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cultivate the compa cultivate a capacity for kindness So Close Your Eyes take a few moments to breathe in and breathe out [Music] h is [Music] [Music] [Applause] [Music] but I would say on a on a deeper level it's more like when when we say work on yourself that involves all kinds of like things about moving your life forward and they struggle with motivation in these things it's because when I don't think I'm worth it I'm not worth fixing [Music] [Music] oh [Music] d [Music] when you develop empathy and compassion for other people there's going to

be room for someone else in the relationship and then this in turn is going to reduce the feeling of being an object now two people can connect and now it's not about getting your needs met in Starvation it's about two human beings forming a relationship [Music] h [Music] [Music] all righty chat let's get started welcome to another healthy gamer GG stream just a reminder that um hello my name is Dr aluk kenoa just a reminder that although I'm a psychiatrist nothing we discuss on stream today is intended to be taken as medical advice everything is

for educational or entertainment purposes only if yall have a medical concern or question please go see a licensed professional welcome everybody so happy Monday to all um we are going to do our deep dive into autism spectrum disorder today um so that'll be fun I think this is going to run about two hours probably at a minimum um and realistically it may go all the way to three uh we have a ton of like questions and posts which I actually don't even know if we're going to get to so like uh thankfully like the the

content team over here at at HG has given me like lots of questions that people have asked about autism I think we're going to cover a lot of it in some basic way in our kind of Deep dive um but I know that there's a ton of interest in this and once again apologies to everyone who was you know waiting for this to happen about two weeks ago I got sick and we had to reschedule so apologies for that one last thing is we've gotten several requests for references for our videos it's an active thing

that we're working on um and hopefully you know we can get that to youall kind of ASAP so uh before we dive in so just a couple of quick announcements we're going to be talking with Dr Ali matu about social anxiety next week super looking forward to that if y'all aren't familiar with Dr matu he's uh he's a content creator um so has his own awesome like YouTube channel and stuff and then uh is an expert specifically on anxiety so we're going to be having a conversation with him and sort of getting his expertise on

anxiety another quick heads up um there are finally coaching spots open so so uh coaching has been full for about 2 years and uh we've been doing our best to you know try to support the people in the community who are interested in it we've got personal spots open group spots open and career spots open so just a quick kind of heads up for people who aren't familiar with our coaching program we do a lot of stuff here at HG we try to educate yall and I think the main reason to try coaching is if

you want results within a particular amount of time so um you know by all means continue watching streams and videos and and what not and doing the DIY stuff but I think the main thing about coaching is that like people actually make progress in a certain amount of time so if you're someone who's always like yeah I always watch this stuff I'm just watching content but I'm never like doing anything about it then definitely check out our coaching program uh couple of things so you know we focus on things like how to develop purpose in

life and how to build your motivation how to understand yourself how to understand some of the patterns that may be affecting things like your relationships and stuff like that and then we also have certain offshoots like career coach in um which we sort of developed with Ethan Evans who's a senior or was a senior VP at Amazon you know led a team of like 800 developers and so there's there's a lot of good stuff in there about if y'all are focused on building a career enhancing your career sort of having that goal Target can be

very very helpful so check out coaching if you all have been interested I know a lot of people have been on the waiting list and we finally have room after about two years um and so the program is also based on evidence-based principles and we've made multiple erations of it because we get a lot of feedback from yall so we keep improving um which is really awesome so I I think a lot of people have benefited from it I ran into some people recently at a restaurant who were like yeah we both tried your coaching

program and it really helped us a lot so we you know it seems like it works pretty well we also have data to that effect um and we'll be presenting outcomes from our coaching program at a conference in about a month probably okay so today we are going to talk about autism spectrum and um this is kind of how I'm going to approach it okay so we're going to start by like understanding first of all like what is autism so there's this angle of like is it neurodiversity is it a diagnosis is it a disorder

is it who I am so we're going to start with actually some of those philosophical questions then we're going to dive into some of the um sort of diagnostic criteria so we're going to try to understand okay when someone is Autistic or on the autism spectrum what is different about them and in the case of a disorder what are the criteria for the disorder then what we're going to um so we're going to go over a lot of the core features of autism there then we're going to talk a little bit about comorbidities in autism

uh Spectrum Disorder so like what about depression and anxiety is it a feature of the disorder is it not a feature of the disorder can I have both all this kind of stuff then we're going to dive into the ideology of autism so what causes autism how does one become autistic and we've learned a lot and also still have a lot to learn then we're going to go into some gender-based uh considerations for autism spectrum disorder including gender dysphoria and gender identity um then we're going to talk a little bit about treatments so once again

like you know if yall are concerned that you have a diagnosis of autism spectrum disorder you think you could be on the Spectrum the gold standard and what you should absolutely do is see a professional right so go through the diagnostic criteria see if it applies to you and as we'll learn treatment for autism spectrum disorder is highly highly individualized so please don't use this as a substitute for treatment at the same time we are going to go over I'm almost like thinking about if I was teaching a group of medical students about what is

autism this is the kind of talk that I would give okay so um we're going to talk about a lot of different treatment options uh and then what we're going to do is I don't know how else to say this I'm going to just short of sort of share my personal approach when I'm working with someone who's on the Spectrum so this is not like you know some of the stuff that we're going to be talking about is like evidence-based like stuff and this is just sort of a clinician a single psychiatrist's experience of okay

all the stuff that I've learned when I take it to a patient how do I think about it what are the different ways that I approach treatment big disclaimer here I have had a fair number of patients who are on the Spectrum but I am by no means an Autism specialist I have never worked in an Autism specific Clinic that I can think of um maybe one thing was kind of close so I one time worked in a school or like rotated is a better way to put it in a school for people who were

on the spectrum that was part of a mental health facility so that's probably the closest that I've come to being ins sconed with within like autism uh treatment at the same time had a ton of patience and doing work in in gaming in on the internet um I tend to see a lot of people who are on the Spectrum and then also I've worked professionally with a lot of people on the Spectrum um so we're not going to go into too many details here for for reasons of privacy but for example you know a fair

percentage of our our coaches in our coaching program some of them are on the Spectrum as they've disclosed to us they don't have to disclose anything like that they just share that and so I think it's really important from a peer support model so and and that seems to work out great like they do an awesome job so let's talk about autism spectrum so the first thing is if we look at in the field of Psychiatry we have this thing called autism spectrum disorder in the dsm5 so the dsm5 is the diagnostic and statistical manual

version number five which is how we in the field of Psychiatry diagnose people with things so we have to start by understanding how the DSM works so a bunch of psychiatrists get together and they basically like often times they're seminal researchers they're like really experts in their field and they will sort of decide okay what qualifies as autism and what doesn't qualify as autism and then what what has happened is traditionally autism has been treated as a disorder so what makes a disorder there's one very common thing so if you look at what's the difference

between sadness and a mood disorder what's the difference between being worried and an anxiety disorder so the threshold from healthy to disorder in Psychiatry has one shared thing it interferes with your life in some substantial way so we use this term impairment of function and the reason that we kind of think of autism spectrum disorders is because these are things that appear to negatively impact people's lives so autism spectrum disorder can interfere with your ability to form relationships it can interfere with your ability to be successful professionally it can interfere with your emotional Wellness can

sometimes lead to things like self-injurious behavior and and stuff like that so this is why we classify it as a disorder now about I would say 20 years ago and this has gained a lot of steam in the last 10 there became this movement to classify certain things as neurodiversity so ADHD is a good example of this where a lot of people will say like this is not a disorder this is a different kind of brain and it's not that I am ill I believe that my brain is different like I we're all human beings

we're all a little bit different and I'm not broken this is just a A variation within a population now even in the case of neurodiversity these people tend to have challenges right because the core problem with neurodiversity is that the world around us is not adapted to your brain it is based on a neurotypical brain so the structure of the institutions in the world assume that the brains of the participants are what we call neurotypical now I've had patients who believe that autism spectrum disorder is a mental illness is a disorder in something that warrants

treatment and I've had patients who believe more in the neurodiversity angle which is that I'm just different and everyone is different everyone needs to learn how to to a certain degree like adapt their internal functioning to the world around them but I'm not ill in some way now in the past I've gotten in trouble so we're banned from the ADHD subreddit because I made a video about how ADHD is positive in some ways and I still believe that fair enough so I'm going to do my best to take the feedback from those kinds of experiences

and and try to be as sensitive and careful as possible so I've worked with patients who are like neuro who view things as neurodiverse and they don't consider autism to be a disorder or a disadvantage it is just a feature of who they are and I've worked with people who consider it to be a disorder and wish it wasn't this way and this is a sign of illness I've worked with both so my take as a psychiatrist is like if y'all are wondering okay is it neurodiversity is it a disorder like is it a diagnosis

is it a pathology and that's for you to decide right so what what the the approach that I take as a psychiatrist do all adopt whatever system my patients want to adopt so if they come to my office and they say I want to get rid of this this is interfering too much with my life I want to learn to be different I want to learn to be healthier I want to have relationships I want I'm like okay totally fine we can treat it as a disorder and something to be fixed other people will come

into my office and they'll be like I want to figure out who I am what makes me me and how to interact with the world I don't necessarily want to cure myself of anything but I want to figure out how to interface with the rest of the world that's fair enough too so generally speaking from a clinical perspective like I said the main thing is does it interfere with function in some way okay so you all have to decide for yourselves if you're on the autism spectrum how do you view this do you view this

as a problem to be fixed or do you view this as who you are and you need to figure out some way to interface with the world now the good news is that in my experience as a psychiatrist like it's somewhat of an academic distinction it can be really important in many ways but when it comes down to what we are going to do often times a lot of the stuff is relatively similar okay now from a clinical perspective I think both views are valid um I have seen cases of that really stand out as

good examples of each view so for example I've worked with patients who have very severe autism and what that means is that they are can be verbal so I'm thinking about one patient in particular just helps me when I think about people I've worked with so verbal but non-interactive so what does this mean that this means that this boy can say speak say things but doesn't know how to respond to questions um doesn't directly communicate with other people doesn't and it it goes to school of A Sort has some degree of like capability but you

know at the age of 12 or 13 still cannot toilet by themselves cannot dress themselves um can be hyper fixated on particular things has temper tantrums this kind of stuff right so when I look at that I look at this person and I think to myself okay this person is not capable of caring for themselves and when I talk to this person's parents there is no doubt in their mind that this is a disorder that this is like this is not just like who he is I mean he certainly has a personality and they've come

to love their child just like any parent does and like that's wonderful and all but like the amount of effort they have to expend in the amount of support that the child needs this does not feel like a non-d disorder if that makes sense I've also worked with people who are very high functioning on the autism spectrum so these are people who are friends of mine in medical school who have become successful Physicians and have very very good bedside Manner and for these people they view things slightly differently I have patients like this too where

to them like this isn't a disorder this is just who I am and I have to learn how to live with it so I see like arguments on both sides and I think it's like up to you to decide what fits with you okay so um the last thing to consider about autism spectrum disorder and I think this is kind of like a good uh point to make is that a lot of the disorder doesn't come out of the features of autism itself it comes out of the interaction between the kind of brain that you

have and the world around you so if we think about like the way that let's say some people on the autism spectrum uh autism spectrum are quite perseverative so they love like a particular thing and they can spend a lot of time focused on that thing talking to other people about that thing this kind of gets made fun of quite a lot is a very strong stereotype for autism that like this person can talk to you about trains for four hours and you can express zero interest and they just can kind of keep going so

I think there's another key feature that we have to understand about autism which is that of large portion of the challenges in autism whether you consider them clinical or a clinical that's your choice many of the challenges that human beings face have to do with the interaction between yourself and the environment around you okay and this is not just true of autism so many people think oh like but is that just autism what about the other illnesses so I'll give you a couple of other examples okay so if you live alone on a desert island

can you have social anxiety right I mean chances are you sort of can right because when you're going to bed at night you'll remember something before you were on the desert island when you were very socially anxious and you said something stupid like someone you know you're at a restaurant at an airport and the waiter says have a nice flight and then you say you too even though they're not going anywhere and feel silly but can social anxiety exist if you are by yourself another good example is if you have a genetic vulnerability to alcohol

addiction and you have no access to alcohol what is that what does that mean are you an addict not an addict so if we look at a lot of our mental health diagnoses they require some amount of interaction between the environment and yourself so in the absence of alcohol an alcoholic has no problems but in the presence of alcohol alcoholics can have a problem so a lot of the challenges that we see when I'm working with people on on the spectrum is not like this is wrong with you this is busted it is that when

your neuroatypical brain interacts in a world that is not designed for brains like yours you run into problems and usually that is what I focus on and that's what we're going to kind of walk youall through towards the end okay so a couple of just perspectives this is is something that we call the stress diathesis model in um in medicine I think I have that right so this is kind of this concept that like illnesses emerge in the right circumstances so diabetes a tendency for type 2 diabetes a genetic vulnerability whatever emerges when you add

a certain kind of diet or exercise to the equation so it's like person plus environment this is really where the problems arise Okay so give me a second make sense okay ableism yeah so that's like I see people commenting about ableism and stuff so that's where all that stuff comes into the picture right is we have like all of these features right so we have like ramps to enter buildings in the United States and this is accommodation for people who use wheelchairs or assist of devices for Mobility Mak sense we don't have similar things very

often for things that are mental in nature so we have a lot of these like physical like we have Braille on drive up ATMs right so we're trying to accommodate for people who are different in some way and often times the challenge with autism spectrum is people aren't aware of what the challenges are and we rarely do we like accommodate and build structures to help these people out okay so it's it's it's a very common challenge all right so let's dive into diagnostic criteria okay so kind of tldr is autism and illness well that kind

of you know it's for you to decide right so you get to decide whether you want to view this as an illness or whether you want to view it as just like a difference okay so let's talk about the core features of autism spectrum disorder okay so the first core feature can you all hear me okay this okay oh this isn't showing anything all right we'll just use this then okay so what are the core features of Autism Spectrum Disorder so the first for core feature is that it is a spectrum as we've already said

