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10 Challenges your autistic teenager likely faces every day

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10 Challenges your autistic teenager likely faces every day

Introduction

If you live with, teach or work with an autistic teenager, it is very likely that you have noticed that many days seem to be characterised by struggle. They often experience very strong emotions, including anxiety, stress, depression, and anger. On some days even the smallest trigger, for example, looking at the person, can trigger a meltdown. They come home from school catastrophically tired, seeming to need hours in the bedroom lying on the bed to recover, or disappearing into a computer monitor, only to emerge in a worse mood than they went in with. What is going on? Why are our autistic teenagers struggling so much with life? In this blog we cover 10 likely challenges your autistic teenager faces every day, with a hope to increase your understanding of why your teenager is struggling so much. We find that when we can understand the reasons for the struggle, that understanding can provide a roadmap of how to better assist our teenagers.

1. Being different

An autistic person often experiences that they are different from other people from an early age, but commonly does not understand why they are different. Within this gap of understanding they can insert many self-derogatory labels, like “weird,” “psycho,” or “stupid.” It is very difficult to be different at school, especially socially. You will remember from your own experiences of high school just how critical, rejecting and punishing teenagers can be to each other. One of the developmental milestones of adolescence is to individuate, that is to become an individual separate from your parents, to gain a sense of self. The individuation process is often characterised by trying to fit in with peers. It is very difficult to fit in with peers when you are socially different. The other kids know you are different, you know it, but you have no idea what to do about it. The result can be very low self-esteem, a poor sense of self and a sense of hopelessness, leading to depression and suicidality. Some teenagers react by denying that there is a problem, and overcompensate with an inflated self-esteem, or arrogance, and blame others. They often have anger problems.

2. Self-regulation

Autism is a frontal lobe condition, which means that it affects the frontal lobes of the brain, which are responsible for executive functioning. In fact 3/4 of people with autism also have attention deficit hyperactivity disorder (ADHD), a condition characterised by poor executive functioning. Executive functioning abilities include the capacity to focus on the right thing at the right time, transition between events, organise ourselves and our time, plan and prioritise, hold a problem in our mind while we are solving it, and to inhibit first responses. An autistic teenager is often struggling with each of these abilities, which truly impairs their ability to regulate their emotions and behaviour. They often ricochet between emotions, acting impulsively, becoming defensive, and avoiding situations that make them anxious. This pattern allows no space to sense themselves, to process what is happening, to learn, or to problem solve. Without self-regulation, your teenagers feels out of control, and increasingly anxious. When someone cannot control themselves, they usually start to try to control other people.

3. Sensory challenges

One of the defining features of being autistic is that there are sensory challenges. Often noises are too loud, light is too bright, and the person can be very distressed by certain aromas, textures and tastes. Having a different sensory system can also affect the person’s ability to register pain and temperature. The consequences of a different sensory system include persistent hypervigilance, exhaustion and sleep problems. There can be difficulty with concentration and focus during the day because of the background stress of trying to process sensory experiences.

4. People

If you ask an autistic teenager what is the biggest problem of their life, they often will tell you that it is people. What they mean is that people are confusing, it is difficult to read them and to know what they expect, and they can also be punishing and rejecting. Research tells us that over 90% of autistic teenagers will have received cruel bullying, including peer rejection, by the time they reach 14 years old. Often our autistic teenagers decide quite early that people are “toxic,” and they prefer to avoid them to stay safe. The problem with this is that they have overlearned the lesson. Not all people are toxic, and your autistic teenager needs people in their life, including friends, mentors, parents, siblings, professionals and teachers. As one autistic teenager said, “I would choose to be alone but I can’t stand the loneliness.” We know from research and clinical practice that having just one friend can protect an autistic teenager from poor mental health outcomes.

5. Double empathy problem

Autistic people struggle to read other people, to infer their expectations and intentions. This problem is called “theory of mind,” or cognitive empathy. It is important to point out that autistic people do not lack empathy, they usually have an abundance of affective empathy, as discussed below. However, they do struggle to “read” people, to have cognitive empathy. We now understand that the problem goes both ways. As much as autistic people struggle to read neurotypical people, neurotypical people struggle to read autistic people. The unique social communication style of an autistic person, which may include less eye contact, facial expressions and body gesture, can lead that person to be misinterpreted and even perceived unfavourably. Similarly, an autistic person can misperceive certain facial expressions, gestures and tones of voice as being negative, and thus perceive the person unfavourably. On each side, whenever an unfavourable impression is made, the person perceiving the unfavourable impression is less welcoming, leading to the autistic person to both reject other people and perceive that they themselves are not welcome (Mitchell, Sheppard & Cassidy, 2021).

6. Overthinking

Due to problems with both social confusion and executive functioning, the person tends to overthink many situations as a coping mechanism. Autistic people often highly value intellect and can utilise their intellect to overcome their problems. This is a very valuable skill, but when overused we call it overthinking. Overthinking one’s problems can lead to both exhaustion and “analysis paralysis,” where the person becomes overwhelmed and avoids the problem. You know your teenager is avoiding the problem when they spend a lot of time in bed or in front of a screen. This avoidance is called thought blocking and leads to much greater levels of distress. Overthinking is also associated with being disconnected from the body and hence from processing one’s emotions. We need to feel to heal.

7. Empathy overarousal

We have talked about cognitive empathy and we mentioned affective empathy. Affective empathy is when the person feels other’s emotional distress as if it were their own. They may not be able to understand how to describe that distress, or why the distress is occurring, but they feel it as if it were their own. Research has shown that many autistic people experience other peoples’ pain more intensively than neurotypical people do. This has been called the “empathy over arousal hypothesis.” Autistic teenagers and adults describe that they often feel overwhelmed by other peoples’ emotional pain, and have no idea how to deal with it, either how to help themselves, or how to help the other person.

8. Alexithymia

Up to 80% of autistic people also have alexithymia. Alexithymia literally interprets to “a” – a lack of, “lexi” – words for “thymia” – emotions. It also includes difficulty sensing bodily sensations associated with emotions, or problems with interoception. When someone cannot detect the early signs of an emotion, or find and words for that emotion, they are severely under equipped for managing the emotion. Alexithymia is one of the reasons many autistic teenagers rise from 0 to 100 in half a second on their Anger Thermometer. Unfortunately, having alexithymia is a risk factor for developing clinical levels of anxiety and depression.

9. A different learning profile

When an autistic person completes an Intelligence Quotient (IQ) test it is very common for them to show a great deal of variability between the various subtests that make up the IQ test. This means that they often have great strengths in their cognitive learning ability, but also areas of great difficulty. Because of their uneven learning profile they can really struggle with new learning tasks, even if they are very intelligent or even gifted. We call this the different learning profile of autism. Being a different learner can be very challenging in all contexts, including school, but also in social situations and within the family and community. Despite good intellect, your autistic teenager may feel that they are stupid, and can feel very depressed and hopeless about that.

10. Trauma or the effects of past trauma

It is unfortunately the case that autistic people are both more likely to experience a traumatic event and are more likely to have a traumatic stress reaction, for example, to develop PTSD, after trauma. It may be that your autistic teenager is suffering current trauma, for example, being bullied or abused, or has developed PTSD, but the condition is undiagnosed. A person with PTSD will experience high levels of hypervigilance throughout the day, distrust of people, flashbacks to the traumatic event, and nightmares that interrupt good quality sleep. If you suspect that your autistic teenager has developed PTSD or is suffering a current trauma, we highly recommend seeking professional assistance for them immediately. Fortunately, PTSD is treatable, and if we know about ongoing traumatic experiences, we can keep our autistic teenagers safe by stopping them.
Summary

The teenage years are challenging for typical teenagers, however our autistic teenagers face unique challenges that can amplify the typical challenges of the teenage years. Over the many years we have specialised in autism, we have discovered that understanding specific challenges that our autistic teenagers face is the most important first step in knowing how to support and assist our teenagers. The 10 challenges we list in this blog are ones that we commonly discover in our clinical practice, and have further understood with research and clinical practice. Hopefully your autistic teenager is not experiencing all of these challenges, but we encourage you to continue to explore and understand the challenges they face. It can be painful to tune in and listen, or to lean in and observe closely. We ourselves may have faced similar issues and have not yet healed. However, one of the most consistent findings across research on what helps to maximise the best outcomes in autism is support. When we provide ongoing support and understanding for our autistic teenagers, we give them the best opportunity to succeed.
What Next?

