Resources: Learn More

• “Everything You Need to Know about Autism in Adults,” reviewed by Erik Mayville, PhD
• “Autism in Adults,” by Luke Beardon
• “The Autistic Brain: Helping Different Kinds of Minds Succeed,” by Temple Grandin & Richard Panek

Things to Think About

• Though it may seem like many parts of an autism assessment are strange or irrelevant, this information is vital for the psychologist in making an accurate diagnosis.
• Because autism is a relatively new diagnosis that was previously thought to only affect children, there isn’t as much research on or services for autism in adults.
• How can you support an autistic family member or friend in your life?

About the Guest

Dr. Hannah Baczynski works with people of all ages—providing diagnostic and psychological evaluations for children as young as 2, adolescents, and adults, as well as individual therapy for adolescents. As the clinical director of Dakota Family Services’ DBT Program for Adolescents, she also provides Dialectical Behavioral Therapy and is a firm believer in using treatments that are well-supported by research and that match the client’s goals. When she understands the “why” or the function of the behavior of difficulty a client is experiencing, she collaborates with them to set goals and find new, more productive skills and behaviors.

Dr. Megan Spencer is a clinical psychologist at Dakota Family Services. She is passionate about working with individuals and their families and highly values the therapeutic relationship. Dr. Spencer enjoys helping people better understand themselves and their psychological functioning. She looks forward to working with anyone who is looking to better understand and/or improve themselves or their children and families. Her practice includes diagnostic and psychological evaluations and individual cognitive behavioral therapy.

Transcript
Autism in Adults (Community Chat Series)

Featuring Dr. Hannah Baczynski, Psychologist, and Dr. Megan Spencer, Psychologist, Dakota Family Services

Tammy Noteboom:

Community chat recordings are presented by Dakota Family Services, an outpatient clinic with mental health providers in Minot and Fargo, North Dakota. Thank you for listening.

Host Gabe Wiese:

Our presenters today are Dr. Hannah Baczynski and Dr. Megan Spencer. Dr. Baczynski and Dr. Spencer are both psychologists at Dakota Family Services and provide psychological evaluations to children, adolescents and adults. Dr. Spencer also provides individual therapy for adults, and Dr. Baczynski also provides individual therapy and dialectical behavior therapy for adolescents. So with that, I will turn it over to Dr. Baczynski and Dr. Spencer to get started.

Dr. Megan Spencer:

Well, good afternoon, all that are on computer land. Thank you for joining us. I stole Dr. Baczynski's line for computer land. And so because this is a webinar, clearly we are gonna be doing education in terms of our topic today, but we also want it to be interactive. So certainly we don't want it to just be us standing up here, sitting, I should say, lecturing. But if you guys have questions or anything that you wanna know more about, put 'em in the chat and we will do our best to address them. And if we can't, hopefully we'll figure something else out. So today we're talking about autism in adults. And so yes, clearly we know autism spans the whole range of individuals, but we are gonna only focus on adults. So with that being said, I always like to give the caveat because I've been asked more times than not, and I think there sometimes can be confusion.

Dr. Megan Spencer:

Autism spectrum disorder is not something that you're going to like grow out of or age out of, but most certainly there are pieces to the criteria or what looks like autism spectrum that most certainly can be improved and worked upon, but it is not a diagnosis that you will definitely grow out of it. That's just not how it works. So with that being said, we're gonna try to focus on one, just kind of what it looks like in adults presenting in a clinical setting, some of the issues, and then we'll kind of go from there. So I can sort of just start off with focusing on symptoms or what individuals might present with. So with that being said, usually, not always, but more times than not adults with autism are gonna have a difficult time making eye contact or even if they can for them it's gonna be more uncomfortable.

Dr. Megan Spencer:

And the idea of how long do I sustain, do I look away? I think those things that are kind of the natural social rhythm of communication just doesn't come naturally in individuals with autism. So you're definitely gonna notice some difficulties with that eye contact and knowing when to sustain and sort of break and come back. Certainly there's gonna be a sensory dysregulation. And so when I say sensory, it's really just, it's your senses, right? It's your sight, sound, smell, taste, touch. All of that relates to that sensory dysregulation where I think, you know, no matter who we are, all of us have certain kind of quirks and things that we like and don't like, but this is gonna be far more than just like, eh, I don't like it, but I can manage it. So for instances there might be a hypersensitivity, so meaning an overly sensitive kind of system to different types of sounds like the phone ringing or commotion, people talking at the same time in a busy environment.

