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

Dr. Pat Friman Author

04/10/2023 Added

61 Plays

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2023 Conference Session

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[00:00:01.050]Good morning.
[00:00:03.870]I've never asked anyone to do what I'm gonna ask
[00:00:08.520]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.
[00:00:23.250]So could somebody just every once
[00:00:24.560]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?
[00:00:30.024](crowd laughing)
[00:00:37.530]Is anybody, does anybody here think of themselves
[00:00:41.190]as an anxious person and be willing to say so?
[00:00:47.319](crowd laughing)
[00:00:49.080]Okay, I'll just, I'll, what if I pick you?
[00:00:51.960]I'm not gonna ask you to do anything
[00:00:53.250]cuz of course you're anxious person.
[00:00:56.125](crowd laughing)
[00:00:57.603](participant talking faintly in the background)
[00:01:01.722](crowd laughing)
[00:01:02.555]Okay, good. Thank you.
[00:01:04.080]So one of the things that I always do
[00:01:06.870]when I work with somebody
[00:01:07.830]that's anxious is reframe their condition
[00:01:12.120]because I'm a clinical psychologist
[00:01:14.190]and I've been one for 30 years
[00:01:15.390]and I know what damage that we have done
[00:01:18.030]in our interpretation
[00:01:19.110]and tendency to pathologize routine human behavior.
[00:01:23.520]And a human being has a capacity for fear.
[00:01:27.180]It's one of our instincts almost.
[00:01:30.990]And it's a huge source of our survival.
[00:01:35.160]But somehow, anxiety has been pathologized.
[00:01:39.600]And so people that have it so does,
[00:01:41.880]even I'm saying people that have it,
[00:01:45.780]you don't say people have fear.
[00:01:47.749]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'm, I reframe.
[00:02:01.140]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
[00:02:12.000]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 way
[00:02:18.180]before any other members of the tribe.
[00:02:20.430]And so they'd alert the tribe to what they had just sensed
[00:02:24.330]and the tribe would get up the trees or into a cave
[00:02:26.250]and be protected from the predators that would be around.
[00:02:28.290]The sabertooth tigers, 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,
[00:02:45.390]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 marauding tribes. Starvation isn't imminent.
[00:02:53.040]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.
[00:03:02.700]At the worst end of the spectrum
[00:03:04.170]is just being out in the open,
[00:03:05.340]like agoraphobia or the various phobias
[00:03:09.420]that where people are afraid of things
[00:03:10.830]that are not at all dangerous.
[00:03:13.290]It's just this thing trying to activate itself.
[00:03:16.080]So what happened was the laid back people,
[00:03:22.470]I'm sorry to say this to those of you that are,
[00:03:24.690]but they won the public relations contest
[00:03:28.200]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 tend
[00:03:33.060]to want to 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
[00:03:42.720]to make sure the garage door is closed
[00:03:44.190]when you go on vacation?
[00:03:45.697](crowd laughing)
[00:03:48.990]You'd be a little nervous about the laid back person.
[00:03:51.540]Which one can you count on
[00:03:52.620]to make sure the credit card bills are paid
[00:03:54.090]before the penalty phase?
[00:03:56.100]Which of you are gonna make sure
[00:03:58.110]that there's somebody to take care of your pets
[00:03:59.880]before you leave on vacation and so forth.
[00:04:02.460]You really can't count on a laid back person
[00:04:04.410]for that kind of thing, but you can absolutely count
[00:04:06.330]on the anxious person for that kind of thing.
[00:04:09.330]So the anxious person is concerned,
[00:04:13.410]although the term they use is worried, concerned, worried.
[00:04:16.461]I don't know. Concerned seems like
[00:04:17.820]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
[00:04:29.070]and I'm thanking the good Lord Almighty that I am
[00:04:33.000]because it has had me always go the extra mile
[00:04:36.390]and that extra mile makes up for what I lack in aptitude.
[00:04:41.280]I mean, if I had the aptitude,
[00:04:42.300]maybe I wouldn't need the extra mile, but I don't have it.
[00:04:44.370]So I have the extra mile.
[00:04:45.270]That's what's really got me where I am today.
[00:04:47.790]And I have, I don't know how many people working for me.
[00:04:49.993]A very large number of people working for me.
[00:04:52.320]And I seek to hire anxious people
[00:04:56.250]cuz I don't have to check on them.
[00:04:59.331]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.
[00:05:03.854](crowd laughing)
[00:05:06.390]I'm reframing. That's all I'm,
[00:05:08.940]I tend to do that when I work with somebody anxious.
[00:05:12.330]It is possible for anxiety to,
[00:05:15.510]fear to get to be so debilitating
[00:05:18.600]that it disorders a person's life.
[00:05:21.150]But those of you that are anxious,
[00:05:23.520]that's not a disorder unless the extent
[00:05:26.250]to which you're afraid has disordered your life somehow.
[00:05:29.280]If you're afraid to fly and fly, that's not a disorder.
[00:05:32.160]If you're afraid to fly and you don't fly
[00:05:34.470]and wouldn't no matter what, well, that's a disorder.
[00:05:37.500]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,
[00:05:44.520]well, that's a disorder.
[00:05:45.750]But if you'll do it, you know,
[00:05:47.160]grit your teeth and do it
[00:05:48.060]and like kinda suffer through it, that's not a disorder.
[00:05:51.570]That's feeling the fear and doing it anyway.
[00:05:54.897]And so anxiety has gotten a very bad rap.
[00:05:59.580]But for somebody that's on the spectrum
[00:06:02.430]that's lower functioning,
[00:06:04.890]this conversation would be meaningless.
[00:06:08.100]For somebody that's on the spectrum and higher functioning,
[00:06:10.170]they would make, they could make a lot of sense out of this
[00:06:12.180]and that, you know, that's why they call it a spectrum.
[00:06:16.350]And the methods for treating anxiety disorders
[00:06:23.490]for persons that are on the lower end
[00:06:24.750]of the spectrum are far less language based.
[00:06:28.620]So anyway, let me roll here.
[00:06:31.110]I'm kind of dependent upon this thing from working.
[00:06:33.090]I think it will.
[00:06:37.401]There we go.
[00:06:41.602]There.
[00:06:42.435](crowd laughing)
[00:06:43.268]Okay, a universal concern.
[00:06:46.200]This has gotten me worried.
[00:06:47.807](crowd laughing)
[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 if, and I don't think of it that way.
[00:07:10.680]If you have, say you're unfortunate
[00:07:12.720]and you have cancer or you have emphysema
[00:07:15.900]or you have diabetes, and I could go on here,
[00:07:18.327]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.
[00:07:29.100]It isn't any different in your body
[00:07:31.170]than anybody else's body.
[00:07:32.310]There's a part of the body that reduces,
[00:07:34.500]that when activated produces fear like responses.
[00:07:37.800]Everybody has that.
[00:07:39.030]So having anxiety is like a misnomer,
[00:07:41.340]like a, 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.
[00:07:48.177]That's not necessarily the case.
[00:07:54.840]Ah, so here I'm, maybe I'll just work from here.
[00:07:59.400]I'm all right for working from here, right?
[00:08:03.690]Can I work from here?
[00:08:04.523]Yeah. Okay.
[00:08:07.380]So here's the technical definition I put together.
[00:08:09.960]Negatively reinforced behavior emitted
[00:08:11.640]in the presence of events
[00:08:13.110]that evoke or elicit the biology of stress or fear
[00:08:15.960]but pose minimal risk of harm.
[00:08:17.430]That's BF Skinner.
[00:08:18.263]Look how delighted he is with my answer.
[00:08:20.441](crowd laughing)
[00:08:23.790]But here's another definition. This is my definition.
[00:08:26.430]Just afraid of stuff that doesn't, is unlikely to harm you.
[00:08:30.060]Fear with a false cause. That's how I think of it.
[00:08:38.965]If you don't like those definitions, make up your own.
[00:08:42.240]And here's the place where you can get some material
[00:08:44.490]for your definition where I got mine.
[00:08:56.580]Ah. Okay, So it started out as a metaphor.
[00:09:01.260]As if like a metaphor, it's like this is like that
[00:09:04.740]and people that were in the grip of fear,
[00:09:07.320]but it wasn't an immediate cause,
[00:09:09.810]felt like they were choking or like they were gonna die.
[00:09:12.960]It wasn't, 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.
[00:09:18.780]And so they had a term for that, a French term,
[00:09:21.810]angoisse, and gradually migrated to anxiety.
[00:09:26.370]And somewhere along the way became
[00:09:28.980]like reified rather than a metaphor.
[00:09:30.960]And that's where we are now.
[00:09:35.370]So signs of clinical anxiety.
[00:09:38.220]Just excessive, excessive, excessive.
[00:09:40.590]Excessive fear-based avoidance of benign objects.
[00:09:44.130]People can be afraid of benign objects,
[00:09:46.380]but excessive fear, meaning it's the fear of
[00:09:49.230]that object disorders their life somehow.
