Comorbid OCD and Autism Spectrum Disorder (ASD)

people are joining hi I see that I think Rafael has joined us so hi we'll do introductions in a minute or so and it looks like well we can't tell from where John is but it looks like it's sunny outside for us northeasterners is it sunny by you yeah okay yes so make sure when you like sign in tell us where you're from so I'm here in New York Bob where are you I mean I'm in the northern the North Hills of Pittsburgh okay and John where are you I am in the sunshine sunshine state I can't even say it Florida okay great great great and we have Mike joining us hi Mike and hi Thomas thanks for joining us and peace of mind found yep and Katie is joining us from Austin and Mike is joining us from Virginia nice at a nice time in Austin last summer yeah we did an errand hi welcome joining us from Arizona and another person from Arizona Evan Wow now it's filling up I don't know if I can read as quickly and Leanne from South Dakota and Elliott just from outside Philadelphia cool we have a nice little representation from all over and Janet from Pittsburgh hi Janet good good good so I think we're gonna dive in so I am even today even though I don't look like Ethan I'm gonna channel my inner Ethan today and welcome to this week's town hall where we're gonna be talking about comorbid or co-occurring OCD and autism and I'm Rebecca Saxe I'm a clinical psychologist in New York and I specialize working with individuals who are experiencing both OCD and our autistic yeah and I love the people that I get to hang out with so and we'll get to introductions of other people like who are part of this Town Hall today but just I wanted to remind everyone that the Town Hall is more of a platform for educational content and this isn't to replace therapy if you do have treatment related questions make sure to work with your local provider or contact your local clinician if you don't have one of those that IO SCDF directory is always a great place to maybe find some local resources but just to make sure that IO CDF is not a crisis hotline and you should have used it if you're feeling in immediate distress or you feel unsafe however sometimes people are in crisis and if you're feeling that way if you're ever feeling suicidal or on safe just know that you should go to the emergency room or call 9-1-1 or you can always call the suicide prevention hotline and the number is up there at one eight hundred two seven three eight two five five great and so we're gonna have an opportunity to have you post questions and we're gonna be able to hopefully select some and respond to some and have a nice conversation just a reminder I would say on a typical day but also in these more atypical times let's remember to be respectful of others and kind and let's make sure this is as safe of a space in place as possible where people can feel free to ask questions and not feeling validated or shut down and so thank you and yeah so let's go to these wonderful people from Florida and Pittsburgh from so on the bottom of the screen dr. Jonathan Hoffman he's the clinical director of neurobehavioral Institute and a licensed psychologist in the states of Florida New York and Utah he is also the co-founder of the NBI ranch dr. Hoffman is board-certified in cognitive and behavioral psychology he's the author of the book stuck Asperger's syndrome and obsessive compulsive behaviors and he's dedicated to the treatment of OCD related disorders in particular complex case presentations and I can assure you that line is true and among his many professional activities dr. Hoffman serves on the scientific and clinical advisory board of the IO CDF and is also co-chair of its OCD and ASD special interest group so great and Robert hudak is up there on top is the associate professor is a associate professor of psychiatry at the University of Pittsburgh School of Medicine and also the medical director of the Center for OCD and related disorders at Western psychiatric hospital he felt it's not necessary for me to mention that he's a billionaire philanthropist and also a part-time superhero but I do think it's important to point those two things out so thank you to everybody joining us on the live stream and a special thank you to John and Bob for joining us so great and I also in my thank-yous I want to make sure to thank the i/o CBF and behind-the-scenes people i'm fran for doing the as Ethan would say digital voodoo I'm gonna just seal that line for Ethan just a reminder sign up for the conference it's coming up you get to be part of something that's happening for the first time the first ever online virtual IO CDF conference and I think it's gonna be great I'm very very excited if you haven't already signed up and you want to be notified of all the programming make sure to subscribe and follow on facebook on instagram on youtube and on twitter and you can get all the fabulous information yeah and so thank you for spending your Thursday evening with us you can always come and talk the foundation and yeah and looking forward to your comments and questions and I think we'll dive in with a couple topics and then see sort of what's going on so I think the first topic that we might wanna talk about is how do you identify OCD in individuals with autism or vice versa how do you identify autism when a person is coming in with OCD sort of what are the things John and Bob that are important for people to look out for or for patients if they're suspecting that's what's going on and they've never gotten the diagnosis what they what might want to mention when they're working with a provider okay well let me let me start off here then well first off hello everybody and thanks for showing up here today and as