Behavioral inflexibility and autistic burnout

Incidents in life disturb us to different degrees according to our personality.  Some people may experience changes in daily routines by taking them in stride, while others may feel mortified. We often see the world from different perspectives and react accordingly.  Although sharing some basic personality characteristics our underlying traits, emotions, and baggage of knowledge are supposed to make each of us unique.  This variability is diminished among autistic individuals.

In autism, lack of behavioral flexibility and insistence on a daily routine may lead to obsessive behaviors. For some individuals, repetitive behaviors may be a source of reassurance and a way of coping with everyday life .  However, when the behaviors don’t allow for adaptation to environmental and social exigencies, repetitions may be clouded in emotions of anxiety and distress.  This anxiety state (obsession) is often accompanied by a whirling of thoughts that overwhelms the capacity for relaxation.   It is often that I hear patients complain that they feel fatigued, stressed, and overwhelmed.  For some, this is ingrained into their autistic condition. Some people call it “autistic burnout”.  According to Dora Raymaker from Portland State University, “autistic burnout is a state of physical and mental fatigue, heightened stress, and diminished capacity to manage life skills, sensory input, and/or social interactions, which comes from years of being severely overtaxed by the strain of trying to live up to demands that are out of sync with [their] needs” (https://www.seattlechildrens.org/globalassets/documents/health-and-safety/autism/autism_206_raymaker_slides.pdf)

It is said that behaviors are influenced by both personality and environment; that is, the situation in which a person finds himself. People that react in the same way all of the time fail to adapt to changing environmental situations.  Although personality traits tend to be normally distributed in the neurotypical population, behavioral inflexibility in autism is a skewed trait and part of its core symptomatology. Furthermore, this personality trait tends not to change with time.

It has been my impression that many autistic individuals suffering from behavioral inflexibility are also introverts. They are less likely to seek engagement in social situations and avert thrill seeking activities. High extroverts may enjoy sky diving, bungee jumping, and riding on roller coasters.  Extroverts are more sensitive towards experiencing rewards.  On the opposite end of the spectrum, autistic introverts engage in self-talk about their future, or self-reflections about possible negative encounters.  For many of them, life is less than satisfying.   Especially in high functioning autistic females, chronic life dissatisfaction is expressed as a mild depression (see previous blog on dysthimia).

In many instances, autistic individuals are the polar oposites of sensation seakers. It is not that they are afraid or cower from a potentially aversive situation but, rather, they find high levels of stimulation unbearable or noxious to the way they feel.   This is interesting as I have done several hundred recordings measuring the balance of the autonomic nervous system in autistic individuals participating in our clinical trials.  I have described that, at a basal level, autistic individuals have a high level of sympathetic activation riding on top of a low parasympathetic tone (see blog on the dysautonomia of autism).  It may be that high levels of adrenalin, provided by the exciation of thrill seeking behavior, may  tend to accentuate the disabling  features of the autism phenotype.

References

Casanova MF. Autism Updated: Symptoms, Treatments and Controversies. Amazon Publishing, 2019.

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3 responses to “Behavioral inflexibility and autistic burnout

  1. Hi Dr Casanova, I’m currently reading your great book (up to chapter 4) so far. My question if autism leaves the cerebral cortex malformed from birth and is therefore fixed, how does this explain therapies like ABA etc having an impact on autism severity? I understand the concept of brain plasticity but how would this effect the cortex / mini columns if at all in theory? Thank you.

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    • Thank you for the kind words regarding my book. For those people who have a brain malformation the same won’t change with interventions. You won’t be fixing the anatomy. Interventions in this regard would be symptomatic rater than curative. You can take as an example cases with heterotopias causing seizures. You can give them anticonvulsants and treat the symptoms, but the underlying malformation will remain the same. Thanks for the comment. Tell me how it goes after you finish reading it.

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  2. Pingback: Autism burnout: challenging symptoms and ineffective therapies | Cortical Chauvinism·

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