Anxiety in Persons on the Spectrum: The Psychological Equivalent of Fever

Dr. Pat Friman Author

04/06/2023 Added

4 Plays

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2023 State Conference Presentation

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[00:00:01.080]Good morning.
[00:00:03.870]I've never asked anyone to do
[00:00:09.177]what I'm gonna ask for someone to do right now.
[00:00:11.730]Back there at the water container,
[00:00:15.090]it leaks and it's gradually filling up a cup
[00:00:18.960]and those cups are overflowing
[00:00:20.340]and before long it's gonna overflow on the carpet.
[00:00:23.280]So could somebody just
[00:00:24.390]every once in a while take a look back there
[00:00:25.890]and take the full cup away
[00:00:27.810]and put an empty cup underneath it?
[00:00:31.034](people laughing)
[00:00:39.011]Does anybody here think of themself as an anxious person
[00:00:42.960]and be willing to say so?
[00:00:49.080]Okay, what if I pick you?
[00:00:51.960]I'm not gonna ask you to do anything
[00:00:53.310]'cause of course you're an anxious person.
[00:00:58.039]We shouldn't have to watch.
[00:01:02.160]Okay, good, thank you.
[00:01:04.080]So one of the things that I always do when I work
[00:01:07.350]with somebody that's anxious is reframe their condition.
[00:01:12.180]Because I'm a clinical psychologist and I've been one
[00:01:14.760]for 30 years and I know what damage
[00:01:16.770]that we have done in our interpretation
[00:01:19.140]and tendency to pathologize routine human behavior
[00:01:23.520]and a human being has a capacity for fear.
[00:01:27.210]It's one of our instincts almost and it's a huge source
[00:01:32.160]of our survival, but somehow anxiety
[00:01:37.980]has been pathologized.
[00:01:39.357]And so people that have it,
[00:01:41.032]even I'm saying people that have it,
[00:01:45.780]you don't say people have fear, you just say they're afraid.
[00:01:49.020]But if they think of themselves as anxious
[00:01:51.473]and you say they have anxiety, but anxiety is fear.
[00:01:57.210]Anyway, so I reframe.
[00:02:01.170]So you had relatives thousands of years ago
[00:02:06.000]And they were very valued by their tribe.
[00:02:08.850]They were what they thought of as the tip of the spear
[00:02:12.030]because they could hear the rustling on the brush.
[00:02:14.160]They could feel vibrations on the ground.
[00:02:15.690]They could smell odors on the air
[00:02:17.910]way before any other members of the tribe.
[00:02:20.400]And so they'd alert the tribe to what they had dissed
[00:02:24.330]and the tribe would get up the trees
[00:02:25.560]or into a cave and be protected from the predators
[00:02:27.720]that would be around the saber tooth tigers,
[00:02:29.250]the mastodons, the marauding tribes.
[00:02:32.070]Highly, highly valued.
[00:02:34.800]That's 10,000 years ago, 20,000 years ago.
[00:02:37.830]That isn't very long in evolutionary time.
[00:02:41.070]And so that capacity hasn't evolved beyond what it was then,
[00:02:45.360]but it doesn't have any work to do.
[00:02:47.340]There aren't any mastodons,
[00:02:48.720]there aren't any sabertooth tigers.
[00:02:50.130]There aren't more rotting tribes.
[00:02:51.240]Starvation isn't imminent.
[00:02:53.070]But this part of us is still very, very active
[00:02:56.610]and it looks for work and it finds danger
[00:02:59.370]in really, really benign situations.
[00:03:02.730]At the worst end of the spectrum
[00:03:04.200]is just being out in the open like agoraphobia
[00:03:06.477]or the various phobias that where people are afraid
[00:03:10.091]of things that are not at all dangerous.
[00:03:13.320]It's just this thing trying to activate itself.
[00:03:16.080]So what happened was the laid back people,
[00:03:22.590]I'm sorry to say this to those of you that are,
[00:03:24.720]but they won the public relations contest
[00:03:27.771]and so they made it seem like laid back is the way to be.
[00:03:31.260]And those of us that are anxious
[00:03:32.850]tend to wanna be laid back.
[00:03:35.400]Let's just say you're married to a laid back person.
[00:03:39.390]Which of you can you absolutely count on
[00:03:42.750]to make sure the garage door is closed
[00:03:44.220]when you go on vacation?
[00:03:45.913](people laughing)
[00:03:49.020]You'd be a little nervous about the laid back person,
[00:03:51.570]which can you count on to make sure the credit card bills
[00:03:53.790]are paid before the penalty phase?
[00:03:55.747]Which of you are gonna make sure
[00:03:58.652]that there's somebody to take care of your pets
[00:03:59.910]before you leave on vacation and so forth.
[00:04:02.490]You really can't count on a laid back person
[00:04:04.440]for that kind of thing.
[00:04:05.273]But you can absolutely count on the anxious person
[00:04:07.170]for that kind of thing.
[00:04:08.437]So the anxious person is concerned,
[00:04:13.440]although the term they use is worried,
[00:04:15.540]concerned, worried, I don't know.
[00:04:16.710]Concerned seems like
[00:04:17.850]the more euphemistic version of worried.
[00:04:20.190]But it's so valuable that they are,
[00:04:22.590]this tendency is the secret to my success.
[00:04:26.400]No question about it.
[00:04:27.690]I've always been an anxious person
[00:04:29.100]and I thank the good Lord Almighty that I am
[00:04:31.182]because it has had me always go the extra mile
[00:04:35.702]and that extra mile makes up for what I lack in aptitude.
[00:04:41.310]I mean, if I had the aptitude,
[00:04:42.330]maybe I wouldn't need the extra mile, but I don't have it.
[00:04:44.370]So I have the extra mile.
[00:04:45.300]That's what's really got me where I am today.
[00:04:46.782]And I have, I don't know how many people working for me.
[00:04:50.160]A very large number of people working for me.
[00:04:52.350]And I seek to hire anxious people
[00:04:55.904]'cause I don't have to check on them.
[00:04:58.975]But if I let some laid back person slip through the cracks,
[00:05:02.130]you gotta keep your eye on them all the time.
[00:05:04.704](audience laughing)
[00:05:06.390]I'm reframing, that's all,
[00:05:08.970]I tend to do that when I work with somebody anxious.
[00:05:12.330]It is possible for anxiety to fear,
[00:05:16.080]to get to be so debilitating
[00:05:18.175]that a disorders a person's life.
[00:05:21.150]But those of you that are anxious,
[00:05:23.115]that's not a disorder unless the extent
[00:05:26.280]to which you're afraid has disordered your life somehow.
[00:05:29.310]If you're afraid to fly and fly, that's not a disorder.
[00:05:32.190]If you're afraid to fly and you don't fly
[00:05:34.052]and wouldn't no matter what, well that's a disorder.
[00:05:37.530]If you're afraid of public speaking
[00:05:38.730]like probably 95% of the people in this room,
[00:05:41.040]including myself are, and you won't.
[00:05:44.550]Well that's a disorder.
[00:05:45.780]But if you'll do it, get your teeth
[00:05:47.700]and do it and like kinda suffer through it,
[00:05:49.486]that's not a disorder.
[00:05:51.570]That's feeling the fear and doing it anyway.
[00:05:54.970]And so anxiety has gotten a very bad rap.
[00:05:59.580]But for somebody that's on the spectrum
[00:06:02.013]that's lower functioning,
[00:06:04.890]this conversation would be meaningless,
[00:06:07.085]for somebody that's on the spectrum
[00:06:09.300]and higher functioning,
[00:06:10.170]they could make a lot of sense out of this
[00:06:12.286]and that's why they call it a spectrum.
[00:06:16.380]And the methods for treating anxiety disorders
[00:06:23.520]for persons that are on the lower end
[00:06:24.780]of the spectrum are far less language based.
[00:06:28.650]So anyway, let me roll here.
[00:06:30.753]I'm kind of dependent upon this thing from working.
[00:06:33.090]I think it will, there.
[00:06:42.810]Okay, a universal concern.
[00:06:46.230]This has gotten me worried.
[00:06:51.630]Anxiety, a universal concern.
[00:06:53.460]And it is, but the damage that psychologists have done
[00:07:00.780]is to have people think that they have rather than do.
[00:07:05.460]And I don't think of it that way,
[00:07:11.430]say you're unfortunate and you have cancer
[00:07:13.594]or you have emphysema or you have diabetes
[00:07:17.070]and I could go on here,
[00:07:18.690]you do have that and we can find where you have it,
[00:07:21.930]you can identify the location of it.
[00:07:24.330]But if you have anxiety, where is it?
[00:07:27.720]There isn't a location for it.
[00:07:29.400]It's any different in your body than anybody else's body.
[00:07:32.340]There's a part of the body
[00:07:35.462]that when activated, produces fear like responses.
[00:07:37.710]But everybody has that.
[00:07:39.030]So having anxiety is like a misnomer,
[00:07:41.612]it's a misapplication of language
[00:07:44.160]but it almost makes it seem
[00:07:45.180]like you have some kind of a condition
[00:07:46.920]that needs to be treated,
[00:07:47.850]that's not necessarily the case.
[00:07:54.911]Maybe I'll just work from here.
[00:07:59.400]I'm all right for working for here, right?
[00:08:03.690]Can I work from here, yeah, okay.
[00:08:07.380]So here's the technical definition
[00:08:08.700]I put together, negatively reinforced behavior
[00:08:11.340]emitted in the presence of events
[00:08:13.140]that evoke or elicit the biology of stress or fear,
[00:08:15.960]but pose minimal risk of harm.
[00:08:17.460]That's BF Skinner.
[00:08:18.999]Look how delighted he is with my answer.
[00:08:20.369](audience laughing)
[00:08:23.790]But here's another definition.
[00:08:25.410]This is my definition.
[00:08:26.430]Just afraid of stuff that is unlikely to harm you,
[00:08:30.090]fear with a false cause.
[00:08:31.650]That's how I think of it.
[00:08:32.490]If you don't like those definitions, make up your own,
[00:08:42.300]then here's the place where you can get some material
[00:08:44.490]for your definition, that's where I got mine.
[00:08:56.550]Ah, okay.
[00:08:57.630]So it started out as a metaphor, as if, like a metaphor.
[00:09:02.730]It's like this is like that and people that were in the grip
[00:09:06.690]of fear, but it wasn't an immediate cause,
[00:09:09.810]felt like they were choking or like they were gonna die.
[00:09:13.074]They weren't choking and they weren't gonna die,
[00:09:15.990]but it was as if they were choking,
[00:09:17.430]as if they were gonna die.
