Welcome to From the Spectrum Podcast. This is a podcast about autism. It is my goal to explain
what is autism. I plan to use a mixture of scientific literature, personal experience,
and opinion. With opinion, I will explain why. I fill the way I do and give examples.
I will provide links to various references for each episode. For each episode, we will discuss
various aspects of autism. The From the Spectrum Podcast will mostly avoid causes of autism.
And I will try avoiding the increase of diagnoses of late. This is like playing tug-of-war with
barbed wire and I don't think I want to travel down that path. For today's episode, we will discuss
autism and anxiety. Autism and anxiety are closely linked. It is common. If you've received an
autism diagnosis, you received one or more diagnosis of anxiety. The DSM classifies a few types of
anxiety. And if you have been assessed and diagnosed with autism, approximately half receive at least
one anxiety diagnosis as well. This is called co-morbid. And the structure of the DSM is to
create co-morbid diagnosis. Some say or more accurately many say. Remember the medical paradigm
and the prescriptions. I don't love it or agree with it. Anyway, I won't review the different
anxiety diagnoses or the symptoms. But they are easy to find. Remember the combination of hour,
restricted repetitive behaviors and our lack of social skills, social communication deficits,
creates a vast conundrum and that confusing paradox of socialness. The outside world is
very social. There's a huge social dynamic and it's pretty chaotic. Anxiety is a state of being
aware, a protective state. It shifts our attention to something typically in the environment. The
number one job of the brain or the nervous system for that matter is survival. A component of
survival is safety. Anxiety intends to keep us safe. It wants to bias our attention into action,
move us to something, whatever that something is. And now we will cover some biology of anxiety.
The downstream projections of anxiety includes three components. It will give us three different
immediate responses that we can measure and understand. The three are avoidance, shifts in
the physiology and valence or how we feel. A brain area called the amygdala is heavily involved here.
It is highly recognized with things like anxiety and fear but it also is associated with things
like motivation. The amygdala sits at the end of another structure called the bad nucleus of the
history of terminalis or BNST for short. The BNST sits alongside an area called the forenecks. These
are kind of C shaped and at the end is the amygdala. If you've experienced a sudden jump, you see a
shadow and you jump. That is the amygdala. However, if you give yourself a moment, just a brief
moment and you think, oh yeah, that's just the shadow of the tree outside, then that's another
area called the hippocampus which is associated with our memory. And the forenecks and the bad
nucleus of the striaterminalis kind of joins the amygdala to areas like the hippocampus,
the hypothalamus, and the thalamus which is that central area for processing senses. Now,
one thing unique and cool about the amygdala is it's privileged. It has special privileges whereby
it does not have to go through the normal sensory processing or informational processing. It receives
information very quickly, more quickly, in order for that survival instinct. Probably best in the
world on the amygdala is Joseph Ladoe and also worthy is Lisa Feldman Barrett. I think it was
Ladoe explained, if you almost step on a snake, you're going to maybe jump back. Your instinct
will be to quickly jump back. That's the amygdala. After the jump back, you will evaluate is the snake
venomous or nonvenomous, am I in threat or is it not really a threat? So just imagine if you had
to discriminate and process all of that information before you respond. Okay, a lot of sidetracks here,
a lot of explanation, but back to the the BNST is associated with controlling autonomic functions.
Remember the excitation and inhibition and some impact with neuroendocrine, which we will talk
about momentarily. The BNST essentially helps determine our behavioral responses, which makes
sense on the subject of anxiety. The BNST is also related to mood, motivation and stress,
and valence. It is very central to our feelings and emotional information processing. So the
first area or the first component of anxiety avoidance. It makes sense. With anxiety, we tend
to avoid the situation or environment. A brief pathway is the amygdala to the BNST to the lateral
hypothalamus. And don't worry about the lateral. That's just like a subdivision of the hypothalamus.
The hypothalamus has direct influence on our autonomic nervous system. So you can see how
these structures kind of share their function. Remember in a previous episode, you shouldn't
really think about one area of the body or brain for being responsible. Typically, there's a whole
system, it's a whole collection of areas, brain structures in our biology. Something to remember
here is activating or excitation and inactivating or inhibition. Remember our previous discussions
on this. This pathway can, depending on our responses, can recruit the prefrontal cortex.
