Ep 30: Neurodivergent Experience - Autistic Burnout & Recovery

[Music] We love an audience, Tim, our harmony and self-acceptance. It's the Audi HD Psych Podcast. Hello friends, welcome back to the Audi HD Psych Podcast. I'm Iron Howe with Clinical Psychologist and we are different, not defective. What is autistic or neurodivergent burnout? And what can we do to protect ourselves from it? Well, I'm so glad you asked because that's exactly what I'm going to talk about today. I'll start by having a bit of a chat about what are the characteristics of autistic or neurodivergent burnout? What are the impacts of it? What factors contribute to burnout? And finally, I'll have a little look at what is protective or helps us recover from burnout. I should hasten to point out, there's actually no specific research on ADHD burnout. All of the ADHD and burnout literature is around occupational burnout in ADHD's. So it's not quite the same though, ADHD burnout is talked about within community. And there is literally no research out there at the moment on Audi HD burnout. So most of the information I'm referring to today comes from the autistic burnout literature. So autistic burnout has been around in the community for a long time. People have been talking about it since I want to say 2008. But it was first published in an academic journal in 2020 where Remaker and colleagues published a description, soon followed by Higgins and colleagues who published another description the following year. Now they diverge a little bit because they were constructed in different ways. But broadly, there's agreement that the characteristics of autistic burnout include debilitating exhaustion, just leads people drained, depleted and fatigued. There's a loss of existing skills and that can lead to increased disability. And also in Higgins and friends description, they included withdrawal, so social withdrawal, withdrawal from the world as a part of their definition. So that exhaustion, I don't think I will need to explain too much in that. In terms of the loss of skills and that increased disability, that can look like increased sensory differences so I can be more sensitive to sensory differences. I can have more emotional difficulties. I can have increased difficulties with cognition or thinking, my memory, my speech, my executive function. And I can have increased difficulties just with daily life activities, showering, cooking, cleaning, getting to work. All of those simple day-to-day lives would call them the activities of daily living. One part that I left out a moment ago was the time frame for autistic burnout. In the first description by Rainmaker and colleagues, they talked about usually three months and that's a commonly cited time frame for autistic burnout. But the lived experience research that is mostly what we're seeing actually doesn't specify a length. Some people experienced it for days, weeks, months, some for years. So it really varies. That hasn't been nailed down and hopefully will have a clearer understanding moving forward. What are the consequences of autistic burnout I hear you asking? Well, there's the impacts on my physical and mental health. There's impacts on my place in the community and there's difficulties with remaining hopeful about the future and about myself. So that's what we see in the lived experience literature, pardon me. And actually, I draw on a systematic review by Dorota Arley and colleagues who synthesized all of the information that was available up until 2025 last year. I also draw on Clarion colleagues published article from this year as well. So those adverse health and well-being impacts. We see long-lasting and longer-lasting disability. Sometimes people don't fully recover. Sometimes there's continued fatigue, difficulty with my cognition, clear thinking, difficulties functioning and that's those daily living but it can also be my occupational functioning functioning across all domains. Difficulty expressing one's intelligence and feeling like we come across as silly. Some people reported the experience of having lost a sense of themselves or a part of themselves. There's anxiety, depression people often experience, increased meltdowns, increased anxiety and depression and increased self-injury due to burnout because people don't want to experience that. There's also somatic experience, chronic pain, distress, things like agrofobia that some people experience. So there's a lot of different impacts but then there's also that impact on our place within the community. People feel a reduction in their ability to engage in education, to engage in work but also there's homelessness has been experienced by some participants in some research, inpatient admissions needing to live with family and that loss of independence that comes with that. One participant in one research article said, "I've given up on a lot of my goals." So there's that loss of motivation to attempt to achieve goals. Finally, difficulty remaining hopeful about the future and myself as a consequence of burnout. That can be low self-esteem, self-confidence, self-worth, doubt in my own abilities, more self-critical and worse comparisons of myself to other people, increased hopelessness and increased suicidality and self-harm. Some people don't actually want to die but they want to escape the feeling of being burnt out. So what causes burnout or what can contribute to it? Well, I'm so glad you asked to go in because this is always the fun part for me. It can be caused by sensory and social exhaustion without enough recovery