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No, Neurotypicals Don’t Hate Autistic People – Examining Sasson et al. (2017)

There’s a clip floating around Tik Tok from Devon Price’s Unmasking Autism.

Sasson and colleagues (2017), for example, found that neurotypical people quickly and subconsciously identify that a stranger is Autistic, often within milliseconds of meeting them. They don’t realize that they’ve identified the person as Autistic, though; they just think the person is weird. Participants in the study were less interested in engaging in conversation with Autistic people and liked them less than non-Autistics, all based on the brief moment of social data. It’s also important to point out that the Autistic people in the study didn’t do anything “wrong”; their behavior was perfectly socially appropriate, as was the content of their speech. Thought they tried their damnedest to present as neurotypical, their performance had some key tells, and was just slightly “off,” and they were disliked because of it.

Unmasking Autism, pg 185

It’s a powerful clip. I remember hearing Dr. Price’s words echo as I walked away from another social interaction feeling awkward and defeated. This clip out of context really negatively affected me. And it wasn’t long before I saw others on Tik Tok post about how their mental health suffered hearing that.

For many, it seemed like a no-win scenario. If allistic people viewed my behavior as automatically less comfortable to be around, what hope did I have when socializing? My social interactions suffered under this self-fulfilling prophecy. I saw myself as unable to interact with others, which made my interactions worse.

Dr. Price’s suggestion to this was the follow-up study by Sasson and Morrison (2019), where disclosure of the person being autistic improved social outcomes. This leaves a bit of a predicament. For those that do not want to disclose their autism, are they then doomed to be seen as less likable than their peers? What about undiagnosed autistic folks? Do these findings generalize to those with comorbid intellectual disabilities?

I want to preface this article because this is not a direct critique of Unmasking Autism. There are a lot of valuable pieces of advice and information in that book. However, this addresses the combination of factors that led to the idea that neurotypical people hate undisclosed autistic people. Dr. Price’s book does not conclude this, but it has been taken out of context to imply this.

This conclusion has been drawn partly because Dr. Price is a compelling writer who wrote this conclusively without addressing limitations. Part of it is how the studies themselves have presented the evidence. And the most significant contributor is how Tik Tok can spread (mis)information so quickly.

This is common for interpretations of autism studies both on Tik Tok and other media sources. Autism is political in the sciences and as a consequence gets summarized in non-scientific language that may not convey the complete picture of how a study was conducted.

So, let’s break down why we need to take the studies about neurotypical perceptions with a massive grain of salt.

Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments

Sasson and colleagues ran three independent experiments, published together in 2017. Different methodologies were used to attempt to generalize the findings along with “natural” interactions of autistic adults and children with researchers. All ASD stimulus participants were “intellectually capable,” according to the study.

Experiment 1

The first experiment videotaped 20 autistic adults and 20 “typically developed” adults performing a mock audition for a game show. 214 typically developed undergraduate students then rated the participants on whether they were smart, trustworthy, dominant, awkward, attractive, and likable. They also had “intention” measures of whether the rater would live near the person taped, hang out with, sit next to, and talk to them.

They separated the format that the undergraduate raters watched by transcript, audio-visual, audio only, silent video, and static frame (pictures from the clips). They found that autistic people were rated less favorably in all measures except in trustworthiness, intelligence, and living near (though sitting next to them was also close).

This experiment seems compelling, but there are some key factors that we need to consider here as far as limitations. The first significant factor is that the raters were undergraduate students. It didn’t specify what the undergraduate students majored in, but considering that most recruitment happens through psychology and similar fields, it was most likely that.

This is a huge issue. This doesn’t mean that neurotypical people view autistic people as less likable. It means that a sample of undergraduate students saw autistic people as less likable.

Another issue (which the author acknowledges in limitations) is that the participants were videotaped. This doesn’t translate to real-life social interaction. And this likely had to do (particularly with static frames) with facial features and other atypical physical characteristics of autism, not with social interaction.

Even though the sample size was adequate, the sample itself was flawed and can’t be generalized. The stimulus was also limited. It’s hard to know if the twenty people in the sample were viewed negatively because of autism or if other variables could explain the difference in ratings.

For example, it’s well documented that physical attractiveness affects rater perception. While audio-only and speech content could mitigate this bias, this effect could have greatly affected the other measures. We don’t know anything about the stimulus participants except their diagnosis (or lack thereof). There are too many variables here to conclusively say that autism was why the stimuli were rated poorly, even if there was an association between autism and rating.

Experiment 2

The second experiment took 12 autistic adults (2 female, 10 male) and 17 typically developed adults (7 female, 9 male) that had to have a conversation with the experimenter about open-ended get-to-know-you type questions (like “Have you seen any good movies lately?”. They were filmed in POV style with a program that took 10 random pictures through the interaction (excluding blurry photos, etc.).

37 undergraduate students that received credit from participating then rated the frames on measures of “how awkward,” “how approachable,” and “how likely to be friends.” Participants were matched by gender, which is concerning considering there were only 2 autistic female stimuli. The raters were shown multiple clips of the same individuals to test if impressions shifted with repeated exposure.

Raters responded more favorably to the three measures to typically developed individuals, regardless of how often they saw an individual.

Again, these were undergraduate students. We’re examining one sample of undergraduates from one university. They received credit, so we can also presume they were in social sciences. This cannot be generalized.

The researchers acknowledged that repeated exposure does not translate to familiarity. So, knowing someone better may improve scores even if seeing pictures of the same individual didn’t produce a more favorable score.