[00:09:51.120]Excessive emotional reaction.
[00:09:52.440]Excessive need for control.
[00:09:54.240]You know an anxious person?
[00:09:56.850]A lot of hands went up.
[00:09:58.590]That means there's a lot of control oriented people
[00:10:00.540]in this room because anxious people like to be in control.
[00:10:05.040]Why? 'Cause they can't control how they feel,
[00:10:08.190]so they like to control the things
[00:10:09.630]that make them feel that way.
[00:10:12.300]You want to take a trip?
[00:10:13.770]Find an anxious person. They're gonna want to drive.
[00:10:16.740]They just feel more comfortable behind the wheel
[00:10:18.270]than they do in the passenger seat because,
[00:10:20.250]or if you do take 'em 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.
[00:10:30.960]Worst case scenariorizing.
[00:10:32.310]Like what if, what if?
[00:10:35.550]And then unresponsive to reason.
[00:10:36.750]You can't reason somebody outta something
[00:10:38.250]they weren't reasoned into.
[00:10:40.620]And then a high frequency of episodes.
[00:10:44.910]So here's the anxiety disorders.
[00:10:46.560]I'm not gonna go through all of them. Let's pick one.
[00:10:48.450]Maybe obsessive compulsive disorder. What is that?
[00:10:52.230]What is that? 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, over again.
[00:11:07.143]It's out there, okay, I did it right
[00:11:09.540]or you gotta like clean the doorknob 37 times
[00:11:12.090]with the microbial wipey.
[00:11:16.680]Not once. 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.
[00:11:31.710]They're hooked on reassurance.
[00:11:33.660]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,
[00:11:41.250]ordering, organizing, and so forth.
[00:11:49.410]The rest I guess are pretty straightforward.
[00:11:57.690]PTSD, yes. Question.
[00:11:58.980]Is there much research on PTSD?
[00:12:00.750]There's a voluminous amount of research.
[00:12:03.630]But like all things that are researched
[00:12:06.030]in the domain of psychology, a lot of it is mumbo jumbo.
[00:12:10.890]However, it's a real condition
[00:12:14.730]and it is highly generalized
[00:12:17.280]and there is a very effective treatment for it.
[00:12:19.560]Very effective.
[00:12:21.660]But, and I'll probably get to this a little later,
[00:12:24.270]the treatment for anxiety in general
[00:12:27.030]and PTSD in particular has to have a component.
[00:12:31.050]If this component is missing, the treatment will not work.
[00:12:35.250]And that component is safety.
[00:12:37.170]There has to be an experience of safety
[00:12:39.510]in the presence of the exposure.
[00:12:42.390]That is the fundamental part of the treatment.
[00:12:44.730]Because bear in mind, the trauma's over
[00:12:48.150]but its effects have generalized
[00:12:50.460]to anything that looks like, smells like,
[00:12:51.840]tastes like, sounds like, or feels like
[00:12:54.480]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 so easily triggered.
[00:13:00.300]And all those things are,
[00:13:02.670]there's object of anxiety
[00:13:03.960]because they're not inherently dangerous.
[00:13:06.240]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
[00:13:13.860]of what they smelled when they were in Vietnam,
[00:13:16.620]it isn't dangerous cuz their body's reacting
[00:13:18.840]with the fear-based response.
[00:13:19.950]You can't talk 'em out of it.
[00:13:23.160]So how do you convince them that it isn't dangerous?
[00:13:26.700]You gotta put 'em in the presence of it over
[00:13:29.640]and over and over again
[00:13:30.930]until finally the brain goes,
[00:13:31.770]wait a minute, this isn't dangerous.
[00:13:34.110]And then you go to the next thing
[00:13:35.580]and you go to the next thing.
[00:13:36.930]But there always has to be that element of safety there.
[00:13:38.697]And the easiest way to get the element of safety
[00:13:41.490]is have the person you're working with agree
[00:13:43.230]to every single step.
[00:13:45.521]And I'll say more about that
[00:13:46.410]with some treatments than I've done.
[00:13:47.850]Would you mind if I held questions until I'm all done?
[00:13:50.640]Because I got a lot of more, but hang on to your question.
[00:13:52.620]I'll call on you first.
[00:13:58.170]So the key symptom
[00:14:03.030]or key constellation of symptoms is avoidance.
[00:14:07.290]That's, I showed you a picture of the DSM.
[00:14:11.430]The DSM, with the exception of just a few classifications,
[00:14:14.520]the DSM is a diagnostic and statistical manual
[00:14:16.650]for the American Psychiatric Association.
[00:14:18.570]Lists all the known mental health disorders.
[00:14:20.880]With very few exceptions, all of the mental health disorders
[00:14:24.120]have a single component, which is avoidance.
[00:14:26.670]It's central to depression.
[00:14:28.170]It's central to anxiety.
[00:14:30.360]And avoidance tends to generalize.
[00:14:35.310]And it reinforces the notion
[00:14:36.990]that whatever you're avoiding
[00:14:39.450]is inherently dangerous or aversive
[00:14:42.510]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.
[00:14:49.560]For our treatment, always involves approach
[00:14:52.440]in the presence of a profound desire to avoid.
[00:14:57.360]In general, it shrinks the size of a person's life.
[00:14:59.340]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 avoiding all of that
[00:15:12.090]by staying home, ordering their groceries in,
[00:15:14.550]never leaving the door.
[00:15:23.310]So there's other kinds of avoidance, however.
[00:15:27.810]There's fear-based avoidance,
[00:15:29.670]which is common in the spectrum.
[00:15:31.800]There's also avoidance of stuff that people just don't like.
[00:15:34.710]And that's also common.
[00:15:36.210]The two kinds of avoidance are different.
[00:15:37.770]So I made a mistake by saying the following
[00:15:44.460]when I was in Canada.
[00:15:46.650]I'm assuming everybody here would avoid Spam.
[00:15:51.660]That's not true in Canada.
[00:15:54.030]Somehow in Canada, also in Hawaii, people like Spam.
[00:15:56.730]I dunno how that happened, but it did.
[00:15:59.130]Anyway, so I can assume that pretty much you'd avoid Spam.
[00:16:02.370]But let's take some Spam and put some whipped cream on it
[00:16:06.540]and then some mustard and then some sprinkles,
[00:16:09.240]then some chocolate, then some ketchup, then some pickles.
[00:16:13.890]Would you be afraid of that?
[00:16:15.330]Yes.
[00:16:16.875]You'd be afraid of it?
[00:16:17.767]I mean it is disgusting but it's not like dangerous.
[00:16:21.120]That's what I'm saying.
[00:16:21.953]It's like, yes, you'd avoid it.
[00:16:23.130]It's like man, that's disgusting.
[00:16:24.720]But it's not scary. It's revolting.
[00:16:29.850]That's a different kind of avoidance.
[00:16:31.980]And there's a lot of that in the spectrum.
[00:16:34.500]A lot of stuff is just like bothersome.
[00:16:38.190]That's important. 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 an elected president and it was in Chicago
[00:16:58.500]and we were at the, I think it was the Hyatt
[00:17:01.230]and they gave her the presidential suite.
[00:17:04.080]The presidential suite at that Hyatt is actually
[00:17:06.630]for the president when he's in town.
[00:17:10.290]And so it has a helicopter pad.
[00:17:12.540]So you can go out of the suite,
[00:17:13.950]down the stairs, and over on the pad.
[00:17:15.450]So we did.
[00:17:16.740]And the pad looks like you could just step right off
[00:17:21.600]of it 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.
[00:17:28.680]But it's black wire mesh finely grained
[00:17:30.780]so you can't see it at night.
[00:17:32.280]So it's there but you can't see it.
[00:17:35.310]So people are messing with each other.
[00:17:36.630]You know, nudging 'em over to the edge.
[00:17:38.880]A lot of people won't even go onto the pad once they see
[00:17:40.890]that there's no guardrails.
[00:17:43.350]But if somebody were to nudge you over to the edge,
[00:17:48.180]you'd resist that, right?
[00:17:50.940]With how much force?
[00:17:53.760]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
[00:18:02.100]to resist being pushed to the edge of a 26 story building.
[00:18:05.250]That's the kind of thing we're working with
[00:18:06.960]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,
[00:18:19.140]a threat based stress response,
[00:18:22.170]when something threatening occurs,
[00:18:25.860]and it could be a very low level of threat.
[00:18:28.170]The body responds immediately with stress hormones,
[00:18:31.080]cortisol and epinephrine,
[00:18:32.190]that immediately recruits fuel glucose
[00:18:35.440]from the muscles and it gets metabolized into energy.
[00:18:40.140]That starts the motor running.
[00:18:43.050]That's what is behind the fight or flight response.
[00:18:45.930]So once that fight based stress response occurs,
[00:18:49.860]if there's something that you can do
[00:18:51.420]to execute that response that is called for,
[00:18:54.540]everybody goes home in the 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
[00:19:02.940]or you end up having a hard time breathing
[00:19:05.280]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.
[00:19:14.310]Like you, I dunno if you noticed all the hands that went up.
