Monthly Archives: March 2022

What is autistic burnout?

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What is autistic burnout?

An autistic life is not an easy life. There is the potential for great stress and chronic exhaustion from trying to cope with social and sensory experiences, being misunderstood and criticized, high levels of anxiety and, for many reasons, not feeling in touch with or able to be the authentic self. In addition, there may be self-imposed expectations that are greater than coping mechanisms and abilities. Subsequent stress can build up over time that can lead to autistic burnout, which is characterised by increased social withdrawal, a form of ‘hibernation’ and reduced executive functioning, the frontal lobes are “closed” awaiting recovery.

Signs of autistic burnout

The concept of an autistic burnout has come from autobiographies, Internet support groups and clinical experience. The provisional criteria for autistic burnout, according to Higgins et al (2021) are:

Significant mental and physical exhaustion.

Interpersonal withdrawal.

With one or more of the following:

Significant reduction in social, occupational, educational, academic, behavioural, or other important areas of functioning.

Confusion, difficulties with executive function and/or dissociative state.

Increased intensity of autistic traits and/or reduced capacity to camouflage/mask autistic characteristics.

There can be associated features such as:

Low self-esteem and not knowing what to do to restore mental energy levels.

Confusion as to whether the signs are indicative of a clinical depression.

Loss of self-care skills and ability to regulate emotions.

Persistent difficulties with daily living skills.

When considering whether someone has autistic burnout, it is important to review the similarities and differences between autistic burnout and depression. In comparison to the signs of depression, in autistic burnout there is increased sensory sensitivity and the need to isolate in order to recover. The current clinical and experiential wisdom is that autistic burnout is a cause of depression, and that the depression is likely to reduce if measures are taken to resolve the causes of autistic burnout.

Causes of autistic burnout

The causes are due to:

A lack of autism awareness and accommodations at school, work, within the family, government agencies and society.

Feelings of being judged negatively and rejected.

Being perceived as defective.

Lack of progress academically or at work.

More demands at school, work or home than coping abilities.

Lack of connection and relationships with others.

Diminishing mental energy and increasing stress and self-doubt.

Camouflaging autism and/or mental health issues.

Autistic burnouts can last months or years and may start in the adolescent years. A burnout may be triggered by life changes such as leaving high school, starting a new job or promotion or the end of a friendship or relationship. The experience of burnout may precede and precipitate a diagnosis of autism, and confirmation of the diagnosis may lead to the recognition of autistic burnout.

A burnout is more likely for autistic adults who camouflage and suppress their autism. They do not communicate their true support needs and level of exhaustion and valiantly try to cope at school or work. However, the cost of peer acceptance is in terms of emotional energy depletion that contributes to a burnout. Camouflaging becomes a barrier to support and relief and increases stress.

Ending an autistic burnout and recovery

The first stage is recognising being in a state of burnout. It is a process that requires self-awareness and being prepared and able to disclose the fatigue, stress, and despair. Those who know the autistic person well may perceive the signs of burnout before the autistic person does themselves. This can be due to problems with interoception (perceiving internal mental states) and denial.

There may need to be guidance and support in becoming a self-advocate and explaining to those at school or work, the daily challenges experienced by an autistic person and the accommodations and adjustments needed to reduce stress and recover from autistic burnout.

Empathy and practical suggestions may be obtained from the autistic online community, sharing experiences and strategies to end a burnout.  The greatest expertise is with those who have themselves experienced autistic burnout.

The autistic person’s current expectations, lifestyle and supportive environment need to be reviewed with a stress assessment to determine which aspects of the person’s life can be ‘pruned’ to help restore energy levels. This may include changing employer, career, and lifestyle. A psychologist or life coach can help determine what depletes and what restores energy levels. Energy restoration can be achieved by activities such as being in nature, acquiring knowledge regarding a special interest, part time work and a social network that embraces autism and does not accept camouflaging the real self. There also needs to be encouragement to be the authentic self and explain rather than inhibit autistic characteristics.