The problem of visual perception affecting trait rating was especially relevant for this experiment. Again, they didn’t give us any info about the stimuli other than diagnosis, so we have no idea how much physical presentation and related factors played into trait rating. Pictures of interactions do not provide much social information, so concluding that this was evidence of autistic people being rated poorly for social cues is not accurate.

It makes me wonder if we arbitrarily grouped neurotypical people into two groups, would we see similar effects? In other words, how much are individual differences affecting these ratings?

Experiment 3

The third experiment consisted of 7 autistic boys and 7 typically developed boys as the stimuli. For this experiment, they had 98 adults and 33 typically developed teens as the raters. The ages of the adults were 19-64, and the teens were 10-16.

Stimulus participants were recorded telling a story of happiness, fear, surprise, and anger. One sentence was taken from those videos where all four emotions were expressed. The boys were rated as likely to start a conversation, have many friends, get along well with others, spend time alone, and have awkwardness. The autistic participants were rated less favorably on all measures by both adults and teens (though not significant on awkwardness for teens).

This sample actually had enough diversity to be decent. The teen sample was not large, but it was recruited through a large sampling database.

I think it’s interesting that they said that autistic individuals were rated less favorably on “spending time alone” (meaning they were seen as spending more time alone). I think that shows a bit of researcher bias as it was implied that this trait was perceived as a negative social trait.

The stimulus sample was the smallest of the three experiments, so individual differences could have played into judgments, similar to the other experiments. The content of speech would have also been very relevant, but the researcher didn’t provide any examples. Also, all stimuli were boys, so this can’t draw any conclusions about how young autistic girls are perceived.

This experiment had some flaws, but less than the other two. Overall, I think this was the best conducted of the three.

Problems with the researcher’s conclusion

One of the factors that went into how Dr. Price wrote their excerpt essentially had to do with how the study was presented.

The researchers presented all three experiments to conclude that neurotypicals create negative first impressions of autistic people, as demonstrated by the various methodologies and samples.

It seems like by using the three studies in conjunction, they were hoping that the limitations of each would be mediated by similar findings in another study.

Considering similar limitations existed for all three (limited stimuli and heavy reliance on visual presentation), and undergraduate students were the raters in the first two studies, concluding that the evidence is “strong” that neurotypical peers view autistic social presentation negatively is not substantiated.

My issues with this conclusion are validated by a follow-up study that Morrison et al. (2019) did that found rater association with autism affected the rating more than traits of the autistic stimuli.

Follow-up study questions their conclusion

The same 20 autistic adult videos from experiment one were used with 505 undergraduate raters. The undergraduate raters were given a series of traits assessments that measured their level of connection to autistic individuals and willingness to interact with autistic individuals the raters had.

They found that among this sample, the higher stigma of autism significantly predicted negative ratings of the videos of autistic participants on all measures except dominance. More stigma was also associated with higher negative ratings when the videos were labeled as autistic.

So, disclosing an autistic diagnosis may only produce a positive outcome if the person the autistic person interacts with doesn’t hold a stigma against the condition. I’m sure this is not surprising to most autistic people, as I do not disclose my diagnosis in every situation (for good reason).

Meanwhile, higher autism knowledge only produced more favorable outcomes when an autism diagnosis was disclosed.

Limitations of this study were the undergraduate sample and not including typically developed videos, so it’s hard to make a direct comparison.


There are many studies to consider when examining how neurotypicals feel when interacting with autistic individuals. There are more studies cited in Dr. Price’s book that I don’t have time to examine in one article. Since the focus is on Sasson et al. (2017) in the video circulating Tik Tok, I felt it was important to break down that particular study.

I also think it is unfair to Dr. Price to take a couple paragraphs from a 300-page book and pick apart the wording of it. That is why this isn’t a review of Unmasking Autism. This directly criticizes this excerpt’s use and the greater trend of misconstruing science in media.

I hope you leave this article feeling slightly less fatalistic about how autism affects your interactions, knowing that the study cited doesn’t apply to all autistic people. It also affirms (and what I think Dr. Price’s greater point was) that autism education is essential to help improve communication between neurotypical people and autistic people.

Different Types of Flashbacks in PTSD and Complex Trauma

After a stressful event at work, I sat in the hall gasping for breath. I rationally knew what had happened. I had been yelled at, which triggered my PTSD. That didn’t stop my body from shaking and going through the panic of feeling helpless to save myself.

Talking about triggers in popular culture sounds like people being so sensitive to little events. You hear it thrown around as a buzzword and politicized as a way to diminish valid emotional reactions.

Trigger refers to an event or experience that reminds you of a traumatic event in your life. It brings up painful emotions.

Many years ago, I thought of triggers as their own PTSD symptoms, separate from flashbacks or other symptoms. Flashbacks were those “video clip” moments where your brain forces you to watch in vivid detail. That’s how they were described in all the resources I could find. I wasn’t familiar with complex trauma at the time.

Then I learned about emotional flashbacks. As the term implies, emotional flashbacks are emotion-focused flashbacks where you experience similar emotions to a traumatic period in time without necessarily getting clear images or somatic experiences.

While sitting in this hallway at work, I was having an emotional flashback triggered by the event. It was like being a child again, helpless and afraid. I likely would have regarded the situation as a panic attack a few years ago. But panic attacks aren’t tied to specific trauma triggers.

I tried looking into the different types of flashbacks further. If there were visual flashbacks and emotional flashbacks, were there other types?

The scientific literature didn’t have much to offer for variations on the “typical” flashback, reliving the moment in detail.