If your autistic teenager, student or client is experiencing any of these challenges and you are uncertain about next steps, we encourage you to come to our next Succeeding with Autism in The Teens Live Webcast on Friday 22nd July, 2022.

More information is available on our website:

https://attwoodandgarnettevents.com/product/succeeding-with-autism-in-the-teens/

References

Mitchell, P., Sheppard, E. & Cassidy, S. (2021). Autism and the double-empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39, 1-18. DOI: 10.1111/bjdp.12350

Nonverbal autism and visual intelligence

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Nonverbal autism and visual intelligence

The term nonverbal autism is used to describe an autistic child or adult who has little or no spoken language. However, does that imply the person is also intellectually disabled? When the cognitive abilities of nonverbal autistic children are assessed on standardised assessment scales such as the Wechsler Intelligence Scale for Children (WISC-IV) there can be great difficulty ensuring the child understands the instructions and has the attention span and motivation to complete the test items. This can result in an assumption the child’s cognitive abilities are untestable, or they are clearly severely intellectually disabled. This contrasts with the experience of parents and teachers who have sometimes been astounded by the nonverbal autistic child’s ability to complete complex puzzles.

A recent research study explored the cognitive abilities of six- to twelve-year-old nonverbal autistic using the WISC-IV and three standardised assessments of visual intelligence (Courchesne et al. 2015). The 30 nonverbal autistic children who participated in the study attended two special schools in Montreal, Canada and their intellectual abilities were assessed using the five WISC-IV subtests that do not require a verbal response. The subtests were block design, matrix reasoning, picture concepts, coding, and symbol search. None of the 30 autistic children could complete all five subtests with only six completing any of the five subtests of the WISC-IV. All the autistic participants would be considered as intellectually disabled according to their response to the WISC-IV.

The children were also assessed using the Raven’s Colored Progressive Matrices (RCPM), the Children’s Embedded Figures Test (CEFT) and a visual search task (a predetermined target to be found within a field of distractors). An age matched control group of 27 typical children were also assessed on the same instruments.

The RCPM is a test of general and fluid intelligence. The researchers chose the board or ‘puzzle’ form given the age of the children in the study. The board form is a one-format 36 item test divided into three sets of 12 items which increases in difficulty and complexity within and across sets. Each item is composed of a pattern or two-by-two matrix with the last piece missing, leaving an empty hole or space in the board. There are six movable pieces underneath, among which the one that best completes the matrix must be chosen to fill the empty space. All three cognitive assessments minimize or eliminate the need for spoken instructions and for pointing and are better suited to measure autistic cognition that can include a talent for identifying patterns.

The administration of the three assessments were observed by each child’s teacher who anticipated that the child’s attention and performance would be dependent on reinforcers as used in their education programmes. However, the nonverbal autistic children often ignored or refused reinforcers while being tested. There was an intrinsic motivation to solve the puzzle.

Although none of the 30 nonverbal autistic children could complete the five WISC-IV subtests, 26 (87%) could complete the RCPM. Their scores ranged from the 2nd percentile to the 90th. Seventeen (65%) of the 26 children with RCPM scores performed in the normal range of intellectual ability, as measured by the RCPM, and eight autistic children performed at or above the 50th percentile and three (10%) were at the 90th percentile.

27 autistic children also completed the visual search task, while 26 completed the CEFT on which the autistic children were faster than the RCPM-matched typical children. Autistic performance on the RCPM, CEFT and visual search were correlated.

The conclusion of the study was that nonverbal school aged autistic children are at risk of their cognitive abilities being underestimated with important implications for intellectual assessment and attitude. For nonverbal autistic children, an absence of speech does not automatically imply an absence of intelligence.

Summary

There can be an automatic assumption that lack of speech in an autistic child means that they are also intellectually impaired. The result is that the child or adolescent can be under stimulated, leading to anger, frustration and/or depression. As the above study shows, and certainly in our clinical experience, many children with nonverbal autism have at least average intellectual abilities.

What Next?

If you are interested in further exploring the intelligence of your nonverbal autistic child, student, or client, for the purpose of better supporting them, consider using the Raven’s Colored Progressive Matrices. A psychologist with knowledge of autism can administer the test. Understanding their intellect will assist in goal setting and programme planning.

If you are interested in learning more about nonverbal autism to better understand and support your you nonverbal autistic child, student, or client, we are presenting a full day workshop live. The recording will be available to you for 60 days after the event. Click here to find out more.

References

Courchesne et al (2015) Autistic children at risk of being underestimated Molecular Autism 6:12

The emotion repair toolbox

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The emotion repair toolbox

Autistic children and adults usually have a limited range of emotion repair mechanisms and are less likely to use the more effective strategies used by typical children and adults, such as putting the event in perspective, reappraising the situation, considering alternative responses, acceptance, or being able to disclose feelings to another person, thus seeking, and benefiting from compassion, validation and affection from a family member or friend. However, autistic children and adults can learn new emotion repair strategies, and these can be conceptualised as acquiring more emotion repair tools.

From a very early age, children will know a toolbox contains a variety of different tools to repair a machine or fix a household problem. The strategy is to identify different types of ‘tools’ to fix the problems associated with negative emotions, especially anxiety. The emotion repair for autistic children and adults can be conceptualised as a problem with ‘energy management’, namely, an excessive amount of emotional energy and difficulty controlling and releasing the energy constructively. Autistic individuals appear less able to slowly release emotional energy by relaxation and reflection, and usually prefer to fix or release the feeling by an energetic, potentially destructive action or thought and emotion blocking action.

The range of tools can be divided into those that quickly and constructively release, or slowly reduce, emotional energy, and those that improve thinking or reduce sensory responsiveness, as well as taking out of the toolbox those tools that can make the emotions or consequences worse such as self-harm.

Physical tools

A hammer can represent tools or actions that physically release emotional energy through a constructive and acceptable activity. For young autistic children, this can include bouncing on the trampoline, going on a swing or using playground equipment. Although these facilities may be available at a school, they may not be used by an autistic child due to the number of children using the same equipment, and the autistic child’s need to achieve solitude and avoid social interactions during break times. They may have special dispensation to use such equipment when the other children are in class. At home, it is easier to encourage such physical activities as an emotional repair mechanism.

For older children and adolescents, going for a run, or dancing alone in a bedroom may be used to ‘let off steam’ or release supressed or increasing emotional energy. An autistic adult described how, ‘running keeps anxiety away.’ Other activities may include cycling, swimming or playing the drums, tennis practice or horse riding, and going to a fitness centre.

Unfortunately, autistic children and adults often feel, and indeed may be, clumsy and poorly coordinated, and have often been teased in the past by peers for not being good at team sports and ball games. While research has confirmed that physical exercise decreases repetitive behaviour, aggression, inattentiveness and escape behaviours in autistic children (Lang et al., 2010), there may be limited motivation and low self-confidence with physical activities. A personal trainer may be able to assess the child or adult’s body type and personality and design a specific programme of realistic and achievable physical activities that can be completed in solitude, and do not involve activities in a social context where there is a risk of ridicule. We recognize that regular exercise is excellent for mental and physical health, but also to improve clarity of thought and problem-solving abilities. ‘Exercise will make you smarter’ is a concept we explain to autistic children and adults who often value and seek to demonstrate their intellectual ability.