there's a wild difference between people who have severe cases of autism spectrum disorder who are like nonverbal non-interactive Etc and people who are highly functional okay so the first thing is like this is it's it's patchy so I think about autism as patchy we're going to go over like what the commonly perceived deficits are but this is part of the reason that first of all it's so hard to do a deep dive into autism because who are we talking about are we talking about treatment for people who are nonverbal non- interactive unable to toil it

are we talking about people who are like third-year medical students so it's really interesting right because the interventions for each person are drastically different so this is the first feature of autism this is also what makes it like sometimes challenging to diagnose so we'll get into more of this later but 70% of people on the autism spectrum also have a comorbid mental illness so that means they have something like uh depression anxiety something in that vein OCD social anxiety so often times what happens is we'll miss autism especially in girls we'll get to that a

little bit later um because the features that girls exhibit if they're autistic are more likely to be called something else so girls are more likely to get diagnosed with autis I mean anxiety disorders OCD because that's what it looks like from the outside so now let's talk a little bit about what are the core features so first thing is that it's a spectrum second thing is that there's difficulties with social emotional reciprocity okay so let's talk about this for a second what does this mean so we have some C C of our brain that when

we socialize do some of this translating work for us okay so if we look at the body and the Brain we have certain functions so let's use something really simple like temperature regulation so when we're hot we have this system in our body that automatically activates looks at the circumstance detects the temperature right so we have temperature receptors on the back of our neck for example and so detects the temperature and says okay our temperature is too high therefore we're going to sweat so results in increased peripheral blood flow the capillaries near our skin start

to expand we have hot blood flowing through there and then we also start to sweat so when we sweat we put beads of water on our skin we extrude water and then water evaporates when water evaporates it cools right so the energy from the phase change of a liquid water to to a gas State requires the absorption of energy we have to boil water to get it to turn from a liquid into a gas now when we sweat where does that boiling energy come from it comes from our skin so literally like sweating is almost

boiling water off of our skin that like that's what sweating is so we reduce the temperature in our body by evaporating moisture off of our skin this is an example of a homeostatic process so one of the core features of autism spectrum disorder is we have this similar stimulus resp response homeostatic process when we interact with other people so I'll do things like I'll make eye contact and when I make eye contact when I look into someone's eyes I see the soul oh the eyes are the window to the soul what does that mean that

means that when you look into someone's eyes you get a lot of information about that purpose right we'll even say this a lot in in things like our our fiction literature and stuff like that someone Smiles but the smile doesn't reach their eyes can you'all tell the difference this is a smile that doesn't reach my eyes I'm not really smiling this looks like a Grimace right so we get a lot of information and then we get a lot of information about things like tone body language eye contact so the parts of our brain that interpret

this in information these are the social circuits of our brain the empathic circuits of our brain for whatever reason are not functional in the same way as a neurotypical person so people with Autism Spectrum Disorder have a lot of difficulty maintaining eye cont so since they have difficulty maintaining eye contact they no longer have access to other people's souls and when they don't have access to other people's Souls their ability to practice necromancy is severely hammered so when they lose access to other people's Souls it is very difficult for them to like get information about

what someone else is thinking or feeling so we see this in practical ways like I can talk about trains for 4 hours because I'm not receiving or processing the information that you were bored and that you don't enjoy this so we see the social emotional reciprocity has something to do with our empathic circuits we also see generally speaking some degree of impairment in something called theory of Mind in people on the autism spectrum so their capacity to step outside of their shoes and put themselves in the shoes of another person is difficult now this remember

it's a spectrum some people don't have a problem with this this is absolutely a skill that can be learned but on average if I take a neurotypical person and someone who's on the autism spectrum disorder uh on the ASD Spectrum what what is the difference there is some degree in like difficulty of like social emotional reciprocity so there's another key feature here let's go ahead and take notes okay so social emotional reciprocity means reading nonverbal cues okay this also means like very simple things like difficulty with eye contact which we'll get into so these are

this is an example of social norms difficulty with theory of mind okay and so this results in difficulty in Social relationships and practically what I see in my patients is like I I don't know if this kind of makes sense but they have they don't have access to certain information and so the way that I kind of view like autism spectrum disorder when I'm sitting with a patient like hopefully this is not offensive this is you know something that we've discussed before with patients of mine I kind of view like autism spectrum disorder as doing

like New Game Plus or like some kind of weird like adaptation to the regular way that you play the game so like for example you know I've played like Final Fantasy games where they do something like a level one challenge so there's no leveling up right so the way that the game is normally played is like you level things up and then as you level up like the game gets easier and then like life is like you're you're better suited to play life right so you have more challenging situations we've got some friends in high

school then we've got boyfriends and girlfriends and then we we're going to get married and then we have kids and then we have in-laws and we have work relationships so if we look at like we level up in life now the challenge with people on the spectrum is that the way that their brains are wired like there's some dimensions of life that they do not easily have access to right so now we're doing a level one Challenge and now this is kind of where we also get to the treatment philosophy which is like okay this

is the way that you are you can still win the game it's just that the solutions that work for normal people may not work for you so we have to understand what are your strengths what are your uh weaknesses what are you good at what do you need to improve on what do you need to adapt to and that's the way that we live the game and play the game okay and social emotional reciprocity is kind of at the top of the list um so there's another like really great example of a couple of these

things so we're talking about um social norms so there's another like really interesting uh a couple of other concrete things so let's talk about social norms for a second so one really interesting kind of diagnostic feature of like there's a simple diagnostic test that you can do now remember that this is patchy okay so this isn't doesn't apply to everyone but you know when I was learning about autism one of the things that I learned is that when a human being points okay so let's say I point I'm pointing so it is it requires some

degree of theory of mind to infer that when I'm pointing I I don't want you to look at this I want you to look at the thing that I'm pointing at and so one of the really interesting like you know simple questions that you can ask to assess the severity of autism spectrum is you can ask parents when you point does your child know what you're looking at and I think this is a really great example not not to try to shame anyone or make people feel stupid it's just I I I hope youall understand

this that see our brain has certain ways of like translating information and if you're on the Spectrum depending on to what degree you're on the Spectrum you don't have access to those things and for those of youall that are neurotypical I want yall to try to imagine and and this is really why I kind of included this example I want you to imagine how difficult your life would be if you could not understand something simple as pointing right we take so much when we're neurotypical we take so much for granted about our ability to move

through the world and these things like when you point at something like do people know what you're pointing at like can they tell whereas if you don't even understand that level of like non-verbal communication it makes things incredibly difficult so for me like when I learned this and I kind of like when it sank into my mind it helped me develop a lot of compassion for my patients with autism I started to really understand like holy crap I'm taking so much for granted about my ability to relate to other people okay um so then there

are a couple of other features of this okay so another one is uh speaking in a concrete way so often times people on the Spectrum will speak very concretely so things like flirtation or innuendo or even to a certain degree humor these things can be very challenging right so like it's like hey like you can call me sometime if you want you know sometimes when I I work with people who are on the Spectrum like they have a lot of difficulty in dating because someone will say like you can call me sometime if you want

to and then they get confused they're like okay when is sometime is now sometime so then what they'll do is they'll like call in like five minutes later and say they said hey you could you said I could call sometime and this is sometime therefore I calling you now right so there's a lot of stuff about developing and maintaining relationships because if we look at the science of relationships like relationships are not developed in a concrete way okay they're not like um you know we don't there isn't actually like a script like we'll have all

kinds of people on the internet who will tell us like here's a script like here's what you should do on a first date here's what you don't do on a first date and this is a really common feature of of the patients that I work with is that when they look at socialization it becomes a process of demystifying the scripts of social interaction so normally like we have an intuitive sense of when is something is okay or not okay but we have to understand this when I have an intuitive sense of oh that joke went

too far like I kind of went too far with that joke if we really think about it what's going on we have sensory input that is coming in through my eyes my ears maybe even my nose and then I'm like looking at all like everyone's reaction I'm seeing that everyone's like ha yeah right when I see something like that there's a lot of like Rich verbal uh uh there's a lot of Rich verbal tone there's a lot of Rich facial expression people are kind of laughing but I see the eye roll I can't do that

unless I'm looking at them right so that requires eye contact so there's a lot of Rich information and so in the absence of that rich information what people on the Spectrum tend to do is they're like I don't have access to that so what they do is they develop very complicated like scripts about social interaction this is this is how they they manage to function right they learn like okay when someone says thank you you say you're welcome like we train all children to say that hopefully but then that's some some some stuff that we

teach children but then the majority of children like learn most of it on their own like they learn some degree of reciprocity they learn some degree of like sometimes I should win and sometimes I should lose they learn some degree of this if this kid invites me to play I should invite them but with people on the autism spectrum what I've noticed is that every one of these is basically like a class that you have to take and none of it is automatic or not none but less of it is automatic so learning social interactions

becomes scripted there just very common and this runs into runs into problems because sometimes things deviate from the script right so a simple example is if we look at something like flirting like sometimes flirting is like requires someone to be insulting right so it's like oh hey you know can I call you sometime you you think I would go out with you you would be so lucky and then like people like why did they call like I don't understand okay like and then they give you their number right they you'd be so lucky you if

you call like I may answer so here they are like insulting you on the one hand but if you pay attention to their body language if you pay attention to their facial expression there's some degree of ambiguity and a big part of flirting is actually ambiguity right so it's kind of like this is why we use things like inuendo right so um I can't think of something in the moment but like when we when we flirt right they're like oh hey uh do you want to do you want me to take your car to the

car wash and then someone's like yeah you can absolutely take my car to the car wash anytime you want right that's like what the hell does I don't even know what that means but that's what flirting is like there's a lot of innuendo there's a lot of non-verbal cues there's a lot of eye contact facial expressions and so these kinds of things become incredibly challenging and so then what happens is people on the Spectrum will usually learn some kind of script right so this is how you ask people out I got to go to the

gym I got to make $100,000 I got to grow to 6 feet tall and once I do this I will ask people out and then they will say yes so they they they're almost very data focused is kind of the way that I think about it when I work with people okay um so there are a couple of other like important things here so let me okay so another important feature is that we also know objectively that this is also difficult because people on the autism spectrum literally experience more anxiety and uncertainty so if we

look at like their physiological level of stress their physiological level of stress is like objectively higher in social situations right so this has been studied in things like fmri studies and stuff like that the intensity of emotion that they experience is actually higher um which is also why like people who are neurotypical like don't understand this like they don't get it uh I'll give youall like a well we'll talk about that a little bit but they don't understand that like okay when I go to the gym like it's a little bit anxiety-provoking but it's not

that bad you just need to go bro like you just need to go they don't understand that like for some people on the autism spectrum going to the gym is like very very uncomfortable that it's the way that I kind of describe it is like nails on the chalkboard like it's like way more there's like an annoying sound and there's like nails on the chalkboard which is like very very painful to listen to and that's the experience of some of these people on on the Spectrum so this is what I was going to talk about

later but we'll just jump into it now so I'll give you all an example of something called arfid I forget what it stands for uh restrictive feeding something let's find out let me look real quick um what is arfid can't believe I blanked avoidant restrictive food intake disorder okay so we have arfid so like this is something a lot of parents don't understand about kids with autism so remember that their brains are different so what's another dimension that the brain can be different so when we eat something okay there's like textures and we find some

textures to be unpleasant and some textures to be pleasant so the challenge is in some people who have autism or something like arfid which is avoidant restrictive food intake disorder their experience of eating things is much more painful than our experience of eating things so a neurotypical brain like really simple example like things like green onions or cilantro so often times when we eat food We'll add a garnish right and the garnish adds a variety of texture and a variety of flavor but for some people who are on the spectrum that that garnish feels like

nails on the chalkboard it's like okay I'm going to turn on music but then what I'm going to do is add some Nails on the chalkboard on top and you're like I hate this so one of the really sad things that I see a lot with kids on the Spectrum especially if their parents don't uh aren't aware is like the parents will punish the kid a lot for like not eating food they'll be like you have to eat this you have to eat this like I don't understand why you want pasta and chicken nuggets and

macaroni like that's the only things that you'll eat like you need to learn that how to eat your vegetables and even then people on the Spectrum can eat vegetables it's just we take for granted that okay when I steamed some broccoli and I had sesame oil and sesame seeds on top I'm adding a little bit of crunch when I add fake to Rice like I'm adding Crunch and texture and all these kinds of things that this is a very unpleasant it's a neurologically unpleasant experience this is not being a picky eater this is very important

to understand this is what we're learning is that literally like the the sensory receptors in your mouth and in your tongue transmit signals to your brain and your the signals in your brain get interpreted in a certain way so the best example that I have is if you all have ever had eggs that have a piece of shell in them think about how that piece of shell ruins the eggs like you can have a tiny bit a piece of shell [ __ ] ruins your eggs right you're like GH it's got shell in it and

now if you're autistic this is what the rest of the world does to you they're like hey take this omelette we're gonna crunch up this shell and we're gonna [ __ ] sprinkle it on top and then like you force this kid to eat and the kid is like this is disgusting like I can't eat this they start vomiting the parents get angry this is like a day in the life of someone with autism spectrum disorder it's like we're going to take the way that you want to live life and we're going to just sprinkle

some shittiness on top of it oh you want to have relationships we're going to sprinkle some difficulty on top you want to eat this food we're going to sprinkle something nasty on top that's the best way I can describe it right and I've worked with these people for years years now and it's like it's crazy how challenging their lives are so if you're working with someone or or you know you have a relationship with someone or you have a brother or sister like you got to understand that these people are not trying to be difficult

they're not picky eaters they're not selfish I mean they can be all those things too but no more or less than the rest of the population that their experience of life is fundamentally different from neurotypical peoples things are harder in a different way the things that we take for granted that we never imagine you're like I can't can just imagine if every meal that you eat someone is sprinkling some amount of broken glass or broken shell or like oh look let's like scoop up some hair let's take this cat's hair ball and toss it on

top of your steak right like this is what their experience of life is like that like something is just we're going to add some crappiness on top and this is why they love chicken nuggets and and macaroni and cheese it's because something about the way that their their sensory receptors they're taste but not even taste I think it's often times due to texture that's really what we see in arfid is like the textures really bother them and so this is It's just challenging okay I know we're talking about social emotional difficulties but you know so

that's a side note we jumped ahead a bit okay does that make sense um like eggshells on top of eggs okay now um so let's go back to developing relationships for a second this goes down okay so there's um this is commonly what I see in my patients so since they have difficulties with these things like eye contact and tone and stuff like that uh they often times get labeled as creepy okay sometimes um they're labeled as aggressive okay um sometimes they have difficulty with appropriate behavior um and sometimes uh they also will have like

a very one-sided friendship and I'll talk about what this means okay so let's go through these in order so why do people on the Spectrum frequently get blamed for being creepy or aggressive or inappropriate and then we'll talk about one-sided relationships okay so the first thing is like what makes someone creepy right so if we look at creepy creepy is not like a thing it like a thing that you do does not make you creepy it is not an action right so if I like if I grab someone's butt right so this could be creepy