PTSD research has focused on single trauma cases, especially since, in the U.S., the DSM-V doesn’t have a classification for complex trauma. Often when going into a new therapy office, I have to indicate which trauma is my “worst trauma” since many of our therapy models rely on dealing with the singular root trauma. There isn’t room to see trauma as compounding, reducing trauma to very defined events of what can count as trauma.

Since practice falls behind research, it hasn’t caught up with the current understanding of things like minority stress, “social traumas,” or other complex traumas.

So, it’s not terribly surprising that research on types of flashbacks is nonexistent.

With all of that in mind, this is an article on a blog. I can try my best to provide a theory based on the current literature, but that theory is not scientific (yet).

To understand flashbacks, we need to understand the senses.

What are the senses anyway?

Oh! That’s an easy one. We learn this in kindergarten – eyes, ears, mouth, nose, and touch. Later on, we may have been exposed to other senses like vestibular (movement awareness) and proprioception (spatial awareness).

Often these are introduced as an accepted understanding of the world. The issue is that they’re phenomenological. And whenever you’re dealing with classification, it’s really tricky to say with any certainty that your classification system is an accurate representation of the world. As a consequence, a lot of the accepted “science” is a bit hazy, and mostly proposed theories with backing for some of the most major.

For example, Aristotle is credited to have first categorized the five senses. Other neurologists have identified and supported other systems. But depending on who you talk to there can be between 5-53+ senses.

This graph by New Scientist does a good job illustrating what senses are generally accepted in science. It also highlighted what “radical” senses have been proposed and a conservative understanding of the senses.

Graph showing conservative, radical, and accepted senses in science. Breaks senses into vision, hearing, smell, taste, touch, pain, mechanoreception, temperature, and interoceptors.

So, why does this matter to our discussion of flashbacks? Flashbacks are categorized by an individual’s somatic/sensory experiences, which requires a solid agreement on what senses count in that experience.

Flashback categories

CW: The following sections contain brief examples containing a variety of traumas.

A study compared flashbacks to regular auto-biographical memory. It found that flashbacks contained more visual, sensory, emotional, and other perceptual content than autobiographical memory. To people that have experienced traumatic flashbacks, this is far from surprising.

From examining the available literature and through my own experience, I’ve divided the types of flashbacks into Primary Sensory, Vestibular, Proprioceptive, Interoceptive/Emotional, Nociceptive, and Cognitive.

While these types of flashbacks may stand alone, most flashbacks are going to contain multiple types. The categories can be thought of as “Sense-Focused” flashbacks instead of as the only sensory experience of the flashback.

Primary sensory flashbacks

These flashbacks are what are most typically studied. They include the five senses as the focus.

The previously mentioned study found that visual information was the most common, followed by auditory for people experiencing flashbacks. Smell and taste were relatively rare. Touch falls under proprioceptive, so I’ll examine that more there.

Primary senses are the easiest to understand regarding flashbacks, so I won’t provide examples.


Vestibular-focused flashbacks are flashbacks that focus on the experience of movement. Motion can relate to the position and speed of you, people, or things around you.

Examples of vestibular-focused flashbacks may feel like hypervigilance, where you feel like your aggressor is following you. It may be like feeling the speed of a car coming at you, the feeling of body parts moving towards you, or your own body moving. It could also explain physiological descriptions of flashbacks like feeling dizzy, nauseous, off-balance, or like you’re falling.


Proprioceptors are nerve endings present throughout your whole body that identify things like touch, pressure, and your body in space.

Proprioceptive flashbacks may feel like someone or something touching you, like your body is present in that traumatic moment, weight on your body, or your skin crawling. It can also happen when someone touches you somewhere triggering, causing an acute sensation like being back in that moment.


Interoception is a wide array of internal experiences, including emotions, sense of time, and internal processes like blood pressure or hunger.

Primary emotions like fear, helplessness, etc., are more common in flashbacks than secondary emotions like guilt or anger.

Interoceptive flashbacks may feel like you’re experiencing the emotions from the trauma. In triggering your fight or flight, it may feel similar to the pounding heart and higher blood pressure you experienced at that moment. It commonly affects your sense of time, like moments are disconnected like a dream. Feeling like you’re in that time is also an interoceptive response.


Nociceptive is the system that senses pain. A study found that individuals who went through a traumatic event experienced pain after the event. They also experienced pain later when recalling the event.

Nociceptive flashbacks are characterized by pain in areas that may have been affected by the trauma or stress-related pain. It can appear unexplained and may be written off as “psychosomatic.” If you only started having pain following a traumatic event, it’s worth considering that the trauma likely affected your nociceptive system.

It could also relate to other descriptions of pain during a flashback, like feeling like you’re burning, shocked, or being pulled apart.


Cognitive flashbacks are not a sensation so much as a pattern of behavior. A CBT therapist might tell you to examine cognitive distortions after a traumatic event, like feeling like people are out to get you, etc.

I think it is worth considering that this is a type of flashback. You may have distinct thoughts and related behaviors that you experienced during the trauma. It may also describe compulsive actions like trauma re-enactment, which may result in thinking you’re gaining control or can prevent the trauma.

Cognitive flashbacks may also affect your mental understanding of a situation like you’re back in the trauma or thoughts like “I deserve this.”

How autism interacts with trauma

With all the different systems involved in flashbacks, it’s important to note that autistic people have a much higher likelihood of over 40% (this varies greatly across samples, but all agree that it’s much higher than the gen pop) vs. 4% in the general population to have probable PTSD.