Some autistic children and adults have identified that destruction is a physical tool that can be a very effective ‘quick fix’ to end unpleasant feelings of suppressed or increasing anxiety, depression and anger. At home, there are some household activities that provide a satisfying and constructive release of potentially destructive energy, without causing damage that may require expensive repairs.  For example, empty cans, water bottles or packaging can be crushed for recycling, or old clothes torn up to make rags. This ‘creative destruction’ might be the repair mechanism of first choice at home, and especially when returning home from school or work.

Relaxation tools

Typical children and adults usually know intuitively how to relax, and it is a state of mind that they will have often experienced. This may not be the case with an autistic person. Our extensive clinical experience has indicated that there is often a difficulty in achieving a state of relaxation, and confusion as to what to do when someone says, ‘Just relax.’

Relaxation tools help the person lower their heart rate and gradually release and reduce emotional energy. Perhaps a picture of a paintbrush or spirit level could be used to illustrate this category of tools for emotional repair. Relaxation tools or activities could include drawing, reading and especially listening to calming music to slowly unwind negative thoughts and fears. Routine chores or activities can result in a sense of accomplishment, satisfaction and relaxation when complete.

A characteristic of autism is find that solitude, in the sense of being alone rather than lonely, is a very effective means of relaxing. Being away from people, and from certain sensory experiences – perhaps retreating to a quiet, secluded sanctuary – is an effective way of reducing anxiety and stress, and achieving relaxation and emotional repair. The autistic person will need islands of tranquillity and solitude both at school or work and at home.  It may be possible for the autistic child or their parent to talk to a teacher about accessing somewhere secluded at school during break times or recess, for example, the library. Such solitude can be emotionally refreshing and a means of true and deep relaxation. A further source of relaxation can come from being in nature, walking or camping in a natural environment, with few social encounters and only natural sensory experiences and engaging with the wildlife.

Cue-controlled relaxation is also a useful emotion repair tool. The strategy is for the person to have an object, perhaps hidden in his or her pocket, that, through association, symbolizes and engenders feelings of being calm and relaxed. For example, an autistic child may feel relaxed when on holiday and going fishing: thus, a fishing float in a pocket can be retrieved and looked at to recreate the feelings, images and sensations of relaxation and enjoyment when fishing.

Meditation tools

In Western cultures, there is a growing awareness and appreciation of the value of activities such as yoga in encouraging a general sense of well-being and providing an antidote to anxiety. We now have yoga activities specifically developed for autistic children to use at school and home (Betts & Betts, 2006; Bolls & Sewell, 2013; Mitchell 2014; Hardy, 2015), and some teachers are now using classroom and individual meditation activities to encourage relaxation and enhanced attention for the whole class. Mindfulness is also being used to regulate attention toward the present moment, to let an emotion pass and encouraging an attitude of openness and acceptance using imagery, meditation and yoga (De Bruin et al., 2015).

A meta-analysis of 123 studies of the effects of meditation of the brain found that eight regions of the brain were consistently enhanced in meditators (Fox et al. 2014). All eight brain areas are associated with autism. Thus, meditation can be perceived as a form of therapy for autism.

Social tools

This tool is to be with someone, or an animal, that can help repair the mood. These tools could be represented by a sponge to soak up the emotional distress. The social experience will need to be enjoyable and without the stress that can sometimes be associated with socialising, especially when the interaction involves more than one other person. For an autistic person, two are company, three a crowd. There are social experiences that reduce anxiety, for example, being with someone who has the ability to be like an emotional ‘sponge’, soaking up worries and anxious thoughts; a particular family member, teacher or colleague who accurately ‘reads’ the autistic person’s emotional state and intuitively knows what to say or do to be reassuring and calming. Another social tool, in the broadest sense, is spending time with pets that are non-judgemental listeners and more forgiving and accepting than humans. Sometimes, even just looking at photographs of favourite people and pets on a mobile phone or iPad can significantly decrease anxiety, despair, and agitation.  Someone emotionally close to an autistic child or adolescent could make an audio recording of soothing comments on their mobile phone to help them cope with extremely anxious or distressing moments.

Helping others

Another tool is the act of helping someone and being needed – an altruistic act. Autistic individuals can change their mood from self-criticism and pessimism to a feeling of self-worth and resilience when they experience opportunities to help and be of value to others. This can include activities such as helping someone who has difficulties in an area of the autistic person’s talents or expertise: for example, helping a teacher or sibling fix a problem with a computer. Being needed and appreciated is a significant emotional repair mechanism for all of us, including autistic individuals.

Internet activities

Internet support groups and conversations between subscribers or multi-player games participants can be an effective emotional repair mechanism. Autistic individuals often have greater eloquence and insight disclosing their inner thoughts and feelings by typing rather than talking; they don’t need skills with eye contact, or to be able to read a face or understand changes in vocal tone or body language when engaged in a ‘conversation’ on the Internet. The chat line or Internet conversation can include other autistic people who have genuine empathy and may offer constructive suggestions to repair a mood or situation.

Thinking tools

Another type of implement, such as a screwdriver or wrench, or a repair manual, can be used to represent a category of tools that can be used to change thinking or provide knowledge. The autistic person is encouraged to use his or her intellectual abilities to control feelings such as anxiety by using a variety of techniques such as self-talk or an internal dialogue such as, ‘I can control my feelings’, ‘I can stay calm’, or, ‘be a mirror, not a magnifying glass’. By using words and thoughts that are reassuring and encourage self-confidence and emotional resilience, the autistic person is encouraged to create a ‘force field,’ ‘suit of armour’ or ‘umbrella’ for emotional protection.

A thinking strategy is the creation of ‘antidotes to poisonous thoughts. The procedure is to think of a comment that neutralizes or is an antidote to negative (poisonous) thoughts. For example, the negative thought, ‘I can’t do it’ (poisonous thought) can be neutralized by the antidote, ‘If I stay calm, I will be quicker at finding the solution’; or ‘I’m a loser’ can be neutralized by the antidote, ‘but I’m a winner at Minecraft.’ A list is created of the person’s negative or poisonous thoughts, and the parent or teacher helps create a personalized antidote to each thought. Cognitive Behaviour Therapy (CBT) focuses on discouraging maladaptive thinking and encouraging adaptive thinking and CBT has been adapted to accommodate the characteristics of autism (Scarpa, Williams White and Attwood 2013). The maladaptive thinking associated with autism is a tendency to catastrophise (meltdown) or supress (engage in a special interest) and CBT encourages adaptive thinking such as self-soothing, perceiving alternative perspectives and the disclosure of feelings to others.

Academic or intellectual achievement

A tool that can be used with autistic children and adults to reduce anxiety and improve mood and resilience, is the achievement of academic success or acquiring knowledge on the Internet. When an autistic child is anxious or agitated in class, the teacher may instruct the child to complete an academic activity that he or she enjoys, and for which the child has a natural talent, such as solving mathematic problems, spelling, playing an instrument or drawing. This is in contrast to typical children, who would probably try to avoid academic tasks when stressed. Adults may reduce stress and improve their mood and self-esteem by seeking knowledge via the Internet or reading.

Additional tools: Sensory sensitivity, nutrition and sleep

The exploration and analysis of the causes of anxiety may include sensory sensitivity (Green & Ben-Sasson 2010). Experience has indicated that repeated exposure to the sensory experience does not easily lead to habituation and a reduction in sensitivity. Sensory sensitivity appears to be a life-long characteristic of autism, with adults creating life circumstances to avoid some sensory experiences or, with maturity, learning to consciously endure and tolerate such experiences, even though they may be just as aversive as they were during childhood. An occupational therapist may be able to provide advice on strategies to reduce or tolerate sensory sensitivity. For example, auditory sensitivity can be for both sounds of a particular pitch or volume, or general noise levels, and can include difficulty filtering out background sounds to focus on a teacher’s or line manager’s voice. Anxiety can occur due to the possibility of not being able to hear important instructions. Specific sounds can be avoided, or encountered less frequently, such as someone shouting; or being prepared and supported for particular events, such as fire alarm testing. A Sensory Integration Programme created and conducted by an occupational therapist may reduce sensory sensitivity.