[00:09:18.647]And so they had a term for that, French term,
[00:09:23.430]gradually migrated to anxiety.
[00:09:26.400]And somewhere along the way,
[00:09:27.930]became like reified rather than a metaphor.
[00:09:30.960]And that's where we are now.
[00:09:35.400]So signs of clinical anxiety,
[00:09:38.250]just excessive, excessive, excessive,
[00:09:40.590]excessive fear-based avoidance of benign objects.
[00:09:44.160]People can be afraid of benign objects,
[00:09:46.380]but excessive fear, meaning it's the fear
[00:09:48.839]of that object disorders their life somehow.
[00:09:51.150]Excessive emotional reaction.
[00:09:52.440]Excessive need for control.
[00:09:54.600]An anxious person and a lot of hands went up,
[00:09:57.952]that means there's a lot of control oriented people
[00:10:00.570]in this room 'cause anxious people
[00:10:03.180]like to be in control.
[00:10:05.070]Why, 'cause they can't control how they feel.
[00:10:08.220]So they like to control the things
[00:10:09.630]that make them feel that way.
[00:10:11.423]You wanna take a trip, find an anxious person,
[00:10:14.850]they're gonna wanna drive.
[00:10:16.037]They just feel more comfortable behind the wheel
[00:10:18.300]than they do in the passenger seat because,
[00:10:20.280]or if you do take them on a trip
[00:10:22.140]and they're in the passenger seat, watch their feet,
[00:10:24.780]they're putting the brake on same time you are.
[00:10:28.290]That would be me too by the way.
[00:10:29.984]Worst case scenario, like what if, what if?
[00:10:35.580]And then unresponsive to reason.
[00:10:36.780]You can't reason somebody
[00:10:38.530]outta something they weren't reasoned into.
[00:10:39.800]And then a high frequency of episodes.
[00:10:44.910]So here's the anxiety disorders.
[00:10:46.530]I'm not gonna go through all of them.
[00:10:47.730]Let's pick one, obsessive compulsive disorder.
[00:10:50.520]What is that, what is that?
[00:10:52.572]That is not quite right syndrome,
[00:10:58.230]basically what that is.
[00:10:59.520]It just isn't right.
[00:11:00.900]And then you have to do a lot of something
[00:11:03.300]in order to make it right.
[00:11:04.230]You gotta like do it over and over
[00:11:05.940]and over and over and over again.
[00:11:07.770]There, okay, I did it right.
[00:11:09.540]Or you gotta like clean the doorknob 37 times
[00:11:12.120]with the microbial wipey.
[00:11:16.710]Not once but until you get that feeling,
[00:11:19.560]that reassuring feeling that it's okay.
[00:11:25.920]Reassurance is heroin for people that are anxious,
[00:11:31.157]they're hooked on reassurance.
[00:11:33.274]And what does it take to get that reassurance?
[00:11:35.460]Those are usually the symptoms of the condition.
[00:11:38.430]And with OCD it's the cleaning, counting,
[00:11:41.280]ordering, organizing and so forth.
[00:11:49.410]The rest I guess are pretty straightforward.
[00:11:56.907]PTSD.
[00:11:58.795]PTSD, yes, the question is there much research on PTSD?
[00:12:00.780]There's a voluminous amount of research,
[00:12:02.717]but like all things that are researched in the domain
[00:12:06.810]of psychology, a lot of it is mumbo jumbo.
[00:12:10.890]However, it's a real condition
[00:12:14.760]and it's highly generalized
[00:12:16.841]and there is a very effective treatment for it,
[00:12:19.560]very effective.
[00:12:21.930]And I'll probably get to this a little later.
[00:12:24.270]The treatment for anxiety in general and PTSD
[00:12:27.810]in particular has to have a component.
[00:12:30.481]If this component is missing, the treatment will not work.
[00:12:35.310]And that component is safety.
[00:12:37.200]There has to be an experience of safety
[00:12:39.510]in the presence of the exposure
[00:12:41.784]that is the fundamental part of the treatment.
[00:12:44.760]Because bear in mind the trauma's over
[00:12:47.336]but its effects have generalized
[00:12:50.034]to anything that looks like, smells like,
[00:12:51.840]tastes like sounds like
[00:12:52.770]or feels like what originally happened.
[00:12:56.100]And then anything that happens in dreams,
[00:12:57.690]anything that happens in thoughts, it's easily triggered.
[00:13:00.120]And all those things are object of anxiety
[00:13:03.930]because they're not inherently dangerous.
[00:13:05.813]They just trigger that anxious response.
[00:13:09.450]But you can't tell the person that that odor
[00:13:12.390]that they just smell that reminds them of what they smelled
[00:13:14.580]when they were in Vietnam.
[00:13:16.167]It isn't dangerous 'cause their body's reacting
[00:13:18.870]with the fear-based response.
[00:13:19.950]You can't talk them out of it.
[00:13:21.983]So how do you convince them that it isn't dangerous?
[00:13:26.700]You gotta put them in the presence of it
[00:13:29.100]over and over and over again
[00:13:30.960]until finding the brain goes, wait a minute,
[00:13:33.030]this isn't dangerous.
[00:13:34.110]And then you go to the next thing
[00:13:35.610]and you go to the next thing.
[00:13:36.639]But there always has to be that element of safety there.
[00:13:39.000]And the easiest way to get the element of safety
[00:13:41.490]is have the person you're working with
[00:13:42.990]agree to every single step.
[00:13:45.240]And I'll say more about that with some treatments
[00:13:47.010]than I've done.
[00:13:47.850]Would you mind if I held questions until I'm all done?
[00:13:50.670]'Cause I got a lot of more, but hang on to your question.
[00:13:52.620]I'll call on you first.
[00:13:53.989]So the key symptom or key constellation
[00:14:04.993]of symptoms is avoidance.
[00:14:07.624]I showed you a picture of the DSM.
[00:14:11.460]The DSM with the exception of just a few classifications.
[00:14:14.550]The DSM is a diagnostic and statistical manual
[00:14:16.680]for the American Psychiatric Association.
[00:14:18.570]Lists all the known mental health disorders
[00:14:20.880]with very few exceptions,
[00:14:22.119]all of the mental health disorders have a single component
[00:14:25.470]which is avoidance, it's central to depression,
[00:14:28.200]it's central to anxiety and avoidance tends to generalize
[00:14:35.340]and it reinforces the notion that whatever you're avoiding
[00:14:39.450]is inherently dangerous or aversive
[00:14:42.028]and you're not getting any corrective experiences
[00:14:45.600]because you're avoiding it.
[00:14:46.680]So it stays kind of static.
[00:14:48.983]For our treatment always approach in the presence
[00:14:51.967]of a profound desire to avoid.
[00:14:55.200]In general, it shrinks the size of a person's life.
[00:14:59.370]And then the ultimate condition
[00:15:02.340]with the shrinkage is agoraphobia.
[00:15:04.110]A person's agoraphobia,
[00:15:05.400]they won't even go outta their house.
[00:15:06.870]Anything out there, it's inherently fearful.
[00:15:09.660]So they just are very comfortable
[00:15:11.250]avoiding all of that by staying home,
[00:15:13.020]ordering their groceries in never leaving the door.
[00:15:22.541]Okay.
[00:15:23.374]So there's other kinds of avoidance, however,
[00:15:27.840]there's fear-based avoidance,
[00:15:29.670]which is common in the spectrum.
[00:15:31.830]There's also avoidance of stuff
[00:15:33.210]that people just don't like and that's also common.
[00:15:36.240]The two kinds of avoidance are different.
[00:15:37.770]So I made a mistake by saying the following
[00:15:41.133]when I was in Canada, I'm assuming everybody here
[00:15:45.423]would avoid spam.
[00:15:48.240](audience laughing)
[00:15:51.690]That's not true in Canada.
[00:15:52.915]Somehow in Canada also in Hawaii, people like spam.
[00:15:56.730]I dunno how that happened, but it did anyway.
[00:15:59.460]So I can assume that pretty much you'd avoid spam.
[00:16:02.400]But let's take some spam and put some whipped cream on it
[00:16:06.570]and then some mustard and then some sprinkles,
[00:16:08.911]then some chocolate, then some ketchup, then some pickles.
[00:16:13.890]Would you be afraid of that?
[00:16:15.360]Yes.
[00:16:16.997]You'd be afraid of it.
[00:16:18.565]I mean it is disgusting but it's not like dangerous.
[00:16:21.150]That's what I'm saying.
[00:16:21.983]It's like, yes, you'd avoid it.
[00:16:23.130]It's like man, its disgusting but it's not scary,
[00:16:26.655]it's revolting.
[00:16:29.850]That's a different kind of avoidance.
[00:16:31.950]And there's a lot of that in the spectrum.
[00:16:34.530]A lot of stuff is just like bothersome.
[00:16:38.220]That's important, it needs to be part of their programming.
[00:16:40.770]But that's different than fear-based avoidance.
[00:16:44.580]So I remember, at an association
[00:16:51.360]for behavior analysis conference when a woman,
[00:16:53.280]a friend of mine, Janet Twyman,
[00:16:55.620]was elected president and it was in Chicago
[00:16:58.530]and we were at, I think it was the Hyatt
[00:17:00.794]and they gave her the presidential suite.
[00:17:04.080]The presidential suite at that Hyatt
[00:17:05.970]is actually for the president when he's in town.
[00:17:10.320]And so it has a helicopter pad so you can go out
[00:17:12.920]of the suite, down the stairs and over on the pad.
[00:17:15.480]So we did, and the pad
[00:17:18.794]looks like you could just step right off of it
[00:17:21.685]and fall into the city.
[00:17:23.730]But it actually has wire mesh extending out
[00:17:26.190]in case somebody were foolish enough to step off.
[00:17:28.710]But it's black wire mesh finally grained
[00:17:30.810]so you can't see it at night.
[00:17:32.310]So it's there but you can't see it.
[00:17:35.310]So people are messing with each other,
[00:17:36.900]nudging them over to the edge.
[00:17:38.271]A lot of people won't even go onto the pad
[00:17:40.380]once they see that there's no guardrails.
[00:17:43.350]But if somebody were to nudge you over to the edge,
[00:17:48.210]you'd resist that right?
[00:17:50.940]With how much force,
[00:17:53.790]it would be a different kind of resistance
[00:17:55.770]than resisting the spam.
[00:17:58.740]You'd resist the spam but you'd fight like the death
[00:18:02.130]to resist being pushed
[00:18:03.270]to the edge of a 26 story building.