The reasons for this are unclear, but it’s theorized that autistic individuals encounter a lot more traumatic social situations and non-DSM-V traumas. Non-DSM-V traumas are any events an individual feel was traumatic but are not currently considered traumatic under diagnostic criteria. Bullying, mental health problems, and cumulative minority stress may be considered non-DSM-V traumas.

Since assessment for PTSD is not built around autistic communication, there can also be an underdiagnosis of PTSD in autistic individuals.

Autism is characterized by an “abnormal” perception of sensory information. It also has many co-occurring conditions that affect perception, like alexithymia, hyperphantasia, and synesthesia.

A recent study indicated that Grapheme-Color Synesthesia, where individuals associate numbers or letters with colors or images, is associated with PTSD. Sensory systems play into the way PTSD symptoms affect an individual.

I couldn’t find any literature indicating whether autism affects the severity of PTSD symptoms, but there was evidence indicating PTSD affected autism symptom severity. Things like social skills and other emotional regulation skills were affected by PTSD, creating the appearance of more pronounced autistic symptoms as a result.

There needs to be more research into how the somatic experience of autism interacts with the experience of PTSD. Until we have more research, it is unclear how being autistic may affect flashbacks.

An exercise for flashbacks

While many coping skills can be helpful in dealing with flashbacks, I’ll leave you with my favorite.

The technique is called “what’s different?”. In the flashback, you ask yourself, “what’s different?”. You keep naming different things about the room until your body returns to the present. It can be anything like “it’s colder”, “there’s this person with me”, “the walls are a different color”, “I’m laying down”, etc.

While it sounds simple, it can be beneficial during flashbacks to remind yourself where you are.

How Do I Know if I’m Experiencing Burnout?

I’m burned out. Between the constant grind of school and work, moving, and the current state of my country, I am completely drained.

I am not alone. In 2021, 79% of U.S. employees reported experiencing work-related stress. Nearly 3 in 5 reported being negatively affected by work, including lack of energy, motivation, and cognitive fatigue.

There are many reasons for stress to pile up in modern life. Having constant access to the news 24/7, being isolated in individualistic cultures, collective traumas like the pandemic, a culture of productivity, and our personal history all contribute to this mass feeling of exhaustion.

What is burnout?

Burnout is a syndrome, not a disorder. This means that any person can experience it at some point in life and generally can process it without intervention from a professional.

To count as burnout, it needs to have three dimensions A person needs to be exhausted, experience cynicism or depersonalization, and have a negative self-view of performance.

Burnout is talked about in the literature solely as related to work. It was first coined to explain the collection of symptoms common among therapists and other service workers that experience chronic stress. Presumably, stressors outside of work can also cause burnout.

Burnout vs. trauma vs. depression

Burnout has a lot of shared symptoms with trauma and depression. It can make it difficult to pinpoint what the cause of the problem is and get proper treatment. Many people use the term burnout when they’re actually experiencing other issues.

The chart above is not exhaustive, and specific symptoms are subjective in where they fall.

Shared characteristics are exhaustion, depersonalization, cynicism, irritability, anxiety, helplessness, headaches, withdrawal from social, and numbness or emotional outbursts.

Some key differences about burnout are that it is usually short-term, that you can pinpoint the source of the stress, and that self-care can prevent it. You can also start with burnout, which leads to depression if prolonged enough.

If your symptoms last a while, you’re experiencing suicidality, you’re getting intrusive thoughts and flashbacks from the source of stress, you have physiological changes, or you’re feeling down most of the time, you should seek professional help. This would indicate you are not experiencing burnout but are experiencing something else.

Common causes of burnout

Something that is not often discussed in the context of burnout is that it is mainly organizational. We typically put it on people as their responsibility to fix their burnout when the organization has a climate that leads people to burnout.

Sweden provides employees paid time off for burnout and other stress-related illnesses. Burnout researchers found that although they got this time off to rest, many employees still didn’t want to return to the workplace. You cannot fix a poor organizational structure or fit by taking time off.

In one study, employees rated their bosses and found that for every point increase in leadership score, there was a 7% decrease in burnout and an 11% increase in job satisfaction.

The most common work structure factors that lead to job satisfaction or burnout are:

  • Workload – how much you’re doing
  • Reward – work incentives/meaning
  • Control – how much autonomy you have
  • Community – the work culture and relationships
  • Fairness – if employees are treated equally
  • Values – your personal values vs. the company’s

If any of the above areas is poor in a given work environment, you will experience stress and less job satisfaction.

Autistic burnout vs. occupational burnout

While autistic and occupational burnout shares a name, the two are distinct. Autistic burnout is a relatively recent term, so the clinical literature is sparse, but the available research points to autistic burnout being longer lasting (up to years), decreased tolerance to sensory stimuli, barriers to treatment preventing relief, and issues with living independently.

Autistic people can also experience occupational burnout, contributing to autistic burnout. The symptoms look similar, but autistic burnout is more severe and enduring.

Like other forms of minority stress, contributions to autistic burnout are the cumulative load of expectations combined with systemic barriers to treatment Things like masking, transitions, dealing with the debilitating parts of autism, and social expectations fray the rope of stress management. Being dismissed by others, poverty, poor boundaries and self-advocacy, and not taking a break causes no relief from the stressors.

More research needs to be done on the condition and the best recovery methods. The early research on autistic people’s perspectives indicates that setting boundaries, asking for help, doing wellness activities, and recognizing autistic traits/diagnosis all alleviate autistic burnout.