Clinical experience and advice from mature autistic adults suggest that physical and emotional well-being can be improved by reducing the amount of junk food consumed and having a good diet with nutritious food (Attwood, et al., 2014). While junk food is popular, well-advertised and easy to acquire, and can provide some comfort in the short term, the problems, which range from unstable mood to weight gain, outweigh the perceived benefits. Healthy food does contribute to a healthy mind.

We recognize that autism is associated with a range of sleep disorders (Chen et al 2021; Kotagal, & Broomall, 2012;). Sleep has many functions, one of which is to refresh mind and body. The sleep cycle associated with autism can be unusual, for example, taking some time to actually fall asleep (especially if worried about events of the day, or fearfully anticipating the next day), with a tendency for there to be a disturbance of the depth and quality of sleep subsequently. While attention to, and modification of, sleep routines, and medications such as Melatonin, can all help establish a reasonable sleep cycle, if problems persist, a referral to a sleep clinic may be needed. Having restful and deep, uninterrupted sleep can lead to an improvement in the ability to manage emotions such as anxiety.

Summary for the emotional toolbox

We recognise that autistic children and adults will have difficulties managing and expressing feelings which become increasingly significant throughout childhood, and especially in the adult years. Autistic adults often rate problems with anxiety and depression as having a far greater effect on their daily lives than making and keeping friends and getting and keeping a job (Attwood, et al., 2014). Thus, we need to recognize the importance of emotion repair at home, school and at work.

References

Attwood, T. Evans C. & Lesko A. (2014). Been There. Done That. Try This!: An Aspie’s Guide to Life on Earth. London: Jessica Kingsley Publishers.

Betts, D. E., & Betts, S. W. (2006). Yoga for children with autism spectrum disorders: a step-by-step guide for parents and caregivers. London, Jessica Kingsley Publishers.

Bolls, U. D., & Sewell, R. (2013). Meditation for Aspies: Everyday Techniques to Help People with Asperger Syndrome Take Control and Improve Their Lives. London: Jessica Kingsley Publishers.

Chen et al (2021) Sleep problems in children with Autism Spectrum Disorder: A multicenter survey. BMC Psychiatry 21:406

De Bruin, E. I., Blom, R., Smit, F. M., Van Steensel, F. J., & Bögels, S. M. (2015). MYmind: Mindfulness training for Youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906-914.

Fox et al 2014, Neuroscience & Biobehavioural Review, (Apr), 20140409.

Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: is there a causal relationship?. Journal of Autism & Developmental Disorders, 40(12), 1495-1504.

Hardy, S. T. (2014). Asanas for Autism and Special Needs: Yoga to Help Children with their Emotions, Self-Regulation and Body Awareness. London.  Jessica Kingsley Publishers.

Kotagal, S., & Broomall, E. (2012). Sleep in children with autism spectrum disorder. Pediatric Neurology, 47(4), 242-251.

Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation, 13(1), 53-63.

Mitchell, C. (2013). Mindful Living with Asperger’s Syndrome: Everyday Mindfulness Practices to Help You Tune in to the Present Moment. London. Jessica Kingsley Publishers.

Scarpa, A., Williams White, S. and Attwood T. (Eds) (2013) CBT for Children and Adolescents with High Functioning Autism Spectrum Disorders. New York, The Guilford Press

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

Autism working

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Autism working

Introduction

Achieving and maintaining employment can be difficult and stressful for autistic adults. Parents and partners also have their concerns, as they often provide employment support and employers, line managers and co-workers need guidance in how to work successfully with an autistic employee.

Unfortunately, many autistic adults who have a job are under-employed, that is, their job does not match their abilities, qualifications, and aspirations or their duration of employment is less than anticipated. This is despite autism being associated with qualities that are sought by employers such as:

ReliabilityAccuracy and precision
PersistenceAttention to detail and a perfectionist
Liking routines and proceduresCreativity and innovative thinking
Problem solvingFactual and technical knowledge
Sense of social justice and compassionNot letting socializing be a distraction
Talent in identifying patterns and systemsIdentifying and correcting errors
Enjoy cataloguing and recalling informationHonest and loyal
Working logically and systematicallyPassion for their chosen career

Having a successful career will significantly improve self-worth and self-identity, provide structure and purpose to the day, an opportunity to make friends, increase income and greater financial independence, and be an effective antidote to low self-esteem and depression.

Career choice

From our extensive clinical experience, we consider that no job or career would automatically be viewed as impossible due to autism. This can include the expected careers in engineering, information technology, science and accountancy but also a career in the arts in terms of being a fine artist, musician, actor or author. We have also known autistic adults who have been successful in the caring professions, from nursing to psychology and caring for animals such as being a vet or zookeeper. There is no automatic restriction on choice of career.

How to choose that career? The first option may be to see if there are employment prospects related to a special interest or talent that is associated with the person’s profile of autism and personality. A childhood talent with LEGO® that develops during adolescence into an intense interest in the design of machines could become the basis of a successful career in mechanical engineering. A determination to understand people may develop into a career in psychology and the caring profession, and a difficulty expressing inner thoughts and feelings using speech may lead to a talent in self-expression and perception in the arts.

We highly recommend that autistic adolescents have a detailed assessment of vocational abilities during the high school years to identify whether a talent or interest could be the foundation of a potential career. There will also need to be an assessment of vocational abilities that need improvement, such as teamwork abilities and coping with changes in job expectations. This information is then included in the high school curriculum. Autistic adults will need similar assessments, careers guidance and improvement of employment skills which could be provided by an employment agency.

When there is a history of failed employment experiences, this can provide valuable information on what skills or employment accommodations are needed and which jobs or workplaces to avoid. It may take several employment experiences before finding the right job with the right employer.

When searching for a job that matches abilities, interests, qualifications, and personality, it is important to find as much information as possible about the social and sensory aspects of the job. This can include personal space such as an open plan or single person office space, working independently or in a team, and sensory aspects such as sounds, lighting, clothing, and scents. It is also important to consider the understanding of autism of the line manager and colleagues and their willingness to learn about autism. Autistic people can sometimes have a ‘sixth sense’ to quickly appraise the social atmosphere of a new situation, and a positive or negative attitude can become apparent on meeting the staff prior to or during the interview. We recommend trusting that intuition.

Job interview

There will probably be a need for guidance in completing the job application form and, deciding whether to disclose the diagnosis. There are no clear rules on disclosure when applying for a job, and it is sometimes a personal decision based on whether disclosure would facilitate or inhibit achieving an interview or being employed. It is also important to decide what to wear for the interview and to rehearse how to answer the anticipated questions during the interview. If autism has been disclosed in the application, it may be an advantage to prepare a brief brochure on autism and associated qualities in relation to the position. The brochure can be attached to the application or given to those conducting the interview.

A job interview is a complex social ordeal. There is an expectation of accurately reading the body language of those conducting the interview, and succinctly and honestly answering their questions. An autistic candidate may have difficulty knowing the non-verbal signals and social conventions in an interview. We highly recommend practice and rehearsal in interviewing techniques and having an informative portfolio of relevant work experience that can be the focus of the interview. If those conducting the interview know that the person has autism, it will help to describe some of the difficulties associated with autism, but that these are significantly less than the qualities required for the position, and that there are strategies to facilitate successful employment.

Starting the job

There are potential employment issues associated with autism that will probably become apparent when starting a new job. These include the social aspects of the work, executive functioning abilities, sensory sensitivity, changes to job expectations and stress management. We have described these issues in some detail and provide strategies to overcome them in our recent publication Autism Working (Garnett and Attwood 2021) These are some of the issues and strategies.