Dr. Megan Spencer:

Or there can be the opposite, which is hyposensitivity where their sensory system is just less sensitive for a lack of better way to say it, which could also relate again to that sight sounds smell, but it could also relate to pain. And so for instance, I've had people, adults coming in and wondering about this and that kind of sticks out because I think you get, I guess for me clinically, I see or hear less of the hyposensitivity than I do the hyper. But this is where it's like people can say like my hand could be resting on a burner and I don't recognize it right away until I've literally burned myself. Where most of us in a split second touching something hot, you're gonna pull back. So it's, it can be sensory dysregulation in either direction. So it can also be pleasure, right?

Dr. Megan Spencer:

Because pleasure is also a sense. So it's things that would typically be soothing or calming or pleasurable for somebody else. They might think like, okay, well how is that not soothing to you or how is that not pleasing? But again, it relates to the way that their system registers that sensory input. I think the most obvious is the difficulties in social interactions. So this encompasses like lots of different things, right? Eye contact is a part of it, but it's even like interpreting those really subtle gestures, facial expressions, those nonverbal kind of like a little smile or a joking wink. But individuals with autism, adults have a really hard time interpreting those really social subtle gestures or facial expressions that are communicated kind of non-verbally that just don't pick up and register. Which I think that also goes back to interpreting like metaphors and understanding when to jump into conversations. The breaks, right? Knowing okay the pause and then the go in and then not interrupting, right? It's all of those very nuances that relate to those social interactions that adults with autism have a really hard time interpreting, which could have been throughout grade school, this could have, you know, somehow a more mild form. And then when they get into the workplace, when those expectations for social interactions and leadership or communications with boss just then become even more impairing.

Dr. Hannah Baczynski:

I think that when we talk about autism in adults, it's tough because you know, autism's only been around as an official diagnosis since about World War II. There were descriptions of it before then. Certainly autism goes back to the beginning of humans, but we don't have descriptions of it or a name for it back then. And for much of autism's short life as a diagnosis, people believed you, I don't know, magically grew out of it when you became 18 or you just disappeared off the face of the earth or something. Like something happened when you reached adulthood that autism didn't exist anymore. And so we don't have the research on what autism looks like in adults. We don't have the services available to autistic adults. We don't have any of the stuff that we have for kids because in its lifetime autism has been essentially diagnosed as you know, a six to eight year old nonverbal boy who's flapping his hands.

Dr. Hannah Baczynski:

And so we don't have the data that we need to be able to really, really understand what autism looks like in adults as a whole. The other part that gets tricky when you're looking at autism in adults is that by the time you're an adult, whether you've been diagnosed with autism or not throughout your childhood, you have learned strategies. You learn what certain metaphors mean, right? I was reading a book once and the mom had autism and the kid had autism and she told the kid to throw his socks on and 15 minutes later she came back downstairs and he was giggling and he didn't have socks on. She got mad because he didn't have his socks on and they were late. So she threw him in the car and said, why don't you have your socks on? And he says, because it's impossible to throw your socks on.

Dr. Hannah Baczynski:

He had been throwing it in the air and trying to catch the sock with his foot. And so by the time you're an adult, you know when someone says throw your socks on that they don't literally mean throw your sock in the air and try to catch it. But that's through experience, that's through learning and getting it wrong. And so by the time you're an adult, you learn strategies for interpreting metaphors, you learn strategies for looking at people, you know that eye contact is necessary. But like Dr. Spencer said, maybe you don't know how to make it. I've had plenty of autistic adults that you could tell they're like, I must make eye contact, <laugh>, eye contact, eye contact. And you're like, man, you can stop because I get it. I get that you're trying to use the social skills that you've learned and we're in a space here for an assessment or therapy where that's not necessary.