[00:19:16.350]I didn't say, I'm not saying that everybody
[00:19:18.030]in the room has an anxiety disorder,
[00:19:19.440]but a lot of, like half the people
[00:19:21.510]in the room self-reported they're anxious.
[00:19:24.660]And the statistics suggest that about a third of the people
[00:19:27.560]in the United States have qualified for an anxiety disorder,
[00:19:30.990]but on the spectrum, it's 40%.
[00:19:33.240]Doesn't mean it's part of the condition.
[00:19:35.040]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.
[00:19:47.460]Okay, so the causes.
[00:19:50.280]Trauma would be one of them.
[00:19:54.390]And chronic abuse, but in a particular form.
[00:20:00.210]Damned if you do, damned if you don't.
[00:20:04.140]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 can
[00:20:10.830]become a very dangerous place to be in
[00:20:12.750]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. You got insecure attachment.
[00:20:31.830]So long time ago, Mary Ainsworth did a bunch
[00:20:35.190]of research on attachment.
[00:20:37.380]And what she showed was that children
[00:20:38.940]that were securely attached,
[00:20:40.800]infants that were securely attached,
[00:20:42.960]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.
[00:20:54.540]She's talking about kids
[00:20:55.620]that will leave the visual range of their mother
[00:20:59.280]and stay away 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 of their mother.
[00:21:06.900]They wouldn't. They, in a strange situation,
[00:21:08.940]they immediately scrambled back to safety.
[00:21:11.130]And so that can, that begins very early in life,
[00:21:14.730]very early even at the infant stage.
[00:21:17.580]And then non-interactive play.
[00:21:23.940]Visit a daycare. Spend an afternoon.
[00:21:28.260]Watch the bonking, the poking,
[00:21:30.300]the screaming, and the biting that occurs.
[00:21:32.640]What is all that?
[00:21:34.560]Is that the animal nature of human beings just coming out?
[00:21:38.790]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
[00:21:48.620]in his face bites that hand.
[00:21:50.520]They're basically teaching each other
[00:21:52.020]to stay away from my body.
[00:21:54.946]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.
[00:22:04.320]And so they end up going further, going out in life,
[00:22:07.260]not knowing stuff that you and I just take for granted.
[00:22:10.560]We just, like we weren't born knowing about the way
[00:22:13.440]to handle ourselves in a social situation.
[00:22:16.080]We learned them.
[00:22:17.460]Like everybody knows instinctively
[00:22:21.030]how to behave on an elevator.
[00:22:23.310]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,
[00:22:33.660]press the number for your floor
[00:22:35.280]and stare at the numbers above the door
[00:22:36.760]as if the secrets of the universe were contained right there
[00:22:40.530]until the door opens again at your floor,
[00:22:42.510]exit, don't look back.
[00:22:45.030]We all know these rules.
[00:22:46.650]But imagine what an elevator ride could be like
[00:22:48.720]if you didn't know the rules.
[00:22:50.700]You enter the elevator. You don't turn around.
[00:22:53.250]You get a little nervous.
[00:22:54.120]You start touching people and talking to them.
[00:22:57.360]What an unpleasant experience
[00:22:58.530]that would be for everybody in the elevator,
[00:23:00.210]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
[00:23:09.180]and regulations of life,
[00:23:11.340]enters into when they go out into life.
[00:23:13.920]And so for you and I, we're pretty comfortable
[00:23:16.350]at everything except a cocktail party,
[00:23:19.350]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
[00:23:23.940]and introduce themselves to people or hide in the corner.
[00:23:29.370]Unlearned social roles and rules.
[00:23:32.310]I have been the beneficiary
[00:23:34.410]of some very, very socially skilled people.
[00:23:37.800]And I learned basically the hard way,
[00:23:40.350]also through their coaching,
[00:23:42.030]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]cuz I'm a hick from Montana.
[00:23:54.720]And so I can remember one, I'm like a,
[00:23:57.480]my first year of graduate school
[00:23:59.790]and I go to my first professional conference.
[00:24:02.490]It's a society for behavioral medicine.
[00:24:04.920]I'm with my best friend
[00:24:06.330]who's extraordinarily socially graceful guy
[00:24:08.490]called Jack Finney.
[00:24:10.860]And I'm dressed in my finest, which is boot cut,
[00:24:14.940]Levi jeans, Tony Lama cowboy boots, a leather vest,
[00:24:18.870]a cowboy shirt with piping and satin
[00:24:20.730]and those kind of pearly buttons
[00:24:22.470]and a sport coat that's got cowboy stuff all over it
[00:24:25.227]and my triple x beaver winter 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.
[00:24:36.990]He's dressed up in a suit.
[00:24:39.060]We meet a couple of women that he knows
[00:24:40.560]that we're assistant professors at LSU.
[00:24:43.238]And so we're talking to them.
[00:24:44.520]I turn away, I turn back,
[00:24:46.560]and I see one of them go, "Where'd you get him?"
[00:24:49.687](crowd laughing)
[00:24:51.090]Not like, it seemed to me like,
[00:24:52.860]oh, she's interested in me.
[00:24:54.214](crowd laughing)
[00:24:56.573]I said that to Jack later.
[00:24:57.406]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?"
[00:25:01.620]I said, "Well, because she said, where'd you get him?"
[00:25:03.690]He said, "No, pat. No.
[00:25:05.430]She didn't say where'd you get him?
[00:25:06.270]She said where did you get him?"
[00:25:08.484](crowd laughing)
[00:25:10.470]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."
[00:25:19.650]Which both of those things,
[00:25:21.360]I was like dumbfounded to hear that.
[00:25:23.880]I always flirted. But to me the world was a bar.
[00:25:26.580]This was just an extension of a bar.
[00:25:28.710]Well, turns out a professional conference
[00:25:30.570]is not an extension of a bar.
[00:25:33.660]Anyway, so I got 50 of those
[00:25:36.270]where I actually was coached on how to behave.
[00:25:39.870]You know, not like keep your hands to yourself,
[00:25:42.540]but kind of like that.
[00:25:44.910]I don't think a lot of people
[00:25:46.290]on the spectrum 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.
[00:25:55.620]Just to stay around people
[00:25:56.580]that are safe, like the family.
[00:25:59.640]And then you get this unfit narrative.
[00:26:01.620]You don't fit into the world very well.
[00:26:04.380]Not true. Just that you haven't learned how to fit yet.
[00:26:08.940]So in children, again,
[00:26:11.250]the key you wanna look for
[00:26:12.390]is just this excessive need for control.
[00:26:14.190]It shows up in lots of different ways.
[00:26:16.140]Arranging and ordering, a movement of objects.
[00:26:18.488]That's not necessarily just stereotypy.
[00:26:21.390]Again, but it's also just exerting control over the objects.
[00:26:26.970]Scripting the play of others.
[00:26:29.010]Correcting the play of others.
[00:26:30.750]Bargaining to get your way.
[00:26:32.370]Ongoingly bargaining to get your way.
[00:26:33.870]Frustration and unexpected shifts in play
[00:26:36.450]that didn't go along with the bargaining and the rules
[00:26:38.490]and then decided just to go and play by yourself.
[00:26:41.117]It's way better if you just go and play by yourself.
[00:26:42.900]Social confusion and independence on adults.
[00:26:45.930]Like this. When you hear the following,
[00:26:50.857]"He really gets along with the adults."
[00:26:53.160]That's not a good sign.
[00:26:55.260]That is not, adults make it easy.
[00:26:57.900]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.
[00:27:02.850]It's funny, odd. Not funny like ha ha.
[00:27:11.520]Then here's what's important.
[00:27:13.980]It's tricky.
[00:27:15.990]Unintentional.
[00:27:17.820]This is unintentional stuff from adults.
[00:27:21.210]Questioning.
[00:27:24.810]How are you doing?
[00:27:26.820]What does that imply? You know, how are you doing?
[00:27:29.640]Like the implication is there's something
[00:27:32.880]that you have to check for to see if it's there.
[00:27:35.730]How you doing? It's not the same as, hey, how you doing?
[00:27:38.040]That's different. It's that kind of questioning.
[00:27:41.010]But the parent is looking for reassurance
[00:27:43.980]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
[00:27:49.587]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.
[00:27:58.380]Checking, of course you wanna check,
[00:28:00.630]but are you checking more with this child
[00:28:02.760]than with that child,
[00:28:03.870]and then does that child recognize
[00:28:05.280]that you're checking more on them
[00:28:06.210]than they are on the others and what does that mean?
[00:28:07.830]That means that, oh, there's something about me.
[00:28:10.680]Reduced independence.
[00:28:12.690]Independence would be risky for the parent.
[00:28:16.410]But without it, then the child doesn't learn
[00:28:18.330]to expand their world.
[00:28:20.280]Enabling avoidance cuz 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. Have them be comfortable.
[00:28:29.220]That isn't always the answer.
[00:28:31.170]In fact, safe and comfortable is not a very good condition
[00:28:39.120]for human functioning except when you're sleeping.