Social aspects

The characteristics of autism include difficulty achieving social and conversational reciprocity, reading non-verbal communication, understanding different perspectives, developing teamwork skills, and following conversational rules. Workplace social communication challenges can also include discussing confidential and personal topics at work and respecting co-worker/employee boundaries. There can be difficulties knowing the social expectations and engagement in social events such as a celebration party and a vulnerability to being bullied and teased.

Strategies to reduce social communication difficulties include having a work mentor to explain the workplace social dynamics and protocols and developing social scripts to explain autism and seek support. Examples include how to communicate a preference for solitude during breaks, end a social conversation and return to work and reading the signals when a colleague or line manager does not want to be interrupted.

Executive functioning

This can include a propensity to be distracted by detail, organizational and planning difficulties, time management, prioritizing, and self-monitoring. We have also noted difficulties regarding unorthodox work routines and coping with errors, both personal and colleague’s errors. The autistic employee may need more supervision and guidance regarding executive functioning abilities than other employees. It is important that the line manager discuss strategies to minimize such difficulties and to have regularly schedules meetings to provide feedback on performance, workplace accommodations and areas for personal improvement.

Sensory sensitivity

The most common sensory sensitivity associated with autism is to specific sounds, but there can also be sensitivity to tactile experiences, light intensity, and aromas. Autistic adults often describe some sensory experiences as painful; the anticipation of such experiences creates anxiety and becoming hypervigilant. There is also the potential for sensory overload which is extremely distressing.

Coping mechanisms include explaining the sensory sensitivity to colleagues and line manager and requesting accommodations such as working some distance from the sound of the hand dryer or fridge and if possible, having natural rather than fluorescent lighting.

Changes to job expectations

A characteristic of autism is a difficulty coping with change and the unexpected. It is inevitable that there will be changes in the work environment, but it is important that the autistic person is given as much warning as possible and provided with an explanation of why there is a change of plan and expectations. This will enable the autistic person to create a new mind set.

It is also important to be aware that while promotion is considered a reward for the quality of work, there can be difficulties if the new role requires greater social and teamwork skills. It is important to consider social communication challenges in career and promotion planning.

Stress management

When work demands exceed an autistic individual’s resources and abilities, stress is the inevitable result. It is important that the autistic employee knows their personal signs of work-related stress, which work situations create significant stress, and that stress levels are communicated to the line manager.

High levels of stress will affect work performance and could lead the autistic person to resign. There may be strategies to reduce stress at work such as having a quiet retreat area to reduce stress and restore energy, using relaxation strategies and an opportunity to de-brief at work or home.

In summary

Autistic adults often have difficulties getting and keeping a job, despite having many qualities that employers seek. We need to assess an autistic person’s employment attributes and challenges, enhance their employment qualities, and address their employment issues. We also need to educate the workforce in how to accommodate and benefit from an autistic employee or colleague.

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 Autism Working and with our colleague Barb Cook, 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 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.

Parents and carers of autistic adults

Reference

Garnett M. and Attwood T. (2021) Autism Working: A Seven-Stage plan to Thriving at Work Jessica Kingsley Publishers, London.

What is high functioning autism?

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What is high functioning autism? An in-depth look

A lot of people still use the term high functioning autism (HFA), which is problematic because it is misleading. In this blog we will define the term, share what is problematic about it, and give you a way of viewing autism that is not only a useful way of talking about autism but also describes the pathway for the most successful outcomes for autistic people.

What is high functioning autism?

First, what is autism? Autism describes a different way of thinking, learning, relating, sensing, perceiving, moving, and empathising (see below). An important word in this definition is different, not disordered, defective or dysfunctional. When people say high functioning autism, they usually mean that the autistic person has autism and typical language skills and average to high average intelligence.

Autism describes a different way of:

Thinking – creative, thinks ‘outside the box,’ literal, systematising, fact-oriented, need to know how things work

Learning – more often a visual and kinaesthetic learner rather than a social or verbal learner

Relating – honest, direct, difficult to communicate inner thoughts and feelings to others, not necessarily interested in people and often confused by their intentions and perspectives

Sensing – a different sensory system for both external (sounds, tactile, taste, visual, smell) and internal (hunger, pain, emotions) senses

Perceiving – notices details, enjoys symmetry, misses subtle social cues and can misread other’s intentions and expectations

Moving – for some, not all, there are particular mannerisms that signify autism, tip-toe walking, a different gait, motor clumsiness, messy handwriting, and sometimes exceptional motor skills for specific sports such as swimming or cycling

Empathising – often overwhelmed by other people’s emotions and unsure how to cope with and convey their strong empathic feelings

What is problematic about the term ‘high functioning autism’?

Using the term high functioning autism implies that there is a linear scale of autism from low functioning to high functioning. Thinking of autism in such a linear way discounts the multiple gifts and challenges that come along with autism.

Rather than existing on a single continuum or dimension, autism is part of the person’s functioning on at least eight dimensions, including their social communication skills, interests, thinking style, behavioural repertoire, motor skills, executive functioning, adaptive functioning, language profile and personality. Thus, the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM5, APA, 2013) now refers to autism as a spectrum disorder.

A spectrum is defined in the Cambridge dictionary (Cambridge University Dictionary, n.d.) as a rainbow, each colour defined by different degrees of refraction of light according to wavelength. We can usefully apply this definition to autism by understanding each dimension of autism as being an expression of the person’s different neurology.

In addition, the person’s level of difficulty in functioning on each dimension can be described in terms of severity. For example, DSM5 now describes two dimensions of autism, social communication skills, and another dimension they call rigid and repetitive behaviours (RRBs). RRBs includes different motor movements , rigid thinking or interests, need for routine and consistency and a different sensory profile. DSM5 designates three levels from Level 1, least affected to Level 3, severely affected.

For example, an autistic person can have high level social communication skills, usually because of camouflaging, (Level 1) and severe RRBs, including need for routines, rigid thinking patterns and significant sensory issues (Level 3). In the past this person would be described as having high functioning autism, which can give a misleading idea about the amount of capacity she has, and how much intervention and support she needs. This example is a common experience for autistic girls and women, but happens for males too.

The way we talk about autism affects our thinking about autism

In talking about autism, most autistic people prefer autism first language, i.e. autistic person, rather than person first language, as in person with autism. Putting autism first indicates that autism is part of who that person is, across multiple dimensions, as described above. Autism on its own is not a disability, instead it is a way of being in the world. Another preferred term is neurodiverse, indicating the common mechanism behind the broad spectrum of autistic differences, which is neurology.

The most useful way to think about autism is to understand it as a different neurology expressed in a ‘rainbow’ of ways that always represent both strengths and challenges in the person’s profile. The person is different not defective and deserves respect and admiration for how they cope in a world where most people are not only not autistic, but do not understand someone who is.

Changing the terms we use for autism from “person who is diagnosed with high functioning autism” to “autistic person who is discovered” leads to multiple and various changes in how we understand, relate to, assist and support autistic people. Changing our terminology changes our attitude.

Some of these changes are:

Old AttitudeNew Attitude
I have HFA, I am weird and defective.I am a neurodiverse person with many personality strengths and abilities.
She has HFA, she will never make friends.She is autistic, she will make a loyal and compassionate friend.
I understand HFA because I taught a student with autism last year.There are multiple dimensions to autism. It will take a little while to understand how to support and accommodate the new autistic student in my class.
A person with HFA is likely to be unemployed.Autism is a reason to be sought out by an employer for autism-specific strengths and abilities, including personality strengths.
That person can’t have HFA, their social skills are too good and/or they use eye contact.Some autistic people have superb social skills, including use of eye contact, because they studied other people and learned them. That is an impressive achievement.
That person with HFA is weird, he sits alone in the lunchroom and never socialises.Autistic people are often exhausted rather than energised by socialising, he is taking a much-needed rest.
She is so intelligent; she doesn’t need support. She is just lazy.School is completely exhausting for an autistic person because of being socially and sensorily overwhelmed. She is a Hero for attending. I will plan how she can have true breaks during the day.