a general comment before we get started I do a lot of teaching as part of my job and I teach residents and students all the time and one of the things that I always do when I am teaching is when I when I'm trying to get residents to understand what it's like to have OCD I talk about the difference between it with contamination OCD the difference between being contaminated I worry about contamination from bacteria and viruses and worrying about you know germs and I'll use dr. Evil's coat fingers germs because there's really no such thing as germs it's bacteria and viruses and other things that are microscopic life but that's not really what OCD people are often afraid of and I always used to make I always had a story I told us that there's no such thing as a doorknob job you'll have to worry about touching a doorknob and getting some evil germ that's gonna kill you and in the last six months maybe that isn't entirely true anymore and I realize I'm gonna have to change the way I teach completely yeah so okay so anyway a little bit on topic here I actually have I work in two different places at Western psychiatric hospital here in Pittsburgh I work in the OCD clinic and I also work in our in our autism clinic and OCD is easily the most under recognised and under diagnosed illness in psychiatry there's research to back that up by the way but ironically in the world of autism in intellectual disabilities OCD is markedly over diagnosed because as a symptom of autism is restrictive interest and repetitive behaviors and so often mental health professionals will see someone who's really focused on on one thing they like superheroes they like a power plants they like cars it's whatever and they focus on that all the time and so mental health professionals will call them OCD but that's not OCD that is a sign of the restricted interest in autism people with autism will still have with OCD will still have the the intrusive thoughts of people with OCD have I think what makes it different is that they often have difficulty describing what that experience of having an intrusive thought is like and rather than talking some more maybe I'll punt it over to a dr. Hoffmann and see if he wants to kind of continue that theme here a little bit sure I'm gonna make a general statement too because I think that's a great idea okay it's gonna be a little corny so bear with me I actually think it's the best of times and the worst of times to have OCD and autism why is it the best of times it's the best of times because we have we have a forum like this in their great forums for IO C D F and a lot of other organizations too whereas this was a topic that actually had almost no forums not too long ago and there are fantastic people like Rebecca and Bob and lots of other people who are involved in and working with people specifically in this dual combination which really again didn't exist that long ago there are evidence-based treatments that are very effective for many years I think people who have been interested in this subject have been saying it's so important to identify OCD and OCD related things in autism and and autism and people who vice-versa and people who have who just who might have a diagnosis of OCD but there's something else going on because either way it kind of Bob your life and having a proper diagnosis and treatment can make all the difference in the world plus it's very confusing for the people who have it to not fully understand themselves and of course for family members and parents to not really have a full picture of what they can do so it's an amazing time and lots of hope and through the efforts of so for so many fantastic people in this field it's it's it's been game-changing especially over the last ten years or so why is it the worst of times right now well here we go again with Colvin hey you know I find with a lot of the people that I work with right now who have both of these conditions this has been really really disruptive and sometimes very very different ways some people say it's the best it seems like the best of times because everybody's around them at everybody's you know focused in the families together and everything could be unmoor under control but it can provide an illusion because what happens when you have to go back to your life but I have found with a number of the people that I work with that a lot of the things that they're used to just aren't happening first of all they're not having the resources available some people like this kind of virtual thing other people feel tremendously isolated it kind of impedes working on independent living skills it it can really make it even hard to see you know psychiatrist like dr. hood Hudak and get your medications right I mean to see in person although much can be done virtually of course it's hard to get a BA it's hard to just have have the same life and and everything plus there can be a lot of fears I've had some situations with people have this kind of combination who let's say they like something which is now being very disruptive disrupted by they can't walk and and do some routine that was familiar to them because they can't go out or they can't do things it's very hard and that can be triggering of OCD and all these and it's a very very stressful uncertain time and I think it's particularly hard for people with these with these combinations so in terms of my identification it's it's kind of very interesting because some people will come to an OCD clinic and will recognize at a certain point is that there are certain social things that that exceed that would you expect just with OCD alone that a person has really having a hard time with harder than you think with reciprocal communication with getting