Solving Burnout

You’ve tried all the self-care under the sun, and you’re still burned out. You’ve been told repeatedly that you need to take time off to solve your problems when that would only lead to more problems. You’re stuck in a cycle of waking up, dreading work, going home, dreading work, and going to bed.

I get it. Burnout is really hard. And unfortunately, there isn’t a magical solution.

You cannot self-care your way out of burnout. Self-care is meant to be preventative, not an intervention.

The first question you have to answer is: is it me or my job? If you look at the lists above and see that your company is missing several crucial dimensions, it may be time to start job hunting. Trying to solve burnout when the organizational problem is like that art installation where the robot is trying to clean up a constant pool of blood.

If it’s not an organizational problem, here are some tips that can help.

  • Disconnect from your phone. Set digital wellness timers, limit the content you’re seeing, and take a break from the news.
  • Prioritize responsibilities. Think of your responsibilities as juggling balls. Some are made of glass, and others are made of plastic. Figure out which ones are glass and focus on making sure those don’t drop. You’ll be fine if you drop the plastic responsibilities for a bit.
  • Take your breaks at work. Use PTO. Think of it as investing in your productivity.
  • Talk to someone, preferably a therapist. Verbally processing your situation can help you realize what will work.
  • Have a physical outlet. Our bodies naturally try to physically shake off stress, but we often inhibit it. Animals shake in the wild to relieve acute stress.
  • Do the wellness activities you can. You can’t do everything, but choose what’s most important.
  • Set time between responses. Most communication doesn’t require an immediate response.
  • Engage the parasympathetic nervous system. “Tricking” your body into calming down will boost your energy and mood.
  • Do nothing. Boredom can be beneficial in sparking creativity and letting your mind rest.

Remember, you are worth more than your job. Your inherent value is not tied to your productivity. You are worth just as much when you’re burnout as when you’re at your peak productivity.

Catatonia – More Than Just Freezing

My heart races as I freeze, my whole body flexed in an uncomfortable position. I cannot move or speak, and I am stuck staring ahead. This feels like sleep paralysis, but I’m awake?

It feels like I should be able to move. I command my legs and arms to move, but nothing happens. My brain is trying desperately to maintain this illusion of control.

Like sleep paralysis, I have the urge to scream, but nothing comes out. The more I fight, the worse I’m pulled into this sense of helplessness. It’s a waking nightmare.

I’m experiencing catatonia.

Over time, catatonia becomes another mental health symptom I greet with resigned familiarity.

At least 1 in 10 people with severe mental illness will experience catatonia at some point.

Despite this, information on catatonia is not widely available. I didn’t learn the name for my catatonia from any doctor or therapist. I had to actively search to find a name for what I was experiencing.

Who Experiences Catatonia?

Catatonia is a prominent feature in schizophrenia (up to 35% of people with schizophrenia). It is classified under psychotic disorders but “can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive disorders, and other medical conditions” (DSM-V, 2013).

Nearly one-third of people with bipolar have it, roughly 3-12% of autistic people have it (across multiple studies), one small sample found 87% of people with Tourette’s met the criteria, and in one sample of inpatients with catatonia, 57% had experienced childhood trauma (ACEs). Psycho-physiological symptoms, BPD, dissociative amnesia, and paranormal experiences may also be correlated with catatonia.

What is Catatonia?

While they are under the same definition in the DSM-V, catatonia is often split into two categories. There are two main types of catatonia, akinetic and excited.

Akinetic is the most common. It is characterized by at least three of the following symptoms:

  • immobility
  • mutism
  • withdrawal
  • refusal to eat
  • staring
  • echolalia
  • echopraxia
  • atypical inflexible postures (posturing)
  • resistance to movement
  • repetitive movements
  • declining requests or not responding for no apparent reason (negativism)
  • grimacing

Excited type may be characterized by any of the symptoms in akinetic type but is also characterized by agitated psychomotor behaviors, which may express as meaningless movements or vocalizations and may result in self-injury or aggression.

Considering the prevalence of catatonia in autism, there are significant implications with excited catatonia type. Self-harm and aggression may be expressions of catatonia in autistic people, which further raises ethical concerns for behavioral interventions if catatonia is not considered as a differential diagnosis.

In extreme cases, there may be malignant catatonia which can be lethal. This is generally descriptive of drastic physiological changes (like blood pressure and hyperthermia) in catatonic episodes or other complications like malnutrition from a prolonged inability to eat.

Catatonia exists on a continuum of severity ranging from minutes to weeks. Historically catatonia was only diagnosed if it was extreme, but now it is considered commonly associated with many mental and medical diagnoses.

Treatment for Catatonia

Treatment for catatonia typically uses electro-convulsive therapy (ECT) or benzodiazepines. In addition to these treatments, psychological therapy also seems to help some people with catatonia. Transcranial magnetic stimulation (TMS) is a potential treatment for catatonia, though the evidence is preliminary.

For less severe forms of catatonia, formal treatment may not be needed. Catatonia is not an extreme enough symptom for me to need treatment for it. Things that have helped me personally are grounding exercises and anxiety coping mechanisms, as anxiety from catatonia can often aggravate it.

If you experience catatonia, you are not alone. Since the condition is not well known and carries some stigma, it can feel very isolating. But it’s far more common than people realize.

Please let me know your experience with catatonia in the comments or reach out to me through the contact form.

Masking 101: What I Wish My Parents Knew Pt. 2

Here is Pt. 1.