When we increase our knowledge about autism, we increase our power for positive outcomes for everyone

Alongside attitude, the best intervention for autism is knowledge. This means learning about autism across each of its dimensions for the person you love, support or work with. There are so many resources for autism (see below).

Tips and reminders for autism

Autism is a spectrum (think of a rainbow) of at least eight dimensions, not a linear dimension from low to high functioning.

Autism on its own is a difference, not a disability.

Most autistic people prefer autism first language, or the term “neurodiverse.”

Approach an autistic person with respect for who they are and how they are in the World. Different is valid, diversity is needed.

The best two interventions for autism are knowledge and attitude.

In summary

The most useful way to think about autism is to understand it as different neurology expressed in a ‘rainbow’ of ways that represent both strengths and challenges in the person’s profile. The person is different, not defective. They deserve respect and admiration for how they cope in a world where most people are not autistic and do not understand autism.

The best interventions for autism are knowledge and attitude. Knowledge about autism in all its dimensions, and an attitude that respects, embraces, and celebrates autism.

We believe this so passionately that, over the past 20 years, we have developed numerous programmes, resources and online courses based on our research and combined clinical experience of several decades.

Our resources are to assist autistic individuals of all ages, and their parents, carers, teachers and health professionals:

Resources for autistic children 4-8 years old

For parents and professionals

“Fun with Feelings” – a two book combination that teaches parents to help their autistic child to manage their anxiety and anger from a very young age to prevent mental health problems later in life.

Garnett, M. S., Attwood T., Ford, L., Runham S. and Cook J. (2020a). Having Fun with Feelings on the Autism Spectrum: A CBT Activity Book for Kids Age 4-8. Jessica Kingsley Publishers.

Garnett, M. S., Attwood T., Ford, L., Runham S. and Cook J. (2020b). Ten Steps to Reducing Your Child’s Anxiety on the Autism Spectrum: The CBT-based “Fun with Feelings” Parent Manual. Jessica Kingsley Publishers.

The online course for Fun with Feelings

During this 5.5 hour course Tony and Michelle describe how to use the Fun with Feelings course with your child for the best outcomes for your whole family.

ONLINE COURSE: Fun with Feelings Training in a CBT Programme for Young Children with Anxiety and Autism

Resources for autistic children 8-12 year old

For parents

Teach your autistic child to understand how like and love is expressed in the family and with friends to set them on a course of better relationships through life.

Attwood, T. & Garnett, M.S. (2014). From Like to Love: Teaching Affection to Children on the Autism Spectrum. JKP: London.

For professionals

Within this book is a 6-session programme that can be run with an autistic child or group of children to demystify the social and emotional expressions of liking and love that strengthen human relationships, but cause so much confusion for autistic children. The programme can be run by a psychologist, social worker, speech pathologist, occupational therapist or counsellor.

Attwood, T. & Garnett, M.S. (2014). Learning How to Express Affection: A Cognitive Behaviour Therapy Programme for Teaching Affection to Children on the Autism Spectrum. JKP: London.

For parents and professionals

Our autistic children can experience very strong emotions such as anxiety and anger that can increase their own suffering and the suffering of people around them. Strong expressions of anger and anxiety can lead to exclusion from meaningful activities such as school, family and community activities. These two programmes were developed to assist a parent or health professional teach an autistic child how to understand and manage their strong feelings of anger and anxiety.

Attwood, T. (2004) Exploring Feelings: Cognitive Behaviour Therapy to Manage Anger. Arlington, TX. Future Horizons.

Attwood, T. (2004) Exploring Feelings: Cognitive Behaviour Therapy to Manage Anxiety. Arlington, TX. Future Horizons.

The online course for managing emotions

During this 5.5 hour course parents and teachers will learn why autistic children experience strong emotions, and importantly how to assist the child to express their emotions more effectively, hence improving behaviour and increasing inclusion.

For professionals

A textbook on how to modify cognitive behaviour therapy for autistic children and teenagers.

Scarpa, A., Williams White, S. and Attwood T. (Eds) (2013) CBT for Children and Adolescents with High Functioning Autism Spectrum Disorders. New York, The Guilford Press

Resources for autistic teenagers and adults

Employment

This book comes with a number of short online courses for both the autistic employee or potential employee and their employer or manager to assist in creating success within the workplace.

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

Autistic girls and women

Autistic girls and women often slip under the radar and are diagnosed later because they are successful camouflagers. Specific issues unique to autistic girls and women are discussed in this book and these online courses.

Cook, B. & Garnett, M.S. (Eds. 2018). Spectrum Women: Walking to the Beat of Autism. JKP: London.

Online course for Autistic women, parents/carers and professionals

Online Course – Girls and Women with Autism
Online courses for Professionals who see autistic girls and women

Online course – MASTERCLASS: Intervention with Girls and Women with Autism

Online course – MASTERCLASS: Diagnosis with Girls and Women with Autism

Beating depression as an autistic teenager or adult

This book was written after 6 years of running and researching groups and individual programmes with autistic teenagers and adults, listening to them and adjusting the programme. The result is a 10-stage programme that can be completed at home with a mentor or in a clinical setting with a health professional.

Attwood, T. & Garnett, M.S. (2016). Exploring Depression: A CBT Self-Help Guide for Adolescents and Adults with Autism Spectrum Disorder Level 1 (Asperger’s Syndrome). JKP: London.

The online course on how to make the ‘Exploring Depression’ programme a success

Online Course – Exploring Depression – Training in a CBT Programme for Adolescents and Adults with Autism and Depression
Navigating life as an autistic teenager or adult

This book was written by elders of the autism tribe and co-edited by Tony to address numerous life issues that have been challenging for many autistic people, and to give strategies and ideas for what may work to face these challenges.

Attwood, T., Evans, C.R. and Lesko, A. (Eds) (2014) Been There. Done That. Try This! London, Jessica Kingsley Publishers.

Parents of autistic teenagers can feel frustration and even despair as they watch their autistic teenager struggle with their friendships and relationships, schoolwork, tasks of everyday living and sometimes anxiety and depression. This online course covers all of these topics and more to help create success during the teenage years.

Online Course – Succeeding with Autism in the Teens

Autism in couple relationships

Your intimate partner may be autistic, and/or you may be. We developed this course for neurodiverse couples who wish to increase their understanding of their own and each other’s neurology for the purpose of enhancing their relationship.

The world’s leading textbook on autism level 1

Prior to the American Psychiatric Association (APA, 2013) revising the diagnostic criteria for autism, ASD Level 1 and HFA were referred to as Asperger’s syndrome. A common question was: what is the difference between HFA and Asperger’s syndrome? The answer? They are spelled differently. If you are looking for the definitive guide on this topic, to this day it is still:

Attwood, T. (2006) The Complete Guide to Asperger’s Syndrome. London, Jessica Kingsley Publishers. Currently translated into 16 languages.

The world’s leading training in autism for professionals

Our next live webcast

If you are a professional seeking to develop your diagnostic and intervention skills for autistic children and adolescents, our next live webcast will be broadcast at times that suit US, UK, Australia and New Zealand time zones:

https://attwoodandgarnettevents.com/liveworkshops/

The online courses

Tony and Michelle teach within four leading Australian Universities and are sought out internationally to provide training to health and educational professionals in autism. These four full day professional courses are designed to be taken individually or as a two-day package, depending on the age of the clients you typically see.