[00:28:42.660]I'm not opposed to it.
[00:28:44.580]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
[00:28:51.240]so that everything's fine and you're absolutely safe,
[00:28:54.150]then you're not doing anything
[00:28:55.650]to expand the boundaries of your life.
[00:28:58.890]Attention to fear, which should be fine
[00:29:04.350]if there was way, way, way more attention
[00:29:07.140]to bravery of any sort.
[00:29:09.060]And so the attention to fear was
[00:29:10.410]like a minority batch of attention
[00:29:12.900]and the majority of batch of attention would be
[00:29:15.390]to any sign of bravery, any sign of trying something new,
[00:29:18.390]any sign of taking a chance.
[00:29:20.190]And then low distress tolerance.
[00:29:21.900]And what do I mean by that?
[00:29:24.780]I don't mean low distress tolerance,
[00:29:26.160]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.
[00:29:38.190]They call it the Bailey scales of infant mental development.
[00:29:41.460]And I wanted to master it.
[00:29:43.183]I was at the University of Kansas School of Medicine.
[00:29:45.630]I went to every office in that large,
[00:29:47.880]the biggest employer in the state of Kansas.
[00:29:49.680]Went to every office looking for young women
[00:29:52.410]that might have children,
[00:29:53.880]asking them 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.
[00:30:07.274]You know, you gotta have the six month old sitting
[00:30:08.610]on his parents' lap.
[00:30:10.290]Then we do these little tests.
[00:30:12.090]One is I put a block down.
[00:30:14.850]They're looking at it and they grab it. Pass.
[00:30:18.450]I put another block down. They're looking at it.
[00:30:21.360]They pick it up. Pass.
[00:30:23.910]Then I put a third block down.
[00:30:25.170]This is the dawn of cognitive development.
[00:30:28.890]And they're like,
[00:30:33.690]and they put down one block
[00:30:34.950]and they pick up the third block
[00:30:36.480]and I'm right back where I started it from,
[00:30:39.840]which is all fine.
[00:30:40.920]You know, 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.
[00:30:52.762](crowd laughing)
[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,
[00:31:03.210]which skews the results of the test.
[00:31:06.060]That's what I mean.
[00:31:10.890]Dilemmas.
[00:31:11.723]Yeah, but I mean, I'm not a parent.
[00:31:13.200]I confessed that this morning.
[00:31:14.580]So I don't have to face these dilemmas
[00:31:16.680]so I can spout out my theories with impunity.
[00:31:20.490]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,
[00:31:28.950]and bravery and allow avoidance or withdrawal.
[00:31:33.270]But at what levels?
[00:31:34.860]You know, where, the parent is always between those two.
[00:31:38.460]And on one, there's a lot of distress and discomfort.
[00:31:44.220]On the other, 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
[00:31:49.320]think they're enabling something they wanna not do.
[00:31:51.900]So they're kind of caught between Scylla and Charybdis
[00:31:56.280]or a rock and a hard place.
[00:31:58.470]So the strategies for the parents and caregivers is a praise
[00:32:03.900]and attend to brave behavior
[00:32:06.180]and ignore more non brave behavior.
[00:32:09.960]Like let it be.
[00:32:12.330]Rather than attend to it,
[00:32:15.060]make it better, reassure, et cetera.
[00:32:18.870]Model brave behavior and use role reversal.
[00:32:21.840]That's a little tricky.
[00:32:24.570]A parent has a tendency to go, "It's simple.
[00:32:28.380]This isn't dangerous. Watch me."
[00:32:31.590]That's not what we're looking for here.
[00:32:34.200]We're looking for, "Yes, honey.
[00:32:37.230]Yeah, that makes me nervous too.
[00:32:39.090]It really does. 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 want to let the child see the distress
[00:32:53.130]and see the overcoming of it with the distress there.
[00:32:57.300]Not like you're already over it
[00:32:58.710]and you're going, "There was nothing."
[00:33:00.180]Just no, I go right over to the neighbor's house,
[00:33:02.880]I just start talking to them.
[00:33:03.750]No. You'd be like, "You know,
[00:33:05.730]the neighbors just moved in next door.
[00:33:08.160]It makes me nervous to talk to strangers. Really does.
[00:33:11.130]But I want to be a good neighbor, honey.
[00:33:12.900]So I'm gonna go over and introduce myself
[00:33:15.930]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,
[00:33:22.920]but I'm gonna do it.
[00:33:24.690]That's the, that's what you want them to see.
[00:33:26.190]Not that it's so easy you don't even think about it,
[00:33:28.710]but that you do think about it
[00:33:30.171]and it is a little challenging,
[00:33:31.004]but you're willing to meet the challenge
[00:33:32.520]and I'm gonna ask you to meet the challenge too like that.
[00:33:35.940]Allocate responsibility. Encourage independence.
[00:33:38.970]Allow mistakes. You know, it's some mix of all that.
[00:33:42.690]Give them some responsibility.
[00:33:44.460]Let 'em set the table even though it involves sharp knives.
[00:33:48.960]I, you know.
[00:33:52.502]Let 'em make sure the dog is fed and check later.
[00:33:56.610]Let 'em 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 to,
[00:34:02.430]they want to avoid them
[00:34:03.780]if there's a big deal made about a mistake.
[00:34:05.490]People make mistakes.
[00:34:07.260]And emotional acceptance.
[00:34:11.910]You've heard of Carl Rogers before?
[00:34:14.430]Extraordinary individual.
[00:34:16.410]And he had this theory that
[00:34:20.580]if a therapist could presence complete acceptance
[00:34:27.990]of what was in front of the person,
[00:34:29.520]what in front of them, in the client,
[00:34:32.310]that everything was just fine just the way it was,
[00:34:34.500]the person was just fine just the way they were.
[00:34:37.830]They had these neurotic fears and people have them
[00:34:41.040]and that they had these worries and concerns
[00:34:42.930]and that happens to people
[00:34:44.260]and I can understand how that makes you feel
[00:34:46.440]and just reflect back what they're saying
[00:34:48.510]and accept exactly what they're communicating
[00:34:51.000]and don't judge any of it,
[00:34:52.230]don't give any directions, that that would be healing.
[00:34:57.930]How much of that do you have in your life?
[00:35:00.420]Is there somebody that you can go to
[00:35:02.400]who has you just be absolutely fine just the way you are?
[00:35:09.030]Or are they pretty okay with the way you are
[00:35:11.460]but you know you shouldn't, you know, try this?
[00:35:14.501]Or maybe you did a little more of that.
[00:35:18.000]That would be very good for them,
[00:35:19.380]at least periodically, to have a dose
[00:35:21.060]of that profound emotional acceptance.
[00:35:24.600]Set reachable goals. Create opportunities for change.
[00:35:29.430]I have anxious clients and I have OCD clients.
[00:35:36.750]I'll rearrange the furniture.
[00:35:38.700]You know, they come in like 10 times.
[00:35:41.310]They sit in the same place.
[00:35:42.990]I sit the same place.
[00:35:44.760]And then the 11th time,
[00:35:46.290]the chair they always sit in isn't there.
[00:35:48.810]A different colored chair
[00:35:49.650]and it's a different part of the room
[00:35:51.030]and I'm behind my desk rather than on the couch
[00:35:52.890]and they're like, it's, huh, this is different.
[00:36:00.600]And they gotta get over that.
[00:36:01.962]You know, they gotta step over. This is different.
[00:36:03.900]And they got that feeling like this isn't quite right
[00:36:06.300]cuz it's not quite right syndrome.
[00:36:08.100]And then just kind of ease into it and I ease with them.
[00:36:13.500]Change a few things. That's all.
[00:36:16.110]And then exposure, extinction,
[00:36:17.940]desensitization, those are all programs.
[00:36:21.000]Exposure's the key.
[00:36:23.760]So medication is one way to go.
[00:36:27.180]They're the medication. Whoops.
[00:36:29.130]Oh, I don't know if I can go backwards.
[00:36:33.600]I can. There.
[00:36:36.420]Did you increase the sensitivity somehow?
[00:36:40.980]Yeah? Because it's working better.
[00:36:43.650]So here's the general types of medications.
[00:36:47.550]Have you heard of the beta blockers before?
[00:36:51.180]Anybody here have stagefright?
[00:36:54.622]You know what I'm talking about?
[00:36:55.500]Like you're real nervous in front of an audience.
[00:36:58.067]Guess who else has stagefright, like clinical stagefright.
[00:37:02.130]Jeff Bridges, Barbara Streisand,
[00:37:04.380]Carly Simon, Pablo Casals, I could go on here.
[00:37:07.620]People that you would think are completely
[00:37:09.960]at ease in front of a camera, in front of an audience.
[00:37:13.200]Absolutely not. Absolutely not. 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.
[00:37:23.130]You don't even know it's in your system.
[00:37:24.690]What it does is it lowers heart rate
[00:37:27.000]and it lowers the threat based stress response
[00:37:30.807]and it allows them to go and perform.
[00:37:32.490]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?