Behavior or it could not be creepy Behavior so it's it's kind of like like it's not the action that's creepy it's the circumstances the relationship the tone that's creepy so I'll tell you all the story about one time that I grabbed my wife's butt and what I what I did is I well I slipped an ice cube down the crack of her pant in the back of her pants and kind of like grabbing her butt and the reason I did that is I was visiting her family's house right so like we were like early on

in our relationship and so you know her mom was in the kitchen that we were all in the kitchen we're making dinner together and then I take a a cube of ice and I slip it down the back of her pants and then she jumps and then it's kind of like this sort of thing where it's like is she really like I'm there because she wants to introduce me to her parents right she's like oh like you know we didn't say it at the time because as Indians you're not allowed to tell your parents you're

dating but like she's like okay so like she wants me to make a good oppression I'm making a great impression I'm like oh Auntie G hello right and I slipped this Cube because now I've like I've trapped her because she's like hey [ __ ] don't do that then it makes me look bad in front of her parents which defeats the purpose then her parents are going to be against the relationships it's kind of like a troll right so if you kind of look at that like slipping an ice cube down the back of someone's

pants is like generally speaking not a good idea like if I'm at school and I slip you know a cube of ice down someone's pants if there's a girl that I don't know or a guy that maybe dudes it's a little bit different case in point right so it's all about context so what happens is if you're learning socialization as a script you're learning like what the sequences are you're not aware of the context because here's the problem with like dating advice from neurotypical people to autistic people is us neurotypical people we assume so much

we take so much for granted that we don't even include it as part of the script right so for example like if I'm it's almost like socialization with people on the Spectrum and I know this sounds insulting it's really not my intention to be insulting it's my intention to really sh care for people who are not on the Spectrum how difficult it is so it's kind of like doing tech support for Boomers it's like if you're doing tech support for Boomers and I know it's like not a very flattering thing but it's like I If

you doing tech support for Boomers it's like you know you don't okay how do I get this program to run well you double click the icon and it's like wait where you need to start is is the computer on is your monitor plugged in we need to there are certain things that we just assume when you are techsavvy and the challenge with autism is that something about their brain makes it very difficult for them to figure this stuff out on their own because the way that they interpret information the way that they access information they

just don't have access to some of it or they have to work way harder to get it and so then we give people advice they're like oh yeah so if you're like into a girl you should slap her on the ass or if you're into a guy you should slap him on the ass and they're like okay I'm going to execute the script and then they run into trouble because they don't have the context that is necessary and then this is what's incredibly traumatic about it like I'm convinced that growing up with autism depending on

whether it's treated or untreated is almost certainly traumatic in some way and like the challenge is like now you've been burn now you get a reputation as a creep and like people no one gives you like the benefit of the doubt no one's like hey this kid doesn't understand socialization in the same way that Boomers don't understand technology we need to be more patient with them we need to be more compassionate I'm not saying that they're incapable or that they're stupid or anything like that it's just they have an uphill battle to climb that's been

my clinical experience of working with people on the on the Spectrum it's an uphill battle in some Dimensions okay so if we look at creepiness creepiness is all about context it's all about tone it's all about appropriateness and so when I work with people on the Spectrum what they'll usually do is they're looking for script so they're like how many after how many dates is it okay to slap someone on the ass and it's kind of like well there's no there's no like it could be one it could be four it could be eight it

could be never depending on the person so you can't learn a script right A lot of it has to be intuitive similarly this can also be viewed as aggressive so I I you know my patients get punished a lot because they're just reciprocating it's like okay this guy like threw a water balloon at me at work so the way that things happen is when someone does something to you you do it back to them so like they threw one water balloon and also there's a certain amount of escalation so I'm going to throw 18 at

them right and they get labeled as aggressive uh sometimes they also have difficulty with appropriate behavior and there like studies about this okay so this isn't just me saying like oh my god like people with Autism are incapable this is like there studies we we've been able to detect this if you talk to people on the autism spectrum and you ask them what do you get in trouble for people will say well you're doing this inappropriately and this has been so heartbreaking when I work with people who are like asking people out like romance is

a really good example where like this is inappropriate and the crazy thing and they're not wrong where like sometimes they'll be like I'm confused because other people do it and they don't get labeled as inappropriate like you know I asked this girl out at work and she said it's inappropriate to ask out a coworker but like my cubicle mate just asked this other person out and they're dating so that wasn't inappropriate and this is inappropriate I'm really confused why which is their experience the other thing is that often times the relationships that they develop can

be quite one-sided so what this means is that sometimes you'll have people and and I know this sounds once again like kind of offensive but you know this is the there studies about this stuff it's not my intention it's just let's call it what it is so sometimes you'll have one-sided relationships where like there isn't reciprocity so sometimes people on the Spectrum are very likely to get taken advantage of in relationships because they don't even realize when they're being taken advantage of or they do realize when they're being taken advantage of but they don't quite

understand what's going on so they feel the negative emotions of Shame they feel the negative emotions of self-esteem they feel some degree of anger but they're not quite sure why um and sometimes what I'll do with these people is like work with them to really like work through okay why are you feeling this way this actually is not appropriate what your friend is doing right and it'll be something once again script oriented where they're like friends make sacrifices for friends since I am a friend I'm going to make sacrifices and then people will expect them

to make sacrifices over and over and over again and they have difficulty Bridging the Gap from like there's reciprocity that's that's what's really difficult for them okay um and then sometimes we also see like there's actually literature about like being taken in by a group of friends so this is also it it's kind of like nice in some ways but it's also like challenging in some ways where often times you'll have one person who's on the Spectrum who is friends with other people who are neurotypical which is fantastic I had that in med school right

so we had a friend who happened to be on the autism spectrum fair enough like we were all Gamers like that's what bound us and so sometimes you can kind of get like patients of mine have described it as being taken in okay now I I don't like the implication of that right it implies like orphanage and stuff like that but we do see that so we'll see like these relationships that aren't fully reciprocal not necessarily negative so these are just things that to be aware of these are what the relationships can look like we're

not saying that they're good or bad or right or wrong or whatever you as an individual have to decide whether you're happy with this or unhappy with this and whether you want to change it or not change it right so we're not trying to imply or I'm not trying to imply a value judgment this is just my experience as a clinician of working with these people okay so that's all of the social stuff okay let's move on so the second domain so this is domain number one actually I guess you could say that's domain number

one so domain number two is um developing maintaining oh sorry we already did that okay restricted behaviors interests and activities as well as repetitive behaviors or activities okay so this can be like basically people on the Spectrum will sometimes have a very restricted or repetitive approach to like interests or activities so on like the you know less harmful end it can be things like obsession with trains or some other object right I'm super into this stuff I love baseball cards I love Pokemon cards so like there isn't if you look at like the average neurotypical

person versus the average autistic person the average autistic person may have fewer interests that are like more intense and the interesting thing is that you know there there are studies on people who are called autistic savants so these are people who are like incredibly gifted because they're so hyperfocused and by the way uh we'll get to this a little bit later but autism spectrum in some ways has a correlation with IQ but in some ways doesn't so the a great example of this is the the guy who I don't know if yall remember this but

in the United States in 20072 2008 there was a problem called a subprime mortgage crisis so basically what would happen is Banks would give out loans to people who really couldn't afford loans and then the banks did something really interesting so if I loan like a million dollar okay to someone really can't afford a million doll house and then I do it four more times right so if you look at this and like this person doesn't make enough money then what the bank does now I'm out a million dollars right and so what I what

what the banks would do is they're trying to sell that loan because over the lifespan of the loan this may be worth I don't know 1.3 right so it's worth 1.3 over the like assuming the person pays it back so normally what would happen is they would sell this for maybe like 1.1 and then they'd get this money and they'd give out another loan they'd sell this they'd give out more they'd give out more but in order to sell these individual loans like someone would have to look at this look at their credit and say

okay like I'll accept that debt because this person will pay it back okay then what happened so they started doing something they started bundling these loans so they started almost turning it into like a sausage so we're going to take all these little bits of meat and we're going to grind them up into something tasty and now I'm going to sell you a $5,900 th000 loan and all the risk is hidden so then the bank got $ 5, 900,000 which means that they gave out six more loans and they repeated this process over and over

and over again until there were a bunch of loans out there that people could not pay back and the way that they like it was this was disguised because we're bundling them together so the first person to figure this out was actually someone on the Spectrum okay so this is something that if you guys have read um who's that uh who's the guy who wrote The Big Short Michael Lewis so he talks about this in in his book right so the first person who figures it out this person like all of Wall Street is like

oh my God this there's so much money to be made so much money to made some guy who's a radiologist who then goes into finance and then like figures this out he's like hey this is a house of cards this is going to collapse so we know that people on the Spectrum have very very like often times they have very restricted interests but they can be like really really competent in those interests okay so we also have kind of less functional adaptations of that right so this is where like I'm not saying that every person

on the spectrum is a a savent by any means but let's just get rid of all this Dr K's random aside great book by the way and I've had patients who are similar so like when I work with people with Autism Spectrum a big part of it is figuring out okay if you love trains like what can we do with that right it's it's super cool it can be very rewarding because often times like people with Autism are like I need to change this about myself I don't necessarily agree it's for you to decide what

do you want to change and what do you want to leverage so this repetitive behavior that this is on the higher functioning side we also have on in autism the lower functioning side of this so we'll have things like flapping um or even echolalia which is repeating what other people say so when I work with people who are not non-verbal but they are verbal so they speak but they don't know how to have a conversation so if you say like how is allo doing today they'll say how is allo doing today so something about their

circuitry around verbalization is like functional in some way but they're not capable of a conversation so we can sometimes get echolalia we can get um things like flapping even the way that they use objects so patterned object use which often times gets mistaken for OCD um but 20% of people on the autism spectrum actually have OCD that complicates things so like this is the way that I'm going to make my coffee it has to be this way every single time we have to add it to the French press it needs to be in the French

price for 60 seconds then I'm going to you know push it down and it has to be like a a repetitive pattern of usage is is common um next thing is we talked about uh oh so then the the next thing is rituals or patterns of behavior we kind of talked about that right so the way that I make coffee or things like that are very very like fixed it has to be this way and if things are not that way then often times there is a what we would call from a neurotypical perspective a

disproportionate emotional response that can result in something like a temper tantrum or or something like that so we see restrictive and repetitive behaviors okay so things are very ritualized things are kind of more set in stone there's less General flexibility in the more severe cases we're seeing things like flapping and echolalia on the positive end we can see an obsession that can make you millions and millions of dollars and then there's also some of these features that look a little bit like OCD okay um okay the next thing that I'm going to talk about so

I don't know if this is actually a diagnostic criteria but this is something that I tend to focus a lot on is emotional regulation so we see this a lot in neurodiversity in general so whether you have ADHD or Autism Spectrum disorder um we'll sometimes see certain like brain challenges so one is emotional regulation so there's a tendency for things like temper tantrums we know that people on the spe Spectrum increase uh uh literally experience more anxiety and sometimes increased levels of stress so what does this mean how can you experience more anxiety we talked

about this a little bit but basically what happens is you can take any scenario like applying for a job or going on a date or you know whatever and if if you measure the average stress response as measured by cortisol cerebral blood flow to your amydala you can take whatever cortisol whatever measurement of stress that you want what we literally see is that people on the Spectrum and people who have ADHD will sometimes experience Amplified emotions so there's even a subtype of ADHD which has been hypothesized to be an emotional regulation subtype type so we

have attention deficit disorder we have attention deficit hyperactivity disorder so this is a subset so hyperactivity means that this person is up and moving around a lot so some kids with ADHD or add some kids have ADHD they move around a lot some kids don't have ADHD they have ADD their attention wanders a lot but they don't move there's a third subtype of emotional disregulation so what we know from working with people on autis the autism spectrum is that their emotional responses to things can be quite amb and this comes down to the neurocircuitry like

literally the the brain's capacity to regulate an emotional response is sometimes often times impaired so what does that mean practically that means that you get pissed faster so the onset of being angry increases the duration of how long you are angry increases and the intensity increases so practically what this looks like is if we have a situation okay of time and anger if our neurotypical person is like this someone on the Spectrum may be like that so the onset is faster it's actually higher and it lasts way longer than for a neurotypical person so often

times in treatment of of kids on the autism spectrum disorder a big part of treatment for parents is managing things like temper tantrums and stuff like that okay because this happens they just experience emotions more intensely more rapidly and for longer periods of time all right this probably has to do with some degree of something called executive function disorder maybe not executive function that's some kind of frontal lobe deficit is a better way to put it so we have the frontal lobes or the part of our brains that inhibit and regulate other parts of our

brains some of those are sometimes that circuitry is a little bit the connections are a little bit weaker okay all right so these are kind of the the overall features of autism spectrum disorder now when you take these core features remember this is derived from a clinical perspective right so this is like looking at things like the DSM where when we're so this kind of assumes that people have impaired function so when we're talking about impairment to function and more severe cases of autism what are the kinds that we kinds of things that we see