Dr. Hannah Baczynski:

You don't have to mask or put those things forward for my benefit. And so this becomes even more tricky in women just in general. Autistic women from a young age are better at masking. They are more forced by society in some ways to mask as opposed to autistic boys. And then even more confusing in people of color because there's no research on people of color and autism. And traditionally services haven't been available to people of color throughout autism's history. They haven't been researched, they haven't experienced the community, the psychological psychiatric community hasn't experienced people with autism and people with color together. And so we are left in an odd position as psychologists trying to diagnose something based on criteria that probably don't match your experience. And so while that is the position we're in, I feel like it is also important to go through with the testing if that's what you want.

Dr. Hannah Baczynski:

Now I know that in, you know, the autistic community self-diagnosis is valid because it's a privilege to be able to get psychological testing. It's expensive. The wait lists are incredible even for children to get autism testing. And here in North Dakota there aren't a lot of people that will even test adults. So it's tricky is what I'm trying to say. Like autism looks different in each person, in each woman, in each man, but there are these commonalities that we can still look at. There's all these like confusions about how am I supposed to react? Or even I've met a lot of people that research things. I had someone come in and they're like, well, I just research topics so I always have something to talk about. Or before I go to the restaurant, I look up the menu online and I figure out where we're gonna sit and I look where the bathroom is so that I don't have to be in that situation and be confused and like make a social mistake that people are gonna notice.

Dr. Megan Spencer:

Or even I've had people that are like, I'm really good at social conversation when it's about history, right? About particular topics of interest. But the second that conversation, whether group or individual then kind of skews and goes in a different direction that isn't like that topic of interest that they're really good at, then it's kind of like almost a fall off, right? Where exactly what you described, they learn how to do things in certain ways, but then it goes beyond what their capacities are that they've masked or learned how to do.

Dr. Hannah Baczynski:

And with those special interests, right? Special interests are a big part of autism. Most people with autism, whether they're young or old or whatever, have had a special interest or something that they're intensely interested in that they spend hours and hours and hours and hours researching. A lot of people honestly who have autism, who have a special interest, autism is one of their special interests. They spend hours researching autism, figuring out how it matches them. They listen to podcasts, they read books, they come to things like this. That is not necessarily something that a neurotypical person would do. Research autism for hours, right? That's not where neurotypical people are at. And so autistic people can be really, really social under the right circumstances. Sociability is different in neurodivergent ADHD and autism versus neurotypical. In neurotypical social interactions, the goal is to get to talk about yourself or your emotions or your thoughts.

Dr. Hannah Baczynski:

Like that's what small talk is, like you go, I come in and I say, Dr. Spencer, how was your weekend? And she's like, oh it was great. I did this and I did this and blah blah blah blah blah blah blah. Right? And then she says, and how was your weekend? And then I say blah blah blah blah blah blah blah. That's a social norm. I mean we care about what the other person says because we know each other and we like each other in general and all of that stuff, right? And I'm not asking her about her weekend because like I am dying to talk about weekends, like that's not what small talk is. And so small talk is really confusing when you're neurodivergent ADHD or ASD because there is no point to it. The point is to be social.

Dr. Hannah Baczynski:

Whereas when you are having a conversation about something that you're interested in, I personally love fun facts. I have so much useless knowledge in my brain. And so if you wanna come up to me and talk about Futurama or how tomatoes are technically fruits but legally vegetables, like I will talk to you about that and I'll be super social. I'll be nodding and I'll be gesturing like I'm doing now because I love autism too. Like I like talking about it, like researching it, I like diagnosing it. But then let's say we have this conversation, I'm great, I'm awesome, I'm making eye contact, I'm smiling, I'm doing all this stuff because we're talking about something that I'm interested in. And then Megan's like, yeah, I wanna talk about monster trucks. And I'm like, gone. I'm gone because I have no interest in monster trucks. I know nothing about monster trucks.

Dr. Hannah Baczynski:

And most neurotypical people can like fake their way through it. They're like, oh yeah, monster trucks. Like let's talk about monster trucks. That's what you wanna talk about. We'll eventually get back to talking about me. I'll tell you about the stuff I know about Monster trucks. Even though it's nothing. Back and forth, back and forth, back and forth. We talk about thoughts and feelings and each other and the world and that everyone's happy and you walk away and it's just a conversation that you never remember because it's just a conversation. Whereas if you are ADHD or autistic, you're like, I don't know what to do in this situation. I have no knowledge to impart, I don't know how to add to this conversation. It's about this exchange of interests. It's about this exchange of information. It's not about an exchange of socialness, which is very different.