[00:37:41.489]Like you get that little tremor over a putt
[00:37:42.870]and you, it's a four foot putt
[00:37:44.250]and you couldn't make it to save your life
[00:37:46.080]cuz you're just so nervous.
[00:37:47.490]Like if you just say the word yips on a green
[00:37:50.460]when you're with a foursome,
[00:37:51.840]they'll probably ask you not to play with them anymore.
[00:37:55.050]Just put that thought in their head.
[00:37:56.580]Now they got 'em.
[00:37:57.690]Anyway, it's the result of fine motor tremors
[00:38:01.230]that are secondary to
[00:38:02.580]being slightly afraid you won't make the putt.
[00:38:05.100]When you take that beta blocker,
[00:38:06.720]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
[00:38:14.700]so they can control their fine motor movements better.
[00:38:19.530]I found out about it when I was
[00:38:21.180]at the University of Nebraska School of Medicine
[00:38:23.190]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.
[00:38:30.373]I had a resident once a month for 36 months.
[00:38:33.720]They'd spend a whole month with me.
[00:38:35.160]And they have a thing
[00:38:36.330]in medical schools called grand rounds.
[00:38:40.530]Blood sport basically.
[00:38:43.530]So in grand rounds, the medical faculty gets
[00:38:48.060]in front of all the faculty and gives a presentation.
[00:38:51.600]And in the front row are all the full professors
[00:38:54.967]that have been doing this for years
[00:38:57.060]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 'em how stupid they are.
[00:39:03.450]So these residents wanted to do grand rounds with me
[00:39:07.170]because there was just one behavioral pediatric expert
[00:39:09.750]on the entire faculty and it was me
[00:39:11.730]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
[00:39:16.500]so they had didn't have to worry about me attacking them.
[00:39:18.510]So they chose me.
[00:39:21.120]But they're still nervous when we rehearse.
[00:39:22.860]I go and rehearse and they're nervous
[00:39:24.120]like a cat in a room full of rocking chairs.
[00:39:25.920]I'm like, sit down.
[00:39:27.660]But day of, I go in there, there I go, "Hey, how you doing?"
[00:39:31.110]Great, Dr. Friedman. So good to see you.
[00:39:33.780]I'm like, what is going on here?
[00:39:36.090]And they go, "Beta blockers, baby. Beta blockers."
[00:39:38.786](crowd laughing)
[00:39:40.140]What are beta blockers?
[00:39:44.010]When my clients are concerned about things like that,
[00:39:47.220]I tell 'em, go to your physician.
[00:39:49.080]Tell 'em that you're worried about X, Y or Z.
[00:39:51.390]Ask for a beta blocker.
[00:39:52.530]They'll know exactly what you're talking about.
[00:39:54.300]They'll give it to you
[00:39:55.133]because they themselves probably use it from time to time.
[00:40:02.190]So into treatment.
[00:40:05.010]Supportive health education.
[00:40:06.330]I've been doing that already.
[00:40:07.860]This is a variation of what I do with all my clients
[00:40:10.770]is I supply health education about what anxiety actually is
[00:40:15.330]so that they have a better understanding of it than the one
[00:40:17.640]that the culture supplies
[00:40:19.080]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,
[00:40:32.880]but I abandon the worst of you
[00:40:36.420]and all its synonyms and I start using the word it.
[00:40:40.260]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.
[00:40:45.540]And we're talking about it like the person doesn't have it.
[00:40:48.900]It is something that they have to deal with.
[00:40:52.170]And with kids, that work especially well.
[00:40:55.740]And I would have them give it a name.
[00:40:58.650]And when the "Lord of the Rings" was popular,
[00:41:01.830]you know that book and that Gollum was
[00:41:04.500]in my office two, three times a week.
[00:41:09.330]So I basically just externalize it
[00:41:12.330]so it doesn't seem like a condition that they have.
[00:41:15.990]Then relaxation. Progressive muscle relaxation.
[00:41:19.920]That's pretty straightforward.
[00:41:21.000]You tighten and then relax every muscle group in the body.
[00:41:24.690]Just go all the way through the body.
[00:41:26.940]Focus breathing, another way.
[00:41:29.100]Focus on your breathing, slowing it down, counting.
[00:41:32.430]Mindfulness, attending to what you're doing
[00:41:34.170]while you're doing it or what the Navy SEALs use
[00:41:38.550]and the navy SEALs have, you know,
[00:41:41.160]consistent sources of genuine fear.
[00:41:44.370]People are shooting at them.
[00:41:46.200]Four by four by four by four.
[00:41:48.060]Anybody heard of this before?
[00:41:49.950]Breathe in for four,
[00:41:52.920]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
[00:42:02.820]and you're trying to shoot,
[00:42:03.720]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
[00:42:07.680]to calm down in their body
[00:42:08.700]and they do it with the breathing next to this.
[00:42:10.200]Let me show you one.
[00:42:12.390]If this is something your doctor would recommend
[00:42:15.900]that you don't do, then don't do it.
[00:42:17.190]But anybody that can do this.
[00:42:18.480]Do, if you wanna do this, do this with me.
[00:42:20.640]Take a deep breath.
[00:42:23.250]Now more. More. More. More.
[00:42:29.940]Let it out really slow.
[00:42:31.560]Really like a balloon.
[00:42:32.580]This is wait...
[00:42:37.740]Like that.
[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.
[00:42:45.840]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.
[00:42:57.390]Then exposure based treatments.
[00:43:00.900]Go through some of those.
[00:43:01.740]So some real life examples.
[00:43:06.180]So some people for reasons unknown,
[00:43:09.960]are terrified of cats
[00:43:12.090]and the exhibit extraordinary problematic behavior
[00:43:15.990]in the presence of cats.
[00:43:19.050]So obviously this is something that warrants a treatment.
[00:43:24.090]And so we start with distal exposure.
[00:43:27.360]You know, pet the cat at arms length
[00:43:29.340]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.
[00:43:39.767](crowd laughing)
[00:43:44.280]A lot of kids are afraid of falling into the toilet
[00:43:46.260]and who can blame them?
[00:43:47.093]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 and they see they'd fit nicely
[00:43:53.370]so they're afraid.
[00:43:55.680]So we do a little bit of exposure by holding them.
[00:43:59.670]Their caregiver holds them over the aperture
[00:44:02.700]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 there's the terminal stage.
[00:44:13.083]There's a lot of intensity to it.
[00:44:13.916]But if they pass this stage,
[00:44:15.630]everybody goes home in a limousine.
[00:44:17.610]There it is.
[00:44:18.500](crowd laughing)
[00:44:22.380]A lot of kids are afraid of little creepy crawlies.
[00:44:24.210]A lot of adults are too actually.
[00:44:26.550]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
[00:44:34.380]and then proximally
[00:44:37.140]and this last stage is a lot of intensity to it,
[00:44:39.810]but when it's passed, they're cure.
[00:44:41.130]There it is.
[00:44:42.296](crowd laughing)
[00:44:46.712]So here's some actual examples.
[00:44:50.310]So this was a kid at Boystown, that's where I work,
[00:44:54.840]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,
[00:45:09.480]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,
[00:45:17.940]but if they're present, they are confirmatory.
[00:45:20.400]There's no other way to explain them.
[00:45:23.040]One you know about probably.
[00:45:24.516]Coprolalia, which is where you, the kids,
[00:45:28.380]the people afflicted will say profane things.
[00:45:32.760]These days, the way the culture is going,
[00:45:35.790]the kid that has Tourette's syndrome used
[00:45:37.620]to be rejected and abused,
[00:45:39.330]now they're the most popular kid in class
[00:45:41.640]because I'm going to, I'm gonna use profanity here.
[00:45:46.380]Just one thing.
[00:45:47.880]They can tell the teacher to get fucked
[00:45:50.430]and get away with it.
[00:45:52.380]And everybody in the class loves 'em for it.
[00:45:56.804]So coprolalia, then there's copropraxia.
[00:45:59.580]Praxia is movement. So those are obscene gestures.
[00:46:02.520]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.
[00:46:09.390]Echolalia where they say what they said
[00:46:12.090]and then palilalia where they repeat what they said.
[00:46:15.180]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.
[00:46:27.270]This is Boystown.
[00:46:28.320]But Boystown has girls.
[00:46:30.690]And the boys when that happened,
[00:46:32.670]they would just smack him.
[00:46:34.350]But a lot of our girls have been sexually abused.
[00:46:37.110]And so he's around the girls.
[00:46:39.120]They talk, you know, they're talking like this,
[00:46:40.650]they touch their chest
[00:46:41.483]and he's right in there touching their chest.
[00:46:44.550]But he's got OCD. So he didn't do it right.
[00:46:48.780]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,
[00:47:06.810]I asked them to send the kid to my shop
[00:47:10.080]so we could do an extra evaluation
[00:47:12.060]to see that if there might be
[00:47:13.020]something there we could work with.
[00:47:14.610]And so that's where we discovered Tourette's and OCD.