The cortex is the reason why we are the dominant species on Earth. If you draw a line straight
from the eyes to the back of the brain, our heads extend up. It's taller, more than any other species.
Now, at the bottom or below that line are a lot of reflexes. A lot of things that we don't have to
think about. Our body, our nervous system, just responds to things like breathing and controlling
temperature and appetite and digestion and all of these just reflexive responding. If you look
at a brain of something like a mouse or a rat and compare it to our lower half, they look very
similar. Mice and rats are considered modeled organisms. They are very similar to us on this area.
Now, above that imaginary line are things like the cortex and the prefrontal cortex. The things
that gives us that dominant species. The area responsible for logic and reasoning and executive
planning, understanding consequences. Remember a previous episode and a previous comment. We want
to recruit these areas so we can properly understand our surroundings and then properly evaluate the
situation so we can make a reasonable response. We can understand what is actually going on. We
also have a larger diameter of eyes and visual cortex. The last part is my observation. It seems
that our eye diameter and the visual cortex is larger than most other species and remember this
is brain and this is all relative, relative to size, the overall size of the brain, head and the
visual cortex. We have to normalize for that. I have not looked up any data on that but it is
interesting and it's probably something that I will do in the near future. Okay, so the hypothalamus,
it also controls the body's hormones. Remember the neuroendocrine comment. This is one way that
the brain and the body are connected. They're entangled through the hormones and those cellular
and neural areas, those neural modulators that we've discussed. Simon Baron Cohen's team or teams
are now looking into hormones and autism. I hope to have Sir Simon Baron Cohen on the podcast this
fall and hopefully he can give us an update on the hormones and autism. The second component is
physiology. Probably the most recognized things like heart rate activation and changes in breathing
and for the experts eye gaze or eye tracking because our eyes dilate or the eyes dilation causes a
stress system. That might be a bi-directional pathway. Remember how crucial the eyes are,
especially to our responses in the nervous system. So much of the brain is dedicated to vision,
roughly 40% or even higher to 50% and sensations approximately 70% of our sensation, sensory
processing or the eyes, vision. The stress system is very finite. It's crude. There is not a lot
of complexity here. It's breath, both the rate of breathing and the depth of your breath. So how
fast you're breathing and if it's short or deep breaths. With stress and anxiety, that gives us
shorter and more rapid breaths. Something that we have likely all of experienced. You know to relax,
you can have deeper breaths or something called a physiological sigh, which is shown to be the
fastest way to regulate. The physiological sigh is quite unique. It requires two inhales before the
exhale. So the initial normal inhale and then a second more brief inhale and then you exhale.
A side note, Jack Feldman at UCLA and David Spiegel at Stanford are worthy on this topic.
Best in the field.
I've heard David Spiegel either say or I'm paraphrasing. It's not about the state you were in.
It's about whether or not you had anything to do with getting there. And if you think about autism
and that social dynamic, those social complications and our interferences with our rigid thinking
and those restricted repetitive behaviors, hopefully you can kind of see and understand
some of the difficulties here. Remember we have discussed we love being in our state,
being within ourselves. Autism gives us that comfort of being there. And it is not known if we
are born like that or if it's learned early on, even before one can communicate with speech and
language to explain it. This is a very interesting topic with autism.
So the projections here include the amygdala, the BNST to the parabracchal nucleus,
which is on the brain stem. So it makes sense why it goes here because it has position
to move to the body. For the bodily responses via the spine, the spine features a couple of
ganglion chain. One is the parasympathetic, which are activated to calm and relax the body.
And then the sympathetic ganglion chain, maybe to no surprise, is used for activating
the muscles and the vital organs, getting that blood flow out to those areas for responding,
quickly responding and reacting to the environment. Remember these are responses
used for survival. Anxiety doesn't care about the context. It doesn't think, it doesn't care
that the situation might not be harmful or compromise our survival. And you can see this
with autism and certainly with people that don't have autism. People are anxious.
This is on a vast spectrum. We've discussed these internal states are all on spectrums.
It's just autism is recognized as something on the spectrum. But everything, all of these
situations, all of these responses in our body are on spectrums. So with the spine,
just remember it is a crucial part of the nervous system.
The third component is valence. Valence is the feelings we attach to the context.
Remember, the nervous system will respond without context, but then we attach the context.