time. We all have a sensory experience and a social experience but when we're a little more sensitive to those, then we need time to recover. Camouflaging is exhausting for a lot of people. Now, there is a conversation around Camouflaging and about whether or not it actually contributes to burnout. Some research, a lot of the lived experience research argues that it does. It's a common experience for many people that participate in that research. But some of the research that's followed that up hasn't really shown a significant influence of camouflaging on burnout or haven't had its participants reporting camouflage as one of the higher impacts on burnout. However, there is an argument to be made that my relationship with my camouflaging will change how much it contributes to my stress and therefore burnout. I mask a lot. It's part of my job as a psychologist. If I'm having a bad day, I don't bring that into therapy with you. I put on my therapy face and I have a conversation with you as I wouldn't any other way. So that's masking. My relationship with that masking is a positive one. The benefits outweigh the costs. I'm a psychologist because I want to help people. If I bring my emotional burden into therapy, that's really unhelpful in the work that I do. And so the benefit of not making therapy difficult or unhelpful outweighs the cost of masking that perhaps emotional distress for me for that hour. However, if I have to mask in all situations and I'm masking my response to sensory overwhelm, my response to social anxiety and I'm masking my autistic stimming. I'm less likely to have a positive cost benefit analysis. I'm less likely to have a positive relationship with that masking. I'm going to feel like it controls me rather than me controlling it. And the argument that I put forward is that that could very well be the reason that some people experience masking is contributing to burnout and others don't. So for those people who do fine-camouflaging exhausting, descriptions have been given, it's like sending and receiving language is really difficult because we either have to script things to get through them comfortably or we're interpreting other people's intent through the language they're using. And that's mentally quite complex. Suppressing autistic needs as camouflaging or masking can be stressful and lead to burnout. And suppressing autistic identity for wanting to fit in, for wanting to feel safe socially can contribute to burnout in some people. Some people reported pushing themselves to prove their capability and being expected to be somebody that we're not, that sense of authenticity, that imposter syndrome that so many of us experience and speak about, that can contribute to burnout. Finally, ignorance and One stigma are exhausting was a theme in this particular research. People don't have a lot of control over their lives. Autistic people don't have a lot of control over their lives. Arguably in neurodivergent people more broadly. And there's not a whole lot of support. And that can play out in sensory harsh environments. Lots of noise, lots of sound. People don't understand our response to it, so we get dismissed. That can contribute to burnout. That contributes to how I see myself. If I constantly get told I'm overreacting, I'm not going to have a great sense of who and what I am. So that's self-esteem, self-worth. We were talking about a moment ago, it was likely to be impacted. If I just have to constantly mask my response to those sensory environments, if those environments aren't supportive or bringing accommodations, then that's going to be impact. My sense of how much value I have to the people who control those environments. Also, not being supported in managing a sensory or cognitive differences. And that's really accommodations. If I have an attentional difference or a sensory difference, if I am really sensitive to sound and I'm forced to work in a group office where everybody's quite noisy and there's music playing, that's going to impact on my concentration, my ability to do my job, my sensory experience, my vocational achievement. And I touched on this a moment ago, there's some people reported disbelief in their autism, in their autistic needs and in the distress that arises from that. So people have been just stressed by their autistic needs and they have not been believed that they were autistic, all that their needs were valid. Which obviously is going to have a negative impact on our day-to-day life. Pardon me, and likely to contribute to burnout. And that ignorance and stigma is across healthcare for some people, education, employment and even within family systems and medical misunderstanding. People might think that we're being overreactive. People might think we're being underreactive and not provide us the service and healthcare supports that we need, that ignorance. And then the stigma that comes with when I'm overreacting, that can contribute to burnout. Finally, what are the protective factors? What are the things that can help us ward off burnout, keep us from burnout and potentially help us recover from burnout? So there were a few things that came up in the systematic review that I was looking at. There were several themes. One was the power of knowledge. One was the power of taking care of our autistic needs, rest, solitude, sensory relief. One was the power of others. With the power of knowledge, that included knowledge about autism. Knowing what autism is, knowing what my autistic characteristics are. There were comments that being undiagnosed or unaware means