Do You Validate?

Maureen Salamon is the Executive Editor at Harvard Women’s Health Watch. She recently penned a piece looking at the importance of validation. As she writes, validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. As she said, people “jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

So how can you offer good validation? Salamon suggests starting with the following for validating another person:

  • Give them your full attention.
  • Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
  • Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
  • Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
  • Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Validation is an approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

Ready to learn more? Read Salamon full article at Harvard Health Publishing.

Record a Win Every Day

Christina Caron is a reporter for the Well section at The New York Times, covering mental health and the intersection of culture and health care. Recently she wrote a pice discussing how cultivating a grateful outlook, and taking a few minutes a day to count our blessings, can reduce symptoms of depression and anxiety, increase self-esteem, and improve life satisfaction. Noting that, she asked her readers to tell her how they practice gratitude, and curated the nearly 800 responses she. received. Some of the best are highlighted below, but be sure to read the whole list and her entire article at nytimes.com. Then ask yourself, which of these might you be able to apply today?

  • Record it. More than 100 respondents said that they use journals or apps like Day One, Gratitude Plus and Flavors of Gratefulness to keep track of the good things in their lives. “The best thing my therapist taught me was to record my ‘win’ every day,” said Elizabeth Chan, 35, who lives in San Antonio. “Doing so helped me develop my optimism muscles, which had atrophied for decades.”
  • Walk It. Deborah Rathbun, 66, from Sharon, Conn., goes on a walk several times a week, always focusing on the beauty that surrounds her: “the blue of the sky, the leafy green trees, how the flag is moving nobly in the breeze, a drizzle that’s badly needed for the gardens.” Next, she reflects on the last 24 hours and thinks about the “very small things that went well or I’m pleased about.” It might be a friendly or funny exchange with a cashier or the thoughtful text she finally sent to a friend.
  • Give thanks as a group. Louise Miller, 52, from Boston, said she writes her gratitude list in a journal and then texts the list to a group of friends who also share theirs. “They almost always include something that inspires more gratitude in me — it’s contagious!” she said. Zach Ford, 33, a Brooklyn resident, said he has been following a near-daily gratitude practice since his first weeks of sobriety about six years ago. Each morning he shares his gratitude list in an email with a handful of others.

The Benefits of Morning Meditation

Research has shown it to help with everything from anxiety and depression to better sleep, lower stress levels and chronic pain relief. In a recent New York Times article, health and wellness writer Holly Burns reviewed why incorporating a mindfulness practice into your daily life can be beneficial, and how to get started.

She suggests starting small, with five minutes of breathing exercises to calm and focus the mind every morning. Not only will it “set the tone for the day,” said Dr. Eva Tsuda, a meditation instructor at the UMass Memorial Health Center for Mindfulness, but meditating earlier may make the practice easier to stick to.

Burns offers a few additional suggestions and things to consider as you get started. These include deciding on a specific, quiet place where you are unlikely to be interrupted. Once you do so, set a timer, again, for as little as 5 minutes and go in without expectations of “success.” Just noticing what that 5 minutes is like is a good start. If you need some place to rest your focus during these 5 minutes, see if you can simply describe your breath or what you are noticing via your 5 senses. A grounding exercise is a good place to start. You can read her full article at https://www.nytimes.com/2023/07/21/well/mind/meditation-morning-practice.html. Or, if you are looking for some help getting started, try a different, brief exercise via any one of many playlists available on YouTube.

Pride and Joy

This year’s Pride Month spans from Thu, Jun 1, 2023 – Fri, Jun 30, 2023. Born out of the Stonewall riots, this is meant to be a time dedicated to celebrate and commemorate the ongoing work and legacy of lesbian, gay, bisexual, and transgender (LGBT) people everywhere. Year round, and especially this month, Pride Month is meant to both honor the movement for LGBT rights and celebrates LGBT culture. To that end, the wellness blog will focus this month on content relevant to promoting wellness in the LGBTA+ community, and we start with a story published by Margot Harris at NAMI entitled “Being Queer is Joyful,” which describes her coming out story, a discussion of privilege, and her hope the future. Please be sure to read this piece at https://www.nami.org/Blogs/NAMI-Blog/June-2023/Being-Queer-is-Joyful.