Dr. Hannah Baczynski:

And so that's why when you get two people who are neurodivergent having a conversation, it can flow really naturally. It can flow really socially. 'cause You both have the same goals to share information about things you're interested in. When I talk to my best friend who's got ADHD, and I have ADHD, I think we're having two separate conversations. But it works. If you look back at the texts, they make no sense. She's talking about whatever she's talking about, I'm talking about whatever I'm talking about. And we kind of respond to each other and it's great. The same thing would happen if you have two people with autism talking to each other, like you responding to each other, you're sharing information, it's great, but there's no socialness to it. If I as a neurodivergent person try to talk to a neurotypical person, that's where things start to feel like it's disjointed.

Dr. Hannah Baczynski:

It doesn't make sense because we have different goals. And so when we're looking at autism in adults, we're looking at like, how is your small talk? Can you respond to a joke? If I bring up something of my own interest, how do you respond to that? Versus like if I get you talking about something that you're interested in, is it a very different experience? Because typically with non-autistic people, it's not gonna be that different of an experience because it's just a conversation. But in autistic people, the small talk or the talk about my interest versus the talk about your interest, it's gonna have a whole different feel.

Dr. Megan Spencer:

Absolutely. I mean it does, yes. And honestly, I think sometimes people wonder too like how did I get this far without realizing I had autism or anybody else saying like, Hey, this is kind of strange. Or that's kind of strange because I think a lot of times we chalk stuff up to different stuff like, oh, that person doesn't come out and do social events because maybe they have social anxiety, right? Or you as the individual might not even think autism is the wheelhouse, but just get really down on yourself because you might think, God, I just suck at relationships or like I'm never gonna be good at them. So what's the point? I mean, you can imagine how there's certain like quirks or things that might show themselves in different ways, but we have to remember that until something becomes impairing, we don't think of it as a problem, right?

Dr. Megan Spencer:

So a lot of times adults might never actually have encountered certain environments or situations where that neurodiversity just didn't cause enough impairment, whether it's in school or at home or at work, to like get those alarm flags going up, that which then would lead them kind of through that door. And then I think just as human beings, when we have a problem or we can't do something, it is natural for us to go in our heads and think, oh, maybe it's because of this. Or Oh, maybe it's because I had depression. Or maybe it's because like I had a really stressful upbringing, I just didn't learn how to like do these things. So there's never one way. Like there's not, it's gonna look like this, it's gonna be like this. But we also have to remember that people can go a long time before certain things become impairing or to the point that it gets recognized by the individual and others as like abnormal. And then it's kind of like, oh, well oh, maybe this is something I should go get tested for or ask about.

Dr. Hannah Baczynski:

Absolutely. And like we also have to remember what I said about research earlier, right? If you are an adult and you're thinking I have autism, I've done my research, I've resonate with all this stuff, it matches my experience as a human being. But no one brought it up when I was a kid. Like you were a kid 20 years ago and 20 years ago, 30 years ago, whatever. Right? We knew very little about autism. It didn't become the spectrum that it is until like the nineties. And still we are fighting against that idea that it is very rare. We are fighting against that idea that it can only look like this one thing, which were ideas that were brought forward by the people who originally like created the diagnosis back then and all that stuff. But we are still looking at figuring out what it is that autism is, what does it look like?

Dr. Hannah Baczynski:

How can it look if it's not severe? And so I see plenty of people in their twenties and thirties who on examination when we do the assessment, it's clear that you have autism. I can see it. You knew it. And so why didn't you get diagnosed? Because people didn't know. Like the simple truth is that people didn't know. Yep. And people didn't know what caused it. People didn't know where it came from. There's been all that like misinformation about autism. And we now know with more recent research that is just super genetic. It's just a genetic difference in how your brain is set up. Just like ADHD, we've always known, I think ADHD is more genetic, but we haven't known about autism. And autism is just as genetic as ADHD. It's a difference in how your brain is formed.