that there was no understanding of people's own needs. And so there was less capacity to meet them. And more likely for people to develop self-concept difficulties. That's self-esteem, self-worth, self-confidence. They're all part of the overarching concept of who and what I am that we have. Their support needs are hidden. If I don't know what my autistic or my neurodivergent characteristics are, I don't know what my needs are in terms of managing those in a typical world that expects typicality. And so that can really cause stress. But if I know what my characteristics are, I can meet my needs. My needs aren't hidden. I know what they are. Understanding myself as autistic allowed some participants an understanding of their own patterns, making life easier and more manageable. And knowing about ourselves and our autistic or neurodivergent characteristics, let's us know that we're not the same as everybody else. Everybody else isn't doing a better job than us. We're not doing life badly. We're not weak or broken or doing things wrong. We're just doing things differently. So that's self-knowledge and that's self-understanding. Really impacts on whether or not we will end up in burnout. Now, I hasten to point out there are a lot of people that have a lot of internalized stigma about their diagnosis of autism or ADHD or learning differences about their neurodivergent characteristics. So sometimes diagnosis and self-understanding can contribute to a negative sense of self. But I would argue that is partial or incorrect understandings of what our neurodivergence is. And we've internalized that from the people around us. It's not actually inherent to our characteristics. The second sub thing there was the power of taking care of autistic needs for rest, solitude, and sensory relief. And I know who and what I am, I can manage myself a little better. So I can make sure that I'm getting rest. And if I do start to burn out or I'm exhausted, that I give myself time to recover. I give myself time to build up that energy and avoid that fatigue. Knowing how to take care of my needs, I can pace myself. I can not do all of the things and say yes to all of the interesting and fun things. I can not go out three times in a weekend. I can go out once in a weekend or once a fortnight. I can give myself permission to leave early. Expectation management. When I know what my characteristics are, I can manage my expectations of myself and of other people. I can say to you, sometimes I will have a thought and I will say it directly without putting the pretty code on it. That's not me attacking you. That's literally me just stating a fact. If I know that about myself, I can manage that. If you know that about me, you're also managing your response. I'm managing your expectations. We get along well. And finally, little things like being able to work from home. That can help me. My sensory needs. I'm setting expectations. I'm meeting my social needs. My need to recharge my social battery. I'm meeting my cognitive needs if I'm easily distracted in a public workspace. And finally, I'm reducing any social anxiety that I might have from a lot of years of feeling other of social exclusion of social difficulties. And that anxiety reduction will also have a positive impact on my anxiety, which will also have a positive, I just said the same thing twice. Of course, anxiety will impact anxiety. But also that social anxiety will impact on my cognitive functioning. It will impact on my focus, distractibility and my ability to pay attention. That will directly impact how well I'm using my working memory and how well I can retain the information that I'm obtaining. Leaning into solitude and sensory respite. Higgins in their definition included social withdrawal as a characteristic of autistic burnout. And that really encapsulated here why I think many autistic people do withdraw. It's leaning into solitude to reduce the social demand on myself and recharge my batteries. Moving into sensory not, no sensory stimuli if I'm overstimulated by some sensory experience. People highlighted that that downtime is a necessity, not a nice to have. Withdrawal for sensory deprivation, that is for recovery. But it can also prevent me reaching burnout. Withdrawal for social respite, respite from masking, respite from that social anxiety is touched on in the workplace before I'm working from home. And making intentional space for low demand time in returns. In family returns for example, I wrote a quote which was one mum said, "Now Saturdays are our day where we don't make any plans. I'm not going to try and push myself. And I love that. That is beautiful self-management organization that helps the whole family out because neurodivergence runs in families. So if I'm neurodivergent, you may not have a diagnosis, but you're likely to have some characteristics." So using masking as a tool, not a way of being, and I love that this came up because this is a conversation that I have with people often. Almost every human masks. Almost every human does something that's not their natural way. Because of a context, in the Schemotherapy we talk about modes that we work in in different contexts. I'm not a Schemotherapy person, but Schemotherapy person too. And that's maybe having slightly different from my authentic self because it serves a purpose here of what I was talking about with the cost benefit analysis before. The problem with masking for us is often we are doing it out of anxiety. We're doing it to try and find social safety or safety so that we can achieve the same