Are You Ready For The Summer?

While it may seem like we just rang in the new year, the unofficial start of summer is slowly creeping up on us. And while you might not think Minneapolis when you think summer, the good folks at the University of Minnesota have put together some great tips for a season of wellness! These tips are summarized below, but be sure to check out their full summer of wellness site at https://www.takingcharge.csh.umn.edu/summer-wellbeing.

Explore new foods: Expand your palate by trying new recipes that include seasonal foods you can’t get year-round. You can visit local farmer’s markets for fresh ingredients, or harvest your own veggies at home. Take advantage of the long sunny evenings while they’re here and grill healthy options outside. [Learn More]

Exercise outdoors: If the weather is pleasant and you have the ability to get outside, do it. If you’re tired of going for a jog, think outside the box of a traditional workout. Mowing the lawn with a push mower, gardening, or swimming at a local pool are all great ways to move your body while soaking up some sunshine. [Learn More]

Get better rest: Long, sunny days may mean you stay up later than usual, and hot, sticky weather can also prevent you from falling into a deep slumber. Make your bedroom summer-friendly by keeping it cool with a fan or open window (experts recommend about 68 degrees Fahrenheit), hanging light-blocking curtains, and relaxing before bed by putting away your phone and reading a few pages of a new novel. [Learn More]

Catch up with loved ones: This summer, double your wellbeing by spending time with the people you care about while doing nature-based activities you can’t do during colder months, such as visiting a beach or eating dinner outside. Funnel your energy toward staying connected even when your schedules don’t match up—if you go out of town, send handwritten postcards to let friends know you are thinking of them. [Learn More]

Ease stress with mindfulness: Even if you go on vacation to a tropical destination, even if you plan on summer to be completely relaxing, there will undoubtedly be situations that cause stress. But that’s not a problem. Rather than putting an expectation on the season to bring a sense of calm, cultivate it yourself. Being in nature is one of the best ways to unwind from stress. Take a few minutes each day—maybe right when you wake up in the morning—to step outside and simply enjoy the outdoors as a child would. Drop thoughts of any plans for the day and simply notice the green of the grass and trees, the feeling of a breeze on your skin, and the sound of birds and other animals. [Learn More]

Combating Loneliness

The New York Times’ Christina Caron recently published a piece reviewing advice given by the Surgeon General, Dr. Vivek Murthy, on how to build meaningful social connections in an increasingly lonely world.

Americans have become increasingly lonely and isolated, and this lack of social connection is having profound effects on our mental and physical health, the surgeon general warned in an advisory on Tuesday.

Advisories from America’s top doctor are typically reserved for public health challenges that require immediate attention. This is the first time one has been used to highlight the issue of loneliness.

More than half of Americans are lonely, according to a 2021 poll, which also found that young adults are almost twice as likely to report feeling lonely as those over age 65.

So what can one do? Dr. Murthy’s advice is summarized here, if you interested, learn more at https://www.nytimes.com/2023/05/02/well/mind/loneliness-isolation-surgeon-general.html

Reconnect with people. To get started, take 15 minutes each day to contact a friend or a relative. Put a reminder in your calendar, if needed, so that it remains a priority. Your relationships cannot thrive unless they are nurtured.

Minimize distractions. How often have you caught yourself looking at your phone while someone is speaking with you? What about during meals? Do other people do this when speaking with you? For more satisfying quality time, put the devices down and give your full attention.

When people call, pick up the phone. Imagine your phone ringing. You see it’s a call from your best friend from college whom you haven’t caught up with in a long time. But instead of accepting the call, you decide not to answer. You tell yourself you’ll call back later when you have more time to chat.