Here it can be direct when we are in the environment or in the situation, or it can be indirect. It can
be just from thinking about something without even being there. Maybe it's from planning
or imagining being in that environment. Remember a critical role of the prefrontal cortex is running
models, imagining ourselves in future situations. Planning, another example of what makes us the
dominant species on earth. This is how we sustain our species. A future episode will parse out the
medial prefrontal cortex, specifically the ACC anterior cingulate cortex, which is highly
researched with autism, and the insula. The insula is a very unique structure in the brain that receives
information from the body, other parts of the brain, and the outside world. It combines all those
three elements into whatever it is we respond to, taking together the body response, the brain,
the brain response, and the environment. It entangles those three components, those three sources
of data. It's very unique. The valence projection is the amygdala to the BNST to the ventral
tegmental area, or VTA. VTA is a hotspot for dopamine. You ought to remember dopamine from a
previous episode. Check out part two of the excitation inhibition discussion. Dopamine is about
pursuing and craving and wanting. Remember the Sapolsky quote, dopamine isn't about the pursuit
of happiness. Dopamine is about the happiness of the pursuit. And if you want to parse that out,
you can see that it doesn't matter the context or the environment, because we're still going to pursue
with that pleasure. But if you don't have that pleasure, then you don't pursue. So you avoid.
Hopefully it's not that complicated now as we are parsing this out.
The more you experience this projection and attach negative valence, the less you will pursue it.
Then the more you will avoid it. Okay, you should now understand there is a double path here in our
brain that is creating this, that is creating the state of unwanted, that lack of pleasure.
Now you can begin to see why anxiety is often challenging to reverse, to overcome. And maybe,
maybe you don't know, but one good way to remove anxiety is biasing yourself into that action,
pursuing it, experiencing it, that exposure, putting yourself in those environments.
Remember neuroplasticity, which makes us more of what we do, more of what we are.
Remember this is learning. Remember at the beginning of learning are underlying thoughts
and feelings of frustration and agitation. We are working. The body, the nervous system, and the brain
is working on changing and experiencing this. A side note, testosterone is highly involved here too.
More information from Robert Sapolsky. Testosterone's role in the body is to make effort feel good.
Dopamine and testosterone are closely related. They are very closely related in our biology.
And they are two of maybe my most fascinating areas of the entire body.
When we experience and we learn things, when we take on that neuroplasticity, this becomes preferred.
Remember, the brain and nervous system does what it knows, does what is easiest for it. It does not
like to work. We passively navigate the world based on this. As we experience this, the first few
times, this is state, a temporary feeling. As we experience it more and more, it becomes a trait
or personality or propensity or behavioral phenotype. Now, I basically just use several
different words, definitions to describe the same thing. Remember that. You can see and definitely
know people that are more anxious than others. The connections are thicker in the nervous system,
though cellular connections. This is called morphology. And the thicker these are, the more
they become activated. This is all people, autism or not. It shouldn't be hard to understand if
frequency implicates this learning mechanism. This neuroplasticity, why autism and anxiety
track so closely. I would like to review specific situations common in autism that leads us to
anxiety. The easy one is socialness. Socialness is very unpredictable with many sources to keep up
with, to evaluate and to interpret or said differently. Makes sense of. There's a lot to make sense of.
One is the sensory processing phenomena, that trait of information. Remember Diceroth's explanation,
that fire hose of information. Two things in the social world have many meanings.
The same thing could have multiple meanings. How does this make sense?
Three, the lack of social skills. This could be the top contour of the problem.
But independent from that sensory processing, all of these things, all of these components or
situations creates pressure. Remember simple things, simple things in life to most. Like how to join a
conversation or how to end a conversation. Both are very challenging for autism.
Another situation or examples include running plans, having expectations and that attention to
detail. There's high attention to detail. Remember the episode on how thrilling it is to execute our
plans with exact precision. Having these sets of items, this routine set. How we are going to execute
this and doing it. When this is disrupted, we hate it. Especially because most or everything
disrupting it does not make sense to us and it's coming from the outside, the outside world.
Understanding the purpose of things in the outside world is chaotic.
Now you can understand more about the preference for little or no social interaction.
It allows us to control the environment. Be aware when this stuff is disrupted,
especially for children or more challenging autism, level 2, level 3 or maybe that profound
autism that I hope to discuss in the near future. It is crushing.