[00:18:05.280]That's the kind of thing we're working with
[00:18:06.990]when we're working with fear-based avoidance.
[00:18:09.000]It's much more potent than just,
[00:18:10.590]I don't like it very well, don't make me do it.
[00:18:17.700]So the body has a response,
[00:18:19.170]a threat based stress response
[00:18:21.024]when something threatening occurs,
[00:18:24.993]and it could be a very low level of threat,
[00:18:28.170]the body responds immediately with stress hormones,
[00:18:31.110]cortisol and epinephrine, that immediately recruits fuel,
[00:18:34.500]glucose from the muscles and it gets metabolized
[00:18:38.880]into energy, that starts the motor running.
[00:18:43.050]That's what is behind the fight or flight response.
[00:18:45.960]So once that foot based stress response occurs,
[00:18:48.994]if there's something that you can do to execute
[00:18:52.500]that response that is called for,
[00:18:54.540]everybody goes home in a limousine.
[00:18:56.160]But if you can't, you got the motor running
[00:18:59.910]and there's nothing you can do,
[00:19:01.140]then you end up with the panic attack or you end up
[00:19:03.750]having a hard time breathing or you feel like horrible.
[00:19:08.220]And that's frequently what we're dealing with.
[00:19:12.870]So the prevalence is high.
[00:19:14.550]I don't know if you noticed all the hands that went up.
[00:19:17.620]I'm not saying that everybody in the room
[00:19:18.453]has an anxiety disorder,
[00:19:19.440]but like half the people in the room
[00:19:22.077]self-reported they're anxious.
[00:19:24.660]And the statistics suggest that about a third
[00:19:27.390]of the people in the United States
[00:19:28.500]have qualified for an anxiety disorder.
[00:19:30.990]But on the spectrum it's 40%, doesn't mean it's part
[00:19:33.870]of the condition, it's just more prevalent.
[00:19:41.760]This is getting exasperating.
[00:19:44.790]I'm gonna count on you for that.
[00:19:46.881](person laughing)
[00:19:47.714]Okay, so the causes trauma will be one of them
[00:19:54.390]and Chronic abuse, but it in a particular form,
[00:20:00.210]damned if you do, damned if you don't.
[00:20:04.170]Children are raised in that environment,
[00:20:06.210]there isn't anything they can do that's safe.
[00:20:08.760]And so for them, very quickly the world
[00:20:10.650]can become a very dangerous place
[00:20:12.300]to be in because no matter what they do,
[00:20:14.250]it ends up in an unpleasant experience.
[00:20:17.760]And then genetics, anxiety, that predisposition,
[00:20:21.870]that tip of the spear thing I was describing,
[00:20:25.170]that's passed on from generation to generation.
[00:20:28.680]And then development,
[00:20:30.265]he got insecure attachment so long time ago,
[00:20:34.050]Mary Ainsworth did a bunch of research on attachment.
[00:20:37.380]And what she showed was that children
[00:20:38.940]that were securely attached,
[00:20:40.830]infants that were securely attached,
[00:20:42.475]would crawl further and stay longer in strange situations.
[00:20:49.500]And when she said strange situations,
[00:20:51.120]she's not talking about these kids crawling
[00:20:52.470]over to the bad side of town.
[00:20:54.237]She's talking about kids that will leave the visual range
[00:20:57.990]of their mother and stay away
[00:21:00.450]from the visual range longer.
[00:21:02.550]But the kids that were insecurely attached
[00:21:05.070]would not leave visual range for their mother.
[00:21:07.173]In a strange situation,
[00:21:08.940]they immediately was scrambled back to safety.
[00:21:11.160]And so that begins very early in life
[00:21:14.357]at very early at the infant stage.
[00:21:17.580]And then non interactive play,
[00:21:23.970]visit a daycare, spend an afternoon,
[00:21:28.260]watch the bonking, the poking,
[00:21:30.330]the screaming and the biting that occurs.
[00:21:32.670]What is all that?
[00:21:34.233]Is that the animal nature of human beings just coming out?
[00:21:38.820]No, it's boundary protection.
[00:21:41.700]It's the kids when they go to get up,
[00:21:44.820]they put their hand on another kid's face
[00:21:46.560]to lift themselves up.
[00:21:47.670]Well the kid that's got that hand in his face
[00:21:49.260]bites that hand.
[00:21:50.550]They're basically teaching each other
[00:21:52.050]to stay away from my body.
[00:21:55.004]They're learning boundaries.
[00:21:57.900]But kids on the spectrum tend to do isolate play.
[00:22:01.890]So they don't learn those boundaries.
[00:22:04.380]And so they end up going further at going out in life
[00:22:07.260]not knowing stuff that you and I just take for granted.
[00:22:11.430]We weren't born knowing about the way to handle ourselves
[00:22:14.280]in a social situation.
[00:22:16.080]We learned them.
[00:22:17.460]Like everybody knows instinctively how to behave
[00:22:21.690]on an elevator, press the button,
[00:22:24.900]when the door opens, enter, do not make eye contact,
[00:22:29.730]do not touch anyone and swiftly turn around,
[00:22:32.905]press the number for your floor and stare at the numbers
[00:22:36.330]above the door as if the secrets of the universe
[00:22:38.340]were contained right there until the door opens again
[00:22:41.640]at your floor, exit, don't look back.
[00:22:45.030]We all know these rules,
[00:22:46.650]but imagine what an elevator ride
[00:22:48.240]could be like if you didn't know the rules.
[00:22:50.730]You enter the elevator, you don't turn around,
[00:22:53.250]you get a little nervous,
[00:22:54.497]you start touching people and talking to them.
[00:22:57.390]What an unpleasant experience
[00:22:58.560]that would be for everybody in the elevator,
[00:23:00.240]including the person that just did all that stuff.
[00:23:02.730]And that's the kind of thing I'm trying to suggest
[00:23:05.070]that a person that hasn't learned those boundaries,
[00:23:07.620]haven't learned the social rules and regulations of life
[00:23:11.340]enters into when they go out into life.
[00:23:13.980]And so for you and I, we're pretty comfortable
[00:23:16.350]at everything except a cocktail party,
[00:23:18.345]where they're uncomfortable.
[00:23:20.790]Everything is a cocktail party for them
[00:23:22.650]where they have to go very uncomfortably
[00:23:24.000]introduce themselves to people or hide in the corner,
[00:23:26.875]unlearned social roles and rules.
[00:23:32.310]I have been the beneficiary
[00:23:33.876]of some very, very socially skilled people
[00:23:37.800]and I learned basically the hard way
[00:23:40.380]also through their coaching,
[00:23:41.717]how to handle myself in life socially.
[00:23:46.620]But I recall the lessons that I learned along the way
[00:23:49.080]and they were really unpleasant to learn.
[00:23:51.780]'cause I'm a hick from Montana
[00:23:54.308]and so I can remember one,
[00:23:56.341]my first year of graduate school
[00:23:59.417]and I go to my first professional conference,
[00:24:02.490]it's decided for behavioral medicine.
[00:24:04.920]I'm with my best friend,
[00:24:06.195]extraordinarily socially graceful guy called Jack Finney.
[00:24:10.860]And I'm dressed in my finest, which is boot cut Levi jeans,
[00:24:15.840]Tony Lama cowboy boots, a leather vest,
[00:24:18.900]a cowboy shirt with piping and satin
[00:24:20.730]and those kind of pearly buttons
[00:24:21.920]and a sport coat that's got cowboy stuff all over it.
[00:24:25.410]And my triple X beaver winner cowboy hat,
[00:24:30.540]dressed up for a conference.
[00:24:32.490]Nobody says anything to me, so I think it's okay.
[00:24:37.020]He's dressed up in a suit.
[00:24:39.090]We meet a couple of women that he knows
[00:24:40.560]that were assistant professors at LSU.
[00:24:42.725]And so we're talking to them.
[00:24:44.520]I turn away, I turn back and I see one of them go,
[00:24:48.330]where'd you get him?
[00:24:49.667](people laughing)
[00:24:51.090]Not like it seemed to me like, oh,
[00:24:52.980]she's interested in me.
[00:24:56.591]I said that to Jack later. I thought, I think your friend,
[00:24:58.500]you know, she was interested in me.
[00:24:59.430]He goes, why do you think that?
[00:25:01.097]I said, well, because she said, where'd you get him?
[00:25:03.690]He said, no, Pat, no, she didn't say, where'd you get him?
[00:25:06.300]She said, where did you get him?
[00:25:10.500]What are you talking about?
[00:25:11.430]He says, man, you can't flirt like that
[00:25:14.790]at a conference and you gotta get some new clothes.
[00:25:19.680]Which both of those things,
[00:25:21.390]I was like dumbfounded to hear that, I always flirted.
[00:25:24.990]But to me the world was a bar.
[00:25:26.610]This was just an extension of a bar.
[00:25:28.710]Well, turns out a professional conference
[00:25:30.600]is not an extension of a bar.
[00:25:33.690]Anyway, so I got 50 of those
[00:25:36.270]where I actually was coached on how to behave,
[00:25:39.679]not like keep your hands to yourself,
[00:25:42.570]but kind of like that.
[00:25:44.479]I don't think a lot of people on the spectrum
[00:25:47.100]get that kind of social training,
[00:25:49.500]which makes the world a strange and scary place socially.
[00:25:52.590]And avoidance would be the natural inclination for them.
[00:25:55.560]And just to stay around people that are safe,
[00:25:57.030]like the family.
[00:25:58.717]And then you get this unfit narrative.
[00:26:01.620]You don't fit into the world very well.
[00:26:03.687]Not true, just you haven't learned how to fit yet.
[00:26:08.940]So in children, again, the key you wanna look for
[00:26:12.390]is just this excessive need for control.
[00:26:14.220]It shows up in lots of different ways,
[00:26:16.140]arranging and ordering a movement of objects
[00:26:18.300]that's not necessarily just stereo,
[00:26:22.560]but it's also just exerting control over the objects.
[00:26:26.940]Scripting the play of others, correcting the play of others,
[00:26:30.780]bargaining to get your way,
[00:26:32.400]ongoingly bargaining to get your way.
[00:26:33.840]Frustration and unexpected shifts in play
[00:26:36.450]that didn't go along with the bargaining and the rules
[00:26:38.430]and then decided just to go and play by yourself.
[00:26:40.800]It's way better if you just go and play by yourself.
[00:26:42.900]Social confusion and I dependence on adults,
[00:26:45.357]like this, when you hear the following,
[00:26:49.981]and he really gets along with the adults,
[00:26:53.160]that's not a good sign.