Serve others. Studies show that volunteering can ease feelings of loneliness and broaden our social networks. Consider donating your time to an organization in your community, or offering to help your family, co-workers or friends.

Get help. Finally, tell someone if you are struggling with loneliness. It could be a relative, a friend, a counselor or a health care provider.

Optimism

What does optimism do for us? In a study conducted by Ciro Conversano and colleagues at the University of Siena in Italy evidence was presented that of a strong relation between optimism wellbeing. Through the use of specific coping strategies, optimism influences both mental and physical well-being by the promotion of a healthy lifestyle as well as by adaptive behaviors and cognitive responses, is associated with greater flexibility, as well as problem-solving capacities.

So how do we cultivate optimism? Carmen Drahl at National Public Radio asked that very question to her readers and listeners. Below are some tips from everyday people on how they stay optimistic in trying times:

  • Humor continues to be one of the things that gives me hope. No matter how hard life can get, there are always people who find a way to make things feel lighter. It could be as simple as silly viral animal videos or the more complex comedy that contextualizes our lives in the broader arc of history. Either way, we as humans tend to know when we need to break the tension and give ourselves a mental reset. –Eric Conrad, Washington, D.C. | 101 Good Clean Jokes
  • I try to keep in mind how little control or influence I have to change the state of the country (and world) and let go of the feeling of responsibility. I do what I can and understand that change is slow. One of the greatest gifts of getting old is knowing how little power you have in the grand scheme of things. It relieves you of the feeling that you have to DO something and the frustration and anger that goes with it. –Mary Theresa McCarty, Halfmoon, N.Y.
  • To remain optimistic I have to deliberately and regularly make room for my grief. If I acknowledge this weight I carry it can be a tool. It will still cripple me occasionally because burying a trans child is just that hard, but I can also fight for change if I bring my grief with me. – Carrie Black, Salt Lake City, Utah
  • I am Buddhist and there is a meditation that helps me: You elect to feel hopelessness or lovelessness as a way of empathizing with others who feel these things. So when I feel hopeless or sad or overwhelmed, I can think, “I am going to fully let myself feel this because this is what hopelessness feels like, what millions of others have felt, going back millennia.” Ironically, framing it this way actually feels more connected, more human, more manageable. –Kristin Harriman, Sacramento, Calif.
  • One of my favorite books is Garth Stein’s The Art of Racing in the Rain. I remind myself, as the book states, “The car goes where your eyes go.” It’s so important, especially as the news cycle is full of cruelty and suffering, for us to carefully choose what we read, listen to, pay attention to. The car, my brain, goes where my eyes go — so I need to keep looking at hopeful art and look for joy in the children I love and remind myself to keep watching for good things. I see more of them this way! -Naomi Krokowski, Berthoud, Colo.
  • Doing something for someone else is my all time high — it always lifts me. –Dianne Oelberger, St George, Maine
  • I read a single poem every morning. There is hope in the verse or between the lines, something else to drift on, beyond the headlines. –Mark Karason, Pittsburgh, Pa.
  • Music in particular kickstarts me and really helps me articulate my feelings in both subconscious and conscious ways. I like to have active listening sessions throughout the day. But what helps me the most is listening to music in bed in the early morning before doing anything else. It puts my mind in a place of zen and allows me to be the best version of myself that day to radiate positive energy not only within, but to the surrounding world as well. –Sean Nguyen, Seattle, Wash.
  • My favorite technique for getting happy is definitely playing loud techno music (or other very rhythmic dance songs), and freestyle dancing in my living room. –Robin McMillan, North Port, Fla.
  • When I’m feeling stressed, I take a walk outside in the sun or in a green space like a park or a forest. Despite the noise in my head, the sounds of nature, including those of birds, wind and rain, comfort me. –Whayoung Cha, Seoul, South Korea
  • Early spring walk under blooming cherry trees with daughter Analesa, beloved pup Rosko and warmth of the sun on my face. –Cassandra Zimmerman, Portland, Ore.
  • The way I stay optimistic is waking up early to watch the sunrise and meditate on where I find light in the darkness. There are great things of beauty and peace in this world. –Michelle Middleton, Reno, Nev.
  • For 30 years, I have volunteered with a nonprofit whose mission is to teach gardening to home gardeners throughout our community. I feel constantly renewed by the generosity and energy of the people I volunteer with. While I often feel overwhelmed by the magnitude and variety of troubles in our world, I am also mindful of the abundant blessings that fill my life. I cannot stop war or famine on a global scale, but I can teach a family how to grow food — and flowers. –Robbie Cranch, Fresno, Calif.
  • I find my source of joy in nature. I salute the sun every morning and affirm the blessings of the five elements: the earth, space, sun, air and water. When I recognize that my body was born from these five elements, I feel a deep kinship with nature, our womb. I talk to the trees, recognizing their generosity and strength. –Pankaja Cauligi, Mysore, India