I understand maybe our reaction does not match reality, but we just discussed that bodily states
involved in anxiety and it must be mentioned and or asked who determines reality. Maybe our reality
differs from you. Remember the comments about don't try to change someone with autism because
they are different than you and different from others. Another component or a source of anxiety
is language. You know my thoughts. The English language is pretentious and lazy. We briefly
discussed how words have double meanings and so forth. It's all very confusing. It's all very human
thought, human creation. Abstract thinking and starting task developed by others. This is complicated
for several reasons. Some reasons we just discussed like language or making sense of others and not
limited to verbal or written instructions, which is just more language or diagrams or the pace of
others or us explaining something to others. Remember the challenges with us using speech and
language to explain something, be it feelings or instructions or a process. Another component
with language or human interaction is a lot of hypotheticals involved. I used to think to myself,
I don't dance to hypotheticals. I used to say this to myself quite frequently. This is opposite of
recall. Recalling information, details, facts, memorization, which are typically superpowers
for autism. These hypotheticals in life are in complete contrast to those. Abstraction is more
gray area. Autism enjoys less gray area and more black and white. We prefer or need that black and
white. Remember B3 and if you don't remember B3, please look it up. Other factors include keeping up
with outside conversations and transposing that language into visual thinking, getting stuck
or delayed. Often people will just jump in and whenever I'm trying to finish or explain something
and they just jump in to finish it themselves. I think maybe they have a propensity and inject
themselves into others or maybe it's a combination of me, my speech and language and their personality.
We or I can get caught while speaking, turning what is happening in my thoughts and feelings
into speech and language. And remember echolalia. Echolalia is challenging or delays our social
communication. It's just another barrier, another source of something that could cause anxiety.
Pairing up, finding a task partner which is common in the classroom. I'm 43 and still hate this.
Either I pair up with whoever is last, whoever does not have a partner yet or AG. I will not
mention his name but AG will holler out to me to pair up and I appreciate that from him. I like AG.
This is very hard to explain. If I ask others and they say no, perhaps they've paired already.
It's just no. But approaching that and trying to navigate through and find someone is very awkward.
Yes, this is certainly a super deficit and likely to change this I need to go back and listen to
the neuroplasticity that we just discussed. Putting myself in that environment, in that
situation and learning it and experiencing it. That is how I would overcome this problem.
Much like any other person with autism. Another source is changes in routine. The world is a
constant change. The outside world. Remember is a chaotic environment insofar as considering
all of the variables and variations. This sits criteria B hard. Especially B2 and B3. Remember
our very first episode. I have B2 and B3 pretty severe. Identifying emotions, labeling them or
understanding them. So therefore managing them. The emotions. Especially younger.
Younger people with autism and those with level two or three. Those requiring more and more support.
Identifying emotions or an inability to identify them. I should say has a clinical definition
called elexithymia. During the ADOS2 mod 4. There was a section on this. That section was of.
Was one of a couple of sections there that made me uncomfortable during this test.
The ADOS2 is considered the gold standard. In the near future. The podcast hopes to have
Dr. Catherine Lord on to discuss autism. Dr. Lord is a top researcher and scientist on autism.
As we wrap up today on autism and anxiety. It is important to understand anxiety is very finite
within the body. But pretty powerful. Anxiety is not necessarily a bad thing. Anxiety just helps us
identify certain things. Anxiety helps us bias ourselves into action. But when our perception
of reality is mismatched or it's off. Our biasing into action can become a problem.
Instead of healthy adaptation or active coping. We can bias ourselves into some negative responses.
Also just the whole neuroplasticity aspects regarding anxiety. Learning how we go from these
acute bouts of anxious and stress into this being preferred in our nervous system. So as we encounter
certain outside stimuli or unexpected things in the outside world. Our responses start becoming
preferred and ingrained in us. And that changes us. That builds us straight. These things build up
and they thicken our connections and increases our propensity of experiencing these. Increasing our
propensity of just reacting and responding in such a manner. Avoiding things. Because
avoiding them becomes safer for us. If you are enjoying the episode or enjoying the podcast.
Please feel free to leave a review or rating. In podcasting reviews ratings and downloads are huge.
And I very much appreciate your feedback. If you would like to contact me please do by email
at info.fromthespectrum.atgmail.com. And thank you for listening to From the Spectrum podcast.