[00:26:54.516]That is not, adults make it easy.
[00:26:57.930]They act like that goofy thing the kid just did
[00:27:00.210]is really kind of funny, but really isn't very funny.
[00:27:02.026]It's funny, odd, not funny like haha.
[00:27:08.579]Then here's what's important, tricky,
[00:27:15.990]unintentional.
[00:27:17.670]This is unintentional stuff from adults.
[00:27:20.270]Questioning, how are you doing?
[00:27:26.820]What does that imply, how are you doing?
[00:27:29.640]Like the implication is there's something
[00:27:32.910]that you have to check for to see if it's there.
[00:27:35.730]How you doing, is not the same as, hey, how you doing?
[00:27:38.040]That's different.
[00:27:39.510]It's that kind of questioning.
[00:27:41.040]But the parent is looking for reassurance
[00:27:43.666]that the child is okay by their question,
[00:27:47.010]but in their question they're suggesting
[00:27:48.600]that they're not okay.
[00:27:49.800]And then it has the person check
[00:27:51.030]to see why they're not okay.
[00:27:52.260]And pretty soon you got this congruence going on,
[00:27:54.240]generating a not okay narrative,
[00:27:56.939]checking, of course you wanna check,
[00:28:00.660]but are you checking more with this child
[00:28:02.700]and then with that child?
[00:28:04.836]And then does that child recognize that you're checking more
[00:28:07.323]on them than they are on the others?
[00:28:08.331]And what does that mean?
[00:28:09.339]That means that, oh,
[00:28:10.349]if there's something about me, reduced independence,
[00:28:12.195]independence would be for the parent,
[00:28:16.410]but without it then the child
[00:28:17.910]doesn't learn to expand their world.
[00:28:20.280]Enabling avoidance 'cause it's more comforting.
[00:28:22.890]The child doesn't cry as much, not as distressed as much.
[00:28:25.050]And naturally you want them to feel good about themselves.
[00:28:27.060]You want to care for them and have them be comfortable.
[00:28:29.220]That isn't always the answer.
[00:28:31.170]In fact, safe and comfortable
[00:28:35.330]is not a very good condition for human functioning,
[00:28:40.080]except when you're sleeping.
[00:28:41.617]I'm not opposed to it.
[00:28:44.610]But when you're safe and comfortable, nothing is happening.
[00:28:47.460]You aren't learning a thing.
[00:28:49.890]When you're absolutely comfortable
[00:28:51.270]so that everything's fine and you're absolutely safe,
[00:28:54.150]then you're not doing anything to expand
[00:28:56.400]the boundaries of your life.
[00:28:58.890]Attention to fear, which should be fine if there was way,
[00:29:05.400]way, way more attention to bravery of any sort.
[00:29:09.030]And so the attention to fear
[00:29:10.230]was like a minority batch of attention.
[00:29:12.930]And the majority of batch of attention
[00:29:15.060]would be to any sign of bravery,
[00:29:16.680]any sign of trying something new,
[00:29:17.910]any ti any sign of taking a chance.
[00:29:20.160]And then low distress tolerance, and what do I mean by that?
[00:29:24.810]I don't mean low distress tolerance,
[00:29:26.190]like the person can't tolerate distress.
[00:29:28.350]I mean low tolerance for the distress of the child.
[00:29:32.760]Does that make sense to you?
[00:29:34.140]Like I used to do these developmental assessments,
[00:29:38.250]they call it the Bailey scales of infant mental development.
[00:29:41.005]And I wanted to master it.
[00:29:43.350]I was at the University of Kansas School of Medicine.
[00:29:45.630]I went to every office in that large,
[00:29:47.910]the biggest employer in the state of Kansas.
[00:29:49.710]I went to every office looking for young women
[00:29:52.410]that might have children, asking them
[00:29:54.690]if they bring their child in,
[00:29:55.770]let me practice on their child.
[00:29:57.450]And that test goes all the way down to three months of age.
[00:30:01.920]So say it's six months,
[00:30:03.720]you can't just bring the kid in
[00:30:05.070]and have the parents in the waiting room,
[00:30:07.020]you gotta have the six month old
[00:30:08.430]sitting on his parents' lap.
[00:30:09.985]Then we do these little tests.
[00:30:12.120]One is I put a block down,
[00:30:13.880]they're looking at it and they grab it pass,
[00:30:18.480]I put another block down, they're looking at it,
[00:30:21.006]they pick it up, pass.
[00:30:23.064]Then I put a third block down.
[00:30:25.170]This is the dawn of cognitive development.
[00:30:27.768]And they're like, and they put down one block
[00:30:33.849]and they pick up the third block.
[00:30:35.216]And I'm right back where I started it from,
[00:30:39.870]which is all fine,
[00:30:40.995]I'm watching them trying to solve this problem,
[00:30:44.700]but the mother gets distressed and helps.
[00:30:50.040]I'm absolutely certain she could pick up three blocks,
[00:30:54.720]no doubt about it, I'm not testing her.
[00:30:57.120]But she gets so uncomfortable with the discomfort
[00:30:59.700]of her infant that she wants to help out
[00:31:01.350]on a developmental test,
[00:31:03.240]which skews the results of the test.
[00:31:05.365]That's what I mean, dilemmas.
[00:31:11.340]Yeah, but I may not feel, I'm not a parent.
[00:31:13.200]I confessed that this morning.
[00:31:14.610]So I don't have to face these dilemmas
[00:31:16.710]so I can spout out my theories with impunity.
[00:31:20.520]Now whether I could actually follow through with them.
[00:31:22.800]It's never been tested.
[00:31:25.740]So you want to encourage participation, exposure,
[00:31:28.980]and bravery and allow avoidance or withdrawal.
[00:31:32.855]But at what levels, the parent is always between those two
[00:31:38.131]and on one, there's a lot of distress
[00:31:41.199]and discomfort, on the other,
[00:31:44.700]there's a lot of safety and comfort,
[00:31:46.140]but nothing's happening.
[00:31:47.220]And the parent might ultimately think
[00:31:49.620]they're enabling something they wanna not do.
[00:31:51.900]So they're kind of caught between
[00:31:55.113]or a rock and a hard place.
[00:31:58.500]So the strategies for their parents
[00:32:00.780]and caregivers is praise and attend
[00:32:04.500]to brave behavior and ignore
[00:32:09.199]non brave behavior.
[00:32:10.032]Like let it be rather than attend to it,
[00:32:15.060]make it better, reassure, et cetera.
[00:32:17.759]Model brave behavior and use role reversal.
[00:32:21.870]That's a little tricky.
[00:32:24.600]A parent has a tendency to go, it's simple.
[00:32:28.410]This isn't dangerous, watch me.
[00:32:31.590]That's not what we're looking for here.
[00:32:34.230]We're looking for.
[00:32:35.850]Yes honey, that makes me nervous too.
[00:32:39.090]It really does.
[00:32:40.890]I'm gonna do it anyway.
[00:32:42.270]I'm gonna go over and I'm gonna just play with the dog.
[00:32:46.830]Oh, that worked out.
[00:32:48.810]So you wanna let the child see
[00:32:51.840]the distress and see the overcoming of it
[00:32:54.739]with the distress there.
[00:32:57.330]Not like you're already over it and you're going,
[00:32:59.250]there was nothing,
[00:33:00.526]I go right over to the neighbor's house,
[00:33:02.880]I just start talking to them.
[00:33:03.780]No, you'd be like, the neighbors just moved in next door.
[00:33:08.190]It makes me nervous to talk to strangers, really does.
[00:33:11.160]But I want to be a good neighbor, honey.
[00:33:12.900]So I'm gonna go over and introduce myself
[00:33:15.634]and then I'll tell you how it went when I come back home.
[00:33:18.150]So you're saying, yeah, we're alike in that way.
[00:33:20.550]It's uncomfortable to go and talk to strangers,
[00:33:22.588]but I'm gonna do it.
[00:33:24.690]That's what you want them to see.
[00:33:26.220]Not that it's so easy you don't even think about it,
[00:33:28.710]but now you do think about it
[00:33:29.820]and it is a little challenging,
[00:33:30.960]but you're willing to meet the challenge.
[00:33:32.520]And I'm gonna ask you to meet the challenge too,
[00:33:34.230]like that, allocate responsibility, encourage independence,
[00:33:39.000]lot of mistakes, it's some mix of all that.
[00:33:42.690]Give them some responsibility.
[00:33:44.460]Let them set the table even though it involves sharp knives.
[00:33:48.960]I don't know how.
[00:33:51.698]Let them make sure the dog is fed and check later.
[00:33:56.640]Let them lock the back door.
[00:33:59.130]Allow mistakes, don't make a big deal about that.
[00:34:01.410]'Cause they're gonna be wanting,
[00:34:03.478]they want to avoid them
[00:34:04.311]if there's a big deal made about a mistake,
[00:34:05.520]people make mistakes and emotional acceptance.
[00:34:11.910]You heard of Carl Rogers before extraordinary individual.
[00:34:16.440]And he had this theory that if a therapist
[00:34:23.790]could presence complete acceptance
[00:34:27.990]of what was in front of the person,
[00:34:29.550]what in front of them in the client,
[00:34:31.724]that everything was just fine just the way it was.
[00:34:34.530]The person was just fine just the way they were.
[00:34:37.860]They had these neurotic fears
[00:34:39.210]and people have them and that they had these worries
[00:34:42.420]and concerns and that happens to people.
[00:34:44.290]And I can understand how that makes you feel
[00:34:46.440]and just reflect back what they're saying
[00:34:48.540]and accept exactly what they're communicating
[00:34:51.030]and don't judge any of it.
[00:34:52.260]Don't give any directions, that that would be healing.
[00:34:57.930]How much of that do you have in your life?
[00:34:59.919]Is there somebody that you can go to who has you
[00:35:03.270]just be absolutely fine just the way you are?
[00:35:09.030]Or are they pretty okay with the way you are
[00:35:11.490]but you know you should try this.
[00:35:13.590]Or maybe you did a little more of that,
[00:35:18.030]that would be very good for them at least periodically
[00:35:20.460]to have a dose of that profound emotional acceptance.
[00:35:24.130]Set reachable goals, create opportunities for change.
[00:35:29.400]I have anxious clients and I have OCD clients,
[00:35:36.780]I'll the furniture, they come in, they've come in,
[00:35:39.557]they come in like 10 times, they sit in the same place.