Autism and Wellness Week 3: In Their Own Words

This month’s wellness series has so far focused on building awareness and fostering acceptance to promote wellness in the Autism community. But, as is the case for any group, it is often most helpful to hear directly from the lived experiences of those who are members of that community. So for this week’s Autism Acceptance wellness post we are sharing an article in which different folks from different places on the spectrum share their experiences of what it is like to navigate wellness in a world that often runs contrary to their ideals and needs. This piece was written by Marianne Eloise in collaboration with Dana Glauser, LCSW, and Anna Harris.


In my ideal world, I’d live inside a spa—only leaving to buy necessities like snacks. In my current, more realistic life, I put a lot of effort into making my bedroom and bathroom feel a sanctuary. Every aspect is designed for maximum peace and comfort. Think: cotton sheets, scented candles, warm lamps, and new products. Every single day I make sure to spend as much time alone in these spaces as I can, diligently following a nightly routine of stretching, bathing, acupressure, and skincare in an environment designed just for me. While all of these behaviors fall under the overused buzzword of “wellness,” for me, as an autistic person, they’re necessary.

Autism spectrum disorder encompasses many ways of experiencing the world, but something we all tend to share is sensory processing issues.1 This can mean extreme sensitivity to some stimuli, like certain textures or sounds. We struggle to process things in the same way someone else might, which can lead to sensory overload and meltdowns, but we’re also driven to seek out positive sensory experiences to enjoy with a unique intensity.

In recent years, tools designed to help keep autistic people stimulated—like fidget spinners—have been assimilated into everyday life. More recently, weighted blankets, designed to help prevent autistic meltdowns, have found their way into more common usage for everything from anxiety to feeling nice. While this could de-stigmatize the use of these tools, it also makes it difficult to explain why you need something that everyone else finds to be a fun novelty. Similarly, a cultural fixation with the ever-growing industry of “wellness” has made it so the significance for those who need curated sensory experiences to function is lost.

Autistic people need structure and often engage in repetitive behavior, so we thrive on routine. Tom, 35, has a number of elaborate sensory rituals. He owns 10-15 different types of lighting which he uses along with a projector or VR while he’s in the bath every day. “A comfortable environment filled with the kinds of sights, sounds, and smells to help you relax can go a long way in allowing a neurodivergent person to focus without distractions and triggers. It gives us a level playing field to think and emotionally respond to things in a much more natural way,” he says. Many autistic people have dopamine processing anomalies,2 but by building up these coping mechanisms, Tom creates an environment that makes it possible to function: “Our bodies don’t naturally react well to a lot of the stimuli in the world, but these are things we do react well to and have control over. It makes sense for us to seek them out and work them into a routine to improve our general moods,” Tom says.

A cultural fixation with the ever-growing industry of “wellness” has made it so the significance for those who need curated sensory experiences to function is lost.