When I was young, I was labeled “gifted.” The Gifted Kid ideology promotes the idea of these young prodigies – talented in academics, social issues, leadership, technology, art, physical skills, or proficient in any other area. There’s supposedly a symptom list associated with gifted children; having a hard time connecting with peers, boredom at school, hyperlexia, having strong feelings compared to other children, and hiding their “giftedness” to fit in.

Sound familiar?

I wasn’t gifted, I was an autistic girl (read AFAB) with ADHD.

The gifted movement has been critiqued for lumping in neurodivergent traits as “symptoms of giftedness” and leading to “gifted kid burnout.” In recent years, the gifted kid movement has tried to pass itself off as a form of neurodivergence in itself, without any professional classification of this so-called “giftedness.”

As is typical of gifted children, I worked hard to hide my “giftedness.” I suppressed my extreme emotions, didn’t discuss my special interests, dumbed down my vocabulary, and tried to remove every autistic trait I could in an attempt to make friends and not be bullied.

I learned masking.

Cutting Away the Parts of Myself That Weren’t Normal

I experience emotions intensely, to the point the smallest injustices feel like a personal calling. Some professionals would likely pathologize it as “moral black and white thinking.” I just call it empathy.

When I was 10, I had a pet ladybug I found outside that I would gaze at for hours. I asked my mom to Google what ladybugs ate and tried to find small bugs in the garden to feed it. I took it out of the little plastic enclosure and let it climb across my arm, engrossed with the little creature.

Unsurprisingly, I lost it somewhere in the kitchen and never found the ladybug again. I cried and cried for days about it. I searched frantically for it. Eventually, I moved on after mourning the loss of my new friend.

When I heard good news, I would jump up and down and flap my hands. I would scream and run around the house and be elated for days.

My emotions were too much for most people in my life to handle. I would get scolded by my parents, teachers, and other adults. I would be ridiculed for crying in school or expressing strong emotions.

I stopped bouncing and flapping my hands when I was happy. I stopped repeatedly asking questions when excited. I didn’t express what I wanted and learned to take whatever was given to me.

I think many adults that punished my emotions wanted me to “be prepared for the real world.” Instead, they left me vulnerable as an adult, struggling to hold boundaries, regulate emotions, and voice what I want.

Like a sculptor, I carefully carved away at my core, creating a socially acceptable version of myself. I chopped off my sensory needs in exchange for dissociation, pushed myself to interact despite my anxiety, forced myself to subdue emotions to meltdown later, and pretended like I had it all together instead of asking for accommodation.

The fear of being mistreated for expressing myself is ingrained so deep, it’s hard to distinguish myself from this mask.

What are the effects of masking?

Research has demonstrated that everyone, regardless of neurotype, engages in some form of masking, like changing your appearance, voice, and mannerisms to fit in. Something unique to autistic individuals though, is that they mask so significantly that it has a severe impact on their sense of self and is detrimental to autistic wellbeing. Masking for autistic people is directly related to suicidality, which is not the same for non-autistic individuals.

Not all autistic individuals mask, but it is often necessary in our present society to succeed. This is especially true for intersectional autistic people that may face discrimination, maltreatment, withheld support, and systemic abuse if they don’t mask. A black autistic person, when confronted by police, is literally faced with life or death depending on their ability to mask.

It’s easy to sit back and say, “well, then stop masking!” when considering the fix to preventing long-term health problems. To be able to unmask is an incredible privilege. On the other hand, the ability to mask can in itself be a privilege because it provides the safety that many autistic people aren’t afforded.

There is no correct answer for what to do about masking, but we know there are adverse long-term effects. Ideally, societal change would be so fundamental that no one would need to mask regardless of identity. But, that’s not currently realistic.

As a late-diagnosed, white, hyperlexic autistic person, I can only provide a privileged experience. For me, I am incredibly grateful I learned how to mask, but I also can unmask now that I’m in a safe place. That’s not going to be true for everyone. It would be inappropriate for me to give a blanket suggestion of what should be done about masking.

The one thing I do wish my parents had known though, is what masking was and passing that knowledge on to me. At the very least, knowing that this “mask” was a separate part of myself would have helped my feelings of inadequacy about my authentic self. It may have aided my ability to cope appropriately because I’d be able to recognize that I don’t have to mask when I’m alone.

Knowing what masking was would have likely helped me avoid mental health crisis because I’d have developed healthier coping mechanisms like I’m doing now as an adult.

And if my parents had known, maybe they’d have understood a little better why I’d lie about how I was feeling and smile when things were terrible. Perhaps they would have tried harder to encourage autistic expression.

I’m not lazy, I’m burned out

Masking is exhausting. If you wear a false version of yourself all of the time, you don’t have the energy to do necessary things. Different autistic people are hit with burnout at different times with different severities, but autistic burnout in children can look a lot like laziness to parents.

Why does my kid want to watch TV and do nothing else when they get home? Why aren’t they doing their homework? Why do they never take any initiative around the house?

The unseen portion of these types of questions are, what emotional and cognitive labor have they been doing all day that you can’t see?

Couple this with ADHD executive dysfunction, depression, or any other comorbidity, and you have a recipe for contention. Nothing is more overstimulating than having someone pester you to do something repeatedly when you’re tired from the day. It explains why meltdowns are so common after kids get home from school.

If I had a time machine, I would have wished my parents had known what masking was so they could have avoided some of the power struggles we had. I couldn’t explain to them that I didn’t have the cognitive/emotional resources to fulfill demands.

This is why environmental support is essential. Having environments to escape through the day can make a big difference for sensory overload. Not being pressured to “act allistic” is incredibly relieving. And being given a clear schedule that can be flexible to my needs can make the difference in whether I hit burnout.