the other really interesting thing is we'll get to is that some of these core features result in a different phenotype so remember that a phenotype is like the presentation the genotype is like where you start and the phenotype is what it looks like so we'll get to things like masking and stuff like that but like we'll talk a lot about masking but if we look at masking like why do we mask in the first place so we mask because do some of this other stuff so I don't understand social behavior I have a script I

have a lot more emotion than is appropriate people tell me like why are you so upset this is not that big of a deal so what does the child with autism learn how to do they learn how to hide their upsetness so these are the roots that emerge as things like masking behaviors and all kinds of other more subjective challenges that people experience okay um so let's talk about comorbidities for a second okay so this is wild first is 70% of people have at least one other diagnosis 40% of people have two other diagnoses these

are mental health diagnoses okay to something like depression anxiety So reading leading the top of the list 30 to 40% have a mood disorder the more realistic numbers are closer to 30 but in my clinical experience I would say closer to 40 um about 30% of people have an anxiety disorder literature says maybe about 25% I think it's a little bit higher about 20% of people have OCD okay and then here's what's really crazy so it's not just these other diagnoses there are a lot of other challenges like we see an increase in suicidality when

you're on the Spectrum we see an increase in gender dysphoria so this is not a diagnosis but these are certain features okay so I'm going to show youall just a quick paper um okay let me just show youall a couple of papers okay so this is what's like kind of wild so first suicidal suicid suicidality and autistic youth a systematic review and meta analysis um so the final selection included 47 papers pulled suicidal ideation was 25% suicide attempts were 8% this is incredibly High suicide deaths were 2% okay so what this means is that like

this is nuts dude one out of four people on the autism spectrum disorder is suicidal almost one out of 10 people on autism spectrum disorder try to kill themselves like that's nuts thankfully the number of people who are successful is quite low right so that's good right but this is this is like this is super scary it gets even worse the combination of autism and exceptional cogn cognitive ability is associated with suicidal ideation so this is what's really crazy if you're on the autism spectrum not only is your life objectively hard you are more likely

to be suicidal you are more likely to try to take your life now here's what I see and then the crazy thing is that see a lot of times we view intelligence as a protective Factor we think oh being like high IQ is really is just good right the higher IQ the better it is but if you look at this is really interesting if you look at income okay the top 10% of earners in the world have a higher IQ than the top 1% in some ways intelligence can actually be a disadvantage and I see

this a lot in the people that I work with I think in my practice I tend to see more higher functioning people on the Spectrum and basically what happens is that you know they have this experience of life where they recognize these difficulties they're smart enough to understand like this is challenging for me and it is not challenging for other people then they're they're smart they're very self-aware they're like good people and they try to fix their problems right they'll do things like okay like I like I recognize that I have these difficulties in social

emotional reciprocity so I'm going to work on that I'm going to go see a dating coach I'm going to go see a therapist I'm going to learn how to meditate they're very very Solutions focused and they work incredibly hard and then what happens is they go on a date and then like you know they've worked they put in all of this effort and then you know their date orders whatever and then they order mac and cheese with no breadcrumbs on top just plain mac and cheese and then their date kind of looks at them and

like what are you like a four-year-old and then they get judged and so this is their experience they look at their situation and they look at it and then they like calculate out they'll make a calculation that like okay like I've done everything that I can do it feels hopeless this then gets combined with remember their higher level of emotional disturbance right so they experience some negative emotions more intensely experience a greater degree of stress and then that results in suicidality like when I work with these people like basically what it is is a relatively

accurate in some ways view of their life and how hopeless their life is because remember the other challenge with autism spectrum disorder is that they're very concrete thinkers so their capacity to even step outside of their mind is very difficult so it's almost like this like uh you know Perfect Storm of first of first of all I'm smart second of all I work really hard third of all I've I have these traumatic experiences fourth I make a prediction about the future that is not good now in a neurotypical brain we have things that protect us

about from a hopeless future one of those things is an improved theory of mind so when someone comes to me and says hey actually your life is okay and you know I love you and I care about you and you'll be okay and I had difficulty when someone offers us this empathic support we are able to step outside of our mind we're able to connect with them in some way we're able to offload our negative emotions so we have that protective capability very difficult if you're on the Spectrum second thing is the level of emotion

that we feel is very very negative right so it's very intense so whereas after a breakup I may feel like 7.5 out of 10 hopeless someone on this autism spectrum is statistically more likely to feel closer to an eight or a N9 or maybe even an 11 so they experience more negative emotion have difficulty with theory of mind so they can't be reassured by other people on an empathic level right so like that empathy what does that mean it's not about logic it's about feeling loved so when someone tells me all this kind of crap

even if logically I don't believe it I still receive their caring emotionally I feel loved I feel cared for I feel valued that is difficult for people on the Spectrum and then the the third thing that's very difficult is concrete thinking so once they arrive at a particular kind of conclusion it is very hard to logically like move them away from that or it is very hard often times the way that we move people away from a logical conclusion is on a more abstract level of thinking look at the big picture you'll get better at

this over time but then the person on the spectrum is like what is that like I don't understand I've already tried to get I tried to get better at it time number one time number two time number three time number four time number five time number six I already tried this what do you mean it's going to get better over time I did this it didn't work it's not working there a very very concrete level of thinking very rigid level of thinking so this is what results in suicidality like this is like a just a

I hope I mean for me this is what helped me understand like this was like a really good example of like why things are difficult it's not just because you have the normal experience of life it's that you have the normal experience of life with these other kinds of challenges piled on top which makes it way harder and so this is the other General thing so we didn't talk about trauma but you know I think like 70 80% of people on the autism spectrum have some kind of major trauma and it's not like that people

were abusive to them or something like that necessarily it's like there's the chances of the normal level of trauma number one right so there's everyone has some chance of trauma then there is the parental frustration of having a child who is not neurotypical immense it's sad but the number of patients that I've had when I like really like you know when they trust me I'll ask them you know if you knew your child was going to be autistic would you have had your child and like it's shocking how many of them say no if I

had known I would have never done this like it's super sad to hear but it's so hard it's so challenging often times and those are the parents that are insightful those are the parents are usually the good parents the worst case scenarios that I've seen are parents who don't even understand that their child is autistic and they're like I'm going to break this child so that they listen really nasty you don't like crushed eggshells on your omelet I'm going to put crushed eggshells in your Coke I'm going to put it in your water I'm going

to put it on your rice I'm going to sprinkle it on top of your chicken nuggets I'm going to sprinkle it on top of your Mac and Cheese we are going to fix this in you we are not going to tolerate this kind of behavior they don't understand that the signals that their child is receiving in their brain are very different from the signals that that we receive this combined with some of the emotional activation they think their child is stubborn they think their child needs to be taught a lesson and so there's a lot

of punitive impact and the parent doesn't understand the kid doesn't understand the kid is [ __ ] traumatized so traumatized and then what the kid does so this is important to understand right so when we experience trauma we adapt and this is where masking comes in so we'll talk about that in a second now question becomes okay where does autism come from give me a second chat okay so let's just check in for a second how are yall um uh how are you all doing with this we okay like what is this okay this one

we don't need um H give me a second this [Music] treatment this one we don't want this one we don't want okay good enough okay how are we doing overall chat are yall like is this good useful like you guys want more detail less detail stick more with the script stick less with the script y'all like the we good okay okay right so we're going to like I'm going to try to like not go too far off with examples but also like I think it's important to illustrate to people like what the experience is actually

like so we're going to we're going to kind of stick with the script and then I'll I'll toss in tangents here or there like I'm already doing okay all right let's keep going so where does autism come from what a great question the answer is we don't really know but chances are kind of everywhere so we know that there are genetic and environment Al factors to autism um this is a great paper uh on autism spectrum disorder um so like here's a like we can look at like you know risk factors so Neo so one

of the reasons that I do think that so one of the strong Arguments for autism spectrum disorder being a disorder as opposed to a normal variant is if we look at something like neonatal hypoxia so you know if your brain is deprived of oxygen when you are in the womb you have what looks like an Eightfold a higher than eight-fold risk a 10-fold increased risk of autism and when we're depriving something like that that makes me think malfunction okay there are all kinds of other things like if you add you know valproic acid during pregnancy

higher maternal age one of the really interesting risk factors is paternal age is one of the largest risk factors for autism spectrum disorder um uh so folic acid intake is protective right so here here's like the strong stuff so we know that like factors during pregnancy are really important um update on the atypicalities of the central nervous system and autism spectrum disorder we're going to scroll down here right so like now we're even like looking at really detailed level stuff so if you study the brains of people who are on the autism spectrum disorder you'll

see smaller bilateral amigdalar volume right we'll see like increased cere cerebral volume in ASD um compared to developmental delay like like changes in the hippocampus in the amydala these are all like emotional circuits um but then there's also an element of uh let me find inflammation so there's also like other kinds of things like so the gut microbiome seems to be very very important for autism spectrum disorder okay we'll talk talk about these in a little bit more detail but kind of the the first point to understand is that like what causes autism well kind

of all kinds of stuff so what do we know as the deficits so let's start with some of the basics so the first is gene mutations genetics so as we saw earlier um no this one right so having an older sibling with autism spectrum disorder increases the risk of autism by like 16 fold right that's kind of that's like that's a lot so there is absolutely a genetic component and what we're going to do is look at these in order of like what you can do about it so there's not really much you can do

about your genetics then we also know the intrauterine environment is very important so we also know it's not just like things like hypo oia but we also know that some infections in pregnancy are associated with autism or increase the risk of autism right and I think this is all evidence that suggests that this is more of a pathology than a variant it's probably both are true um then we've also seen evidence of things like uh mitochondrial dysfunction so what does this mean so remember that the mitochondria is the PowerHouse of the cell so if our

cell if our cells have a fundamental difficulty generating energy it's going to be kind of like this Global debuff so we've seen evidence that mitochondria can be involved in that um and then we're going to get to a couple of other things so we're going to talk about gut brain so we also know that in so when we're dealing with things like the brain we know know that there are things like neurotransmitters and neurotransmitters are important things like serotonin oh 5ht right that's serotonin we have dopamine um Gaba dysfunction has been implicated so we're gonna

I'm going to kind of like get technical here for a hot second okay because this will become important so let's talk about gut microbiome neurotransmitters and autism so when I was in residency there was an Autism spec expert at this PL place called mlan hospital so mlan hospital is one of the best psychiatric hospitals in the country arguably the world it's super cool because it's a freestanding psychiatric hospital so most hospitals you know they have like departments like there's the Cardiology division there's the Orthopedics division there's the Pediatrics division there's the Psychiatry division but mlan

is one of these hospitals where all they do is Psychiatry so their divisions are like we've got autism we've got bipolar disorder we've got addictions we've got all of the subp Specialties of Psychiatry and so I was talking to this person and I was like okay what are the treatments for autism spectrum disorder and she was even telling me that she does a lot of like gut brain kind of stuff and a lot of like supplementation with things like iron so even in low functioning autism spectrum disorder things like iron supplementation according to her reduces

things like temper tantrums so like how does this stuff work like what the hell is going on what's up with gut microbiome neurotransmitters iron supplementation so I'm going to try to just share with youall my understanding of this okay now some of this is most of this is extrapolated from the literature but there are tons of studies we'll show youall a couple that support what I'm saying but this kind of a clinician take okay so the first thing to understand is when we have microbes in our gut okay we we have microbes in our gut

so for every one cell in your body that is you for every one eukariotic cell that has your DNA we actually have 10 procaryotic cells or 10 bacterial cells so your cell your body actually houses 10 times as many bacteria is it houses your cells okay this is wild so what is the per what is a bacteria do in us so bacteria do a couple of things the first is that if bacteria have an unhealthy relationship ship with us this results in inflammation anytime there is inflammation our brain gets more messed up our body gets

more messed up so gut microbiome and autism is very important from a very simple way it's because of the cellular the inflammation that is triggered by the inappropriate gut bacteria now why do we have inappropriate gut bacteria because we eat chicken nuggets and mac and cheese very common so this is something to understand not all bacteria can d digest the same things so the gut bacteria that we will have in our body depend on what we eat so if you eat a lot of high fiber foods the bacteria that can break down complex fibers will

grow because we're feeding them if we eat a lot of simple carbohydrates highly processed foods and what do we mean by process this means that literally the chemical composition has been broken down ahead of time it has been processed so if it has been processed into simple sugars and simple carbohydrates another kind of bacteria will grow because they could they don't need that I don't need the complex I don't need the enzymes to break down complex carbohydrates I get the stuff that's already broken down okay this is why when we look at things like you

know electrolyte replacement and IV nutrition we break everything down it's highly processed so that your bacteria doesn't have to do any work your body doesn't have to do any digestive work so then what we have is we have a food preference that correlates with a certain kind of food now here's the problem see the bacteria in our gut that we think are friendly are the ones that we have evolved with we'll talk about why we've evolved with them but and so if we kind of think about it the gut bacteria that we view as friendly

are the ones that have lived there for a long time right we're like neighbors we've been neighbors for millions of years so when our immune system sees those bacteria they're like hey these people have been living here for millions of years this is not an infection this is not a new bacteria we know this guy and literally what activates our immune system is proteins on the surface of the cell of bacteria so if there are proteins that have been our immune system is like oh yeah these bacteria have been here for a long time we

recognize these proteins no reason this is not an enemy this is not an outsider this is a friendly friendly bacteria fine now what's happened is as our diet has changed new bacteria have entered because we haven't had Twinkies dino nuggets or mac and cheese for most of the history of humanity so those bacteria don't exist in our gut the ones that eat those as we start adding these processed foods to our diet we get a new set of bacteria these new set of bacteria are foreign our immune system is like no no no no this

is bad therefore it activates and we know that autism spectrum is associated with neuroinflammation let me try to find the paper right so this is a good one I'm going to show you all this um hold on this one here we go okay so let's take a quick look at a few papers first one maternal gut bacteria Drive intestinal inflammation and Offspring with neurodevelopmental disorders by altering the chromatin landscape of CD4 plus cells I'll translate this for youall so here is healthy pregnancy normal gut bacteria pregnant Offspring CD4 cells that are normal be have normal