I wasn’t diagnosed until I was 27—but growing up, I had frequent meltdowns and burnouts as a result of overwhelming stimuli. I didn’t understand why everything felt so bad. All I knew was if someone came near me with an itchy sweater I would scream, lashing out at them and insisting that it hurts. That’s how it felt, and how it still feels to me: a wrongness, an itch that is so deep it burns my skin. I will not eat anything outside my limited selection of “good” foods and I have extreme reactions to noisy environments. The only thing that really ever felt good was swimming. I knew once I was underwater, the world became silent and dark and my body was wrapped in water. I didn’t want to get out.

As I got older, I began to understand the link between my senses and wellbeing. I gained new awareness that I was different and started to orient my life around my sensory needs. For example, I only wear certain materials and comfortable clothes, which means most of my wardrobe is loungewear and the rest consists of the same American Apparel skirt in five different colors. I only surround myself with colors that feel “right,” struggling to look at anything bright. My home is quiet, I eat what I want, I wear earplugs and an eye mask to sleep, and I avoid situations I know will send me into meltdown. As a result, I have a much easier time being who I am. In the absence of these negative triggers, I fill my life with carefully curated sensory experiences to put me back in touch with myself. 

Lindsay, 37, was only recently diagnosed as autistic but has always known she had different sensory needs, and created rituals to fulfill them. “I got really into wellness for a while but it didn’t feel like a ‘spiritual’ expression for me. It felt more like a way to understand and manage the unique energy I had that I didn’t totally understand,” she says. On a daily basis, Lindsay “stims,” a term for the movements that autistic people do to seek stimulation. She uses tools like Chewlery, adult jewelry that you can chew on, fidget toys from Black Girl Lost Keys and handmade stimulation toys from A Sense of Self. Being able to use these tools is integral in preventing Lindsay from shutting down. “I find it pretty strange that ‘wellness’ stimming is seen as socially acceptable and ‘autistic-type’ stimming is not,” she adds.

What is Stimming?

A self-stimulatory behavior that is marked by a repetitive action or movement of the body.

Lindsay puts her wellness rituals into two categories: “preventative” (things that allow her to start with a good sensory baseline) and “rescue” (things to be brought back down from sensory overwhelm). Her preventative behaviors include a morning tea ritual. The movements of scooping and pouring, the way the tea smells, and the feeling of steam put her in a good place. Her rescue behaviors include baths, lights, and candles. “The salt bath is usually unscented salt. I like to soak in the water and enjoy the splashing water sounds. It’s calming and centering,” she says. She also uses a dim-colored light in her bedroom and sound baths to recover from meltdowns. Without these behaviors, Lindsay says she either has a meltdown or just feels “off.”

While these rituals are likely to improve anyone’s mood, they can be essential to autistic people’s wellbeing. We may not have interoception, which is the internal sense of what a person feels or what they need.3 Throughout the day, without intervention, I will forget to eat, drink, or even go to the bathroom. My body feels completely separate to my brain, and I don’t even know that I’m in pain until it’s too late. While I can’t fake having a sense of interoception, what I can do is have time daily to deliberately get in touch with my body. I force myself to finish work and I go to do some stretching and yoga in a dark room with a nice-smelling candle, drink lots of water, and have a long bath. Without that routine, I’m much more likely to burnout, lose the ability to speak, or have a meltdown (if not that day, then soon). 

What Is Interoception?

Interoception is the perception of sensations from inside the body and includes the perception of physical sensations related to internal organ function such as heart beat, respiration, satiety, as well as the autonomic nervous system activity related to emotions.

Chloé, 23, is an autistic influencer and advocate who goes by Princess Aspien. Her daily sensory rituals are diverse depending on her needs. “When I need more input, dancing, singing, and stimming help me to gain that,” she says. “When I need less input, allowing myself to retract from the world is incredibly vital for me to be able to continue to function, be settled, and be happy.” Without the ability to sensory seek in a way that she needs, Chloé shuts down. “Allowing myself both the time and understanding of what I need is absolutely vital to me as a neurodivergent person,” she shares. However, she also finds joy in her sensory-seeking activities. “As a neurodivergent person, my body needs more help with sensory input than someone who’s neurotypical,” Chloé says. “It’s so important we reduce that stigma both within our own community and as a society, and create the understanding that sensory differences and sensory seeking are a normal, vital thing.” 