Dr. Hannah Baczynski:

And so it's neither good nor bad, it's just a difference. And it is not how the world is set up. The world isn't set up for your brain if you have autism or ADHD. And that's what makes it hard. If the world was set up for your brain, it would be less hard. That is why groups of autistic people group together, right? In like Silicone Valley and certain occupations, like we see a much higher rate of autism because those situations are set up for people with autism, like designed by autism for autism essentially. The other thing is that autism in kids, and especially girls, but in kids when it's not super severe, gets misdiagnosed. We just had a question about co-occurring diagnoses and misdiagnoses. And so the biggest co-occurring diagnosis is of course ADHD. We've always known that there's a high correlation between autism and ADHD.

Dr. Hannah Baczynski:

Even though back a couple DSMs, the the diagnostic manual, you couldn't diagnose them both. You had to have one or the other. That's not the case anymore. And we know that the correlation between autism and ADHD is super high. If you have autism, you're like 50, 60, maybe more percent likely to have traits of ADHD, if not full on ADHD. Recent research has also shown the opposite. We thought that ADHD was a bigger separate thing than autism, but it looks like people with ADHD-- 60 to 70%, 50, whatever, I don't know the exact percentage, also have traits of autism. And so we can see that Neurodivergence has this relationship that we don't yet understand between ADHD and autism. But things that commonly get misdiagnosed. If you have someone with autism, let's say you were a little girl and you had autism, people would probably diagnose you with anxiety before you're diagnosed with autism.

Dr. Hannah Baczynski:

You might've been diagnosed with social anxiety, generalized anxiety. You might've been diagnosed with OCD 'cause you're just constantly checking things. It's hard to grow up neurodivergent, whether that's ADHD, autism learning disorders, whatever. And so you might've eventually been diagnosed with depression. You might've had depression, you might've been diagnosed with depression. There's also a type of burnout that happens with autism that is often misdiagnosed as depression. But the problem is we don't have a diagnosis for it. It's called autistic burnout. And I can't diagnose it. It's not in the DSM. And so it ends up being diagnosed as depression, which they're different things. Research shows that they're very different things. The other thing that we're learning I think about autism is its relationship to personality disorders. Personality disorders are an old idea, very old. And they've been around for a really long time.

Dr. Hannah Baczynski:

And I think that as we learn more about personality disorders, I think we are learning that they come from three different places. One trauma, right? If you are dealing with long-term trauma as a kid, then you're going to develop problematic coping habits that don't go away when you come out of the trauma. And if those stick around for a long time, that's bam. Personality disorder. That's what it's, the other thing that I think we're learning about personality disorders is that they were probably a good chunk of them autism. And so there is a form of autism that especially occurs in girls where you're kind of, you know, emotionally dysregulated. Your special interests sometimes are people. And so you might clinging to one person where you're like, you are my best friend and I am going to take on all of your habits and all of your likes and we're gonna be the exact same person.

Dr. Hannah Baczynski:

That's a little freaky to people. And so that freaks people out. And then you develop this fear of abandonment and then you have a new best friend. And so this is a cycle that from the outside looks really, really dysregulated. And if you add into the idea of sensory sensitivities, and a lot of autistic people deal with sensory sensitivities by self-harming, whether that's banging their head or like scratching themselves or whatever. You get what looks like borderline personality disorder. And so basically anything can be misdiagnosed. And the reason that those misdiagnoses happen so often is because unless you ask me to look for autism, I'm really not looking for autism. And that's been even more true I think, historically.

Dr. Megan Spencer:

Well, and there's overlapping of symptoms, right? What some people might come in and think is a symptom of this, that or the other thing. I mean, in all reality assessment has to focus on what the issues are, right? And so there is a lot of overlapping stuff. I mean, a lot of individuals with autism, just like Hannah was saying, have a lot of those problem solving, executive functioning difficulties, right? So they're coming in with what we might think is questioning ADHD, but unless you truly dig in deep and do right, we're not gonna automatically assume that these executive functioning issues are ADHD or you know, are gonna be absolutely in autism. So I think because there is those overlapping symptoms that can occur with autism spectrum, ADHD, definitely some of that anxiety piece, which is more of a product of the difficulties that that individual with ASD has been having, right? It's like what's the primary and what's the secondary? A lot of times these, these individuals are coming in with these secondary issues and problems and diagnoses, but have never actually addressed what that primary is. So it leads to all of these coping and habits that can look like a lot of other stuff. But genuinely it's what is that underlying kind of primary thing,

Dr. Hannah Baczynski:

Right? So if you think you have autism or you want like an assessment, I think this is, it'll help kind of understand a little bit like how we separate those things out. So let's say you walk into my office or Dr. Spencer's office or any psychologist's office and you wanna be assessed for autism, like what is gonna happen? Probably a lot of things that make you not wanna get assessed. So there was a question earlier about how do you set up waiting rooms and stuff like that. But the fact is if you have autism, you might not like the way that healthcare systems are set up, right? You have to come to a waiting room that often is very, very bright. There's a lot of people you don't know just like hanging around you have to talk to. As far as like accommodations, like some things that have really been helpful I think for people since covid is the ability to wait in your car.

Dr. Hannah Baczynski:

Like my hairdresser still does that. Like I text, I'm here and they text me when to come in and so I don't have to sit in a waiting room that's bright or talk to a receptionist that I don't know, I can sit in my car in my comfy space and wait until they're like, okay, we're ready for you. And then I walk in and my hairdresser meets me at the door and like takes me to her little spot so I don't have to meet anyone else. But unfortunately that's not how a lot of healthcare is set up though. It is kind of working in that direction. But you will come in and you'll tell us why you think you have autism. And if you don't mention autism, I know a lot of people I've, I've seen on Reddit and I've talked to people who are like, well if I tell them that I have autism or think I have autism, then they're not gonna look for it.

Dr. Hannah Baczynski:

Then they're not gonna find it on their own. And then will it really be a real diagnosis? Like the fact is <laugh>, as a psychologist, I cannot look for every single diagnosis in this book every single time. And so if you think you have autism, you should tell me that you think you have autism. It won't spoil the diagnosis. I won't give it if I don't think you have it. And so a lot of people come in with like their little binders full of evidence that they have autism. I love that. But be prepared to leave it with me <laugh> because I won't read it in front of you. Be prepared to leave it with me or email it to me or whatever. I'll give it back to you after I make copies, but I can't read that fast. So you'll tell me why you think you have autism.

Dr. Hannah Baczynski:

I'll ask a lot of questions. I'll ask questions about special interest. I'll ask questions about sensory stuff. I'll ask questions about stimming and stimming when you're an adult is totally different. I don't think I've ever seen an adult come into my office and like flap their hands. Is that possible? Totally. But by the time you're an adult, you probably save your hand flapping, if you do it, for private. Because you've learned to do that, right? And stimming is much more subtle when you're an adult. You're picking at your nails, you're twirling your hair, you're rubbing your sweater, you're rubbing the table, rubbing your jeans.

Dr. Megan Spencer:

Rubbing your fingers, right?

Dr. Hannah Baczynski:

Rubbing your fingers. It can also look like holding your limbs or hands in seemingly odd positions as just like how they hold their hands. And that's fine. No, it's no problem with it. And that is not how neurotypical people hold their hands when talking, right?

Dr. Hannah Baczynski:

And so it's important that the testing that you do, which you'll do a lot if you come here, it's important that we do a lot because we need to give you time to let your guard down to drop the mask. You'll do things that you think are silly. I often ask people to show me how to brush their teeth. <Laugh> Not like with a real toothbrush, but like you'll be like, I'm an adult, Dr. Baczynski, I do not want to pretend show you how to brush my teeth. And that's just part of it. That's part of the whole system of how I figure it out. And even if it doesn't make sense, it really does help me figure it out. And so you will do all of these different things. Some with the psychologist, some with other people. You'll fill out forms, you'll talk with us for what seems like forever-- a couple sessions, right?

Dr. Hannah Baczynski:

And at the end we put all of that information together and try and figure out what's going on. And so how do we figure it out? If it's something like social anxiety versus autism, autism is gonna be more pervasive. Social anxiety isn't going to include some of that other stuff. Like people with social anxiety typically don't have special interests. It's not gonna get better over time, right? So social anxiety, as you get comfy with me and you've spent so many hours with me or whatever, it's gonna improve. You're gonna feel less anxious, you're gonna feel less distressed in those situations. If you have social anxiety, you're gonna feel less distressed with someone that you know,

Dr. Megan Spencer:

No matter the topic, right, it's not about the topics or the content. So yes.