As clinicians, we have a few words of caution regarding the value and effectiveness of cognitive behaviour therapy (CBT) and behavioural activation as automatic therapy for an autistic burnout and associated depression. The genuine need for withdrawal and downtime (avoidance) for recovery may be contrary to the central themes of CBT and the characteristic of reduced cognitive capacity may inhibit the effectiveness of a cognitive based therapy.

Maja Toudal, an autistic psychologist in Copenhagen and Tony are writing a book on Energy Accounting as a means of stress reduction and prevention of the experience of burnout. We anticipate the book will be published by Jessica Kingsley Publishers towards the end of 2022. We include a description of Energy Accounting in our forthcoming webinars Autistic Girls & Women on the 25th March (LINK) and Emotion Management for Autistic Children and Adolescents on the 22nd of April. [link] which will include sections on managing a meltdown, shut down and recovering from burnout.

Summary

We are increasingly recognising the causes, signs, and effects of an autistic burnout. We need to share personal experiences and clinical wisdom to ensure burnouts are recognised and strategies developed for recovery and prevention.

References

Higgins et al (2021) autism 25 2356-2369

Mantzalas et al (2021) Autism in Adulthood (published online)

Raymaker et al (2020) Autism in Adulthood 2 132-143

How to address social challenges at work as an autistic adult

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How to address social challenges at work as an autistic adult

Introduction

The characteristics of autism include difficulty achieving social reciprocity, reading non-verbal communication and teamwork skills. This can lead to problems at work with social communication. Further difficulties can arise because autistic people tend to be primarily motivated to achieve work goals, for example, getting the job done to a high standard and finalizing the details, whereas typical people often focus to a greater extent on social goals, for example, relating to someone, being liked, receiving compliments, pleasing others etc. Both sets of goals are important and valid in a work setting, but these goals need to be balanced and appropriate for the work environment.

Problems can arise when an autistic person in the workplace does not realize their own role and contribution to social communication breakdowns, and when the work culture does not understand or embrace the characteristics and motivations of the autistic person. It is important at work to recognize that it takes two to make a social interaction successful and that successful social communication requires all participants in a social interaction to understand each other’s perspective, motivation, and social abilities. If you are autistic, or that person’s colleague or line manager, take a moment to consider any social communication difficulties at work. These are some potential social challenges.

What are the social challenges at work that autistic employees face

It is important for an autistic employee to identify their social difficulties at work. They can do this from both their own perspective and from feedback from work performance interviews and comments from colleagues. Social challenges commonly experienced by autistic adults include:

being able to ask for help when needed.

being able to offer strategies for repair of the interaction when communication breaks down.

being able to assertively manage workplace bullying.

understanding another person’s point of view or objectives.

taking a literal interpretation when this was not intended.

responding with conventional empathy.

recognising personal space.

knowing when to initiate and end a conversation.

understanding office politics, interpersonal dynamics, and social hierarchy.

recognising a ‘hidden agenda’ and someone intending to take credit for the autistic person’s work.

Autistic employees may also find other people at work socially challenging when:

they expect socialising beyond the capacity or endurance of the autistic person, e.g., more eye contact, social chit chat, talking about popular topics, self-disclosure etc.

they do not seem to appreciate an honest answer and being corrected.

they interrupt the autistic person’s concentration.

they do not seek to understand the autistic person’s point of view.

How to manage social challenges at work

Once the challenges are identified, the next stage is to create a social support network that may include a trusted colleague, appointed work mentor, line or HR manager, or family member to help see the social communication problem from another perspective and to suggest strategies to acquire specific social abilities.

It is important to decide what to tell each person in the support circle about any social communication difficulties depending on the person’s role in the circle, remembering that a person in the support circle can be invaluable in facilitating seeing the problem from another point of view, which then has good potential to lead to a solution.