[00:35:42.630]I sit in the same place and then the 11th time,
[00:35:45.981]the chair they always sit in isn't there,
[00:35:48.145]a different colored chair and it's a different
[00:35:50.160]part of the room and I'm behind my desk rather
[00:35:52.230]than on the couch.
[00:35:53.658]And they're like, this is different.
[00:35:59.799](person laughing)
[00:36:00.632]And they gotta get over that.
[00:36:01.920]they gotta step over, this is different.
[00:36:03.900]And they got that feeling like this isn't quite right
[00:36:06.330]'cause it's not quite right syndrome.
[00:36:07.927]And then just kind of ease into it and I ease with them,
[00:36:13.740]change a few things, that's all.
[00:36:15.793]And then exposure, extinction, desensitization,
[00:36:18.960]those are all programs.
[00:36:20.607]Exposure's the key.
[00:36:23.760]So medication is one way to go, they're the medication.
[00:36:27.930]Whoops, I don't know if I can go backwards.
[00:36:33.630]I can there did you increase the sensitivity somehow
[00:36:41.580]because it's working better.
[00:36:43.078]So here's the general types of medications.
[00:36:47.550]Have you heard of the beta blockers before?
[00:36:51.210]Anybody here have stagefright?
[00:36:54.450]You know what I'm talking about, like you're real nervous.
[00:36:56.250]Get in front of an audience.
[00:36:57.610]Guess who else has stagefright, like clinical stagefright,
[00:37:02.160]Jeff Bridges, Barbara Streisand, Carly Simon,
[00:37:05.430]Pablo Casals, I could go on here.
[00:37:07.620]People that you would think are completely at ease
[00:37:10.740]in front of a camera, in front of an audience.
[00:37:13.200]Absolutely not, absolutely not.
[00:37:14.564]They're terrified.
[00:37:17.790]But there's a medication called the beta blocker,
[00:37:21.480]doesn't have any side effects.
[00:37:23.160]You don't even know it's in your system.
[00:37:24.690]What it does is it lowers heart rate
[00:37:26.524]and it lowers the threat based stress response
[00:37:30.390]and it allows them to go and performance.
[00:37:33.293]It's a performance enhancement drug.
[00:37:34.230]Like who golfs in here?
[00:37:36.330]Anybody golf, you know what the yips are,
[00:37:41.280]you get that little tremor over a putt,
[00:37:43.380]it's a four foot putt and you couldn't make it
[00:37:44.910]to save your life 'cause you're just so nervous.
[00:37:47.520]Like if you just say the word yips
[00:37:49.201]on a green when you're with a foursome,
[00:37:51.840]they'll probably ask you not to play with them anymore.
[00:37:52.673](person laughing)
[00:37:55.050]Just put that thought in their head.
[00:37:56.580]Now they got them, anyway.
[00:37:58.450]It's the result of fine motor tremors that are secondary
[00:38:02.220]to being slightly afraid
[00:38:03.570]you won't make the putt, when you take that beta blocker,
[00:38:06.750]you don't have those fine motor tremors.
[00:38:08.280]So people that have fine motor performance
[00:38:11.220]like Pablo Casals for example,
[00:38:12.810]or pianists will take the beta blockers so they can control
[00:38:15.510]their fine motor movements better.
[00:38:19.530]I found out about it when I was at the University
[00:38:21.870]of Nebraska School of Medicine
[00:38:23.220]and I was a professor that was in the faculty
[00:38:26.280]and pediatrics and residents would come
[00:38:28.890]and spend a month with me.
[00:38:30.190]I had a resident once a month for 36 months.
[00:38:33.720]They'd spend a whole month with me.
[00:38:35.190]And they have a thing in medical schools
[00:38:37.283]called grand rounds, blood sport basically.
[00:38:43.530]So in grand rounds the medical faculty
[00:38:47.493]gets in front of all the faculty and gives a presentation.
[00:38:51.630]And in the front row are all the full professors
[00:38:54.987]that have been doing this for years
[00:38:57.090]and years and years ready to pounce,
[00:38:58.920]waiting for the person to make a mistake
[00:39:00.420]so they can jump on them and show them how stupid they are.
[00:39:02.738]So these residents wanted to do grand rounds with me
[00:39:06.769]because there was just one behavioral pediatric expert
[00:39:09.750]on the entire faculty and it was me
[00:39:11.820]and you always had to have an attending faculty
[00:39:13.950]do your presentation with you.
[00:39:15.120]So they had me doing it with them.
[00:39:16.530]So they didn't have to worry about me attacking them.
[00:39:18.510]So they chose me,
[00:39:19.947]but they're still nervous when we rehearse.
[00:39:22.890]I go and rehearse and their nervous is like a cat in a room
[00:39:24.900]full of rocking chairs, I'm like, settle down.
[00:39:27.690]But day of I go in there, there I go, hey, how you doing?
[00:39:31.110]Great Dr. Fryman.
[00:39:32.910]So good to see you, I'm like, what is going on here?
[00:39:36.090]And they go, beta blockers, baby, beta blockers.
[00:39:39.098](person laughing)
[00:39:40.140]What are beta blockers?
[00:39:43.980]When my clients are concerned about things like that,
[00:39:47.220]I tell them, go to your physician.
[00:39:49.080]Tell them that you're worried about X, Y or Z.
[00:39:51.420]Ask for a beta blocker.
[00:39:52.560]They'll know exactly what you're talking about.
[00:39:54.300]They'll give it to you because they themselves
[00:39:56.010]probably use it from time to time.
[00:40:02.190]So into treatment, supportive health education.
[00:40:06.330]I've been doing that already.
[00:40:07.890]This is a variation of what I do with all my clients
[00:40:10.800]is I supply health education
[00:40:13.260]about what anxiety actually is
[00:40:14.952]so that they have a better understanding of it
[00:40:17.190]than the one that the culture supplies
[00:40:19.050]and the one that my profession routinely supplies.
[00:40:26.160]Then I externalize it,
[00:40:30.180]people don't even notice I'm doing it,
[00:40:34.050]I abandon the words of you and all its synonyms
[00:40:38.100]and I start using the word it.
[00:40:39.957]And so now it's like three things in my office.
[00:40:42.690]There's the client, there's me and there's it.
[00:40:45.570]And we're talking about it like the person doesn't have it.
[00:40:48.680]It is something that they have to deal with.
[00:40:52.170]And with kids, that worked especially well.
[00:40:55.740]And I would have them give it a name.
[00:40:58.680]And when the Lord of the Rings was popular,
[00:41:01.830]you know that book and that,
[00:41:04.685]Gollum was in my office two, three times a week.
[00:41:09.360]So I basically just externalize it
[00:41:12.330]so it doesn't seem like a condition that they have.
[00:41:16.020]Then relaxation, progressive muscle relaxation.
[00:41:19.950]That's pretty straightforward.
[00:41:21.000]You tighten and then relax every muscle group in the body,
[00:41:24.720]just go all the way through the body,
[00:41:26.850]focus, breathing another way.
[00:41:29.100]Focus on your breathing,
[00:41:30.780]slowing it down, counting mindfulness,
[00:41:33.150]attending to what you're doing while you're doing it
[00:41:35.134]or what the Navy seals use and the navy seals
[00:41:37.689]have consistent sources of genuine fear.
[00:41:44.370]People are shooting at them, four by four by four by four.
[00:41:48.060]Anybody heard of this before?
[00:41:49.980]Breathe in for four, hold it for four,
[00:41:54.930]breathe out for four for four minutes.
[00:41:58.890]See what they're trying to do is they're trying
[00:42:00.390]to get their hands to not shake
[00:42:01.830]because when you're hands shake and you're trying to shoot,
[00:42:03.750]it doesn't take that much to throw a shot off.
[00:42:05.610]So they're trying to get that threat based stress response
[00:42:07.710]to calm down on their body.
[00:42:08.700]And they do it with the breathing exercise.
[00:42:10.765]But let me show you one,
[00:42:12.390]if this is something your doctor would recommend
[00:42:15.930]that you don't do, then don't do it.
[00:42:17.190]But anybody that can do this, if you wanna do this,
[00:42:20.070]do this with me.
[00:42:20.903]Take a deep breath, now more, more, more, more.
[00:42:29.940]Let it out really slow, really like a balloon.
[00:42:33.030]Just deflating.
[00:42:39.540]Feel that, you do that for four or five minutes
[00:42:42.660]you'll lower your systolic blood pressure by 20 millimeters,
[00:42:45.870]but you can feel it if you just do it once.
[00:42:47.673]It's just kind of a relaxation response that you can have.
[00:42:50.760]You can do it naturally.
[00:42:57.450]Then exposure based treatments go through some of those.
[00:43:01.740]So some real life examples.
[00:43:06.180]So some people for reasons unknown,
[00:43:09.590]are terrified of cats
[00:43:12.090]and the exhibiting extraordinary problematic behavior
[00:43:16.020]in the presence of cats.
[00:43:17.663](people laughing)
[00:43:19.050]So obviously this is something that warrants a treatment.
[00:43:24.090]And so we start with distal exposure,
[00:43:27.570]pet the cat at arms length and then proximal exposure,
[00:43:31.710]get close and sniff them.
[00:43:33.390]And then this final step has a lot of intensity to it.
[00:43:35.970]But if they do this step, they are absolutely cured.
[00:43:44.310]A lot of kids are afraid of falling into the toilet
[00:43:46.290]and who can blame them?
[00:43:47.123]They've seen stuff go in,
[00:43:49.080]they've never seen stuff come out.
[00:43:51.390]They do the math
[00:43:52.223]and they see they'd fit nicely so they're afraid.
[00:43:55.710]So we do a little bit of exposure by holding them.
[00:43:59.670]Their caregiver holds them over the aperture
[00:44:02.197]or we have them sit there independently,
[00:44:04.680]but they can bring a friend and have the aperture closed
[00:44:08.250]or mom can have them sit over the aperture
[00:44:10.080]while she distracts them with a book.
[00:44:11.460]And then it's the terminal stage
[00:44:12.660]has a lot of intensity to it,
[00:44:13.830]but if they pass this stage,
[00:44:15.630]everybody goes home in the limousine, there it is.
[00:44:19.156](audience laughing)
[00:44:22.410]A lot of kids are afraid of little creepy crawlies.
[00:44:24.210]A lot of adults are too actually.
[00:44:26.580]And so in our program we start off
[00:44:28.530]with very small creepy crawlies
[00:44:31.290]and then we have them hold it distally and then proximally.
[00:44:37.170]And this last stage is a lot of intensity to it,
[00:44:39.810]but when it's passed, they're cured.
[00:44:41.190]There it is.