Tom has found that by occupying and overwhelming all of his senses with good stimuli, he can take his mind off everything else and be present: “Our external environments have more of an effect over us in getting to a place of internal calm,” he says. Basically, the same principles as mindfulness or wellness for anyone apply, but to an extreme extent. While these things reduce pain and the risk of meltdown, they are also incredibly enjoyable for us. “These behaviors activate our senses and our bodies respond to them more intensely, so we are drawn to them,” Tom says. 

Conversations around sensory-seeking behaviors are often negative and geared towards parents to make their kids stop “stimming,” as it’s often considered “inappropriate” or “embarrassing.” What people miss is not only the necessity of these behaviors, but how much joy and comfort can be found in them. Without the ability to control my own sensory experience, like Chloé, I do shut down. But exploring new ways of feeling good, whether it’s through bath products, new candles, massages, acupuncture, playing with my dog, or swimming, is the baseline for both my wellbeing and my happiness. Autistic people exist on a spectrum of extremes, but for every painful, difficult extreme, there is something that we enjoy so much more than someone else can.

Autism and Wellness Week 2: Five Ways to Improve Wellness for Autistic Adults

Promoting wellness in those diagnosed with Autism can look very similar to general wellness approaches, though at times can benefit from some modifications and insight into each individual’s needs. Recently, in their paper titled “Five Ways Providers Can Improve Mental Healthcare for Autistic Adults: A Review of Mental Healthcare Use, Barriers to Care, and Evidence-Based Recommendations“, researchers at The Ohio State University reviewed the literature from 2017 to 2022 on autistic adults’ use of mental healthcare and barriers to care and from this produced five strategies mental health providers can use to better care for autistic adults. They start by noting that while autistic adults use mental healthcare more often than non-autistic adults their experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. All of this contributes to unmet needs. You can read the full paper at https://link.springer.com/article/10.1007/s11920-022-01362-z, and review the five recommendations offered by the authors below: 

Be an Agent of Change in the Workplace

Attending continuing education courses on autism, completing other autism-focused trainings, or self-directed study is a simple way to increase knowledge about autism and correct misconceptions and harmful stereotypes about autistic people. Trainings can help providers to understand their autistic patients’ needs and provide better care, which has been recommended by autistic adults. In particular look for trainings and materials that were created by autistic people or co-created via collaboration between autistic and non-autistic people; and select trainings/materials that emphasize neurodiversity-affirming care by promoting well-being in autistic people rather than encouraging “passing” as non-autistic at the expense of the autistic person’s health and well-being. They recommend providers look to the following sources of information to enhance their knowledge about autism: Autistic Self Advocacy Network’s resource library (https://autisticadvocacy.org/resources/), Academic Autistic Spectrum Partnership in Research and Education (AASPIRE)’s topics for healthcare providers (https://autismandhealth.org/?a=pv&p=main&theme=ltlc&size=small), Asperger/Autism Network (AANE) provider resources (https://www.aane.org/resources/professionals/).

Make Thoughtful Language Choices

The language that is used to talk about autism or to refer to autistic people is very important. How autism is discussed, especially by healthcare providers, has implications for how society views autistic people and how autistic people shape their own identity. Some language choices perpetuate the idea that autism is something to be “fixed” or that autistic people are inherently inferior to non-autistic people. The authors strongly recommend that providers use thoughtful language that does not perpetuate biases against autistic people or focus solely on perceived deficits. For example, instead of using “functioning labels” (e.g., high/low functioning, high/low severity), they recommend providers instead refer to the individual’s specific strengths and needs, while recognizing that the level of support likely varies across contexts and environments. Rather than referring broadly to “challenging behavior” or “problem behavior,” providers should use more accurate, specific terms such as meltdowns, stimming, self-injury, aggressive behavior, or other descriptors as appropriate [54••, 5663,64,65]. Additional examples of potentially problematic language choices and preferred alternatives recommended by members of the autistic community are summarized in Table 1 of [54••].