Dr. Hannah Baczynski:

And absolutely you will feel better in social situations if you have autism after you've known someone for a long time and all of that other stuff, the special interests, the sensory sensitivities, the difficulties gesturing or making eye contact, those don't change as much. Whereas if it's just social anxiety, you're gonna see a bigger shift as you get comfortable in your behaviors, in your willingness to talk about things in the range of things that you will talk about. And that's not to say that people with autism can't have social anxiety. You definitely can. And we are looking at sort of the patterns over time when we're trying to decide if it's autism versus this versus that. Like how does it change in different situations? How does all those things impact everything?

Dr. Megan Spencer:

So yes, the comment of oh wow, the potential for all those misdiagnoses is mind blowing. Yes. And this is why psychological testing is so important. And of course we don't know everything and certainly we can make mistakes, but here is why it's so important to have an evaluation because this is exactly what happens is unless you do the type of comprehensive assessments that we do to look at autism, you can think it's a whole array of different things. And then it goes back to once you have a diagnosis that informs treatment, whether it's therapy, medication, all of that stuff. So if you think about it, that evaluation, yes is intense and complex and it takes time. But there is a reason for the madness that we do when it comes to psych testing. And that's because it is so, so important to make sure that we identify what is the actual issue? Like what is the diagnosis versus trying to diagnose all these secondary symptoms or problems when in fact it's been autism all along or it's trauma, right? From this age to this age, there was multiple and significant traumas, but nobody looked at that and they were focused on this behavior or that behavior or why you do this. So this is exactly why evaluations and that comprehensiveness is so important.

Dr. Hannah Baczynski:

So we only have a couple minutes left and one of the questions that we just got was like, what's the best way to support an adult loved one with autism? And that is going to be like, there's a saying that everyone repeats back and forth. Like if you've met one person with autism, you've met one person with autism. And so it's going to be about understanding some of their triggers, especially the sensory triggers, right? Yeah. If someone is starting to go into a meltdown or a shutdown or just sensory overwhelm, which can get to the point if you've never had sensory overwhelm that like your own voice is too loud and you are irritating yourself by existing sort of. And so in those situations, like you want to back off as the other person involved, right? You want to allow that person time to chill out, to sit in a dark room with noise canceling headphones or their favorite music or whatever to just kind of like bring that sensory overwhelm down.

Dr. Hannah Baczynski:

Because the more you push in those situations, the worse it gets. It's just like when we, I mentioned autistic burnout, but like if you went to a therapist for depression, they might suggest that you go out and do pleasant things. And if you have misdiagnosed autistic burnout as depression, going out and doing pleasant things is gonna make it worse. Because what is happening is you're overwhelmed and you need to do less things. And so being knowledgeable about those signs that someone is just sensory overwhelmed or overwhelmed with life or whatever, so that you know when to back off versus when to jump in and provide more support and the person who's gonna know best about whether you need to back off or jump in is the person with autism that you're trying to support. Other things that can help would be like just learning about autism as much as you can.

Dr. Hannah Baczynski:

Learning about the person's interests. Like if you're having trouble connecting with a loved one or a friend, whether they're a child or an adult who has autism, like learning about their interests is the best way to connect. Like that's how they express love by saying, look, I have all this knowledge that I'm giving you. It's like instead of giving chocolates and they're like giving you knowledge, love knowledge, that's how they're expressing their love. That's how they're expressing their enjoyment. It's also important to understand that empathy is expressed different when you're neurodivergent. So if Dr. Spencer told me that her, her dog died, I might be like, wow, that really, really sucks. Like is there anything I could do for you? Can I get you some chocolate? I guess I'm stuck on chocolate <laugh>. Can I get you some chocolate? Whatever, you know, what can I do for you?

Dr. Hannah Baczynski:

Which is showing empathy versus like if she said that to someone who is autistic, perhaps they'd be like, you know what, like when my dog died, this and this and this and this happened. And it sounds like you're taking Dr. Spencer's tragedy and turning it towards yourself, but really oftentimes that's an expression of empathy. Like I understand how you feel because I have gone through the same thing. And so being patient and understanding what's happening when someone does something like that, if you, if your loved one has autism, like they're not trying to one-up you, they're not trying to turn the attention to them, they're trying to share their love knowledge by explaining that I have also gone through the same thing so I understand exactly what you're going through. They just don't say it that way.