the idea of what's in other people's mind or they'll have outright communication deficits that haven't been diagnosed sometimes we'd say wow surprising nobody ever brought this up before and it's been called OCD and as has been said it's really it's really more in the line of autism and if I and you know and vice versa you sometimes in the if the ASD is being the primary focus of treatment and and all of a sudden someone will you'll see they won't touch certain things that you're saying the same phrases over again repeating things not just because of like repeating a phrase which is ASD but because if they don't get it exactly right there's gonna be some consequence there's gonna be some discomfort so it can go both ways I think it's an interesting question for and I'm so always so interested in and what Rebecca and Bob think is well well well there is a lot of truth clear that OCD and ASD can be compartmentalized and sometimes very very confused to one another where is actually the line where something becomes more OCD like or more ASD like sometimes it's very very hard to tell and sometimes it doesn't have that much of a practical implication because a lot of the techniques that would help with OCD might also help with rigidities a lot of the behavioral techniques might help with all sorts of things that go along with autism but it's a very interesting kind of I think when you see OCD in autism you have to think about it as different than OCD without autism in the sense that it's filtered in a very differently minded brain and a different way of understanding the social world so of course it's gonna scale to throw it back to both of you what do you think about that well I think so I see two great comments from the live comments that I guess if we're all sort of giving a statement sort of weaves into the statement that I'd like to give with everything going on see ya Darcy brought up at 7:09 this question of do any of us have a lived experience it feels like this is a missing piece and then and then Mary at 7:15 sort of acting like hey it doesn't appear that any of us are autistic why not and I wholeheartedly agree and I think those are great comments to directly sort of just address it the this I think Town Hall was put together actually pretty quickly and it was something that I kind of heard that IO CBF actually threw out there like do we want to do it the conundrum I would say when we were putting the Town Hall together was most of the people that we knew were patients of ours or what I would say and this is where Kovan has sort of thrown a wrench into things there used to be people that I would call on who were like previous patients who I felt like I'd moved on from therapy and with kovat a lot of old patients have been coming back and eating support right now because life has just felt a little disorienting and just because of this idea of little relationships not putting undue pressure on somebody losing their current pollution there might be a current patient in terms of sort of our rolodex it was a little bit more challenging to bring someone on that might feel like a little bit of an excuse and that's why I really love seeing people who have chimed in and I would say is Darcy and Mary if you're willing to send any of us an email or the IO CDF and email as sort of resources that aren't directly our patient and maybe we can work on in the future for you guys to contact and share your information because I think wholeheartedly you have a lot more to add and especially from like a neurodiverse kind of panel perspective and we don't want it to be totally a left side and then you're right right now the panel is a little off sided which I think then goes with my general statement that I was going to me is I do think when these conditions come occur especially given what's going on right now with kovat it can feel particularly disorienting but I would also a the things that have been therapy targets for people with OCD and for autistic individuals that if they've been sort of a mesh tin therapy for a while and hitting their therapy targets I actually think they're even better equipped to be dealing with the uncertainty which we know is an OCD but also is like present in everybody's day the idea of having to change and transition and create new functional routines and like a whole new world that's something that autistic people have been grappling with and probably grappling with in therapy I have to say is a lot of the tools and techniques that I often talk about when my patients going outwardly like about how do you prioritize how do you think about your spoons like how much energy or like bandwidth do you have to devote to different things how can you retool when your world has been flipped upside down and start to create new functional habits for yourself and like taking a problem-solving perspective all of these things that I often do with my patients I've realized I'm so glad I talked about these things since I've had to access this and a lot of the things that my patients have sort of done in the past few years when I've been working with them and seeing their sort of problem solving approach to how do you deal with transition and change and feeling big emotions and sometimes also having other family members dysregulated and sort of how does this affect a mutual regulation um I've really it's benefited me so it's just a slightly different perspective saying it's like if you've already been in sort of the wading through the reeds of this in some ways I think you're actually really equipped to have the tools to deal with what's going on yeah yeah well this this is kind of I'm practicing looking at the chat things and the pictures because it isn't this