[00:44:46.500]So here's some actual examples.
[00:44:50.310]So this was a kid at Boystown, that's where I work,
[00:44:53.556]that had obsessive compulsive disorder
[00:44:57.180]and Tourette's syndrome.
[00:44:58.920]So I talked a little bit
[00:45:00.300]about obsessive compulsive disorder,
[00:45:03.300]but I haven't talked about Tourette's syndrome.
[00:45:05.520]So Tourette's Syndrome is a chronic neurological disease.
[00:45:09.510]Incurable, that's typified by vocal and motor ticks.
[00:45:14.610]And there are five kinds of ticks
[00:45:16.590]that aren't part of the diagnosis,
[00:45:17.970]but if they're present, they are confirmatory,
[00:45:20.430]there's no other way to explain them.
[00:45:22.084]One you know about probably coprolalia, which is where
[00:45:27.630]the kids, the people afflicted will say profane things,
[00:45:32.850]these days, the way the culture is going,
[00:45:35.790]the kid that has Tourette's syndrome
[00:45:37.410]used to be rejected and abused.
[00:45:39.330]Now they're the most popular kid in class
[00:45:41.056]'cause I'm gonna to use profanity here.
[00:45:46.380]Just one thing they can tell the teacher to get fucked
[00:45:49.863]and get away with it and everybody in the class
[00:45:53.520]loves them for it, so coprolalia, then there's Copropraxia,
[00:45:59.580]praxia is movement, so those are obscene gestures.
[00:46:02.550]lalia is the obscene speech,
[00:46:04.470]echopraxia where a person echoes
[00:46:07.590]what the other person does with their body.
[00:46:09.420]Echolalia, where they say what they said
[00:46:12.060]and then pallylalia where they repeat what they said.
[00:46:16.005]So this kid, he had echopraxia,
[00:46:17.610]which meant when somebody touched anywhere on their chest,
[00:46:21.480]he had to touch anywhere on their chest.
[00:46:24.630]It would've been fine if it would've been his chest.
[00:46:27.300]This is Boystown.
[00:46:28.320]But Boystown has girls and the boys
[00:46:31.950]when that happened he, they would just smack him.
[00:46:34.350]But a lot of our girls have been sexually abused.
[00:46:37.140]And so he's around the girls, they talk,
[00:46:39.930]they're talking like this,
[00:46:40.763]they touch their chest and he's right in there
[00:46:43.160]touching their chest.
[00:46:44.550]But he's got OCD.
[00:46:46.650]So he didn't do it right.
[00:46:48.750]So he is gotta do it again and again and again.
[00:46:53.580]And at some point this looks a lot like groping.
[00:46:56.820]And nobody at Boystown knew about these conditions.
[00:47:00.390]They just knew he was groping our girls.
[00:47:01.770]So they're gonna kick him out.
[00:47:03.450]But back then,
[00:47:04.560]whenever they were gonna terminate a kid at Boystown,
[00:47:06.840]I asked them to send the kid to my shop
[00:47:10.110]so we could do an extra evaluation
[00:47:12.060]to see that if there might be something there
[00:47:13.560]we could work with.
[00:47:14.610]And so that's where we discovered Tourette's and OCD.
[00:47:18.120]And this data is from one of my female interns
[00:47:25.620]sitting in front of him touching her chest.
[00:47:29.130]And the instant that he'd reached for her chest,
[00:47:31.050]we'd block him, so it's exposure and response prevention.
[00:47:35.310]And the result was gradually, gradually,
[00:47:37.950]gradually stop doing it.
[00:47:39.570]And these data are published
[00:47:42.570]in the Premier Child Psychiatry Journal in the world.
[00:47:45.642]But I don't know if you,
[00:47:47.700]how much you know about this kind of data collection.
[00:47:50.550]There is no experimental control there.
[00:47:52.747]There's not an AB design there.
[00:47:55.440]It's just B, in other words,
[00:48:00.421]it's meaningless in the world of science.
[00:48:01.254]But this finding was so unique
[00:48:02.869]that they published it anyway,
[00:48:05.400]but we continued on and found another kid.
[00:48:08.490]This is real experimental data, same kind of problem.
[00:48:11.550]This is published in the Journal
[00:48:12.570]of Implied Behavior Analysis.
[00:48:15.900]It's a nice looking young man
[00:48:18.030]looking like he's getting ready for a job interview.
[00:48:23.220]Here's his clinical description.
[00:48:24.390]Above average IQ,
[00:48:25.290]suspicious of adults, very socially anxious,
[00:48:27.930]socially phobic, really, pervasive fear of public failure,
[00:48:32.160]uncomfortable with attention, very controlling,
[00:48:35.940]very manipulative, here he is as an adult.
[00:48:41.460]Oh my God.
[00:48:43.500]So I have his psychiatric evaluation.
[00:48:45.270]I have the evaluation of Charles Manson
[00:48:47.130]when he was 14 and I have one when he was 44.
[00:48:52.138]And the reason I have the one for me when he was 44
[00:48:55.260]is because I did research
[00:48:57.750]on what I thought was his condition,
[00:48:59.730]which is a co-occurring conduct disorder with social phobia.
[00:49:06.840]Those two blended together,
[00:49:08.400]that hadn't been reported in the literature before.
[00:49:11.040]People at 60 Minutes found out about it
[00:49:12.822]and found out about Charles Manson connection.
[00:49:15.480]They sent a producer to talk me into being on 60 Minutes
[00:49:18.510]to talk about my research,
[00:49:19.620]which really they just wanted me
[00:49:20.550]to talk about Charles Manson.
[00:49:23.040]So I told them I would do it
[00:49:25.560]if they got informed consent from Charles Manson.
[00:49:30.120]So the producer, Norm Green, went to Folsom,
[00:49:32.952]got an appointment with Manson, but Manson was under attack
[00:49:36.630]at that time by people in the prison.
[00:49:38.550]Whenever he was under attack, felt at risk,
[00:49:41.430]he would either burn his mattress or flood his cell.
[00:49:43.440]They put him in protective custody for a couple of days.
[00:49:45.990]When green showed up, he like flooded his cell,
[00:49:48.810]he's in protective custody, he didn't get his meeting.
[00:49:51.510]So he bribes a guard and gets that evaluation
[00:49:53.910]thinking he'll give me the evaluation and then buy me off.
[00:49:57.390]They'll talk me into doing the thing.
[00:49:59.340]I got the evaluation, but that wasn't,
[00:50:01.230]I still wouldn't agree to do it.
[00:50:04.641]I have it, when he was 14, he was a resident of Boystown.
[00:50:08.670]That's why I have that evaluation.
[00:50:11.049]He wasn't a monster at 14,
[00:50:14.760]he'd been in 20 different foster homes.
[00:50:17.010]His mother was in and out of his life.
[00:50:18.540]She was part-time prostitute,
[00:50:19.980]some bringing men into his life who abused him.
[00:50:22.200]He was small of stature, very controlling, very nervous,
[00:50:25.320]highly abused, neglected and very smart.
[00:50:29.820]And he gradually became controlling,
[00:50:33.120]trying to control the world around him
[00:50:34.980]so that it wouldn't do what it has been doing to him.
[00:50:37.800]And control can ultimately be inherently reinforcing,
[00:50:41.490]which is what happened with him.
[00:50:43.440]So when he was ultimately convicted,
[00:50:45.915]he didn't kill anybody, he wasn't even at the scene.
[00:50:51.540]He manipulated other people into killing for him.
[00:50:54.330]That's how much control he was able to exert
[00:50:56.417]and that can kind of feed on itself.
[00:50:58.560]So by the time he was doing that, he had turned monstrous.
[00:51:00.652]But at 14, like if he would've come to see me
[00:51:04.950]as a client now, nobody would ever hear of him again.
[00:51:08.550]He would just be a like an anonymous clinical record
[00:51:11.070]'cause that condition is so easy to treat.
[00:51:12.960]But back then, nobody knew what they were doing.
[00:51:17.370]So this is data from a kid.
[00:51:20.730]And we've done with lots of kids,
[00:51:22.200]who had exactly the same clinical presentation,
[00:51:24.588]very easy to treat.
[00:51:27.594]This kid was socially phobic.
[00:51:32.370]And at Boystown, they have this big point system,
[00:51:37.320]they do teaching interactions,
[00:51:39.150]nine step teaching interactions
[00:51:41.480]and five step reward interactions.
[00:51:43.651]And all that's done in kind of a public way.
[00:51:46.950]Other kids are watching, other adults are present.
[00:51:49.111]And this kid was just like Manson,
[00:51:52.350]he was like socially phobic.
[00:51:53.610]And so he would just, he's a big kid,
[00:51:56.160]he'd just punch people
[00:51:57.090]when they were doing teaching interactions.
[00:51:58.440]So they're gonna kick him out.
[00:52:00.180]I did his evaluation, I said I think we can work on this.
[00:52:03.090]And so here was our intervention.
[00:52:04.380]Pretty straightforward, you know what, I told them,
[00:52:08.820]treat him like you'd want to be treated
[00:52:11.430]if you were in his situation.
[00:52:15.210]Do it privately.
[00:52:17.190]Adults don't like to have a lot of attention drawn to them
[00:52:20.010]when they've made a mistake.
[00:52:21.640]I guess kids do, no, especially not teenagers.
[00:52:25.560]So just do it privately,
[00:52:26.880]like you're gonna do a teaching interaction,
[00:52:28.290]just take it and do it privately,
[00:52:29.820]whether it's at the school or in the home, do it privately.
[00:52:33.060]That's what they did.
[00:52:33.900]Those are the data that we got,
[00:52:35.010]completely solved the problem.
[00:52:39.150]Insect phobia.
[00:52:40.050]So here's a cricket and those of us in the room,
[00:52:43.290]I don't think very many of us are afraid of crickets.
[00:52:46.770]We sort of think of a cricket as a benign creature.
[00:52:50.016]Jiminy Cricket, part of the Disney world.
[00:52:54.960]But the kid in my study
[00:52:56.730]had a different relationship with crickets.
[00:52:58.680]I think this is sort of what he thought of.
[00:53:00.870]And if you look at a cricket really carefully,
[00:53:02.970]you can see they got the little saw things
[00:53:04.590]on their legs and it looks like they have teeth
[00:53:09.060]and they're scary when you really look at them.
[00:53:15.510]So for this kid we did a graduated exposure
[00:53:18.600]and the key thing here is safety.
[00:53:21.120]I mentioned that on the front end.
[00:53:22.620]So we designed these steps with him,
[00:53:26.100]we designed these steps with him.