behavior inflammation during pregnancy gut disbiosis you see these are the unfriendly bacteria over here activate this looks like a kidney il7 and then The Offspring has behavioral abnormalities and altered CD4 plus accessibility okay so there's one study so what this basically means CD4 plus cells have a bunch of genes CD4 plus cells are immune cells and when there is gut disbiosis and inflammation during pregnancy our immune cells get turned on in a different way and their activity changes and when their activity changes during development there is in inflammation right so it's like I'm building a

house but a hurricane goes through so now the house that I built hasn't been stabilized yet so the hurricane sweeps through and it messes up the way that the house is built then we try to patch things together and so the foundation of the house has cracked beams on the inside so it's not stable so this is one of the things that has been uh implicated and now we've even figured out the mechanism the me mechanism one of the mechanisms is alteration of the activity of the genes of our immune system multi-level analysis of gut

brain axis shows autism spectrum disorder Associated molecular and microbial profiles right so um so carbohydrate and lipid profiles predominantly encoded by microbial species in the Genera preva bifidobacterium dulfo vibrio and bacteroides right so and correlates with brain gene expression changes restrictive dietary patterns and pro-inflammatory cyto profiles okay so what does this mean this means that we figured out that these four bacteria are part of the culprits okay and then neuroinflammation and autism spectrum disorders exercise as a pharmacological tool right and so what this means this is saying okay there's neuroinflammation neuroinflammation makes autism worse if

we reduce neuroinflammation via exercise which reduces inflammation this seems to help okay um so your mileage may vary so we're not sure if any of this crap works we're not sure we're going to talk about what I think works in a second so the key thing to understand is the gut bacteria in this inflammatory profile makes autism worse now let's understand how so remember that when we're inflamed our neurons are jittery they're more likely to activate and so what this means is that this stuff like this emotional disregulation remember the emotional disregulation is don't remember

this so emotional disregulation makes this process worse so when we have sorry uh uh inflammation makes the emotional disregulation process worse so when we're inflamed when our brain is inflamed we are more likely to feel anxious we're more likely to feel depressed so when you get the flu or if you get covid how do you feel mentally not good you become more irritable you become more depressed it's harder to do things your empathy goes down right your your your romantic your significant other comes home and they're like man I had a rough day today and

you're like I've got [ __ ] covid I ain't go got no time for you and if we kind of think about it like let's understand this how does that happen it's because our brain hasn't empathic circuits our our neurons have a higher level of inflammation when they have a higher level of inflammation they become jittery they activate very quickly so our amydala hyperactivates this results in neuroinflammation but gut bacteria also do something else they also do neurotransmitter production so you know our serotonin precursors are developed by the gut so that's that's why we're friends

like we have like this agreement with theut got bacteria in our body we're like I'm going to give you food I'm going to give you a place to stay in return I need you to be a factory for my neurotransmitters and the gut bacteria like got it bro this is our agreement now what happens when you start eating unhealthy food highly processed food is the gut bacteria that produce all of these things are not the ones that exist now you've got all these [ __ ] bad bacteria that have moved in and they're occupying your

gut and they're not they're they're lazy they're not doing their part so we also see in autism spectrum Gaba alterations in Gaba transmission just as one example so Gaba is a neurotransmitter that generally speaking activates chloride channels and hyperpolarizes the membrane of neurons now what the hell does that mean this means that it calms neurons down it makes it harder for neurons to activate so good examples of Gab energic substances are alcohol so alcohol kind of chills you out benzo diazines kind of chill you out they reduce anxiety alcohol is also an analytic in some

ways so we see alterations in Gaba transmission as an example so anytime I see alterations in Gaba transmission I would expect a hyperactivity if we're reducing the transmission I would expect a hyperactivity in the brain and that's what we see in autism spectrum disorder increased emotional disregulation so gut bacteria become quite important because they not only increase our inflammation they also do a lot of the work of like developing neurotransmitters now there is another problem when it comes to uh the gut in autism now this is less evidence-based this is more clinical so the other

thing that happens is when people get started when people get become Autistic or when they get diagnosed with autistic uh autism often times we'll start them on medication and a lot of this medication and the diet that they eat results in very small what I believe to be nutritional deficiencies and it's not just the diet it's also the medications so like when we when we have certain medications remember these are activating different channels all over our body and one of the things I'm I'm thinking about this expert in autism that I worked with at or

who taught me things at mlan you know she was sort of saying that she sees like nutritional supplementation is very very important at helping autism because there's all these ult nutritional deficiencies which we don't detect now the question becomes how can you have a nutritional deficiency that you don't detect and this is important to understand so when we measure your nutrient levels we're looking at the average population and we say that okay an iron level between like a hemoglobin between like 11 and 14 let's say is nor normal okay whatever the problem though is that

even if you have objectively a normal level compared to the rest of the population you don't have the same brain so the alterations in your neuroarchitecture the alterations in your receptor profiles some of these genetic modifications some of the way that your mitochondria work mean that even though you may have a lab value that is normal you have a functional deficiency because your cells maybe need a little bit more iron than average because we know like if we look at something like neonatal hypoxia this is going to be a whole brain effect so even there

are going to be signals that measure your iron levels that in some way may be related to your brain right we know this because we have things like heat chock proteins and all kinds of other like measurements like hematocrite levels and our body is sensitive to iron uh like you know fertin levels and things like that there's all kinds of like ways that we detect iron some of those uh mechanisms may be messed up too we don't know so it seems that a good diet which is challenging because of the arfid likee features some of

the medications probably create nutritional deficiencies or absorption problems and then some degree of inflammation some degree of our body needs different levels of neurotransmitters or iron or all kinds of stuff we don't know exactly what's going on so on a clinical perspective fixing this stuff is very important so in very severe cases of autism you know this person was saying that she's had patients who were like you know have to get hospitalized or in straight jackets and things like that and iron supplementation seems to help them a lot now practically what does this mean for

yall this means first of all don't give up hope second of all get help third of all if the help hasn't been helpful don't give up help go don't give up hope right so there's so much that we're learning about autism spectrum that who knows right maybe some degree of like nutrient supplementation or iron supplementation some degree of bacterial change this could reduce your gut inflammation could reduce the jitteriness of your neurons could reduce your neurotransmitter precursors and and then like you could get way better and that that's what I've seen clinically we'll get to

that later so why do we dive into the ideology we dive into the ideology because if we understand what's wrong then we know how to intervene okay so inflammation gut bacteria seem to be a big part of it um okay so someone saying you know a ketogenic diet can greatly reduce problems related to autism so I I don't know about the veracity of that but uh another uh you know teacher of mine um a guy named Chris Palmer he's also based at mlan so he's a big advocate of the ketogenic diet wrote a book about

it has been on like all these podcasts and stuff um Chris is fantastic really good researcher big believer in the ketogenic diet so this is why what we're kind of saying what I'm trying to show yall is that like you know if you're hopeless like I understand but there's a lot of stuff that we're still figuring out and I'm optimistic and I've seen good outcomes with people that I work with who are on the autism spectrum okay all right now let's talk uh differences in gender and autism and then we're going to get to masking

okay so let's do this now you could say okay Dr K like maybe you should have talked about this with the diagnostic features but I I don't know I just felt like including it here now I'm wondering if I should have moved it up but so um men or boys are diagnosed uh let's say about three to four times as often as women or girls okay now we have to understand this diagnosis just means catching it it doesn't mean that men or boys are three times as more likely to be d uh it doesn't mean

that they have the rates of autism are three to four times higher it just means that we're able to catch it three to four times higher now I don't know what the real number is I suspect that it is not 1: one so remember that we looked at paternal age so I suspect that autism has something to do with the Y chromosome that's my personal belief so I I would be very surprised if it was like actually one to one but we also know that men are more like boys are more likely to be diagnosed

because their manifestations of autism are different they're more likely to have in attention plus hyperactivity they are much more likely to be aggressive have anger issues or throw temper tantrums and they're much more likely to be oppositionally defined so if we look at what's driving the diagnosis a part of it is absolutely possible that men or boys are more likely to be autistic but their manifestations of a ISM are more observable and more disruptive so one of the challenges in mental health diagnosis is unless it's causing someone a headache chances are we're not going to

pick it up right so we we diagnose things the most not when the person is suffering but when we cause PE problems for people around us when you drive while intoxicated and you get a DUI that's what prompts addiction treatment right not like we don't half the people who are addicted to alcohol you'll never see because they don't cause problems they just drink at home all day they're functional alcoholics they hold down jobs like whatever it's when you cause problems for other people that we start slapping diagnoses on you now girls have a different presentation

of autism spectrum so they have way more internalizing symptoms what does this mean they're more likely to experience depression they're more likely to experience anxiety um they are also way better at masking which we're going to talk about in a second we're working our way up to masking and they are much more likely to be vulnerable to diagnostic overshadowing now what does that mean so let's understand this for a second so when you are on the Spectrum you can sometimes do things that cause other people problems right so you throw a temper tantrum you didn't

your backpack was not packed in the way that you wanted and suddenly you're having a meltdown and you're smashing your fists and the parents are fed up so they're like you need to see a psychiatrist right so boy gets diagnosed with autism now girls have more internalizing symptoms so they struggle a lot more internally right so they have difficulties with things like eye contact and stuff like that but they tend to shut down they tend to involute so when they get frustrated they don't like externalize their frustration their negative experience their internal experience gets compacted

they like pound all the negativity like inside of them so I know that we talk about men bottling up their emotions but I would say clinically like with the number one winner in my book for people who are good at B bottling up their emotions is autistic women there's so much negativity and it all gets internalized so then what happens is something called diagnostic overshadow so when these people present since they don't have some of the features of autism that are visible because they mask them girls are more likely to mask by the way what

ends up happening is they get diagnosed with things like depression or anxiety and we miss the autism diagnosis because they don't appear as autistic right so like girls are like it's more socially acceptable there are all kinds of things on the spectrum that are more socially accept ORS learn how to like socially adapt to them so you know I don't know how to say this but like I'm trying to figure out like I I don't want to be offensive but so like we have like certain like societal stereotypes so for example like you know an

old lady living in the woods or like a cat lady right like so we have these stereotypes of okay there are people out there that are like cat ladies and like that's like a normal variant of society there's nothing wrong with being a cat lady I'm just saying that this is not we don't look at a cat lady and say like oh this person is mentally ill but if like when I work with like literally my patients who are you know on the Spectrum who are women many of them have difficulty in romantic relationships right

just like anyone else on the Spectrum but for some reason like being a woman who's 38 being single and having four cats is like not a sign of a problem this is just like oh there are just some women who are like that right they're just the cat ladies and so we we these women are less disruptive they're often times incredibly accommodating right they're kind of like the outside friend where they like have a Social Circle where they get like invited to stuff often times these girls also become Gamers they hang out with like their

friends are online so there's like these internet you know like the the modern generation of like Millennial Gen X gen Z gen Alpha like girl gamer who's on spectrum is something we see a lot in our community and there there are um Studies by the way that show that online communication and video games are like helpful for people on the Spectrum so girls tend to mask their behaviors because if we think about it like we socially correct girls way harsher than we socially correct boys now that may trigger a bunch of dudes in the environment

but I'm not saying that we don't socially correct dudes or that your life can't be hard what I'm saying is that like you know girls are taught to be like prim and proper right like you have to be proper like you got to be accommodating you got to be nice like you can't be disruptive and so like we induce much more masking for girls this is a societal impact I haven't seen studies to this effect but I'm sure that they're out there so this is what what tends to happen in terms of gender now this

doesn't mean that boys don't mask as well is absolutely mask and maybe now we'll talk a little bit about masking okay but this is what we tend to see now I did a video or a lecture about two years ago about gender identity in in autism spectrum so I I'm I'm not going to repeat everything there because we have a whole lecture on it but we also know that the likelihood of being having gender dysphoria is about 10 times the normal if you on the Spectrum so not only is it like men and women but

there's a good chance that a large chunk of y'all are non-binary in some way and what's going on there so it turns out that our understanding of our gender identity has to do with there are two major components of it there's more than this but these are the two major components that I think are relevant in autism spectrum so the first is our sense of identity has in part to do with the way that other people treat us I feel like a boy because I'm one of the boys I feel like a girl because I'm

one of the girls the second thing is that our sense of gender identity has a lot to do with the emotional integration of our experiences so if yall are interested in this stuff highly recommend youall check out the trauma guide because we talk about this in a lot of detail there or if you guys want specifically the autism version that's I should be on YouTube somewhere but if yall want to understand identity in formation and the integration of emotional experiences into who you are that's in the trauma so what tends to happen is like there

are certain things like my emotional like what I feel makes me feel like a man right so like when I change a tire when I like when there's you know one day when I was 19 years old and I was I was on a date we were driving down the road and we got a flat tire and so then you know there's my date who's driving and then there's me and I'm like I will change the tire thank God the lug nuts weren't too tight and I was able to change the tire but I felt

like a man right these are the experiences that make you feel like a man so if you sort of think about it it's not just changing the tire it's the Panic of oh crap can I change this tire then being able to change the tire having this girl be impressed by me changing the tire and then it's like now I feel like a man right that's how it works so our sense of gender identity has a lot to do with the emotional experiences that we have and the social experiences that we have which are altered

when we're talking about autism spectrum so we see a high level of gender dysphoria gender identity 10x the normal population so about 10% of people maybe even more on the autism spectrum have some degree of gender identity fluctuation okay so that's the those are the gender differences now let's talk a little bit about I have a a quote that I want to share with y'all so now we're going to talk a little bit before we get into treatment we're going to talk a little bit about masking and then we're going to talk a little bit

about what it's like to be on the Spectrum I know it's like what have we been talking about so far give you so this is one I I don't I wish I had an attribution so I copied and pasted a quote this could be from a paper I think it's maybe from a paper maybe from the internet um yeah I can't find the source right now which is a real tragedy I'll try to find it so I'm going to just read yall something that I think really captures the experience of someone who's high functioning autism