Seeking support, advice and knowledge

The first strategy is to seek support. It can be stressful and challenging to experience social challenges at work, and the support and understanding of others can relieve the stress of having to cope alone.

Members of the social support circle may also be able to provide guidance, advice and knowledge. For example, it may help to acquire knowledge on social communication abilities such as learning how to improve the ability to read body language and being a member of a team.

Someone from the support circle may help identify the relevant social cues and context for a situation associated with social confusion or criticism. They may be able to see different perspectives and potential social communication breakdowns that can be repaired or avoided using their social advice. They are social mentors, and it is wise to seek their advice.

Another strategy is to acquire knowledge on social communication skills using the literature and Apps on reading body language. There is also literature on how to be a successful team member. It is not only autistic employees that benefit from improving social communication.

A member of the support team may be able to translate the perspective of the autistic employee to other team members. Autism is a case of double-theory of mind difficulty. Autistic employees may struggle to understand another person’s perspective, and equally the other person struggles to read and understand the autistic person. A translator who understands both perspectives can help.

Social scripts explaining autism

With an insight into problems with social communication and motivation to repair any problems, we have found that it is possible to use social scripts to manage a breakdown in social communication. Social scripts can be useful for most of the social communication difficulties associated with autism.

Consider the following questions based on potential difficulties in social situations, and with a social mentor, creating a script for each situation. It is important to consider how to communicate specific social communication difficulties to different people at work, for example, line manager or work colleagues. A social mentor may be able to provide some insight and advice.

Question 1: How could you communicate to your line manage that you prefer to be alone during lunch breaks and do not want to talk to your colleagues?

Potential script: To improve my work performance, I need to be refreshed by solitude during the lunch break. Socialising is not refreshing for me.

Question2: How could you communicate to your colleagues that you sometimes interrupt others during their conversation, but you do not mean to be rude or disrespectful?

Potential script: Sometimes I annoy people by interrupting them. It is because I have difficulty recognising the ‘not now’ signals. Please give me a hand signal to wait until you are ready to listen to what I have to say.

It will be worthwhile creating and rehearsing the social script for a specific social situation. This can clarify the intention of the communication so that it is clear and succinct and to consider appropriate facial expressions, tone of voice and body posture. It is also important after using a social script to debrief with a social mentor.

Sometimes using a script does not have the desired effect, and the social communication problem continues, we highly recommend using someone in the social support circle to determine further strategies. Sometimes someone outside the problem may be able to help develop further self-insight or insight into the problem, as well as develop a new idea about what to do. In other cases, a mediation process at work may be helpful.

In summary

A core characteristic of autism is difficulties with social communication which can affect aspects of successful employment. It is important to identify the specific social challenges at work and to create a social support network. The social support network can provide support, knowledge and advice. One member of the team may assist by serving as a translator between autistic and neurotypical cultures at work. With clarification of points of misunderstanding, scripts can be developed and rehearsed to avoid future misunderstandings.

Employment resources for autism

We have applied our extensive experience of autistic adults to create a seven stage plan to facilitate successful employment in our new book:

Garnett, M.S. & Attwood, T. (2021). Autism Working: A Seven-Stage Plan to Thriving at Work. Jessica Kingsley Publishers. www.jkp.com

With our colleague Barb Cook, we have created a presentation on autism and employment to be webcast on the 4th of March with more information at www.attwoodandgarnettevents.com This webcast will include aspects of social communication and be of great interest to:

Employers

HR Managers

Line Managers

Team Members

Mentors and employment agency staff

Autistic employees, and

Autistic adults looking for and maintaining employment.

Partner, parents and carers of an autistic adult

Autism and camouflaging

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Autism and camouflaging

Why camouflage autism?