[00:53:28.200]He agreed to every one of them,
[00:53:29.610]but we had to go very slowly.
[00:53:31.200]So we start off with just holding a jar with crickets
[00:53:35.190]and then that bottom one is hold a cricket
[00:53:39.120]in each hand for 20 seconds.
[00:53:45.180]And we used this worry scale to help us calculate
[00:53:48.900]which step would be first and second and so forth.
[00:53:51.330]And then here are these data.
[00:53:54.990]I don't have a pointer on here, or do I?
[00:53:58.140]Yeah, okay.
[00:53:59.790]I know the people online can't see
[00:54:01.290]what I'm doing with his pointer.
[00:54:02.730]But here are the three conditions.
[00:54:05.010]So we got this kid in the room
[00:54:06.870]and he has to do math problems.
[00:54:08.970]So he is doing math problems in a condition called no bugs,
[00:54:14.010]where I go in, search the room thoroughly
[00:54:17.130]and they go, nope, there's no bugs in here.
[00:54:19.470]Do your math.
[00:54:22.530]Then this condition where I go into the room and I go,
[00:54:27.150]I don't see any bugs but I'm pretty sure
[00:54:29.010]there's some in here, do your math.
[00:54:31.040]So I'm saying bugs.
[00:54:34.506]And this one was releasing two live crickets, right?
[00:54:36.780]When he is watching me into the room, do your math.
[00:54:40.350]So what we see is a significant decline
[00:54:43.380]in his math 'cause he would jump up
[00:54:45.080]on a table and do it like this.
[00:54:49.110]So he'd do the graduated exposure
[00:54:50.661]and we're doing pretty well, and what happened?
[00:54:54.990]What happened there?
[00:54:56.579]I think he just got sick of doing math.
[00:55:02.100]That's my assumption.
[00:55:03.510]So what we do then is we start paying him off.
[00:55:06.930]We're doing math problems,
[00:55:08.490]giving him some points for doing math.
[00:55:11.700]And we do a little reversal there.
[00:55:14.325]And back to like in other words,
[00:55:16.770]the combination of the exposure and the incentive
[00:55:20.460]for doing the math problem solved that problem.
[00:55:22.887]And this is serendipitous, serendipitous.
[00:55:27.060]My research partner showed up over at the classroom
[00:55:29.850]just to observe, he sees this kid get out of his chair,
[00:55:33.990]go up to the teacher's desk, gets the tissue, comes back,
[00:55:37.530]gets down on on the floor and does something
[00:55:39.900]and then throws the tissue in the waste basket
[00:55:41.947]and then class empties out.
[00:55:45.630]My research partner goes to the waste basket
[00:55:47.880]and in the tissue it was a dead cricket.
[00:55:49.003]Now just coincidentally, we happen to see that.
[00:55:51.590]Before this happened, this is a big kid
[00:55:56.520]and every kid in his class knew he had this condition.
[00:55:59.670]Do you think that they were really careful with him?
[00:56:01.560]No man, they would go,
[00:56:03.450]I think there's a cricket on your desk.
[00:56:04.980]Or they'd find a dead cricket and put it in his desk
[00:56:07.140]and wave one in his face and he'd go berserk
[00:56:08.820]and knock over the desk, punch people on the face.
[00:56:11.040]That's why I came to our attention.
[00:56:15.420]So this is a kid with blood phobia.
[00:56:17.040]I'm just gonna show you what his program looked like.
[00:56:20.280]He needed blood draws,
[00:56:22.020]that's what's gonna happen with some kids on the spectrum.
[00:56:24.750]When they have something related to a medical phobia
[00:56:27.810]or a dental phobia, they gotta have the service.
[00:56:31.170]They're terrified of that service.
[00:56:32.850]They go in kicking and screaming.
[00:56:34.221]The thought that the physician might have
[00:56:36.840]is you just sedate them and then take them in like comatose.
[00:56:39.630]And that's no solution really.
[00:56:42.600]But it's a very significant challenge.
[00:56:46.500]So this is his program.
[00:56:48.830]I'll just do the first and last step.
[00:56:50.520]Walk in, sit in a waiting area, leave.
[00:56:53.246]In, down, gone, all the way down to walk in,
[00:56:57.780]sit in the waiting area,
[00:56:59.795]sitting parents' lap and exam chair with arm down,
[00:57:02.070]nurse draws blood, that's the terminal stage.
[00:57:04.800]But all along the way is graduated exposure with incentives.
[00:57:10.320]This is dental phobia and I'm gonna play this video.
[00:57:14.310]Can you take my picture out of the corner?
[00:57:18.300]This will go on for a while.
[00:57:19.680]Here's the steps for the dental phobia.
[00:57:22.950]Step number one, therapist states, let's go to the dentist.
[00:57:25.350]Sit down, Joey sits down
[00:57:26.610]in chair in front of the therapist with dental tools
[00:57:28.980]removed from, there were no dental tools.
[00:57:30.990]Step 10, all the steps and the kids' teeth are counted.
[00:57:36.720]But I have a video of this.
[00:57:44.760]Oops, that's the data.
[00:57:47.610]Yes, there you go.
[00:57:48.443](people chattering)
[00:58:06.583]This girl is severely appeared on the spectrum.
[00:58:10.687](person crying)
[00:58:32.028]Remember that for your dental visit.
[00:58:38.388]Good job, sit back.
[00:58:47.073]Nice job, look at you, all by yourself.
[00:58:50.843]Good job.
[00:58:57.793]This is before everybody
[00:58:58.908]in the world wore masks.
[00:59:04.215]Nice work.
[00:59:07.293]Here we go, gonna hold the mirror.
[00:59:14.209]Look at you.
[00:59:18.724]Look, can I touch your teeth?
[00:59:20.520]Say ah, good job.
[00:59:25.050]Open your mouth, put your feet down please.
[00:59:28.260]Thank you, can you open your mouth?
[00:59:31.552]Open your mouth.
[00:59:33.000]Good, let me see.
[00:59:35.122]Oh, Addie, your teeth are so pretty.
[00:59:38.940]Can I look with the mirror?
[00:59:41.190]Say ah.
[00:59:44.604]Say good job big man.
[00:59:48.264]Hello, we're the Wiggles,
[00:59:50.428]we're going to sing and dance, hello.
[00:59:55.612]All right, sit back, open your mouth, open.
[00:59:59.890]Ah, good.
[01:00:01.290]Keep it open, you have to stay back.
[01:00:03.900]Keep it open, ah, awesome.
[01:00:06.840]Keep going.
[01:00:08.513]Let's see those teeth.
[01:00:09.538]Sit back, see you.
[01:00:12.381]See those teeth.
[01:00:13.901]See those teeth.
[01:00:15.910]Okay, sit back, sit back.
[01:00:23.881](person shouting)
[01:00:24.898]Sit back, sit back.
[01:00:26.198]Sit back.
[01:00:30.540]He's not gentle enough.
[01:00:31.950]Open up, there we go.
[01:00:35.718]He's still working but he's not gentle enough.
[01:00:38.285]Open up, nice job.
[01:00:41.010]Ready?
[01:00:56.640]Good work.
[01:00:58.590]Yeah, she's way more gentle.
[01:01:02.749](person humming)
[01:01:09.360]Nice job Addie.
[01:01:26.990]Nice job.
[01:01:29.669]Good work.
[01:01:31.420]That was awesome.
[01:01:33.982]Now the dentist.
[01:01:36.046](upbeat music)
[01:01:40.584]Good job Addie.
[01:01:53.021](person shouting)
[01:02:41.561]Sit back.
[01:02:43.089]It's like a drive-in movie.
[01:02:52.631]Okay, you get the idea.
[01:02:59.020]So it just graduated exposure.
[01:03:02.130]And there has to be at least modicum
[01:03:04.800]of comfort and a lot of safety along the way
[01:03:08.880]because the thing that you're exposing the person to
[01:03:11.370]is not inherently dangerous.
[01:03:13.410]It's being experienced as dangerous
[01:03:15.720]and you're deprived of the ability
[01:03:17.700]to explain effectively that it's not dangerous.
[01:03:20.820]So what are you left with?
[01:03:22.020]It has to be experienced as not dangerous.
[01:03:24.330]That requires exposure.
[01:03:26.100]But exposure always have to have this component
[01:03:29.610]is essential, which is safety.
[01:03:31.410]Comfort isn't quite as important, you have to have some,
[01:03:34.260]but you have to have a lot of safety.
[01:03:40.110]So the typical treatment demystify,
[01:03:42.157]which I did a fair amount of
[01:03:43.560]on the front end, then externalize,
[01:03:46.020]especially with kids, exposure in some form.
[01:03:50.160]Incentives where necessary
[01:03:51.630]and always helps to have it incentivized.
[01:03:54.570]Modifying parenting practices,
[01:03:56.400]you'll find a lot of overprotection
[01:03:58.050]because they don't know what else to do with it.
[01:04:00.930]That makes, in most circumstances,
[01:04:04.170]that's really good parenting,
[01:04:06.510]protecting your child from danger.
[01:04:08.760]They're behaving as if that they are in danger.
[01:04:13.410]And so that activates a parent's protective practices.
[01:04:16.440]But in those instances, they're not exactly helpful.
[01:04:22.050]Relaxation and sell it.
[01:04:23.689]Sell it, now what have I been doing?
[01:04:26.310]Selling, that's all I've been doing for the past hours.
[01:04:29.400]Just trying to sell this approach.
[01:04:31.200]And it has to be sold, some of it's counterintuitive.
[01:04:35.340]And so you'll be working with a parent potentially,
[01:04:37.800]you gotta sell them this procedure for their child
[01:04:40.260]or you're working with with,
[01:04:41.509]I just work with typically developing adults.
[01:04:44.550]But I also have to sell my procedures to them,
[01:04:49.982]You got the code.
[01:04:52.200]Can can they see the code online?
[01:04:54.420]Okay.
[01:04:56.340]Somebody back there had a question and I promised, yes.
[01:05:01.080]I wondering what do you feel?
[01:05:04.471]Okay, so I'm hypersensitive to fireworks.
[01:05:07.033]To fireworks.
[01:05:08.149]Of course every year we have, guess what?
[01:05:10.074]Yes.
[01:05:11.087]Fireworks.
[01:05:12.087]I don't know how to help myself
[01:05:14.594]because I have a negative reaction every time,
[01:05:18.295]negative reaction.
[01:05:19.506]And of course we can't do the fireworks.
[01:05:21.698]Right.