probably my husband and I describe him as being at once the most capable and most disabled person we know he can be the starting pitcher on his little league team without incident participate and perform in a school sponsored musical all while not actually being capable of attending school he is currently not at school at all and he is being referred by our local district for an out out of placement evaluation his disregulation manifests in severe emotional outbursts both verbal and physical however again when regulated he is more rational kind and mature than his older neurotypical

brothers emotional disregulation is absolutely his chief obstacle to living a life and having the chance to enjoy his many talents and there are many so I think that this describes well many of the challenges that my patients face is that you are simultaneously capable and incapable right on a good day you can do anything that anyone else can do and you're fine with it it doesn't affect you at all and at the same time when things become disrupted when there's that emotional disregulation when you're put in a particular circumstance like a party or whatever then

you can't function the way that other people do and this is what makes it so damn difficult from a subjective experience because you know you're capable you know you can do it and you can't and then you start to hate the part of you that can't do it and you start to wish that you could be that person who can do it all the time there's a lot of self-hatred there's a lot of frustration sometimes we see this almost this overcompensation into leaning into neurod diversity there's almost this like rage filled no I'm normal right

but it's like it's not driven by positivity it's driven out of resentment I've seen that too and they get mad at anyone who calls them not normal which is like fair enough but also like where is that coming from is it coming from like a peace and acceptance of who you are what your challenges are or is it coming out of like resentment that 50% of the time you're awesome 50% of the time you can't live life the way that other people do and you're so angry with yourself and so then we get to masking

now there's a great um questionnaire about masking that I'm going to pull up for yall it's called the cat Q so let's talk a little bit about masking and then we'll show you all the cat Q so what tends to happen is if you're someone who's on the Spectrum early on you discover something really really important which is that the way that you are automatically living life is not working so like you just you're just living life just like any other kid but then the World shows up and tells you that's wrong and you're like

this is just the way that I do things and they're like no do things differently this is incorrect so I'll give you all a really good example this so [ __ ] sad dude eye contact so something about eyee contact is deeply uncomfortable for some people on the Spectrum it could be eye contact it could be that as you change your relationship eye contact becomes more comfortable but often times like it's really uncomfortable for whatever reason we don't really know why so then what happens is like you know you have parents so you'll have like

a three-year-old kid and the eye contact is uncomfortable for them and remember what we're talking about is the eye contact makes you feel like shell sprinkled on top of your omelet tastes or Nails on the chalkboard it's just a deeply when I work with my patients they're like it's just really uncomfortable like tell me how you feel I don't know it just [ __ ] sucks I hate it I don't know why it activates parts of your brain that make you feel stressed out and anxious so then what happens is you have parents who are

like look at me when I'm talking to you and then they force eye contact and if you guys have ever had forced eye contact I imagine you know what it feels right like forced eye contact even for a NE neurotypical person doesn't feel good look at me when I'm talking to you eye contact is one of the ways that we hide it's one of the ways that we feel reassured too when we downcast our eyes it's a sign of Shame it's a sign of submission there's all kinds of stuff that's rolled up into eye contact

and so a three-year-old three and a halfy old child learns hey you need to look at me when I'm talking to you pay attention look at the teacher so what happens is we take these kids and we force them to behave a certain way because their natural inclination is to behave this way and then we force them to behave another way so now if we kind of look at this like what does that mean that means that the child learns early on the way that I normally am is not working another good example of asking

is making friends because you're totally content playing with your trains you know for like 6 hours a day six days a week you don't need other humans you're fine but then your parents tell you hey like you you need to have friends and then they force you to go on play dates and you sort of like having friends like sometimes it's fun to talk about trains sometimes if you're lucky you find someone else who also has trains right but then we're kind of forced in this situation where now you have to make all these adaptations

and sometimes a people on the Spectrum are just as lonely as the rest of us right there's no like they're not protected some of them are protected against loneliness who knows some of them aren't and so then you begin to learn that like life has a script like all these people got this Playbook of rules that you did not get and so then what happens is you start taking your natural impulses I Like Trains but when I talk about trains for 6 hours no one wants to be my friend so I'm going to take a

part of who I am and I'm going to shut it down I don't like looking other people in the eyes but people tell me that that makes me a bad friend so I'm going to start looking people in the eyes I feel deeply deeply uncomfortable about the disorganization of this room I want it this particular way but when I do it that way my parent with undiagnosed autism wants it a different way and that creates conflict seen that too super sad but boy the therapeutic value of discovering that the reason that your one of your

parents treats you like [ __ ] is because they're on the Spectrum too is eye opening okay so we start to mask we start to hide ourselves and as we start to hide ourselves we suppress our experiences we learn to suppress our anger we learn to suppress our shame but it's not just that we also learn to suppress the positive things I suppress my excitement I'm so excited holy [ __ ] did you see that train oh my God we learn to hide who we are when we go on dates why because the world doesn't

treat us very well we learn to hide on places like the inter internet where we can find the other thousand people in the globe that love trains as much as we do so we learn to hide ourselves now let's let's take a quick look at the cat Q right so when I'm interacting with someone I deliberately copy their body language or facial expressions so this is like this is what they end up doing right so it's like instead of just naturally empathically mirroring someone I have to control myself and be like okay this person is

crying therefore I should cry too I monitor my body language or facial expressions I rarely feel the need to put on an act in order to get through a social situation see if your neurotypical social situations are to be enjoyed you don't even think about them as social situations you just call it hanging out if you're on the Spectrum it is a social situation to get through kind of like a surgery or an MRI I have developed a script to follow in social situations I will repeat phrases that I've heard others say in exactly the

same way that I first heard them I adjust my body language or facial expression so that I appear interested by the person I'm interacting with in social situations I feel like I'm performing rather than being myself in my own social interactions I use behaviors that I've learned from watching other people interacting so everyone does this but if you're on the Spectrum it requires intentionality it requires effort I always think about the impression I make on other people I need the support of other people in order to socialize I practice my facial expressions and body language

to make sure they look natural I don't feel the need to make ey contact with other people if I don't want to I have to force myself to interact with people when I am in social situations I've tried to improve my understanding of social skills by watching other people I monitor my body language or facial expression so that I appear interested by the person that I interacting with when in social situations I try to find ways to avoid interacting with others that's all of us I research the rules of social interactions to improve my own

social skills I am always aware of the impression I make on other people I feel free to be myself when I with other people I learn how people use their bodies and faces to interact by watching television or films or by reading fiction I adjust my body language or facial expression so that I appear relaxed when talking to other people I feel like the conversation flows naturally I have spent time learning social skills from televisions television shows and films and try to use these in social interactions I do not pay P attention to what my

face or body are doing in social situations I feel like I am pretending to be normal so this is the cat Q it is a I think it's a verified like it's a validated instrument for assessing masking I think it illustrates the point which is that what we see in masking is that social interaction is not something to be enjoyed it is something to be studied invested in practiced it is a labor it is something to get through and this is what masking does okay now a lot of y'all may say oh but Dr K

that sounds like me so there's another thing that we got to talk about which is everyone self- diagnosing themselves with the autism and what's the deal with that hold on let me find this okay the reach and accuracy of information on autism on Tik Tok let's take a quick look at this paper the informational content about autism made available on Tik Tok reaches a wide number of people most of the information provided however appears to be misaligned with current knowledge it is important for healthare providers and other professionals to be aware of the autism related

content being shared on Tik Tok so they can better engage with the large community of Tik Tok users so when I went through the cat q i resonated with a lot of it so this brings us to the first thing about understanding autism see when we have a questionnaire and we resonate with some of it that doesn't make us autistic this is scored and you have to have a score above a certain number in order to screen positive and this is about masking right I don't even know if it's it's not like a diagnostic instrument

for autism that's the other thing to understand so there are a couple things that are going on right now that make us all that give us certain features of autism spectrum disorder now that doesn't mean we're all autistic or we're getting more autistic what that means is that Society is changing the way that we socialize and if we look at the way that people on the Spectrum socialize these things are starting to get Blended doesn't mean we're all autistic you know I think the reasons that we're seeing a rise in the autism diagnosis are a

coupleold the first is we're getting better at picking it up that's number one number two is people are having children later and maternal age and paternal age are associated with autism so I think we are in seeing an increase in autism spectrum disorder not just because we're catching it but because there are more people who are autistic now right so if you look like 200 years ago like most people started having kids around the age of like 15 16 17 and life expectancy was like 40 years so the idea of having a you know having

a dad who's older than 50 when you're born was like unless you're like a king or something it doesn't happen so just because you test positive for this stuff doesn't mean that you're autistic there are all kinds of other factors that are going on that may lead us in this direction our diet on a whole all this stuff about gut microbiome doesn't just apply to people on the spectrum that applies to basically the society at large we're seeing a social skills atrophy a loss of empathic circuits weakening of our theory of mind on society as

a whole the more time you spend on in Echo Chambers on the internet the weaker your theory of Mind becomes so we're seeing a lot of features that look like autism I don't think that means that we're all becoming more autistic right I think there's like and this is what kind of frustrates me about that is like people like oh my God I'm so autistic like no you're not like you know cilantro or green onions on the top of your bowl of ramen doesn't taste like eggshells on the top of eggs like the experiences of

people with Autism are just incredibly difficult incredibly difficult and it's not the same so be careful about about you know watching something and saying oh does this make me autistic I do this that means I'm autistic no that's not how autism diagnosis is done it's it's about you know measuring a ton of things not just like I resonate with question number 14 and I resonate with question number 18 but if you look at short form content all they they can only cover one question but that's not what makes a diagnosis a diagnosis is like an

integration of a bunch of different questions okay now let's talk about treatment does that make sense so okay so let's start with a couple of like disclaimers the first is I don't treat autism I tend to treat people who sometimes are autistic and there's like a subtle difference there I'm not an expert so we're going to cover some evidence-based interventions none of which I've like learned formally okay so let's start with treatment so behavioral interventions this is really common so we have things like ABA applied behavioral analysis and CBT okay um we also know that

early intervention is good we're going to talk about them don't worry guys parental involvement is good okay then we have pharmacologic interventions then we have things like social skills training there's some a variant called adaptive CBT okay and then we also have a lot of problems because standard treatments don't work in ASD and I'll explain what that means okay so let's start actually let's start here I want to move this around okay let's move it over here all right so let's understand treatment for autism so we're going to do kind of like a quick review

of the evidence-based approaches oh whoops and then what we're going to do is I'm going to just talk to you all about my treatment philosophy so the first thing that we know is that the earlier you catch autism the better off you will be so as we are developing as we are forming our as our circuits are forming as we're learning how to socialize if we intervene early we can help people out a little bit more so we know that early intervention and early diagnosis is very helpful so people will go to special schools that

and now think about what we're doing so we know that your brain is different right so if your brain is different let's create an environment that is supportive of the brain that you have if we think about that stress dith thesis model of here is my genetics here's my environment it's when I combine these two things that illness arises so if I can change my environment to be more accommodating for my genetics then the the likelihood of illness actually goes down so parental involvement is also very important because once again once the parent understands what

is going on with the child their ability to parent becomes far more effective so instead of blaming the child for oh being a picky eater like we understand that their tongue is different their mouth is different their brain is different and we need to be a little bit more accommodating so we still want them to eat healthy and this is like the problem that parents run into it's like okay well you know he doesn't like anything except for mac and cheese and Dino nuggets and when I talk to parents like this it's like okay well

what else have you tried like let's understand what's going on right so I once was working with a a group of parents who are Chinese and they would like make things like mapa tofu and if you understand what mapa tofu is right there's like a sauce that has like sometimes like Sichuan peppercorns has like green onions on top has little bits of ground pork in there like delicious dish but it has a lot of other stuff and if you just make it just with the tofu and the sauce and you don't add any other stuff

the kid will eat it doesn't like his vegetables well how do you prepare your vegetables you know steamed broccoli or steamed asparagus or steamed green beans with a little bit of butter and salt and you're fine use garlic powder instead of garlic right it's the textures that are the problem your child differs in the way that they you know they need a lot of routine they need a lot of organization they have difficulty making eye contact they're going to have difficulty making friends they're not disrespecting you when they are like not looking you in the

eye right like there's a lot of stuff that when parents don't understand that they're raising an autistic child then you have two problems you have autism and then you have the trauma of not knowing that you have a child with autism incredibly frustrating for the parent incredibly damaging for the child so you just need to understand that your child is different and most parents will figure out in some ways that their child is different but there are also like interventions that you can do to help them engage with Society more so early intervention and parental

intervention are incredibly important and the goal of these things like there are people who know this stuff better than I do right not my area of expertise but when we look at some of these interventions it's to understand some of these Concepts and what I tend to find is even when I teach these Concepts like parents do better kids do better so let's like problem solve around how to have you eat things over the course of seven days I'm going to make you mac and cheese and dino nuggets alterate altering each day of the week

and we're going to try in a very intentional way we're going to try sweet potato we're going to try regular potato we're going to try green beans we're going to try asparagus we're going to try broccoli we're going to try smoothies right we're going to try a lot of stuff and see what works for you that's the emphasis of the treatment at least when I treat it now let's talk about things like behavioral interventions like ABA and CBT so applied behavioral analysis is about getting kids who are on the Spectrum to fit into society right

we're going to change their behavior now ABA I have mixed feelings about so on the one hand AB is a I believe well tested well understood intervention that is effective at at treating the symptoms of autism we're going to shape someone's behavior in many cases the experience of people on the Spectrum who go through ABA is traumatic results in masking some people have argued that ABA is essentially a course in masking okay now I've had patients who who appreciate ABA and I've had patients who hate ABA I also think that one of the things that

we don't really consider with ABA is that I've seen a variety of Professionals in terms of their competency with ABA so this is what a lot of people don't realize ABA is its own separate path of training in some places so you don't have to become a therapist to be an ABA person you can just study ABA directly now that's like has pluses and minuses on the one hand it's good because we can train people directly we can train people in a very specialized way on the downside in a lot of the ABA people that

I've worked with some of them don't have some of the basics of what like a therapist has right so they're trained in a particular kind of protocol and and we see this a lot in mental health and even physical health right we're seeing a lot of like physician assistants nurse practitioners and medical doctors and they have different levels of training on some level they can all do the same thing and on some but are they really all the same at the end of the day I don't believe so and it's not about superiority or inferiority