whether you have an ASD or not or OCD or not this is a discombobulating world about to interact this way and have these meetings but I have noticed that we will be having a part two of this and we will do our best to have somebody with okay variance because that really is very very important we completely agree with that perspective to address what what John brought up in the and the two of us have had these discussions many many times over the years there there definitely is a big gray area when you're when you're dealing with someone on what is an OCD symptom and what is an autism symptom that can be very difficult to tell which it is I probably have a different opinion than John on this I I do believe that if we had a a magic microscope that I could look in your brain and look at the neuron neurons in your brain I think there are two very different things from from that kind of a very micro perspective there are two very different kinds of symptoms two very different kind of things and the clinical real world very difficult to tell apart where we're we're we're an agreement here is that I am not sure that ultimately it makes that much of a difference certainly not in treatment because John said the treatment that you're going to use is going to be the same in both I think where the difference comes up is with expectations if it's an autism symptom the expect expectation isn't necessarily that you're going to get rid of this symptom completely it's more of learning to manage and live with it whereas with OCD I think that an obsession or compulsion the goal is always to I want to stamp this out and it may not be something that is ever achievable or ever fully a table it's always the idea that this isn't a part of me and if I can put this aside I will whereas with the autism symptoms is this is a part of me but I want to incorporate other things into my life as well well and I wouldn't and I just want to add one thing I would even take that a step farther because I think even though autism is in the DSM I don't always think of it as a disorder and think if you've noticed I use the word conditions a lot I think of autism more as information processing difference sometimes it can feel like we're bumping up against the world you know an autistic person in neurotypical worlds or sometimes the severity of the thinking differences really is creating enough distress or like functional problems in a person's life and just like everything else then we are a bit more in the disordered world but I would say is you know autism really to me I see as a thinking difference and it's a lifelong condition and there are actually some real awesome strengths in those thinking differences it's more not every autistic person out there ends up in therapy or like would benefit from therapy sometimes there are a lot of autistic people would like that it isn't a need there's nothing that needs to be therapies for lack of a better word whereas I think we would say is most people with OCD or suffering that this isn't just a thinking difference this is where we would say we have a therapy or we have a technology where technologies whether it be medication or psychotherapy like most specifically CBT with ERP that can really really like be a game changer and probably most people with OCD really would benefit from therapy whereas I don't know if that's always the case I think where it does get complicated that is you take sort of this different information processing condition or brain and then when we add OCD into the mix how does maybe this different way that people process information differently more black-and-white thinkers more focused on details processing information differently experiencing the world sensorimotor differently and then also impacted with these social differences maybe even sometimes being socially isolated or even socially isolated within their family this is when it really can with the OCD get sort of complicated so yeah yeah and and I don't know if you guys want to respond to that and then maybe we can go back to that original I hope in like how do we delineate what is OCD because I think that's really important you know we have this technology for OCD how do we clearly understand when something is OECD and would benefit from treatment yeah well I think one of the things to in this particular combination of OCD and ASD one of the interesting things are that we think about people and again that's like you know typically this is all very heterogeneous because everyone's different who has these combinations and all ranges naturally and you could see our panel is going to be heterogeneous too and we all kind of share ideas and really are passionate about the way we discuss things and you know hopefully we find by you know we're all don't walk in lot lockstep but by by sharing ideas we can help move the field forward but I think that one of the interesting things about with OCD when someone doesn't have autism I would say almost always the person will say they're suffering I would say in ASD often the person isn't the other people around them Travel might be suffering more than they are it might make more sense to them because it might fit even though it meets the structure of OCD that kind of saying well it has to be you know something that seems like not part of itself is harder for somebody with ASD to distinguish and it could just seemed like something that seems fine to do which makes it very very hard to treat and I would also like to mention that I think of you know we can all quibble about what's this and what's that but I think the most important thing or in terms of expectations and and things like that is what we're trying to do in all cases is take a whole person a