Gradually a young autistic child will come to realise that they are different to their peers. They notice that their peers are able to easily and accurately ‘read’ social situations and people’s thoughts, feelings and intentions, an ability that an autistic child finds elusive. There are also differences in interests, learning style and sensory perception. An autistic child can have a personality characteristic of being an extrovert, that is wanting to connect and engage with their peers. Unfortunately, their social approaches to play and talk may be rejected, and they experience teasing, humiliation, and bullying from their peers for being different.

A characteristic of autism is to seek patterns and systems, and this can be applied to social situations. An autistic child can be very sensitive and reactive to making a social ‘error’ and quietly observe the play and social interactions of their peers from a discrete distance. Their intention is to imitate their peers. They become a ‘child psychologist’ exploring and analysing the dynamics, personalities, and social conventions of their peers. Once they have a ‘script’ they may be brave and launch themselves into social play in the hope that they will be accepted and liked. This process has been described as camouflaging autism or creating a ‘mask’ or alternative persona.

There have been at least 25 research studies exploring autism and camouflaging from early childhood to the mature years, with a recent review by Julia Cook, a friend and colleague of Michelle and Tony (Cook et at 2021). This article autism and camouflaging is based on our extensive clinical experience of the art of camouflaging by our autistic clients and friends and the research literature.

Camouflaging is an autism adaptive mechanism that can be acquired by autistic males and females to achieve social acceptance and connection as well as to be valued by others and to avoid being bullied or abused. We recognise gender differences in camouflaging in that those who identify as being a female, camouflage more than those identifying as male, across more situations, and more frequently and for a longer duration. They are more likely to perfect the art of camouflaging autism. However, autistic males may also use camouflaging in everyday life and also when dating to achieve a long-term relationship. Their neurotypical partner may only become aware of their autistic characteristics after the relationship has been formalised.

Camouflaging can commence in early childhood but not be conspicuous to parents and teachers. The young autistic child can be very aware of their social errors or ‘clumsiness’ and sometimes the ‘mask’ will slip. Their autism will be revealed. However, extensive practice, especially in the teenage years, leads to an increasing proficiency in ‘acting’ neurotypical in social situations, such that the authentic self is rarely seen by peers, but may still be recognised by parents at home.

Psychologists and parents recognise the consumption of considerable mental energy, to intellectually rather than intuitively, process social cues and responses. This requires good

executive functioning skills. We know that autistic females often have greater executive functioning skills compared to autistic males which may contribute to camouflaging success.

There is also the requirement to cognitively supress aspects of autism such as reacting to aversive sensory experiences and the inclination to reduce stress by mannerisms such as rocking. These autistic characteristics can be supressed and compressed but subsequently released in solitude or at home. While camouflaging may be a temporary ‘cure’ for autism, it can lead to a greater expression of autism at home.

Camouflaging behaviours

Julia Cook has identified several categories of camouflaging behaviours. These can eventually become automatic, with the autistic person not consciously aware of what they are doing. However, these behaviours still require the consumption of considerable mental energy.

Masking

These behaviours are designed to limit or avoid self-disclosure in a conversation.

There are also conscious modifications to gestures to ensure synchrony and equivalence to the conversation partner.

Consideration is also given to physical appearance to ‘wear the same uniform’.

Innocuous socializing

Maintaining eye contact or at least the appearance of eye contact, such as looking at the other person’s forehead or the bridge of their glasses.

Mirroring the other person’s accent, phrases, and facial expressions.

Smiling frequently when speaking or listening.

Using verbal and gestural encouragers such as nodding and saying “Oh really” at key points in the interaction.

Giving compliments to the other person.

Guiding or maintaining the topic of conversation or activity to an interest of the other person.

Apologises or provides explanations for perceived social errors.

Learns the ‘small talk’ and topics of interest of their peers.

Avoids appearing overly knowledgeable or making jokes.

Active self-preservation

Find points of commonality.

Asking questions.

Reciprocity when listening and talking during the interaction.