Masking may be unavoidable and necessary for many people, but there are ways we can support autistic individuals in their lives to minimize the damage of long-term masking. Through education, support, and compassion, we can help prevent autistic burnout in ourselves and the people we care for.

For more information on specific sensory supports that can be used to prevent burnout check out Pt. 1.

The Great Big List of Sensory Coping – What I Wish My Parents Knew Pt. 1

This post contains affiliate marketing links.

Pt. 2

When I was 8, my parents took my family to Disneyland. I remember meeting Disney princesses in my Snow White princess dress, being invited on stage to fight Darth Vader, and swallowing about a gallon of seawater trying to learn how to boogie board. It truly was the trip of a lifetime.

My mom is a very go-go-go type of person, so she pushed us from activity to activity, wanting to experience Disneyland to the fullest. My dad was the type of person who liked to stage large family photos (his special interest at the time was photography). Family photos often included me holding a screaming child, standing in the same place for an hour, and squint-smiling as the sun shone directly in my eyes.

Together they were an unstoppable duo of go-wait-go-wait, trying to get the most out of the money they spent during the 2008 recession. It’s easy to feel pressured to have the maximum amount of fun when you’re trying desperately to create a memory-forming experience.

At one point, my mom dragged me into the bathroom, begging me to use the toilets, but I sat down on the floor and cried. “It’s not scary,” she reassured me, but the looming monster of automatic toilets begged to differ. I had a meltdown on the bathroom floor, my mom frantically trying to calm me down while equally stressed parents passing by watched the unfolding “tantrum” with a judgemental look.

To me, it felt like the world was ending. I was hungry, tired, needed to pee, and my mom was trying to get me to use automatic toilets (how dare she?!). I was terrified of the noise and the abruptness. It had been a long-waged war between us to get me to use automatic toilets in public.

She flipped open her guidebook and tried to find toilets at Disneyland that weren’t automatic. She found one bathroom in all of Disneyland that didn’t have automatic toilets installed.

Our family ran down Main Street, rushing to get to the bathroom. I went in and did my business, relieved.

For the rest of the trip, we walked over to that bathroom regardless of where we were.

It’s funny looking back now because I was so obviously autistic. But back then, as recent as it is, girls (read AFAB) weren’t diagnosed with autism. I was just “quirky.”

My parents handled some of my autistic behaviors well, and others… not so much. If I could go back and give them a guide on what to do differently, here’s what I wish they would have known.

Sensory Coping

Learning sensory coping as an adult solved my “panic attacks” overnight.

What is sensory coping? Sensory coping is any sensory intervention that helps the person regulate sensory stimuli. This can be both the addition or removal of sensory experience.

One of the biggest “a-ha!” moments with sensory coping was realizing how vital oral stimulation is to help me regulate. It is one of the less acceptable ways of seeking sensation because of the association with childishness.

I sucked my thumb until I was 5. I would have done it longer, but my mom trained me out of it using aversives. “You’re too old to be sucking your thumb!”

When thinking about it critically though, what is the actual harm in children or adults using safe objects in their mouths to cope? Nothing really, it’s just not socially acceptable.

An autistic teenager I mentor chews on the rubber tires on his toys. His mom came to me in exasperation and said, “Why is he doing that?! How do I get him to stop?! He’s too old for that.”

I smiled and said, “If you want him to stop, give him something to chew on.” I helped her find a chew necklace on Amazon.

When considering sensory coping, you need to understand the person’s unique triggers, sensations they enjoy, and the type of sensation they naturally seek. Never force a sensation someone is expressing discomfort towards.

Auditory Coping:

  • Music. Everyone I’ve ever encountered has a type of music they like. Try cycling through different genres (even ones you don’t listen to)
  • Ear plugs. Noise-cancelling headphones can be great during a meltdown or rising sensory-overstimulation. High fidelity ear plugs are great if you can’t stand bulky noise-cancelling headphones.
  • ASMR can be enjoyable to some people
  • White-noise or other non-content noise. One kid I knew liked standing next to the outdoor A/C units because he found the noise calming.
  • Stop talking. Try communicating without speaking for a bit. I’ve heard this can be especially helpful for people who have selective mutism.

Oral Coping:

  • SAFETY: Make sure to regularly sanitize chew toys/etc., especially during the pandemic. Keep them in a designated place when not in use and don’t let others touch them. Watch for items that can become choking hazards or that someone could injure themselves on if a part breaks off.
  • Chewies – chew jewelry/chew toys. There are chew toys that exist that are meant to be subtle and ones that are different textures and materials. You can find them on Amazon or from autistic creators. One of my favorite autistic creators of subtle chew/fidget jewelry is The Divergent Minds Club.
  • Safe objects – straws, pencils, clothing, toys, etc. I know it seems frustrating when you see your child chewing on objects, but it is serving a purpose. Give them designated items based on what they normally chew on if they don’t like chew toys. A friend of mine likes chewing on plastic straws because they’re a different texture than the silicone toys and keeps a few in their office.
  • Ice – one warning is don’t chew ice (it’s bad for teeth) but sucking can provide a lot of sensory stimulation
  • Baby Ice Teethers – if you like chewing ice, this is a great substitute
  • Gum – have them choose the flavor. I really like the dessert flavors the Extra brand makes.
  • Food that imitates inedible items – edible playdough, chocolate “dirt”, candy rocks

Visual Coping:

