42:55,490
I've achieved this.

594
00:42:55,490 --> 00:42:56,520
This was fun.

595
00:42:56,900 --> 00:42:57,770
Um,

596
00:42:57,780 --> 00:43:00,980
one example of that are the conqueror challenges,

597
00:43:00,980 --> 00:43:12,490
but there are a lot of versions of this and you can google what really works for you and what you think might help you get that really concrete goal,

598
00:43:12,500 --> 00:43:13,810
that motivation.

599
00:43:15,500 --> 00:43:21,210
So this wraps up our second and final episode of question and answer.

600
00:43:21,220 --> 00:43:26,540
We're going to go back to some themes of episodes next and then in the future,

601
00:43:26,540 --> 00:43:31,870
we're going to return to more questions and answers from listeners around the world.

602
00:43:31,870 --> 00:43:32,510
Like you.

603
00:43:33,000 --> 00:43:34,950
If you do have questions,

604
00:43:34,950 --> 00:43:44,570
you can email them to adultandgeriatricautism@gmail.com and I will collect those for episodes in the future.

605
00:43:44,580 --> 00:43:48,020
Thanks for tuning in and I hope you join me next time.