[00:47:18.090]And this data is from one of my female interns sitting
[00:47:25.890]in front of him, touching her chest.
[00:47:29.130]And the instant that he'd reached
[00:47:30.360]for her chest, we'd block him.
[00:47:32.070]So it's exposure and response prevention.
[00:47:35.280]And the result was gradually,
[00:47:37.440]gradually, gradually stop doing it.
[00:47:39.570]And these data are published
[00:47:42.570]in the premiere child psychiatry journal in the world.
[00:47:46.770]But I don't know if you,
[00:47:47.730]how much you know about the, this kind of data collection.
[00:47:50.550]There is no experimental control there.
[00:47:53.520]There's not an AB design there. It's just B.
[00:47:57.180]In other words, it's meaningless in the world of science.
[00:48:01.050]But this finding was so unique
[00:48:03.450]that they published it anyway,
[00:48:05.370]but we continued on and found another kid.
[00:48:08.490]This is real experimental data. Same kind of problem.
[00:48:11.520]This is published
[00:48:12.353]in the Journal of Implied Behavior Analysis.
[00:48:15.870]That's a nice looking young man.
[00:48:18.000]Looking like he's getting ready for a job interview.
[00:48:23.190]Here's his clinical description.
[00:48:24.360]Above average IQ. Suspicious of adult.
[00:48:26.220]Socially, very socially anxious.
[00:48:27.900]Socially phobic, really.
[00:48:29.580]Pervasive fear of public failure.
[00:48:32.130]Uncomfortable with attention.
[00:48:33.930]Very controlling, very manipulative.
[00:48:38.910]Here he is as an adult.
[00:48:41.569]Oh my God.
[00:48:43.430]So I have his psychiatric evaluation.
[00:48:45.300]I have the evaluation of Charles Manson when he was 14
[00:48:48.960]and I have one when he was 44.
[00:48:51.715]And the reason I have the one for me when he was 44 is
[00:48:55.410]because I did research on what I thought was his condition,
[00:48:59.700]which is a co-occurring conduct disorder with social phobia.
[00:49:06.840]Those two blended together
[00:49:08.370]that hadn't been reported in the literature before.
[00:49:11.040]People at "60 minutes" found out about it
[00:49:13.440]and found out about Charles Manson connection.
[00:49:15.480]They sent a producer to talk me into being
[00:49:17.820]on "60 Minutes" to talk about my research,
[00:49:19.590]which really they just wanted me
[00:49:20.550]to talk about Charles Manson.
[00:49:23.010]So I told 'em I would do it
[00:49:25.530]if they got informed consent from Charles Manson.
[00:49:30.090]So the producer, Norm Green, went to Folsom,
[00:49:34.050]got an appointment with Manson,
[00:49:35.490]but Manson was under attack at that time
[00:49:37.290]by people in the prison.
[00:49:38.550]Whenever he was under attack, felt at risk,
[00:49:41.400]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,
[00:49:54.750]thinking he'll give me the evaluation and then buy me off.
[00:49:57.390]They'll talk me into doing the thing.
[00:49:59.310]I got the evaluation, but that wasn't,
[00:50:01.200]I still wouldn't agree to do it, so I have it.
[00:50:06.210]When he was 14, he was a resident of Boystown.
[00:50:08.670]That's why I have that evaluation.
[00:50:11.580]He wasn't a monster at 14.
[00:50:14.640]He'd been in 20 different foster homes.
[00:50:16.980]His mother was in and out of his life.
[00:50:18.540]She was part-time prostitute.
[00:50:19.950]So bringing men into his life who abused him.
[00:50:22.200]He was small of stature, very controlling,
[00:50:24.330]very nervous, highly abused, neglected, and very smart.
[00:50:29.790]And he gradually became controlling,
[00:50:33.090]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,
[00:50:41.460]which is what happened with him.
[00:50:43.440]So when he was ultimately convicted, he didn't kill anybody.
[00:50:49.140]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
[00:50:57.000]and that can kind of feed on itself.
[00:50:58.530]So by the time he was doing that, he had turned monstrous.
[00:51:01.800]But at 14, like if he would've come
[00:51:04.350]to see me as a client now,
[00:51:06.570]nobody would ever hear of him again.
[00:51:08.550]He would just be a like an anonymous clinical record
[00:51:11.040]cuz 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 kid, 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.
[00:51:25.440]Very easy to manage, very easy to treat.
[00:51:28.260]This kid was socially phobic.
[00:51:32.340]And at Boystown they do, they have this big point system,
[00:51:37.290]they do teaching interactions.
[00:51:39.150]Nine step teaching interactions
[00:51:41.790]and five step reward interactions.
[00:51:44.190]And all that's done in kind of a public way.
[00:51:46.950]Other kids are watching. Other adults are present.
[00:51:50.040]And this kid was just like Manson.
[00:51:52.320]He was like socially phobic.
[00:51:53.610]And so he would just, he's a big kid.
[00:51:56.130]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.
[00:52:00.150]I did his evaluation.
[00:52:01.389]I said, "I think we can work on this."
[00:52:03.090]And so here was our intervention. Pretty straightforward.
[00:52:06.660]You know what? I told them, "Treat him like you'd want
[00:52:10.710]to be treated if you were in his situation."
[00:52:15.180]Do it privately.
[00:52:17.160]Adults don't like to have a lot of attention drawn
[00:52:19.650]to them when they've made a mistake.
[00:52:22.140]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.
[00:52:31.860]Do it privately. 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.
[00:52:46.590]You know, we sort of think of a cricket
[00:52:47.730]as a benign creature.
[00:52:48.990]Jimmy Cricket is 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.
[00:52:58.650]I think this is sort of what he thought of.
[00:53:00.900]And if you look at a cricket really carefully,
[00:53:02.940]you can see they got the little saw things
[00:53:04.620]on their legs and it looks like they have teeth
[00:53:09.030]and they're scary when you really look at 'em.
[00:53:15.510]So for this kid, we did a graduated exposure
[00:53:18.570]and the key thing here is safety.
[00:53:21.090]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.
[00:53:28.170]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
[00:53:39.090]in each hand for 20 seconds.
[00:53:45.180]And we used this worry scale to help us calculate
[00:53:48.870]which step would be first and second and so forth.
[00:53:51.300]And then here are these data.
[00:53:54.960]I don't have a pointer on here.
[00:53:56.970]Or do I?
[00:53:58.140]Yeah, okay.
[00:53:59.760]I know the people online can't see
[00:54:01.260]what I'm doing with his pointer.
[00:54:02.700]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.
[00:54:08.940]So he is doing math problems in a condition called no bugs,
[00:54:13.980]where I go in, search the room thoroughly,
[00:54:17.130]and then 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
[00:54:25.740]and I go, I don't see any bugs
[00:54:28.350]but I'm pretty sure there's some in here.
[00:54:30.150]Do your math. I'm saying bugs.
[00:54:34.477]And this one was releasing two live crickets
[00:54:36.570]right When he is watching me into the room.
[00:54:38.340]Do your math.
[00:54:40.320]So what we see is a significant decline in his math
[00:54:44.070]cuz he would jump up on a table and do it like this.
[00:54:49.080]So he'd do the graduated exposure
[00:54:51.390]and we're doing pretty well.
[00:54:52.530]And what happened?
[00:54:54.990]What happened there?
[00:54:57.510]I think he just got sick of doing math.
[00:54:59.270](crowd laughing)
[00:55:02.100]That's my assumption.
[00:55:03.510]So what we do then is we start paying him off
[00:55:06.900]for doing math problems.
[00:55:08.490]Giving him a little some points for doing math. Boop.
[00:55:11.700]And we do a little reversal there.
[00:55:14.760]And back to like, in words,
[00:55:16.770]the combination of the exposure and the incentive
[00:55:20.430]for doing the math problem solve that problem.
[00:55:22.887]And this is serendipitous. Serendipitous.
[00:55:27.030]My research partner showed up over
[00:55:28.920]at the classroom just to observe.
[00:55:31.230]And he sees this kid get out of his chair,
[00:55:33.960]go up to the teacher's desk, gets a tissue,
[00:55:36.900]comes back, gets down on on the floor, and does something,
[00:55:39.870]and then throws the tissue in the waist basket
[00:55:43.230]and then class empties out.
[00:55:45.600]My research partner goes to the waist basket
[00:55:47.880]and in the tissue it was a dead cricket.
[00:55:50.250]Now just coincidentally, we happened to see that.
[00:55:53.370]Before this happened, this is a big kid,
[00:55:56.520]and every kid in his class knew he had this condition.
[00:55:59.700]Do you think that they were really careful with him?
[00:56:01.920]No man. They would go,
[00:56:03.337]"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
[00:56:07.110]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 it came to our attention.
[00:56:15.390]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.
[00:56:21.510]See that's what's gonna happen
[00:56:23.040]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.
[00:56:31.140]They're terrified of that service.
[00:56:32.850]They go in kicking and screaming.
[00:56:34.590]The thought that the physician might have
[00:56:36.840]is you just sedate 'em and then take 'em in like comatose.