whole person who has ASD OCD and whatever else because there's usually other pieces to this puzzle too it's not just those two things we know there's a lot of other associated symptoms that are common whether it's depression or attention concentration issues or executive functions is to say alright well how can we all work together whether it's new medicines new behavior therapy grew all sorts of social skills training all sorts of different disciplines and say well taking all of this together what's interfering with the person having the best life that's possible for them and what tools can we equip someone with to help we to help them move to a the life that that makes that's gonna make them the happiest and most functional yeah well one of the the difficulties in in in in dealing with this in people with autism and and OCD is the fact that people with autism often are not able to distinguish what their different emotions are so it sounds I mean I get on paper it sounds very simple an obsessive thought is going to make you feel anxious whereas an autism restricted interest something you enjoy do may give you pleasure but the autism person often can't distinguish between pleasure and anxiety they may know that they're getting a rush of some sort of emotion but what that emotion is they're not always easy easily able to tell and there's a term for that called being mind blind where I can tell I'm having an emotion I'm not really sure what that emotion is and I know that one of the things that I've done in the past is in working with patients as trying as best as I can to get them to learn to recognize what their different emotions are sure yeah well I would say czar sometimes people yeah it's either having the vocabulary I think sometimes people know I'm either experience something positive or negative or often what we might find is sort of this more like tornado or swirl of emotions and then being able to separate that a little bit I want to make sure yeah ID that we're staying a little bit on topic I guess I feel like we can loop back to this idea but maybe about like what is OCD and what's not but I think one of the things that might be helpful is this idea of the role of family or even the role of like spouses so family if it's a child or spouses when we're talking about this mix both autism and OCD because I think in some ways when we're talking about autism there are these ideas of mutual regulation which we all do mutual regulation when I have a hard day sometimes I'll call my mom I'm not expected to just regulate my emotions all on my own but sometimes that regulation looks a little different with a neurodiverse family I think also when we think about executive functioning and daily living skills sometimes being impacted that what feels a lot more normative for a neuro-diverse family is parents or spouse may sometimes take on different roles which in an OCD world looks very much like accommodation or reassurance and I think sometimes families get confused as to what is supportive of the autism and different needs and like what is accommodating or even sometimes sensory needs and then when do either sensory needs or OCD needs sort of take over and maybe are being accommodated in a negative way so yeah if you guys want to speak to that well I think that again I would bring it back to whether it's the autism symptoms or the OCD symptoms the the real question and it's very hard for parents is not necessarily to be supportive you know it's hard because parents generally or family members want to make a person feel better the question is is the feeling better going to serve the overall adaptability of the person in the long run and that's it that's a tough question so the question that I tend to want to look at and and analyze and and and help people you know coach people to make these difficult decisions are is is this the kind of support that's going to help the person with this these these conditions occurring together move forward in their life so sometimes you're going to say well for this moment maybe you know doing something that self soothing is going to be the answer and sometimes you're gonna say well they're trapped in this and it's prevent them from engaging in life to their fullest ability and in which case you might come to a different conclusion it's a very it's a very murky question but I think if the bottom line is always what helps a person move forward to greater adaptability then I think that it's it's easier to formulate a plan and sometimes those things might actually be jumbled up their name is hard to tell right it's where I think actually taking a step back and saying like let me really figure out this behavior and as a family member what's my role in this behavior like what am i either maintaining and like in a negative way or what am i helping with because I think of a patient who used to couldn't and I put put it in quotes do laundry by herself and it was really like confusing when I first met this family about how parents would just do the laundry for a young adult and at first it wasn't clear was this is sort of an executive functioning hard for me to understand and remember for working memory all of the steps of what goes into doing laundry and things like that or was this a contamination thing and what we ended up finding it was a little bit of both so what we really did is we started to address the working memory and multi staff issues that a visual right there a lot of practicing session of like doing it or doing even two steps and then they were responsible for at least the first two steps and once we started placing that responsibility on the patient started to see like this is when contamination was actually still rearing its ugly