Additionally, when speaking to an autistic individual, the authors recommend providers mirror the language used by the autistic person (e.g., when deciding whether to say “adult with autism” or “autistic adult”) or ask the individual how they would like to be addressed. If this is not possible to do, we suggest using the language “adult on the autism spectrum” as this phrasing may be considered the least offensive. Providers can positively impact the way that autism is discussed in their workplace by sharing these suggestions, and the importance of language choice when speaking about autism, with colleagues.

Take an Individualized Approach for Autistic Adults’ Mental Health Treatment

Recognizing autistic adults as individuals rather than as members of a homogenous group is an important step to meeting their needs. Like with any patient, providers should aim to build a working relationship with autistic adult patients to better understand their needs. Ultimately, this may help improve mental health outcomes for autistic adults. For example, providers can take steps to accommodate an autistic adult’s sensory needs to help the individual feel as comfortable as possible and promote satisfaction with healthcare. These accommodations could be as simple as dimming the lights or using only natural light from a window, shutting a door to reduce background noise, or allowing the patient to bypass the waiting room before their appointment.

Regarding treatment and planning, the authors recommend providers collaborate with the patient to find a treatment approach and style that works well for them. Providers are also encouraged to adjust their patient schedules for autistic adults who may need more mental health session time, or increase the frequency of appointments for medication management, as autistic adults may be at increased risk for side-effects of psychotropic medications often used in mental healthcare. To modify CBT to accommodate a patient’s literal use and understanding of language, providers may increase the use of visual supports by using video models of relaxation exercises or reduce abstract language by using concrete terms to explain concepts. Developing autism-specific crisis management plans may be beneficial as well. These, and other individualized patient-centered approaches, are a solid foundation for successful mental health care for autistic adults.

Leverage Autistic Adults’ Strengths in Treatment

Another benefit of establishing a relationship with autistic adults is that providers can learn about their strengths, which can often be leveraged in treatment. For example, if an autistic adult has strengths in planning and decision-making, the provider can encourage them to develop a schedule for how they would like to spend the appointment time or prepare a list of talking points. If an autistic adult is experiencing high levels of stress or anxiety, the provider can inquire about and encourage the autistic adult’s intense interests, which may be effective coping strategies. Importantly, leveraging strengths may improve confidence, and is congruent with high-quality patient-centered care and a neurodiversity-affirming approach to care.

Provide Actionable Steps to Promote Patient Progress

Providers can facilitate autistic adults’ progress in meeting their mental health goals by providing practical recommendations and guidance for how to navigate life situations that impact their mental health. Focusing heavily on autism itself, early childhood experiences, or other topics (unless directed by the patient) may not be helpful for autistic adults in their day-to-day lives. Many autistic adults have jobs, relationships, community involvements, and many other facets to their lives, all of which may affect their mental health and may need to be points of emphasis during mental health treatment. For example, if an autistic adult is struggling with social anxiety about interactions with work colleagues, it may be more helpful to talk through recent situations and identify practical strategies for managing anxiety rather than to analyze early childhood experiences that could have originated the social anxiety. The authors encourage providers to check-in with autistic adults regularly about their experiences with treatment, listen to their feedback, and be willing to modify treatment approaches when necessary.

Autism and Wellness Week 1

As we welcome in April we look forward to longer and warmer days, the blooming of our favorite plants, and the return of baseball. Nestled in there alongside those things is Autism Acceptance Month. There has been a shift of late from Autism Awareness to Autism Acceptance, and for good reason. As one advocate, who themselves are on the spectrum, shared “Awareness is focused on shortcomings or deficits. Acceptance is focused on what you’re good at and what can you do for yourself. Awareness means you can identify a neurodiversity. Acceptance means you’re able to talk to neurodiverse individuals and gain understanding and compassion.”