[00:56:39.600]And that's no solution, really.
[00:56:42.600]But it's a very, very significant challenge.
[00:56:46.500]So this is his program.
[00:56:49.140]I'll just do the first and last step.
[00:56:50.490]Walk in, sit in a waiting area, leave.
[00:56:53.100]You know, in, down, gone.
[00:56:56.460]All the way down to walk in, sit in the waiting area,
[00:56:58.650]sit in parents' lap,
[00:56:59.550]exam chair with arm down, nurse draws blood.
[00:57:03.360]That's the terminal stage.
[00:57:04.800]But all along the way is graduated exposure with incentives.
[00:57:10.290]This is dental phobia.
[00:57:12.570]And I'm gonna play this video.
[00:57:14.280]Can you take my picture out of the corner?
[00:57:18.270]This will go on for a while.
[00:57:19.680]Here's the steps for the dental phobia.
[00:57:22.680]On step number one, therapist states,
[00:57:24.397]"Let's go to the dentist."
[00:57:25.350]Sit down, Joey sits down in chair
[00:57:26.850]in front of the therapist with dental tools removed from,
[00:57:29.520]there were no dental tools.
[00:57:30.990]Step 10, all the steps,
[00:57:33.720]and the the kids' teeth are counted.
[00:57:36.720]But I have a video of this.
[00:57:44.730]Oops. That's the data.
[00:57:47.640]Yes, there you go.
[00:57:49.308](parent and child talking in indistinct voice)
[00:57:54.488](child crying)
[00:58:06.660]This kid, is severely apparent on the spectrum.
[00:58:09.421](child crying)
[00:58:31.671]Remember that from your dental visit?
[00:58:46.737]Nice job. Look at you. All by yourself.
[00:58:57.870]This is before everybody
[00:58:58.703]in the world wear masks.
[00:59:07.441]Here we go.
[00:59:09.062]Gonna hold the mirror?
[00:59:13.740]Look at you.
[00:59:17.220]Look. Can I touch your teeth?
[00:59:20.520]Say ah.
[00:59:23.070]Good job.
[00:59:25.020]Open your mouth.
[00:59:27.093]Put your feet down please.
[00:59:28.425]Thank you. Can you open your mouth?
[00:59:31.572]Open your mouth please.
[00:59:33.220]Good, let me see.
[00:59:34.830]Oh, Addie, your teeth are so pretty.
[00:59:38.970]Can I look with the mirror?
[00:59:41.190]Say ah.
[00:59:44.070]Good job big man.
[00:59:46.776]Hello. Would you like to sing and dance?
[00:59:49.908]Hello.
[00:59:55.416]All right, sit back.
[00:59:57.396]Open your mouth.
[00:59:58.726]Open.
[00:59:59.700]Ah.
[01:00:00.630]Good. Keep it open. You have to sit back.
[01:00:03.900]Keep it open.
[01:00:04.967]Ah.
[01:00:05.970]Awesome. Keep going.
[01:00:07.410]I see those teeth.
[01:00:09.242]Sit back. I'll see you.
[01:00:11.450]I see those teeth.
[01:00:13.963]I see those teeth.
[01:00:15.538]No!
[01:00:16.371]Okay, sit back.
[01:00:17.652]Sit back. Sit back. Sit back.
[01:00:20.449]Let me see your teeth.
[01:00:23.909](child crying)
[01:00:24.878]It's okay. Sit back. Sit back.
[01:00:26.912]No!
[01:00:27.883]Sit back.
[01:00:30.540]He's not gentle enough.
[01:00:31.950]Open up.
[01:00:32.783]You get that?
[01:00:34.140]There we go.
[01:00:34.973]It's still working but he's not gentle enough.
[01:00:36.840]Open up.
[01:00:38.970]Nice job.
[01:00:41.010]Ready?
[01:00:46.273]Ah.
[01:00:56.640]Good work.
[01:00:58.590]Yeah, she's way more gentle.
[01:01:09.450]Nice job, Addie.
[01:01:26.824]Nice job.
[01:01:29.608]Good work.
[01:01:31.345]That was awesome.
[01:01:33.896]Now the dentist.
[01:01:34.729](upbeat music)
[01:01:35.672]Give me that.
[01:01:39.796]Good job, Addie.
[01:01:40.979](upbeat music)
[01:01:54.073]Ah.
[01:01:54.971]Sit back.
[01:01:56.507](upbeat music)
[01:02:08.086]Sit back.
[01:02:12.444]Lean back.
[01:02:14.428]Ah.
[01:02:28.275]Ah. Open your mouth.
[01:02:35.206]Open.
[01:02:37.297]Open.
[01:02:41.546]It's like a drive-in movie.
[01:02:44.237](upbeat music)
[01:02:52.275]Okay, you get the idea.
[01:02:58.883]So it's just graduated exposure.
[01:03:02.130]And there has to be at least modicum of comfort
[01:03:05.610]and a lot of safety along the way
[01:03:08.880]because the thing that you're exposing the person
[01:03:11.130]to is not inherently dangerous.
[01:03:13.410]It's being experienced as dangerous
[01:03:15.690]and you're deprived of the ability
[01:03:17.670]to explain effectively that it's not dangerous.
[01:03:20.790]So what are you left with?
[01:03:22.020]It has to be experienced as not dangerous.
[01:03:24.300]That requires exposure.
[01:03:26.130]But exposure always have to have this component.
[01:03:29.610]It's essential, which is safety.
[01:03:31.380]Comfort isn't quite as important.
[01:03:33.300]You have to have some, but you have to have a lot of safety.
[01:03:40.110]So the typical treatment.
[01:03:41.400]Demystify, which I did a fair amount of on the front end.
[01:03:44.910]Then externalize, especially with kids.
[01:03:47.730]Exposure in some form.
[01:03:50.130]Incentives where necessary.
[01:03:51.630]It always helps to have it incentivized.
[01:03:54.570]Modifying parenting practices.
[01:03:56.370]You'll find a lot of overprotection
[01:03:58.050]because they don't know what else to do with it.
[01:04:01.232]That makes, it's, 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.
[01:04:16.410]But in those instances, they're not exactly helpful.
[01:04:22.050]Relaxation and sell it.
[01:04:24.030]Sell it. Now what have I been doing?
[01:04:26.310]Selling. That's all I've been doing for the past hours.
[01:04:29.370]Just trying to sell this approach.
[01:04:31.170]And it has to be sold.
[01:04:32.520]Some of it's counterintuitive.
[01:04:35.340]And so you'll be working with a parent potentially.
[01:04:37.770]You gotta sell 'em this procedure for their child
[01:04:40.260]or you're working with with,
[01:04:41.607]I just work with typically developing adults.
[01:04:44.130]I have, but I also have to sell my procedures to them.
[01:04:48.900]So I can...
[01:04:50.640]Hold it. You got the code?
[01:04:52.200]Can they see the code online?
[01:04:54.420]Okay.
[01:04:56.310]Somebody back there had a question and I promised.
[01:05:00.150]Yes.
[01:05:01.278](participant talking indistinctly in the background)
[01:05:06.660]The fireworks.
[01:05:09.812]Yes.
[01:05:10.866]I don't know how to help myself
[01:05:13.706]'cause I have a negative reaction
[01:05:16.088]and of course you can't avoid the fireworks, right?
[01:05:21.571]Right.
[01:05:22.404]Anytime except for the fourth,
[01:05:23.923]it's really hard.
[01:05:25.467]The young woman is afraid of fireworks.
[01:05:27.240]What do you do about that? Move to Montana.
[01:05:29.563](crowd laughing)
[01:05:30.450]Because in Montana all you get
[01:05:31.800]to have are Twizzlers and black cats.
[01:05:36.120]You don't wanna live in Nebraska.
[01:05:38.869]Everything short of dynamite is permitted in Nebraska.
[01:05:44.400]I can't believe it.
[01:05:46.230]Well, is it the sound?
[01:05:49.680]I don't know
[01:05:50.513]if I'm necessarily scared of fireworks.
[01:05:52.110]I think I'm scared of, I don't know.
[01:05:57.810]Nonfunctional. So like when I was younger,
[01:06:00.506]I would go wind up and shut down and help out.
[01:06:05.599]So that was scary.
[01:06:07.730]And so not really, I don't know if I'm scared of fireworks.
[01:06:11.187]I'm scared of the response that I have.
[01:06:13.963]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,
[01:06:20.040]but the response to fireworks is a fear-based response.
[01:06:22.500]So I would say they're causing that fearful response.
[01:06:27.570]So it sounds like you're afraid of them,
[01:06:29.296]but then there's a lot of components to this.
[01:06:31.980]One is the sound, which is incredibly aversive.
[01:06:35.610]The other is the fire. The other is the risk.
[01:06:40.200]So which part of that,
[01:06:41.630]of the experience is, activates that response?
[01:06:46.020]Sound?