I don't think it's about ego it's just if you spend eight years in school versus two years in school if you see 10,000 patients versus 1,000 patients I think that there's going to be a difference that's all so ABA is an evidence-based approach that can work and some people have very negative experiences of it now then the confusion the confusing thing like I said is somebody is like what is that what part of that is the intervention and what what part of that has to do with the person who's doing ABA to you okay um

let me just show youall a paper real quick hold on [Music] uh oh yeah okay here it is so let's just take a quick look at a paper Okay um intensive intervention for adolescence with autism spectrum disorder comparison of Rehabilitation treatments so uh so in our study we evaluated the effect of three different high-intensity interventions namely applied behavioral analysis treatment and education of autis autistic and communication handicapped children teach and behavioral education intervention Bei in 93 ASD adolescence ranging from 12 to 8 years our results show that all adolescence with a ASD reported an improvement

of core symptoms regardless of treatment type okay so what this kind of means here's how I take this away and it's been a long time since I looked at this paper so I don't remember the details of it because I I read this like a month ago so we know that there's a lot of Behavioral interventions it doesn't seem that one is superior to another so practically like when I'm working with patients who are anti- ABA I say [ __ ] it don't do ABA you don't need to do ABA if you don't like it

if you feel like it's masking if you feel like it's traumatizing if you feel like it's disconnecting from who you are don't do it it's not like there aren't others and this is a really common experience in Psychiatry and Psychotherapy and Medicine in general generally speaking the intensity of what you do is very important as opposed to like the kind of thing that you do so in Psychotherapy like I do think the kind of psychotherapy you do is very important but it's not that one is objectively better than the other it's that you have to

find something that fits well with you and you have to do it seriously so whether you want to do yian dream analysis or you want to do cognitive behavioral therapy or you want to do dialectical behavioral therapy with a heavy dose of mindfulness it's all going to work relatively well if you take it seriously it'll all work it's about finding the thing that fits for you so a lot of people will argue about ABA I think it's fair enough like it's not my place to say that everyone should do ABA I'm not an expert in

ABA some people will say hey ABA is the thing help some people doesn't help other people fair enough okay so behavioral interventions work so now we get to a couple of other things let's talk about pharmacology so generally speaking we do not have medications that treat autism so as I've shown y'all hopefully autism comes from all kinds of places it comes from your intrauterine environment it comes from your genes it comes from your upbringing it comes from the age of the Y chromosome in the sperm it also comes from the level of inflammation it also

comes from Gaba transmission it also comes from all kinds of stuff so there is not a treatment for autism and I think this is what sort of helps us you know argue that it's not a discret pathology as well so on the one hand we know that neonatal hypoxia leads to the risk of it which makes me think that it is a pathology but it's not like there's one piece that's broken we also know based on some of these stories like The Big Short that there are some people on the spectrum that are capable of

doing things that people who are not on the Spectrum may not be capable of so there could be an argument for some kind of adaptive or evolutionary advantage of some of these features of autism there's also some kind of anthropological I even hesitate to call it evidence but there's some anthropological evidence or opinions that if we look at some of these things like the Oracle at dely and like some of these other like weird Greek mythology that some of these like religious or spiritual figures may have had some kind of autism so I've seen like

some papers about that I don't know if that really qualifies as like hard scientific evidence it's just evidence from a soft science standpoint so Pharmacology can be useful so there isn't a pharmacology that like works but we have all kinds of things so we'll use things like you know um Alpha agonists we'll use blood pressure medications we'll use anticho we'll sometimes use things like caline or like serotonergic medications those don't really work that great and usually what we're targeting is like symptomatic treatment of things why do we give kids on the Spectrum antis psychotics because

we want to prevent outbursts because we want to like slow down that like we'll give people sometimes like mood stabilizing medication so that the jitteriness of their neurons kind of calms down so I think that like there's all kinds of pharmacologic agent out there you know like um let me try to find right so like let's just take a quick look at a paper so this is uh from neurotherapeutics in 2022 an update on psychop psychopharmacological treatment of autism spectrum disorder um you know so commonly used medications to address comorbidities uh let's see okay so

um medications including metformin ARB arbaclofen canabidol oxytocin bu this must be these are not these are potential treatments these these are new things chat this is not what works this is what people think may work I'm just looking at this this is not the list this is like new potential treatments right so the point here is that there's all kinds of stuff that like could be useful um so this is like a Statin medication met form is something that we give to people with diabetes there's all kinds of stuff uh commonly used medications to address

comorbidities with ASD include atypical anticho serotonergic agents Alpha 2 Agonist this is a medication like clonidine stimulant medications Etc so there's a lot of stuff out there that can help and I would say nothing is going to cure you of anything so it is a tool pharmacology is a tool in our tool belt and I would even say that autism disorder is one of the diagnoses where our medications are not great okay and then the last thing is that people are developing you know novel treatments in the realm of things like social skills training so

these are like formal educational classes ABA draws on some of this stuff but I think social skills training is a little bit more patient centered as opposed to like confirmation centered where we're we're going to teach you how to socialize it's not about inducing a behavior it is like we're going to equip you with information and try to balance this out a little bit so once again I'm not an expert in autism treatment by any means and I'm sure that there are going to be people who are watching this who know more about autism treatment

than I am and by all means comment tell me what share our WIS share your wisdom with the rest of us now when I'm working with someone with autism this is the last thing that we'll talk about how do I approach working with them so there's all this stuff how do I know what to do so here's how I understand it the first thing is to resolve the discrepancy between internal and external now what the hell does that mean so the world is a particular way and you are a particular way the first thing that

I do with my patients is figuring out what of this do you want to change so this will be like really simple stuff like are you tired of masking by the way masking correlates with worsening mental illness so we know that it's damaging in some ways so the first thing is what do you want to change do you want to be different on the inside do you want to change the person that you are are you interested in fitting with the rest of the world right this is the first thing that we have to figure

out do you want to adapt yourself to the external world or do you not want to do that and everyone's on a spectrum like some people will come to me and say you know what I want more than anything else the majority of patients I've worked with are men so what they'll come in is they'll say like okay by majority I mean maybe like 60 to 70% they'll say like I want a girlfriend and I feel incredibly alone I'm suicidal if I just had a relationship that's the one thing that's missing in my life I

this is what I want and I'm willing to do whatever it takes to get there okay fair enough so then we'll start changing the person that you are to not the person that you are we we'll work on your internal environment with the goal of adaptation we're going to work on social skills we're going to work on temper tantrums we're going to work on eye contact socialization we're going to figure out some way that you can get to your goal if that's social scripting if that's eye contact if it's hugging if it's learning how to

eat different food like whatever so then like the question becomes okay what gets in the way of you having a girlfriend well when I go to dinner my dates are always is like make fun of me and I feel ashamed because I order mac and cheese wherever I go okay fair enough so now we've got two options do you want to learn how to eat things besides mac and cheese or do you want to learn how to deal with the shame of eating mac and cheese and work on other ways that people can accept you

does that make sense it's not there's not like a right answer or wrong answer so the foundation of when I work with someone with autism is like let's figure out this internal versus external what do you want to focus on do you want other people to accept you is that what you want to shoot for or do you want to focus on like being yourself more second thing that we work on is this issue of masking so the way that we work on this is that often times people who are on the Spectrum I do

this with all my patients but it's manifest slightly differently is that we have certain internal drivers and in and external reactions or even internal reactions and there's a method of masking by the way that has nothing to do with behavior there's something called compensation which is something that we do cognitively to ourselves to fit with everything else it's not even a behavior it's a mental response so then we start to dig into okay what are all the internal things that you experience I feel anger I feel frustration I feel shame I only want to eat

this food and then how do you respond to those things I mask it I lie about it I try to force myself to do it anyway so we start to gain insight into the autopilot nature of autism and that that's really important because the main thing that it's not about doing something right or wrong it's about let's stop behaving automatically let's think through what our inputs are how we deal with those inputs and what our outputs are so when your friends you know when you guys are queuing up for a game and then like one

of them picks the character that you want to play I always play DPS and in my D and group I'm the Rogue in the party and someone else showed up and now they're playing a rogue they're cramping on my style I'm really angry about that so let's understand okay how does it feel well this is the script that I know right like when I was learning to play D and D like I learned how to play Rogue and I understand what Rogue is supposed to do I'm supposed to abandon the and go steal things while

the rest of them get bored cuz I'm sneaking around I'm supposed to make the DM's life harder that's my job as a rogue I'm going to play a single player game while pretending to play a Co-op multiplayer game I know this so whatever it is and if I have one thing that gives me like you know some degree of competency in working with autism I've played D and D okay so we just have to understand okay like what's going on within you what are your internal experiences how do you react to those how do you

interact with the world and the more that you like open up this process the better people get they learn to deal with their shame a little bit they learn to like deal with their reactions they learn like not to react right they think through things and then they address things in the right way and over time they level up often times these are social interactions okay so that's Dimension number one is figure out what you want how much of this is internal work how much of this is external work Dimension number two is let's figure

out let's stop operating on autopilot let's understand what your triggers are what you feel and how you respond and which of those we want to change then there are a couple of other dimensions there are there's a pharmacologic dimension so if medications are appro will do that I have very little experience with the psychopharmacology of autism spectrum disorder thankfully most of my patients who have autism have other providers who will handle their medications for them just not something I'm very experienced in right I understand some of the basic okay we got some temper tantrums maybe

take a little bit of clonidine if it's very severe maybe we'll use an antis psychotic right I'm not going to try an SSRI because chances are it won't help much another thing that I found is is quite helpful could be Placebo we don't really know is is doing all this diet exercise gut microbiome inflammation meditation kind of stuff doing the wellness that's what I tend to do pretty well so let's understand okay what's going on here let's get your levels checked let's try this iron supplementation let's understand what your symptoms are if you have for

some reason you know this one person told me that iron supplementation helps with temperat trips let's give it a shot right we're going to monitor your iron levels make sure you don't have iron toxicity you're going to get constipated so we got to give you something for that that fair enough so we can do some amount of like nut nutritional supplementation I work a lot on diet and inflammation reduction seems to help and then the last Dimension that we tend to work on quite robustly is emotional regulation so I find that like emotional regulation is

the primary obstacle it's the thing that will sandbag you when you're doing everything else else right so once you learn how to script social interactions once you learn how to flirt once you learn how to order mac and cheese with a side of broccoli once you do everything right it is the temper tantrums and the emotional disregulation that will damage your relationships so that has to be addressed so that can be everything from the inflammation management exercise management two things like meditation two things like decompressing your sscar all of that kind of stuff right and

over time I think the other value of something like a therapeutic interaction is like we try to accept this person right so we try to form a a foundation of a relationship where they feel more emotionally comfortable hopefully where they can try out a little bit of eye contact like whatever and so like it seems to help so that's kind of how I approach things so I would say like first of all oh and then there's also like a a gender dysphoria component which also has to do with like emotional regulation and getting in touch

with your feelings and not masking yourself and understanding the way that you feel and all that good stuff that's a part of it too so you know I I think that autism spectrum disorder can be a very very crippling diagnosis and for some people it doesn't feel crippling at all I think key things to understand take away number one is it's variable it's a spectrum and it doesn't matter what is right or wrong the most important thing is what your experience of the disorder is right so people are like ABA Works ABA sucks whatever it

can work it can suck so remember that if you've got autism it's not about treating autism it's about treating a person a human who happens to have autism spectrum disorder you are not an autist you are a person with autism it does not define you unless you want it to if you want it to then go for it gamer I'm a person who plays video games not a gamer right I'm an alcoholic I'm a diabetic that's up to you so if you're working with if you're struggling with this stuff acknowledge a couple things where first

of all it's different secondly recognize that your brain is different from neurotypical people's brains that is almost certainly going to make your life harder I cannot think of a single person I've ever worked with whose diagnosis of autism has made their life easier I'm not saying better or worse this is important to understand literally every person I've worked and there could be a selection bias right there could be people out there who have autism spectrum disorder whose lives have been easier as a result of it but they're not the ones that wind up in a

psychiatrist's office but my overwhelming experience is that these people are playing like some new game plus even the basic things are really hard right that's like the new game plus is like even your first boss it has more HP than the last boss of your first run so so many the basics are very difficult now the good news is that if you have autism spectrum disorder there are some things that could be advantageous about it really depends on your particular patch work of symptoms and whatnot and the more important good news is whether it's an

advantage or disadvantage or whatever everyone gets caught up in that I think the main thing is like it's about the way that you want to live and what I have seen very consistently is that it does not have to prevent you from living a fulfilling life and if I had to say like my Crux of treatment for autism spectrum disorder is Let's help you live a fulfilling life whatever that entails if medication is a part of that great if forcing yourself through ABA is a part of that great great if meditation is a part of

that great if changing your diet is a part of that great but the whole point this is kind of a weird Advantage is that we have so many different interventions not it's not like as there's a silver bullet which also means that there's a lot of variety so you don't have to do this one thing that everyone says is great there's lots of different options out there and we do see that things work right people get better people engage in relationships people get married people have kids people find jobs it's doable it's just hard and