  • Youtube videos – the videos marketed for “baby sensory”, “sand sensory”, “visually pleasing”, “surprisingly satisfying” can all be great places to look
  • Hourglass, color, or “visual toys” – lava lamps, bubble hourglass, sand toys, kaleidoscopes, Jacob’s ladder, I Spy book, light toys, and color changing optic lights
  • Projectors – there are fairly inexpensive light show projectors or you can easily make your own
  • “Beer goggles” – the type of goggles used in high school classrooms to warn students against drinking and driving, or any glasses that distort the world
  • Eye masks
  • Simulating an odd perspective – fish eye lense, going somewhere high up, spinning, tutting
  • Smart devices – you can get smart lights that are able to dim or change color and connect to smart home devices like Alexa

Tactile Coping:

  • Water, sand, and sensory tables
  • Dancing, exercise/movement, trampolines
  • Fidgets – I’m a big fan of this fidget toy set online or you can make your own.
  • Squeezing – autism “steam-rollers” (though these are pricey), full body hugs, hand or foot massages, head squeezes (can be good in place of headbanging), using objects around like pushing your body against a wall
  • Things to throw your body against – mats, beds, wearing a helmet, wrestling, punching bags, foam pits, diving
  • Sensory swings – in my living room this looks like a hammock chair and stand (no screwing into the wall needed)
  • Body suits
  • Bodies of water – swimming, bathtub, etc.
  • Weird/Pleasant textures – soft rugs/blankets, lotion, walking through the fabric aisle at Walmart, items that vibrate, smooth/bumpy items, temperatures (hand warmers or ice packs)
  • Activities that keep your hands busy – knitting, baking, puzzles, video games, drawing, rubix cube
  • “Safe space” – a small area that there’s a lack of stimulation or only pleasant tactile stimulation available
  • “Medicinal Herb” – if legal and of age

Olfactory (Smell) Coping:

  • Candles, incense
  • Scratch and sniff stickers/markers
  • Nose plugs – ones that you can still breathe through are usually less irritating
  • Perfumes/lotions of a preferred scent
  • Cooking fragrant foods – cookies, spicy foods, anything with cinnamon
  • Scented toys – stuffed animals, bubbles, play dough,
  • Essential oils – these can be put on diffuser necklaces to be worn around
  • Scent diffusers

Hopefully, you find some of these suggestions for sensory coping helpful. Consider putting these things in a “coping kit”.

If my parents had been equipped with how to help me sensory cope, I likely wouldn’t have developed as severe of anxiety pre-diagnosis. Sensory coping is an essential part of understanding autism and should be a staple for every autistic kid. These are all things you can try at home, but if you are looking for professional help, Occupational Therapy can be a great way of learning how to cope with sensory issues. Some areas offer OT services to children and adults, so check your local resources.

Let me know which ideas you found most helpful! For more information on why sensory coping is important check out pt. 2.

Why I’m Moving Platforms – A Confession of A Burned Out Advocate

I never intended my Tik Tok to be a route for advocacy. It was a place where people related to my darkest parts for the first time. A place to share trauma that most people don’t want to hear.

I don’t regret that it launched my advocacy platform. I couldn’t have predicted a job I had taken to help other people, autistic children, would turn into such a traumatic and life-changing experience. My job as an ABA therapist was a relatively short blip in my life, and yet it made such a significant impact on who I discovered myself to be.

I suppose finding out you’re autistic from ABA, an industry that views your existence as inherently wrong is just about the worst way you can find out. The guilt I felt at leaving helpless children at the hands of people who saw them as manipulative, dysfunctional, and in need of saving was nearly unbearable. I started posting on Tik Tok about it as a means of gaining sanity. A touch of reality when I was being gaslit by my coworkers and boss. Being fired was just about the best thing the clinic could have done for me.

Motivated By Spite

My goal was to reach 10K. That was the number my father had at the height of his relative “fame,” which he weaponized against me growing up. It was a spite-motivated goal and one I craved desperately to reach. But when I achieved it with a controversial video, I was wracked with anxiety I hadn’t felt since starting the account.

I had thousands of people telling me I was wrong, spewing the worst kind of hate towards me, and arguing with each other. I became obsessed with managing the comment section, refreshing the page repeatedly to see dozens of comments pouring in.

My victory was hollow. I had reached my goal, but what was the point? It marked a year-long project that devolved the second half a million people saw my video. I started noticing other activists’ efforts, posts of friends and mutuals that went viral. The comments were filled with all sorts of projections, removing nuance and accusing creators despite their content being less than a minute long.

While it isn’t just Tik Tok, it seems especially bad because of the level of audience that you can reach and the length of videos. Being seen by more people isn’t necessarily a good thing. I grew bitter as I got comments on my videos critiquing minutiae, putting words in my mouth, and insulting me. It made me realize my efforts required a much more nuanced approach than Tik Tok.

Welcome to Life of Lieu

Advocacy is exhausting, even if it’s behind a keyboard. It’s a ton of emotional labor to explain the same things over and over to the same questions/arguments. I don’t pretend to have it harder than most activists. I haven’t reached a platform where I’ve experienced a fraction of some of the abuse I’ve seen. I am also not out in the field advocating in harsh conditions against cruel people. But, I’m still tired.

I created this blog because I need a place to flesh out my ideas. I can’t articulate what I need in only 150 characters. I hate talking on video. And writing has always been the way I communicate best.

This blog will be a mix of my thoughts/feelings/experiences on mental health topics I feel are essential to address. Like Tik Tok, I imagine it will take on a life of its own. Welcome to Life of Lieu.

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