things as everybody else, have the same access to resources and supports as everybody else. Part of me. So, masking can serve us. Reducing masking when it doesn't have a positive outcome or it doesn't have more benefits than costs, that's likely to be really helpful in helping us avoid burnout and recover from burnout. We don't owe anyone social ability so we can actually just not engage with people. We don't owe anybody a conversation, we don't owe anybody, you know, joyful, happy face. We have the right to claim back our time and what we do with ourselves. And masking does cost energy even in those positive cost benefit analysis situations. There's still energy that's taken from Matt. Make sure that it earns more than it costs. If I do something and I really get positive social interaction or I get a good job that I enjoyed doing out of it and it costs me a little bit of energy, that's okay. If I'm constantly feeling exhausted for very little reward or very little recompense, there's a word that I use, very little benefit back, then there's probably something that we can try to manage for ourselves. And that can help recover from or help us avoid burnout. Engaging in preferred passions, activities and stimming. Now there's a bit of mixed-star conversation around the benefits of stimming for recovery from burnout. But there's also some research out there that quite clearly shows a lot of us really enjoy stimming. A lot of us use it to ward off anxiety and stress. And a lot of us use it to recover from burnout. The restricted and repetitive patterns of thought, behavior, use of objects, and sounds, sensations or sites, arguably are all forms of stim. I listen to the same songs over and over again because I love them. It's nice, it's predictable. I know what's coming and I enjoy the emotional response that I have to it. I know lots of people that will watch the same thing over and over again. I have a friend who watches Star Trek when they're really overwhelmed. I know what's coming, they've seen it a million times and they really enjoyed it. It helps down-regulate them. But even when they're not stressed, they just enjoy that. So it can be preventative and somewhat curative when we're burning out or stressed or overwhelmed. The power of others being trusted, accepted and seen can help protect and recover from burnout, supportive environments, supportive and accepting people who won't try to change us and try and shame us for being neurodivergent, supportive work spaces that are accommodating, places and people that provide us safety to be neurodivergent, to be our authentic cells without having to mask. That can be prophylactic and recovery for burnout. Access to appropriate and time services and adjustments. So this is disability services, child care, respite, affirming therapies, affirming workplaces and friends, and those affirming workplaces or affirming spaces and people also accounting for hidden disability that is not obvious because neurodivergence itself not visible from the outside. So those places and people that recognize that we have different needs, even if it's not clearly visible and obvious, pardon me, that can be really preventative and help us recover from burnout. So what we've seen is burnout primarily comes with significant exhaustion, with reduction in needs and increased sensory requirements. It can impact most areas of life and there are lots of things that we can do to manage our risk of burnout but also to manage burnout once we're in it and help recover. Most of those involve taking care of our authentic cells, managing our sensory needs, not pushing ourselves too far, not feeling that we owe the world typicality and where we can not allowing ourselves to be forced to be typical, letting down the stressful masks and masking when it serves us, finding people and community around us who make us feel good about our cells. I've said it before I'll say it again and I bang on about community because when we see ourselves reflected in other people around us, we no longer feel broken. Our self-concept becomes much stronger and we recognize that in some situations maybe I can't pay attention as well as somebody else. Maybe I can't hold a conversation not about neurodivergence when I'm at a party. But you know what I can do? Monologue a lot about neurodivergence when you want to know something and I can bounce from idea to idea and link different ideas together really, really well. They're exactly the same brain processes in one context, a weakness in another context, a strength. Pardon me. So I invite you now to think about over the next week or so what something you can do to either help recover from burnout and sometimes the thing we can do is nothing or help prevent burnout for you. Could it be not going out that extra time and dealing with that extra social stress and pressure? Could it be asking from accommodation at work asking for an increased or a hybrid role where I get to work from home one or two days a week and don't have to put on that mask that causes me more stress than the benefits that are gained? Could it be wearing my headphones even when people think it's rude? Could it be some other sensory difference? Maybe changing up the clothes that I wear so that they don't rub on me later in the day? What is it that you could do that improves your overall experience? Helps stopping you get so exhausted and helps prevent burnout? Well that's it for me today friends thank you very much for joining me again and remember we are different not defective. I'll see you again next time.