Masterclass: Diagnosis and intervention with autistic children and adolescents

Online course – MASTERCLASS: Diagnosis with Children with ASD

Online course – MASTERCLASS: Intervention with Children with ASD
Masterclass: Diagnosis and intervention with autistic adults

Online Course – Masterclass Diagnosis with Adults

Online Course – Masterclass Intervention with Adults

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Cambridge University Press. (n.d.). dictionary.cambridge.org Dictionary. Retrieved November 27, 2021, from https://dictionary.cambridge.org/dictionary/english/spectru

Computer gaming and COVID

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Computer gaming and COVID

The following article is Tony’s chapter from the new book:
Life After Lockdown: Resetting Perceptions of Autism Strategies and Reflections

Edited by Rebecca Silva, Ruth Prystash, Rene DeLoss, and Carol Burmeister (Foreword by Peter Vermeulen)

Available to purchase here

The past year has marked us as one of the only generations to experience a global pandemic. The pandemic kept people at home, something that suited many autistic individuals. But it also limited the opportunities for social and emotional growth for autistic teens and young adults, and one of the obvious outlets became computer games. These games were already intensely important to many autistic youth, but now they became more so, as there was little else to occupy their minds and their time. Computer games can be beneficial, but they can also be addictive. This is a story that needs to be told, because nobody else is talking about it.

COVID’s impact on the autistic teen or young adult

Many individuals have begun displaying an increase in routines and rituals, heightened sensory sensitivity, and more engagement with special interests. These are all ways of coping with anxiety. People have been cooped up together for the past year, which can be difficult for a person with autism who craves solitude. There may even be anxiety about what will happen when we begin to have more face-to-face contact and are forced to endure crowds again.

There is a misconception that people with autism lack empathy. The opposite is actually true: Autistic individuals are often acutely aware of other people’s mental states. The news speaks of a killer virus and the rising numbers of dead; children worry about their family members’ health. There has been more free time at home this year for the anxiety to percolate and one way to alleviate that anxiety is the computer game.

Computer gaming—a perfect fit for autism

There are a number of factors that make computer games extremely popular with people on the spectrum. Gaming provides a sense of achievement and identity. It allows you to show your capabilities independent of autism. The main issues of autism are social-conversational, but in gaming you have no real socialization and you have no conversation, so you have basically bypassed autism. Gaming is a natural talent because it suits the autistic cognition. However, it also involves considerable practice. A person can become a master of a skill that requires great ability but also practice. It is the same for a child with computer games. They are talented at computer games, and are motivated to practice. If you want to measure the intelligence of an autistic child, watch them play computer games. The game bypasses their autism, they are highly motivated, and you can see how quickly and effectively their brain works.

If you are not good socially and you are not good at sports, your intellect is very important to you, and you want to prove how smart you are. You want to demonstrate your intelligence and you want other people to appreciate that intelligence. With gaming you have a sense of achievement that is truly gratifying, especially as it is valuable to your peer group.

Autistic teens are searching for identity. Who am I? Why am I here? What is the meaning of life? Where do I fit in? I know I’m supposed to be like everyone else, but I’m not. I want a sense of identity and self-worth that is defined by something that is valued by my peers. The computer game does that. It gives a sense of identity to someone who is searching. The computer game becomes a way of fitting in. It becomes your identity when you have few ways to define that identity. And autism can make a person very lonely. Without social skills, it is sometimes hard to fit in to most same-age groups. Bullying and being excluded can leave autistic teens feeling isolated, while gaming provides a connection with fellow gamers who actually seek you out, rather than shun you.

Computer games give you immediate feedback. As many as 75% of those with ASD also display characteristics of ADD and ADHD. Computer gaming suits those characteristics, as it is based on immediate feedback on one’s performance without any waiting, which autistic people often dislike. Unlike school, where you may be waiting on feedback from a teacher, the game provides immediate feedback.

People are excited to see you online and that kind of genuine, deep welcome is intoxicating to someone with autism. Someone in your peer group actually wants to know you, and is pleased that you are there. Rather than the students who sometimes bully and tease and reject and humiliate, these gamers want to know you and are proud to be your friend. They give you compliments and admiration. But more than that, with your gaming skills, you also become a teacher to some, a mentor to others. You advise them. You are wise. You are talented. You are someone special.

In e-sports, a subgroup of gaming, there are leagues with teams and supporters; logos and colors; managers and favorite players. Players are bought and sold. There are e-sport competitions held in convention centers with thousands of people watching gamers. And in this world, you, the autistic individual, are the person the team wants to recruit. You are a hero in that world. Finally, you have a social network where you shine.  

Gaming as a coping mechanism

During COVID, anxiety and depression increased for many people, including people on the spectrum. A computer game is a thought blocker for anxiety and depression. When you are engaged in the game, you don’t feel anxious and you don’t feel depressed. Instead, you suppress and compress your thoughts and feelings. Computer games are more powerful than medications or cognitive behavioral therapy because they encourage the classic autistic characteristics of avoidance and suppression. When you are playing the game, you are in a bubble. Your problems disappear and you don’t care about anything else, but when you switch off the game, those feelings come back. Parents become frightened to see how angry their child becomes when asked to turn off the computer. What is actually happening isn’t really anger: It is the fact that their powerful feelings have not been dissolved or resolved. Once the game is gone—boom! The feelings are back, and they flood you with fear and despair.

A substitute for social interaction

In autism social emotional reciprocity is a core issue. In a computer game, you don’t have a real conversation going on. You don’t have to worry about reciprocity, you don’t have to read body language, and you don’t have to be involved in social chit-chat. One of the interesting things is that there are often chat lines in computer games, and they provide a means to communicate through typing, rather than talking. Clinically, that can be very valuable. When a client sends me an email, I may receive far more information and insight into the individual’s world than I do in person, because it involves typing, not talking. There is a greater fluency and disclosure of thoughts, feelings, and revelations of the self through typing, rather than talking.

The games have very clear and simple rules that aren’t like social rules. Social rules are inconsistent and complex, and there are always exceptions. Neurotypical kids do things that that are against the rules and get away with it, even though you’re not supposed to get away with it! But in gaming, there are simple rules that are always enforced. There is no inconsistency and no uncertainty, so you are secure in the rules of the game.

A sense of pleasure and enjoyment

If you ask a neurotypical about the greatest moments of excitement and joy in their life, it usually involves another person–giving birth, getting married, falling in love. But with autism, other people can be a source of confusion, so pleasurable memories rarely involve them. Computer gaming, on the other hand, gives you experiences of pleasure and enjoyment when there are very few in your life. This is incredibly intoxicating. Gaming is addictive because it feeds into pleasure-seeking and enjoyment. For someone who may have few pleasures in life, experiencing such a high level of excitement—perhaps the greatest enjoyment you have ever received—is euphoric.

Creating an alternative world

In the real world of daily life, the teen with autism is often not respected or included. But here in the computer game, you are in a world where you are both respected and included. The special interests of people on the spectrum are often an attempt to find a world in which to belong. Anime, Pokemon, Manga–another culture, another country, another time in history where you fit in. Science fiction–you go to another planet where you are recognized and valued. The game creates an alternative world where you have a sense of belonging. The real world may not value you or respect you, but in this world you are remarkable, and that’s why you want to stay.

Avatars are virtual selves that you can create in a computer game. An avatar allows you to experiment with personality, analyzing the interests and people who are important in your life. This is what most teenagers do in the real world. I’m going to be an adult, so what kind of adult am I going to be?  Who do I value, who are my heroes, and can I borrow some of their characteristics? In a computer game you can experiment with that even further. If you’re concerned about your weight, your avatar is slim; if you’re concerned that you’re not smart enough, then your avatar is a genius. It is very powerful.

The dangers of computer gaming

Immersion into computer gaming can mean that individuals are not learning to cope with emotions. Instead, they’re learning to avoid them. They are compressing and suppressing, and are not processing their feelings appropriately. This means that when they start playing the games in earnest, their emotional maturity freezes and levels off. Emotional regulation is stunted. Individuals learn to rely on the game rather than the actual social skills which will serve them in the real world.