So as we move into AAM we wanted to highlight the unique ways in which we can promote wellness in the Autism community, today starting with sleep. Whether you are a member of the Cooper community with an Autism diagnosis or you care for someone with Autism keep in mind that navigating life gets a bit easier when we have good sleep! So here are some thoughts on promoting sleep-related wellness across the Autism Spectrum.

Researchers have extensively researched sleep and its influence on health, behavior and other areas of life for those with Autism. Many kids, teens, and adults with autism have problems sleeping which can be hard on the them and those with whom they live. Some have trouble falling and staying asleep, or wake up too early and have a hard time getting back to sleep.

Problems sleeping happen more often in the setting of the restricted and repetitive behaviors common in ASD, as well as secondary to anxiety, or sensory problems that are often common on the spectrum. Watching TV, videos, or playing on the computer, especially if the shows are very stimulating (highly humorous, intentionally frightening) can lead anyone, especially those living with ASD, to having more trouble sleeping. Fixing this usually starts with gathering data and trying some of the most common solutions related to the problem, whether you are experiencing this yourself or trying to help a loved one.

Sleep Resources

ATN/AIR-P Strategies to Improve Sleep in Children with Autism Parent Booklet and Quick Tips
This informational booklet is designed to provide parents with strategies to improve sleep in their child affected by autism spectrum disorders (ASD). The suggestions in this tool kit are based on both research and clinical experience of sleep experts.

ATN/AIR-P Sleep Strategies for Teens with Autism
Many teens with autism have difficulty with sleep, which can affect their daytime functioning, as well as that of their families. This tool kit is designed to provide parents with strategies to improve sleep in their teens affected by autism. It helps tackle the problems of falling asleep and staying asleep through the night. 

ATN/AIR-P Melatonin and Sleep Problems: A Guide for Parents
Melatonin is a common medicine your doctor or healthcare provider may suggest to help improve sleep. This tool kit is designed to provide you with information about melatonin and help you decide if trying melatonin is right for you child.

Download a one-page overview on sleep for quick tips you can use at home.

Establishing Good Sleep Hygiene

Carin Lamm, MD is Associate Clinical Professor of Pediatrics Diplomate American Academy of Sleep Medicine and Director Pediatric Sleep Disorders Center Columbia University Medical Center and shares the below regarding sleep and Autism:

  1. Sleep environment: the bedroom should be dark, quiet and cool. As those with ASD might be particularly sensitive to noises and/or have sensory issues, the environment should be adapted to make sure one is as comfortable as possible.
  2. Bedtime routine: the routine should be predictable, relatively short (20 – 30 minutes) and include relaxing activities such as reading or listening to quiet music. Avoid the use of electronics close to bedtime such as TV, computer, video games etc. that can be stimulating making it difficult for individuals to fall asleep.
  3. Sleep\wake schedule: the schedule should be regular with not much of a difference between the weekday and weekend schedule.
  4. Exercise: Daytime exercise can make it easier to fall asleep and those who exercise tend to have deeper sleep. Avoid exercising too close to bedtime as it can make it difficult to fall asleep.
  5. Avoid caffeine particularly close to bedtime, which can be alerting making it difficult for people to fall asleep. Caffeine is found not only in coffee, but also in tea, chocolate and some sodas.
  6. Naps – avoid them at all costs! While a good nap can be needed from time to time, over-reliance on this can perpetuate sleep problems.

It is important to address medical or psychiatric issues that potentially interfere with sleep. Medications might need adjustment if they affect sleep. If one suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, they may need a referral to a sleep specialist. Some with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.

In summary, although sleep problems are common those with ASD they often can be helped. Better sleep for these children can potentially improve their daytime functioning as well as the sleep of family members.