[01:05:22.707]Anytime except for the fourth
[01:05:24.007]it's really hard.
[01:05:25.272]The young woman is afraid of fireworks.
[01:05:27.240]What do you do about that?
[01:05:28.110]Move to Montana.
[01:05:29.719](people laughing)
[01:05:30.552]Because in Montana all you get to have
[01:05:32.190]are Twizzlers and black cats.
[01:05:36.150]You don't wanna live in Nebraska.
[01:05:37.754]Everything short of dynamite is permitted in Nebraska.
[01:05:44.370]I can't believe it.
[01:05:45.945]Well, is it the sound?
[01:05:49.710]I don't know
[01:05:51.134]if I'm necessarily scared of fireworks.
[01:05:52.427]I think I'm scared, nonfunctional.
[01:05:58.557]So like when I was younger,
[01:06:00.582]I would go wind up and shut down and meltdown.
[01:06:06.048]So that was scary.
[01:06:08.353]And so not really, I don't know if I'm scared of fireworks.
[01:06:11.769]Scared of the response that have to fireworks.
[01:06:14.681]But well that response is a fear.
[01:06:16.530]She's scared of her response to fireworks,
[01:06:18.360]not fireworks themselves,
[01:06:19.627]but the response to fireworks is a fear-based response.
[01:06:22.500]So I would say they're causing that fearful response.
[01:06:27.600]So it sounds like you're afraid of them,
[01:06:29.501]but then there's a lot of components to this.
[01:06:32.010]One is the sound, which is incredibly aversive.
[01:06:35.640]The other is the fire, the other is the risk.
[01:06:40.230]So which part of that,
[01:06:41.630]of the experience activates that response sound?
[01:06:50.430]I don't know that it's something
[01:06:51.744]that you wanna really get used to or can,
[01:06:55.590]but I'd say instead is when you think
[01:06:59.040]there's gonna be a lot of fireworks around,
[01:07:01.080]buy some silicone earplugs that swimmers use
[01:07:05.910]that block out person's, I mean, literally like that,
[01:07:11.160]they can block out that much sound where
[01:07:12.829]you can watch somebody
[01:07:15.325]moving their lips and you can't hear
[01:07:16.350]what they're saying if you make a good seal,
[01:07:19.170]it's what I do.
[01:07:20.120]My neighborhood goes crazy for three days.
[01:07:27.090]What's that?
[01:07:29.340]Our fireworks in our area
[01:07:30.443]is like anywhere from seven to 10 days
[01:07:32.460]and they go nuts on it.
[01:07:34.175]Yeah.
[01:07:35.173]Try having sensory issues
[01:07:37.407]and wearing ear pods.
[01:07:40.822]EarPods, earplugs,
[01:07:42.330]headphones rather than just getting used to it.
[01:07:45.480]I mean, they obviously aren't dangerous,
[01:07:47.160]but I don't know that we're talking about danger here.
[01:07:49.080]It sounds like it's just aversive.
[01:07:52.425]Yeah, it is aversive.
[01:07:54.060]It's just highly, highly unpleasant.
[01:07:55.769]And if you wanna see how unpleasant it can get,
[01:07:58.200]watch what happens to dogs 'cause it's terrible for dogs.
[01:08:02.190]They go hide under the bed,
[01:08:03.330]they go run down into the basement,
[01:08:04.980]they cover their head with their paws
[01:08:06.960]'cause their hearing is so super sensitive
[01:08:08.720]that the owners of these dogs
[01:08:10.710]are blowing off these fireworks and don't realize
[01:08:12.630]what they're doing to their dog.
[01:08:14.640]So your response sounds like a,
[01:08:18.270]it doesn't sound like a clinical response.
[01:08:21.690]It sounds like a natural response
[01:08:23.370]to a really unpleasant situation.
[01:08:26.010]And you're not gonna do anything
[01:08:27.210]by talking your neighbors out of this.
[01:08:28.440]So you gotta figure out something
[01:08:29.273]you're gonna do while they're doing it.
[01:08:31.199]That's the best I've got, really.
[01:08:35.340]Online.
[01:08:36.270]Yeah.
[01:08:37.320]I have a teen who is afraid to learn to drive.
[01:08:40.815]He refuses to drive, we struggle with how to encourage,
[01:08:43.740]incentivize him to engage in practice.
[01:08:47.850]The question from online is the person
[01:08:49.950]has a teen that's afraid to learn to drive.
[01:08:53.430]How can they encourage him to learn to drive?
[01:08:56.130]What can they motivate him?
[01:08:57.270]What can they use to motivate him to drive, he's a teenager.
[01:09:00.810]It's very common to driving with kids.
[01:09:04.140]What's that?
[01:09:05.160]I teach drivers ed
[01:09:06.060]and that's getting very common.
[01:09:09.273]Why not go the other way?
[01:09:12.720]I mean, who's more afraid?
[01:09:15.450]The kid that's afraid to drive the driving
[01:09:17.190]or the parent of the kid that's afraid to drive
[01:09:20.700]but they know he is out there driving.
[01:09:21.930]I mean, what's lost if the kids don't drive?
[01:09:26.280]And inevitably the peer pressure for getting from point A
[01:09:32.700]to point B in a car is gonna be motivating enough.
[01:09:35.760]Then they're motivated to learn,
[01:09:36.930]but while they're not learning to drive,
[01:09:40.980]why not just let it be?
[01:09:42.771]I don't know that a parent is gonna be able to supply
[01:09:45.120]that motivation, but their first girlfriend is anyway.
[01:09:51.360]Anybody else have a question?
[01:09:55.350]Yes.
[01:09:56.610]So you were talking
[01:09:58.410]about the signs with children.
[01:10:00.360]I have a nine year old and when the play,
[01:10:03.600]not on the spectrum, and when the play doesn't go her way,
[01:10:10.200]even with her five year old sister to like break down cry
[01:10:13.980]and like go and hide it, her bed cry.
[01:10:16.920]And so then when you were talking about the strategies,
[01:10:19.170]I guess my question would be do I attend
[01:10:21.480]to her crying, break down at all?
[01:10:24.150]Or do, is that a ignore situation?
[01:10:26.323]Well I guess it would be.
[01:10:32.200]Yeah, I'm just gonna do that.
[01:10:33.736]When play doesn't go her daughter's way,
[01:10:37.380]she has a version of a hissy fit where she cries
[01:10:40.740]and breaks down and goes to her room.
[01:10:42.597]And I don't know, sobs to herself
[01:10:49.890]factor this in, I don't have any kids.
[01:10:53.220]So what, I mean she's not hurting anybody.
[01:10:59.280]She's not disrupting anything.
[01:11:00.842]And it's possible it has a function
[01:11:04.680]which is sympathetic attention.
[01:11:06.313]You seem like you would be a sympathetic person.
[01:11:10.110]No, you just coldhearted.
[01:11:13.475](people laughing)
[01:11:16.063]Am I doing the right thing by ignoring it?
[01:11:18.060]Yes, that would be my suggestion
[01:11:20.490]is don't give it anything.
[01:11:22.697]Incentivize the opposite when you see it
[01:11:26.280]in small drips and drabs.
[01:11:28.050]But yeah, I would ignore it because that
[01:11:32.610]could have the function of drawing you away from the play
[01:11:36.150]and then getting that extra something from you,
[01:11:39.240]which would be a win for her,
[01:11:41.430]a loss for her sister and ultimately a loss for her.
[01:11:46.530]Anybody else have a question, yes.
[01:11:48.150]This might be a good question,
[01:11:50.790]but does a person who's struggling with anxiety has phobias
[01:11:54.360]have to meet all the criteria
[01:11:56.280]to be diagnosed with an anxiety disorder?
[01:11:59.610]Does a person have to meet all the criteria
[01:12:01.157]for an anxiety disorder to qualify as having one?
[01:12:05.400]Not necessarily.
[01:12:06.716]I just try to determine how much impairment is present
[01:12:09.319]and if it's a significant amount of impairment,
[01:12:13.320]then I figure that's enough 'cause their life is impaired.
[01:12:16.529]Yeah, that's where the disorder is.
[01:12:17.830]That makes sense.
[01:12:19.380]Yeah, yes.
[01:12:21.430]That's all right, that's all right.
[01:12:23.183]No, no, go ahead.
[01:12:24.330]Question, I'm a speech therapist
[01:12:26.100]in school, I don't have the license behind my name
[01:12:30.990]to say, I can treat anxiety or anything,
[01:12:33.480]but is it legal for me to give them all those strategies?
[01:12:36.060]Yes, you don't have to have a license
[01:12:37.890]to give common sense.
[01:12:39.372](person laughing)
[01:12:41.100]People are so anymore.
[01:12:43.320]That's true, that's true.
[01:12:48.090]I guess if it could be characterized
[01:12:49.940]as a prescription of treatment
[01:12:54.101]by the parent that's litigation happy maybe.
[01:13:00.750]And you are a licensed professional
[01:13:02.355]and so a like ambulance chasing lawyer
[01:13:07.951]could possibly characterize you using your power
[01:13:10.063]as a licensed professional to step outside
[01:13:14.220]your area of expertise and tell this young girl
[01:13:16.950]to do X, Y, and Z.
[01:13:18.240]It didn't go very well and the parents
[01:13:19.680]are upset, now they're gonna sue you.
[01:13:21.363]That could happen.
[01:13:24.300]So my recommendation would be,
[01:13:25.957]make it as common sense as you can.
[01:13:32.040]And I go outside the bounds
[01:13:34.325]of what you might call safe practice
[01:13:39.334]in my office frequently,
[01:13:41.520]but I've always tested those boundaries first
[01:13:43.899]just to see, is this the kind of person
[01:13:46.977]that's gonna take what I've said and turn it
[01:13:49.500]all the way backwards and use it against me or not?
[01:13:53.130]And so far so good.
[01:13:54.502]It just is a natural tendency to want to help.
[01:13:58.560]You know, and you can help, but it's slightly risky.
[01:14:05.220]And I have studied breath work.
[01:14:08.463]I just don't have the certification.
[01:14:10.564]Right.
[01:14:11.580]So I do feel confident,
[01:14:13.320]it's just legally, I didn't know.
[01:14:15.625]You're a speech therapist,
[01:14:17.340]I think that legitimizes you to do anything with breath.
[01:14:20.460]There you go.
[01:14:21.629](person laughing)
[01:14:22.462]True, done.
[01:14:24.488]Thank you very much everyone, thank you.
[01:14:27.267](audience clapping)

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Anxiety in Persons on the Spectrum: The Psychological Equivalent of Fever

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