When we look at the long term effects of gaming, we see medical issues. Individuals become overweight, with poor eating habits. Junk food is quick and easy while you are on the computer. Some individuals will spend enormous amounts of time online—from 10- 16 hours per day. There is a lack of exercise and exposure to sunlight, so health effects arise.

It is also very disruptive to sleep patterns. One of the effects of extended screen time is that a person’s thoughts increasingly spiral once the game is turned off. Thoughts become incoherent and chaotic, and sleep becomes more and more elusive. That’s why there should be no screen time for one to two hours before bed. In autism, sleep is always been a problem, from infancy on through senior adulthood. Sleep is important for processing intellectual information and processing emotions. When you have a good night’s sleep, inappropriate behaviors diminish. With too little sleep, the opposite is true.

One of the inherent dangers in gaming is a potential tie-in to gambling. In computer games there are commodities called loot boxes. These loot boxes pop up during a game, offering the opportunity to purchase something that may or may not contain useful items. Most boxes have ordinary items, but the gamer will continue to buy them, lured by the possibility of scoring something big. The odds of it having what it advertises are very rare, but the possibility keeps gamers buying more, and so gambling becomes embedded in games. Parents should be aware of this connection, as it is one more avenue to addiction.

When gaming becomes an addiction

The computer gaming industry has the potential to rob us of some very bright minds, who may get caught up in the addictive side of gaming. When teens begin to avoid things that were recently part of their routine, there may be a problem. If you tell your teen to get off the computer for lunch and they become incredibly agitated, avoiding lunch in order to play the game—that’s a worry. If they become upset when a legitimate request interferes with access to the game, then the depth of engagement is now of considerable clinical concern. Their world revolves around the number of hours they spend on the game, and they become agitated when other activities interfere. For example, you used to have evening meals as a family, spending time together. Now the teen arrives at the table at the last moment, bolts down food, and then, boom. Gone. No conversation. No engagement. The individual withdraws from a variety of activities that used to be important for the family and enjoyable for themselves. The game is taking control. This is common in addiction: instead of the person controlling the game, the game is controlling the person.

One of the first casualties of any addiction is truth. The individual will hide their actual time online, like an alcoholic hides their alcohol. They will also have access to games on their phones. Gaming should absolutely be included in the same category as alcohol and drugs for individuals with autism. These individuals struggle, not with autism, but with emotional regulation. Because the game is so good at moderating intense emotions, they are reluctant to switch to anything else.

Dealing with the addiction

One thing that parents should not do is take away the game as punishment. The games provide the teen or young adult with an identity, coping strategies, a social network—what they live for. If adults remove this without providing the child with other coping mechanisms or alternative activities, this ends up being, not punishment but revenge. Parents will end up escalating the punishment from a day to a week to the threat of totally removing the computer, and the teen will respond with defiance and anger. It can quickly escalate into a civil war which no one wins.

If we want to address the behavior constructively, it is important to carefully identify the issues of behavior management or encouragement of chores or other commitments. There must absolutely be consequences, but they must be appropriate. For example, if a teen does something that upsets his sister, an appropriate response might be to have him take responsibility for one of her chores for a week. The time that is spent on that chore would have been spent on the computer, so it is a means of restricting access through teaching an appropriate replacement. It is possible to use the computer as a reward. For example, if the child does their homework, they can have an extra half hour on the computer. This uses the computer as a reward or an encouragement, rather than as punishment. It also teaches a part of growing up. You want more time on the game, but you’ve got to do your chores. That’s life.

When a parent suspects addiction, they can use logic to deal with it. Get a big piece of paper and list the positives and negatives of computer games with the individual. The positives are that it helps manage emotions and it makes the child popular. So how can we help the individual achieve these things outside the game? We can find more conventional and diverse ways of achieving those things, initially in addition to the computer game and eventually as alternatives. Next list the negatives: being overweight, spending huge amounts of time on the game and nothing else, the lack of honesty, and the lack of constructive ways in their lives to learn to deal with emotions. Help the individual compare these lists and set goals.

In terms of strategy, first get an accurate accounting of the amount of time spent gaming. Instead of aiming for an unrealistic goal, like an entire game-free day, try for something more reasonable. For example, start with reducing time by 15 minutes every day for three weeks. If successful, then decrease by 15 more minutes for three more weeks. Use small steps. Parents must provide alternatives that bring pleasure to the child, like being outdoors or spending time with pets. Families must also try to help the individual increase their social network through constructive means so the individual is actually learning to relate and manage conflict.

There are currently few treatment options for addiction in autistic individuals. Therapy for addiction needs to develop expertise, theoretical models, and a whole range of strategies for gaming addiction, especially for autistic individuals. We need psychiatrists and psychologists who are aware of this and work to modify therapy to accommodate the autistic way of thinking.

Final thoughts

As we continue to deal with the effects of the current pandemic, it’s important to realize that many of our brightest autistic individuals are going into the medical and research fields. These individuals, with their logical brains and skill at analyzing systems, have the ability to understand the behavior of a virus and can use their intellect to help develop cures. The intense focus of which they are capable allows them to tolerate 18-hour days in a lab. Instead of looking at a computer screen, they are looking into a microscope. Let’s hope that we can guide them to those labs, and show them that their brilliance is not only appreciated, but desperately needed, and that they are indeed invaluable members of society.

Depression attack strategies

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Depression attack strategies

Checklist for your parent/teacher/manager

The following are strategies that someone can use to help you while you are experiencing a ‘depression attack’. Your support person should …

Stay calm and reassuring

The agitation or confusion of another person will intensify your depth of despair, adding ‘fuel to the fire’. You may make hurtful comments, but the person helping you move through and out of the depression attack must not express their own distress in response to your comments and actions.

Not ask what is causing the distress

In such an intense emotional state, insight and coherent explanations are elusive and trying to explain and re-enter the experience may make the situation worse. It is more important to move on through and out of the depression attack.

Stay with you

Left alone, there is the risk of an impulsive action that could be dangerous. For safety reasons, someone needs to see you and be able to protect you from yourself or any destructive action. They do not have to be physically close, but within the same room or just several metres away.

Not try to ‘fix the problem’

Such intense emotions prevent the acceptance of suggestions which, at this stage of despair, will almost certainly be rejected, and perceived as provocative and lacking understanding and appreciation of the problem.

Not move in too close without prior approval

Encroaching uninvited into your personal body space, perhaps to express affection or compassion, may cause a physical reaction of rejection, such that they could be pushed away and be physically hurt. Affection may be used in such circumstances, but only with your prior approval, and at a level of expression that is soothing rather than confusing or overwhelming.

Validate the feelings and just listen

You may need to express your despair in words and expletives. This helps you to release the intense emotion. Your listener needs to acknowledge your feelings in a non-judgemental way, even if he or she does not agree with them. For example, he or she may say to you, ‘I know and appreciate how you feel completely hopeless and in such despair right now.’

Remind you that the intense despair will go

One of the characteristics of a ‘depression attack’ is that it is usually of short duration. You can be reassured that the feeling will eventually go.

Engage in minimal conversation

This is not the time for a conversation, on any topic, as a distraction, as the ending of the depression attack will come from within you. You need to withdraw from conversation and any social interaction in order to focus all mental energy on recovery.

Find a quiet sanctuary you can share to relax

There is a clear need to retreat to a safe sanctuary, without social, conversational or sensory demands. Neither should there be criticism, disappointment, anger or fear as to what you may be thinking or might do.

Avoid intense eye contact

Staring into your eyes whilst you are enduring a depression attack, especially with an intense facial expression, will probably create greater despair or confusion. It may be wise for your support person to look at your shoulder, or about a metre to the side of you.

Encourage participation in a special interest if you feel able

This can be the ‘off switch’ to provide an intellectual distraction, restore constructive rather than destructive energy, and enable a feeling of familiarity and well-being.

Allow time to process the intense emotions

The restoration of an emotional equilibrium may be a solitary process, with time to process thoughts, events and emotions before being able to move on to a new, positive frame of mind.