[01:06:50.400]I don't know that it's something
[01:06:52.380]that you wanna really get used to or can,
[01:06:55.590]but I'd say instead is
[01:06:58.230]when you think there's gonna be a lot of fireworks around,
[01:07:01.050]buy some silicone earplugs that swimmers use
[01:07:05.880]that block out...
[01:07:10.410]I mean literally like that.
[01:07:11.730]They can block out that much sound
[01:07:13.080]where you can watch somebody moving their lips
[01:07:15.750]and you can't hear what they're saying
[01:07:17.040]if you make a good seal.
[01:07:19.140]It's what I do.
[01:07:20.100]Cuz our, my neighborhood goes crazy for three days and I-
[01:07:27.150]What's that?
[01:07:28.950]Oh the, our fireworks in our area
[01:07:30.660]is like anywhere from 7 to 10 days and they go nuts on it.
[01:07:33.924]They get, yeah.
[01:07:34.763]Yeah. So try having sensory issues
[01:07:37.741]and wearing some earplugs.
[01:07:40.685]EarPods, earplugs, headphones rather than
[01:07:44.610]just getting used to it.
[01:07:45.450]I mean, they obviously aren't dangerous,
[01:07:47.130]but I don't know that we're talking about danger here.
[01:07:49.050]It sounds like it's just aversive.
[01:07:52.288]Yeah, it is aversive.
[01:07:54.030]It's just highly, highly unpleasant.
[01:07:56.160]And if you wanna see how unpleasant it can get,
[01:07:58.200]watch what happens to dogs cuz it's terrible for dogs.
[01:08:02.190]They go hide under the bed.
[01:08:03.300]They go run down into the basement.
[01:08:04.950]They cover their head with their paws
[01:08:06.930]cuz their hearing is so super sensitive
[01:08:09.450]that the owners of these dogs
[01:08:10.680]are blowing off these fireworks
[01:08:12.000]and don't realize 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
[01:08:23.340]to a really unpleasant situation.
[01:08:25.980]And you're not gonna do anything
[01:08:27.210]by talking your neighbors out of this.
[01:08:28.280]So you gotta figure out something you're gonna do
[01:08:29.610]while they're doing it.
[01:08:31.710]That's the best I've got really.
[01:08:34.981]Question online?
[01:08:36.300]Yeah.
[01:08:37.320]I have a teen who is afraid to learn to drive.
[01:08:39.963]He refuses to try.
[01:08:42.060]We struggle with how to encourage,
[01:08:43.740]incentivize him to engage and practice.
[01:08:47.880]The question from online is the person has a teen
[01:08:50.670]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?
[01:08:58.950]He's a teenager.
[01:09:00.780]That's very common. Driving the kids.
[01:09:04.300]What's that?
[01:09:05.133]I teach drivers ed
[01:09:06.060]and that's getting very common.
[01:09:10.590]Why not go the other way?
[01:09:12.720]I mean, who's more afraid?
[01:09:15.420]The kid that's afraid to drive the driving
[01:09:17.160]or the parent of the kid that's afraid to drive
[01:09:20.670]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
[01:09:31.530]for getting from point A to point B in a car
[01:09:34.170]is gonna be motivating enough.
[01:09:35.760]Then they're motivated to learn,
[01:09:36.900]but while they're not learning to drive,
[01:09:40.980]why not just let it be?
[01:09:43.140]I don't know that a parent is gonna be able
[01:09:44.700]to supply that motivation, but their first girlfriend is.
[01:09:50.220]Anyway. Anybody else have a question?
[01:09:55.350]Yes.
[01:09:56.640]So I have, you were talking
[01:09:58.410]about the signs of children.
[01:10:00.360]I have a nine year old and when the play,
[01:10:03.570]not on the spectrum,
[01:10:05.490]and when the play doesn't go her way, you know,
[01:10:10.200]even with her five year old sister,
[01:10:11.820]she like break down cry and like go
[01:10:14.645]and hide under her bed cry.
[01:10:16.737]And so then when you were talking about the strategies,
[01:10:19.170]I guess my question would be do I attend
[01:10:21.450]to her crying, break down at all?
[01:10:24.150]Or do I just gotta ignore the situation.
[01:10:26.640]Well, I guess it'd be-
[01:10:30.407]Pardon me?
[01:10:31.826](participant talking indistinctly in the background)
[01:10:32.659]Yeah. I'm just gonna do that.
[01:10:33.960]When her daughter, 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
[01:10:42.513]and, I don't know, kept, sobs to herself.
[01:10:49.920]Factor this in. I don't have any kids.
[01:10:53.220]So what.
[01:10:54.230](crowd laughing)
[01:10:56.645]You know, I mean she's not hurting anybody.
[01:10:59.280]She's not disrupting anything.
[01:11:01.950]And it's possible it has a function
[01:11:04.650]which is sympathetic attention.
[01:11:07.320]You seem like you would be a sympathetic person.
[01:11:10.110]No, you're just coldhearted.
[01:11:13.214](crowd laughing)
[01:11:16.197]So you're saying I should be ignoring it?
[01:11:18.307]Yes. That would be my suggestion.
[01:11:20.790]Don't give it anything.
[01:11:22.980]And incentivize the opposite when you see it
[01:11:26.250]in small drips and drabs.
[01:11:28.020]But yeah, I would ignore it
[01:11:29.760]because that could have the function
[01:11:33.510]of drawing you away from the play
[01:11:36.600]and then getting that extra something from you,
[01:11:39.210]which would be a win for her, a loss for her sister,
[01:11:42.960]and ultimately a loss for her.
[01:11:46.500]Anybody else have a question? Yes.
[01:11:49.555]This might be a stupid question,
[01:11:50.790]but does a person who's struggling
[01:11:52.950]with anxiety or phobias have to meet all the criteria
[01:11:56.250]to be diagnosed with an anxiety disorder?
[01:11:59.607]So does a person have to meet all the criteria
[01:12:02.010]for an anxiety disorder to be, to qualify as having one?
[01:12:05.400]Not necessarily. I don't, it,
[01:12:07.290]I just try to determine how much impairment is present
[01:12:10.980]and if it's a significant amount of impairment,
[01:12:13.320]then I figured that's enough cuz their life is impaired.
[01:12:16.702]Right.
[01:12:17.535]Yeah. That's where the disorder is.
[01:12:18.810]That makes sense.
[01:12:19.643]Yeah.
[01:12:21.900]Yes. Sorry.
[01:12:23.064]That's all right. That's all right.
[01:12:23.897]No, no, go ahead.
[01:12:24.730]Quick question.
[01:12:25.563]I'm a speech therapist in school.
[01:12:27.411]And I, you know, I don't have the license behind my name
[01:12:30.960]to say, you know, I can treat things.
[01:12:32.763]I don't have anything.
[01:12:33.596]But is it legal for me to give them all those strategies?
[01:12:35.970]Yes. Like relaxing.
[01:12:37.176]You don't have to have a license to give common sense.
[01:12:39.289](crowd laughing)
[01:12:41.011]You know, people are so happy anymore.
[01:12:43.200]Oh, that's true.
[01:12:44.299]A little scary to-
[01:12:45.825]That's true.
[01:12:48.090]I guess if it could be characterized
[01:12:51.300]as a prescription of treatment by the parent
[01:12:56.040]that's litigation happy, maybe.
[01:13:00.750]And you are a licensed professional
[01:13:03.360]and so a, like ambulance chasing lawyer
[01:13:09.060]could possibly characterize you using your power
[01:13:12.060]as a licensed professional to step outside your area
[01:13:14.670]of expertise and tell this young girl to do X, Y, and Z.
[01:13:18.210]It didn't go very well and the parents are upset.
[01:13:20.070]Now they're gonna sue you. That could happen.
[01:13:24.300]So my recommendation would be make it
[01:13:27.210]as common sensey as you can.
[01:13:32.010]And I go outside the bounds
[01:13:34.474]of what you might call safe practice
[01:13:39.690]in my office frequently.
[01:13:41.520]But I've always tested those boundaries first.
[01:13:44.340]Just to see is this the kind of person
[01:13:47.910]that's gonna take what I've said
[01:13:49.110]and turn it all the way backwards
[01:13:50.280]and use it against me or not?
[01:13:53.100]And so far so good.
[01:13:55.740]It just is a natural tendency to want to help.
[01:13:58.698]You know, and you can help.
[01:13:59.670]You know what they...
[01:14:02.017]But it's slightly risky.
[01:14:05.220]And I have studied,
[01:14:06.960]you know, breath work.
[01:14:08.010]I do. But I just don't have the certification.
[01:14:11.100]Right.
[01:14:11.933]So I do feel confident.
[01:14:13.290]It's just legally, I didn't know for sure.
[01:14:16.110]You're a speech therapist.
[01:14:17.340]I think that legitimizes you to do anything with breath.
[01:14:20.594](crowd laughing)
[01:14:21.427]There you go.
[01:14:22.380]True.
[01:14:23.550]Done.
[01:14:25.230]Thank you very much everyone. Thank you.
[01:14:27.277](crowd clapping)

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

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