Consequences of camouflaging autism

As clinicians we are increasingly recognising that camouflaging autism is associated with increased levels of fatigue and stress, anxiety (general and social) and depression and suicidal ideation. Thus, camouflaging can contribute to secondary physical and mental health diagnoses.

Camouflaging is potentially emotionally and cognitively exhausting and often requires prolonged periods of solitude to recover. There can also be a tendency, even after successful social engagement, to conduct a social ‘autopsy’ and to ruminate for some time on social performance and the interpretation of ambiguous or subtle social cues.

Being successful at camouflaging autism can lead to greater social expectations from friends and employers. This can lead to wanting to ‘stop this train’ and that nobody recognises the degree of stress and self-doubt.

Psychologically, camouflaging creates a feeling of being disconnected from the authentic self. There can be thoughts that the real self must never be revealed as that would destroy all the work undertaken to achieve social connections and acceptance. Being unable to express the authentic self can also contribute to feelings of low self-worth and depression.

Camouflaging can also delay consideration of a diagnostic assessment for autism, often until a secondary psychological condition is identified such as an eating disorder, gender dysphoria and self-harm.

Resolution of camouflaging autism

Our clinical experience, recently confirmed by research studies, is that confirmation of a diagnosis of autism and maturity can resolve many of the issues associated with camouflaging. The diagnostic process and discovering the characteristics of autism is often central in the development of self-awareness and self-acceptance. The autistic person no longer feels ashamed and reluctant to reveal the real self. Authentic socializing becomes an alternative to camouflaging.

We have created an eight-session programme for autistic teenagers called ‘Being Me’ which focuses on discovering the real self and communicating who you are to adolescent peers. The programme includes group activities for the participants to explore and express themselves,

improve self-esteem and self-acceptance and enhance social skills as well as coping with potential social rejection.

We have also noted that mature autistic adults have decreased desire to camouflage their autism as it is too exhausting, not seeing the point anymore and not being ashamed of who they are. Better late than never.

As clinicians we recognise there needs to be guidance on how to authentically socialize and recognition of safe situations to learn how to express the authentic self. There is also the issue of whether and how to disclose having autism to friends and colleagues. Many of our autistic adult clients have been surprised how accepting friends have been and how employers have made appropriate adjustments. The autistic person is also probably aware that being the authentic and not so mentally exhausted will help reduce feeling depressed and exhausted. There is no need to camouflage when people understand and accept autism and fortunately society is becoming more aware of autism and associated qualities and difficulties, and we have noticed a greater acceptance of autism at school and work.

In summary

Camouflaging autism is a tempting means of achieving social acceptance. However, in the long-term, camouflaging will affect mental health and inhibit the expression of the authentic self. Be true to who you really are.

Further information and resources

We have created a presentation on autistic girls and women that will include a major section on autistic camouflaging. The presentation will be webcast on the 25th of March with more information at www.attwoodandgarnettevents.com.

This webcast will be of interest to:

Autistic teenagers and adults

Their parents and family members

Psychologists

Social workers

Psychiatrists

Teachers

Allied Health

References

For those seeking to read the relevant research literature we recommend:

Bernardin et al (2021) autism 25 1580- 1591

Bernardin et al (2021) JADD 51 4422-4435

Bradley et al (2021) Autism in Adulthood 3 in press.

Cage and Troxell-Whitman (2020) Autism in Adulthood 2 334-338

Cook et al (2021) autism 25 in press

Cook et al (2021) Clinical Psychology Review 89 in press.

Halsall et al (2021) autism 25 2074-2086

Hull et al (2021) Molecular autism 12:13

Miller, Rees and Pearson (2021) Autism in Adulthood 3 in press.

Scheerer et al (2020) Autism in Adulthood 2 298-306

Tubio-Fungueirino et al (2021) JADD 51 2190-2199

For autistic adolescents and adults and their families, we recommend the books on autism and camouflaging published by Jessica Kingsley Publishers with more information at www.jkp.com