I I don't know I I don't like it's one of those things where like I I don't know that it evens out in the end in some way like I I just don't I don't know like from a medical standpoint spiritual standpoint kic standpoint whatever from a medical standpoint like you know if you get diagnosed with a gleo blasto multiform me at the age of 26 which is a rapidly progressing and basically fatal brain tumor happens between the ages of 25 and 40 like I don't think that evens out somewhere I I just don't not

in this lifetime sometimes people just have it worse than other people like I I wish I could say that it wasn't like that but like that's my experience as a psychiatrist like some people just have worse lives and so like our job is not I mean we it's really easy to get bent out of shape over that I empathize but like our job is you know I don't I don't know how useful that is our job is to help you get to wherever you want to go I don't care where you start I don't care

how hard your life is what's my job my job is to help you to get where you want to go the only difference is the amount of work that we have to put in and I'm sorry that if your chances are you're on the autism spectrum you're probably going to have to work way harder than neurotypical people I think that's a pretty safe evidence-based kind of scientific statement but don't give up hope just because it's hard it's easy to give up hope especially if you're smart because you can project out into the future but recognize

some these problems like the concrete thinking and the hyper emotionality that this is going to change the way that you see things we know scientifically that you're more likely to be suicidal don't give up hope it's okay to have hopelessness but try to get some help last since I'm painting such a delightful picture last thing to consider about autism spectrum treatment is that we're getting better at it so the one reason that I have hope is you know the last time I had a full time practice which had a fair number of people that had

autism spectrum disorder in it I we did not know this was like maybe six years ago something like that I I don't even know but we've learned so much in the last few years we're getting better at it the other kind of weird Silver Lining is that everyone is having more features of autism so it's becoming a more common like Society is taking it more seriously as a whole Okay so that concludes our Deep dive into autism spectrum disorder there is so much more we could talk about I have a list of like 20 or

30 questions and posts that really capture some of these things that we could address individually we haven't gotten to dating with autism having a career with autism being an entrepreneur with autism you know meditation with autism spectrum disorder all of these things deserve their own time and energy right but this is what we kind of start with I hope it's been helpful to y'all um and like it doesn't this is the beginning right this is not the end this is just chapter this is like a preview and if y'all are struggling with autism you have

my condolences you have my sympathies I wish I could say you have my empathy but I don't one of the things I learned a while ago I have some degree of probably you know empathy for some neurodiversity on the 8 spectrum and there's some overlap there and things like that but I I I mean I really don't and this is one of the things that I learned as like as a clinician is you know I really don't know what it's like and the closest and after working with people for years the best I have is

it's sprinkled eggshells on top of your omelet right and when you just think about it like how hard life is when [ __ ] everything that you do is that now I have to go to a job interview and I have to have eye contact now I'm going on a date and I have to figure out what's the right level of humor now I have to figure out when to grab their ass so that we can advance a sexual relationship but if I do it too early I'm going to get accused of sexual assault like

it's so hard everything becomes difficult and I just don't know what that life is like and I don't think many people do and I think like us neurotypical people need to stop pretending that we know what it's like to be on the Spectrum we like really don't know it's crazy man some of this stuff like arfid and like socialization like we take so we have no idea and so the primary responsibility for us people who are neurotypical is to try to have some compassion let's give them cut them a little bit of slack cut them

a little bit more slack let's try a little bit harder to incorporate them to help them feel welcome to recognize that just because I feel uncomfortable with a lack of eye contact does not mean that I should force this other person to do something that makes me feel comfortable that's the most damaging thing parents do it boyfriends do it girlfriends do it friends do it I don't like the way that your behaviors make me feel I want you to change so I feel better how selfish does that make sense Okay so people are saying please

post this ASAP I think this is live streamed to both twitch and YouTube there's a VOD that's available that anybody can watch and it'll probably live on in some way on the YouTube channel as well so thank you all very much for coming today I guess we're going to do questions for like five minutes but we're already 40 minutes over let me just double check my schedule good if Bruce feels heard we are happy um let's Okay so like let's do a couple of questions what a Bruiser oh my God I love this community does

experiencing ego death help coping with autism okay what a awesome question I think so I would think so but honestly like I've never thought about it um let's see hold on a second chat um you know I'm so curious from disorder psychedelics let's see if there's a paper interesting okay so we're going to have to like look at this Holy G holy based dude holy based okay evaluating the potential use of serotonergic psychedelics and autism spectrum disorder okay this is Migel um let's see whoa so there are studies from the 60s and 70s we highlight

the positive behavioral including enhanced mood and social behavior as well as the adverse effects of these trials including increases in aggressive and associative and psychotic States okay no cookies [Music] uh okay let's see um glutaminergic system play the systematic review comprehensively discussed the prevalence trends of autism and youth suicide globally and in Taiwan and discussed an association between Autism and suicidality that we know furthermore this review proposed a neurobiological connection between Autism suicide and psychedelics okay okay oh so there's one other thing I didn't talk about in treatment so standard treatments don't work great so

what does that mean so there's one this is important one thing to remember about autism spectrum disord is if you have a comorbid diagnosis remember that the use of serotonergic agents in the treatment of something like a mood disorder like uh major depressive disorder something like let's say caline okay or fluoxitine ssris all of these studies are done in neurotypical individuals if you're on the Spectrum that's an exclusion criteria from being included in the study so one of the most frustrating things about psychiatric treatment if you're on the spectrum is it's not clear so all

of the studies are done in people that are not on the Spectrum or not all the original FDA approval studies and like when the drug compan is like marketing the drug and developing the drug they don't include autism so there's a lot of like your mileage may vary now does experiencing ego death help with Co coping with autism short answer is I don't know but I would guess probably um why did I look at studies on psychedelics because we also know that ego death experience correlates so when you you have a psychedelic experience if you

just like hallucinate and stuff that doesn't necessarily lead to any mental health benefits it appears that an ego death experience is what correlates with mental health benefits and there is a huge caveat that I don't know if youall know this but um so you know MDMA recently got rejected by the United States Food and Drug Administration as a treatment so there was an application to make MDMA a treatment for like PTSD or whatever and that was rejected now the reason it was rejected now a lot of people will say like oh this is because of

like big farming I I don't know I mean that stuff could be true I don't know but I think like a much simpler reason is that the evidence is just not quite as compelling as people think right so we have these small studies some people show a big benefit but a lot of people don't get like cured by MDMA and so we're not quite sure and the the data is just there yet which I think is a good take on psychedelics as a whole um so can trauma such as complex PTSD cause neurod Divergence no

I'm going to say no so could be wrong but what we know is that neurode Divergence like we said has a lot of data that shows that it has a very genetic and physiological roote neonatal hypoxia genetic genetics are very important neuroinflammation the process of PTSD is different now one thing that can absolutely happen is you can have autism spectrum disorder and have PTSD in which case the two really blend together in a mush of awfulness we also know that some of the manifestations of things like PTSD can be very similar to the manifestations of

things like autism spectrum so for example both disorders have emotional disregulation temper tantrums executive function uh executive uh dysfunction difficulties with attention sometimes difficulties with socialization a lot of difficulties forming relationships difficulties and empathy all of these can come from trauma so if youall want details on that definitely check out the trauma guide it is one of the things that I personally am the most most proud of like I think I did a good job with that um but I there's a lot of similarities but I I think it's very important this is why we

talk about ideology because just because all the symptoms look the same does not mean that they're the same on the back end right so I have difficulty my car doesn't leave the driveway now there could be a problem in the engine or there could be a problem in the tire there could be a problem in the gear shaft there could be lots of problems that keep my car still just because the car isn't moving does not mean that one causes the other we don't say that a flat tire causes a problem in your engine that's

not how it works ideologies are different great question um let's see what does the ayurvedic take on autism great question so ayurva classifies autism I think is something called an un so there's some like developmental delay kind of things and it classifies that way I don't know exactly what the doic balance is and I don't know what the treatments are or how effective they are but it's like one of these things that's like sort of like an incurable disease if that kind of makes sense uh how do I know if I'm subclinical or highly masked

ASD or if I'm modeling my parents ASD symptoms do you have any other suggestions for being a child of someone with autism what about being in a relationship with someone with autism so if you're concerned at all like you're like trying to figure out am I Autistic or not my recommendation is to spend less time on shortform content like Tik Tok and spend more time speaking to a clinical professional so remember that like I know there's a lot of people who are into testing but the majority of psychiatric diagnoses are still accomplished through clinical means

you don't have to get tested for ADHD you don't need to get tested at all a clinician can make a diagnosis of ADHD a clinician can make a diagnosis of autism spectrum disorder now tests are useful tools right so like it's just like with a heart attack I don't need an EKG to diagnose a heart attack what you need is like history right you can ask people questions and figure out if they had a heart attack or not now EKG is just one of the tools but it's like you know I mean if yall practiced

clinical medicine you understand this like if someone has a heart attack and their EKG is normal you scratch your head and you get another EKG or you check their troponin or something like that right and like some of the biggest mistakes in medicine is when we use tests as substitutes for clinical assessments because someone has some kind of bundle branch block or something like that and since they have some abnormality some congenital abnormality of the the heart or something else it masks the EKG detecting a myocardial infarction and then the the AI based read on

the EKG it says normal Rhythm but hold on a second two wrongs can sometimes look right same is true for something like Autism Spectrum Disorder so I I wish that I know that all yall are like oh like how do I figure this out without seeing a professional see a professional that's what they're there for right and it's a great question it's like how do I know the difference between whether I have autism or whether this is like learn behaviors from my artistic parents that's a perfect question for a a professional okay um Dr K

my autism syndrome had a side effect of giving me genius level intellect do you have any specific advice for geni genius autists or savants yes absolutely man but that's a whole topic for a whole another day so I've worked with a ton of people who are neurodiverse and have high IQ that's part of the reason I included that bit about suicide a lot of them are very highly suicidal um so I think if you guys want we can do like maybe we should do a stream about you know how to live life if you're a

genius because I think it's a different set of rules and IQ correlates with suicidality not just in autism I think uh you know the the basics is something that I would already share when I was talking about the suicidality so the basics are that if you're a genius who is on the Spectrum your Genius is going to be handicapped by some of the features of autism spectrum disorder and the real solution to let your Genius flow is to address those things so focus on concrete thinking focus on emotional disregulation like those are two of the

biggest things because that's really going to like it it keeps these people from flying and when we can focus when we can reduce the concrete thinking when we can improve theory of mind and we we improve emotional disregulation it's kind of like we're you know these are like sandbags that are weighing us down and when we get rid of these three things then the genius will fly but as long as you're having temper tantrums and your a genius your Genius will have a lot of difficulty manifesting as long as you cannot see the shortcomings in

your logical thought process it creates a lot of problems so I don't know if this kind of makes sense but see if you're feeling emotionally hopeless your intellect will run in that direction and will develop a very very strong argument why you should give up because the robustness of the argument depends on your analytical capability and so then these people have this profound hopelessness because it's logically backed right 150 IQ developed argument for why my life is not worth living very hard argument to argue against because it's so much better so often times what gets

in the way is that we don't realize we're not in control of our intellect our shame factors in our trauma factors in our hopelessness factors in this is why depression is worse there's a whole video we did lecture we did on on why higher IQ people are more likely to be depressed in suicidal it's simply because in depression the mind gets turned against us and the more powerful the mind the more damaging it can be right so if I'm playing like a video game and I cast m control and I get to control one of

my enemies if I if I mind control a level one Fighter versus a level 20 fighter which one is going to be more damaging so that's what happens in depression is our IQ gets turned against us so a big part of when I work with people who are twice exceptional which is like people who are high IQ and have some kind of neurodiversity is it's about really focusing on the things outside of intellect and the problem with people if you're super smart and on the Spectrum or even if you're super smart is that often times

when you're very intelligent you are emotionally stunted why it's because when you're growing up your brain learns to use IQ as a substitute for all kinds of other mental faculties so I don't need to be empathic because my cognitive ability to understand a social situation I can break things down into a protocol or an analysis I don't need to feel because I can calculate so then what happens is I I see this a lot where and this is why like high IQ kids are so far behind in life because they they focus on the IQ

so much that they don't de develop the other parts of themselves I never learned how to study because I didn't need to I figured everything out until I hit pre-calculus and I couldn't figure out pre-calculus then you hit a wall so often times the IQ is the focus should not be the IQ the focus should be everything else get in touch with your emotions right so why is it that kids who are super smart struggle with motivation it's because motivation is not doesn't come from the part of our brain that does analysis motivation comes from

our emotional circuits of the brain and our reward circuits of the brain see once the motivation is there then the analysis comes in the analysis is not what drives you it's the how you get there once you've decided to move so if you're someone who's on the Spectrum this is going to be doubly difficult because you may have not invested a lot in empathy and it may be a little bit more difficult for you to begin with and I think that there's like a lot of good work that can be done there's also a lot

of work around shame that has to happen if you're twice exceptional a lot of trauma work too all right okay y'all that's our time for today thank you all so much for coming I know we ran about an hour long I knew it was going to be about an hour long but there's a lot to cover there's a lot more to cover so um you know by all means I you know some people were like is this going to be posted I I want to share it with my friends by all means share it with

your friends uh and then also let us know right so when this goes up on YouTube or whatever like let us know if youall have questions and stuff if you want to share your experiences like leave comments and stuff like we read that stuff um so I'm working on about so we did a uh I did we did this uh YouTube upload about how to ask for help if you're a dude and the top comment on that video was I tried to ask for help for a dude and boy was I punished for it this

is my experience so now we're doing a follow-up video on why you shouldn't ask for help what are the experiences of people who ask for help right why is it a bad idea to ask for help and we wouldn't have that perspec persective unless yall communicate with us so when we say you know hey we're here because of you it's not just for you it's that this there's like this is interactive so we decide what to talk about based on what y'all ask for right um so thank you all very much for coming today if

you'all have been interested in coaching just a quick reminder that we finally have spots open on the personal the group and the career side so uh we do things like deep Dives where we introduce youall to the these topics but if yall are interested in like you know really focusing on like making a change and investing in that then I'd highly recommend coaching if you're struggling with things uh specifically related to to autism I would say start with a therapist um but if y'all are interested in like career goals and stuff like that there's a

lot of things that we don't get trained in as therapists so like we don't get trained in helping someone find a job so from a career coaching standpoint coaching is a discipline that's really about goal achievement and that's what it really focuses on so if yall are interested in getting outcomes in a fixed amount of time then I'd strongly recommend youall check out coaching thank you all very much for coming today and next week we're going to be talking with Ali matu about social anxiety brilliant clinician awesome content creator in his own right he's going

to be sharing us he's a specialist in anxiety so we're going to be getting some of his expertise so yall take care and if you'll say more stuff on autism what what is the more stuff give me a direction okay so thank you all very much we'll see you um if yall we have two memberships lectures on Wednesday and Friday on Deep dive into emotions and deep dive into intuition otherwise we'll see youall next week okay take care everybody