Dr. Megan Spencer:

Seriously, understanding and not assuming, like that's literally it. How do you help someone, whether it's a kiddo or adult, don't assume, ask, try to help communicate, try to understand rather than assuming that well this person or this, you know, individual's having a meltdown in their adult. Like what's wrong with them? No, you know, maybe, maybe there's something you can do to help rather than assuming. So I think in all reality there's no magic, like here's what you have to do or here's what will work or here's what won't work. I think it's genuinely getting to know the person as an individual and what works for them and what doesn't versus making the assumption that you know, or you think you know, and operating off of that, which more times than not is gonna make it worse and make them retreat versus come to you.

Dr. Hannah Baczynski:

And I think believing people when they say what they need, like there's a lot of times in my own life or in other people's lives that I've talked to, like you'd say what you need, like I need a break, I need to go sit in my room in the dark. And if you have autism, like that might be the best thing, but well-meaning people are like, no, no, no, you need to get out, you need to be in the sun, you need to do this, you need to do that. And so I think unless coping mechanisms are getting in the way of life, you know, by like you're not going your job, you're not going to school, you're not doing all of these things for long periods of time, unless coping mechanisms are getting in the way like that, believe people when they say what they need and if it is starting to get in the way of life, encourage therapy, encourage getting checked out, encourage those things because we can't be everything everyone needs all the time.

Dr. Megan Spencer:

It's understanding. I mean that's what like a lot of stuff just boils down to is communicate, try to understand and if you make a mistake, just own it. Like wow, I'm sorry, I could tell that obviously made things worse for you. What would be more helpful? Right? It's putting the words out there versus just thinking, you know, and then moving on and going to something else because lives are busy and days are busy and it takes more work to try to understand sometimes than to just pretend and move on. And that's really what it's about.

Dr. Hannah Baczynski:

Absolutely. So I think that we're basically out of time.

Host Gabe Wiese:

Alright, Hannah and Megan, thank you guys so much. A lot of awesome information. I think you guys touched on a lot of the questions in the chat, but one question from Shannon was about services that can help kids diagnosed with autism. And I think first of all, Dakota Family Services, definitely, we provide services for autism, but are there any others that come to your guys' mind right away?

Dr. Megan Spencer:

So with kiddos and adolescents, most certainly, I mean there's the North Dakota Autism Center, there's Anne Carlson, I can think of. Adults, that's where it gets a lot more tricky. I do know there are some, you know, occupational therapists in our community that do work with adults on the autism spectrum. But to be honest, both the North Dakota Autism Center, I think for kiddos and adolescents and Anne Carlson are great ones, but those aren't gonna necessarily be the same for adults and in the same way. So in that case, you know, Hannah, you probably have some other good ones too. But there are other places in the community, certainly not just individual therapy that do certainly have more specialties with autism and adults, but it's a lot harder to find, to be honest with you.

Dr. Hannah Baczynski:

Unfortunately, I think that's one of the areas North Dakota is missing those services. So you just kind of have to look around for speech and language or occupational therapy or an individual therapist that you like. And it's gonna be probably some trial and error and it might be difficult to find, but if you can find someone that's really matches what you need, then, then that can be really helpful. But it's hard.

Host Gabe Wiese:

All right. And I think we're just about out of time, but I'll try and ask one or two more questions. One from Chuck who works in higher education with students in determining academic and housing accommodations. A challenging conversation is how to navigate group work in classes where working in groups is a fundamental piece of the course. Do you guys have any suggestions or strategies on how to work with students and faculty on an equitable experience?

Dr. Hannah Baczynski:

I think that's just tough. Like it's something, if it's required, it's required. Helping the student like navigate the choices that they do have. Like maybe there's people in the class that they feel more comfortable with. Maybe there's a way to do group work that involves less face-to-face time. Like can they create a Google Doc together or something. But it is also one of those things that if it's required, it's required, we try to provide as many accommodations or useful things that we can. Like some of the things that I mentioned. It's probably gonna be hard no matter what accommodations you provide, unfortunately.

Tammy Noteboom:

Thank you for listening to this community chat presented by Dakota Family Services. To make an appointment with one of our mental health providers or to learn other ways to mind your mind, go to Dakotafamilyservices.org.

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