head and that's when we could like zero in with exposures in that way by just saying like let's do the first two steps of laundry because we know you can handle that from like EF point of view and that's when we saw wait a minute if you're still relying on parents to do it this now seems more like an OCD thing and we have to address it so I think sometimes like breaking things down and slowing things down can also really help and that's why it's so important to do a very careful analysis of this because one perspective alone from any discipline from any one person really doesn't tell the whole story and it is very easy to get confused in this area and so in so many ways so so there are a lot of things that are you know just doing some kind of formal psychological assessment sometimes is very useful doing all sorts of different observational assessments and actually sitting down and really thinking through what in this case is going to support progress even if someone has a sensory issue will it be supportive to have them have a person ask them to where more comfortable things will be more supportive to do not accommodate that behavior and eat each person in each situation is is is unique to them and that's why it's it's hard to it's very important not to come up with a one one-size-fits-all idea about this and one of the things that we want to convey that although there's so much hope and there's so much more knowledge about this these are complicated issues and we're really in even though it's been a lot of progress we're really in the infancy of understanding just how for a particular individual a different treatment a different medicine and dr. Hooda can comment about that more you know actually is going to be the right idea it's because I would imagine working with someone who has OCD and ASD using medications will be different than some widows have some differences anyway with someone with OCD alone and the same as when we for Rebecca and myself I don't want to speak for Rebecca but but the way we would implement the cognitive behavioral therapy the way we would help somebody under you know understand and implement exposure and response prevention the way we'd use more visual aids and cases we might vary the pace we might explain it in a slightly different way which is not enough on anyone's intelligence but just so it's more comprehensible if a person tends to be a more literal than the next person all of these things have to be modified to fit a part of that the individual situation and of course what the ultimate goals are so yeah I I want to thank you both for for the the previous comments you just made I think I think the last couple men here is very important for anybody listening here you know being able to take difficulty that someone is having and breaking it down you know is this because of executive dysfunction is it because of germs that you're having trouble doing the laundry and you know breaking it down slowing it down and taking the exposure that way I think is one of the keys that that you have to do when you are treating people with autism and OCD from the psychiatrist perspective I have I have a couple more comments here just about these treatments is as far as in therapy is concerned exposure exposure response prevention works you do ERP it works and so patients get better when they do it you may have to modify it and some of the ways that they've already talked about it but people can get better and you do the therapy just briefly about medications because a johnathan dimension that please always keep in mind that autism is not a childhood illness autism doesn't sound how magically go away when when people are 18 years old Nia it's often felt as a by the general public as a childhood illness that's important because children are not little adults the the medical literature and and in fact the OCD literature is really filled with examples where children do not respond to medications the same way as adults do and this is particularly important in autism in kids with autism they do not respond to the SSRIs very well and they have lots of bad reactions I mostly treat adults when adults come to me I will hear often well you know I can't take or my child can take SSRIs because they had a bad reaction when they were 10 years old again adults being different than children and often a 25 year old can tolerate an SSRI and do very well with it when at the age of 10 ma then bounced off the walls and had to be hospitalized because of the same medication yeah okay yeah thanks I'm gonna go backwards in time I guess Stacey Beth had a question and I think it was 718 asking about how do you help somebody who has autism and OCD but doesn't understand how much their OCD impacts them because people are constantly reassuring them and I think this is an interesting question I don't think this just has to do with autistic patients I think we see this with people with like OCD only and I'll put that in quotes is sometimes the yeah of like insight and also when some when this sort of system is so full of accommodation and so full of reassurance that the person actually feels like I don't have OCD like nothing's bothering me life is okay but it's actually because one there is not so much insight and also like the world is basically now been colluding with OCD what would you say as a recommendation to love the ones who are wondering like how do they shift this dynamic or how do they ship the insights well I think it doesn't sound very nice but you basically shift by gradually withdrawing the the artificial supports the accommodation reassurances and that are masking what's really going on but you do this alongside a lot in a loving and compassionate way and then it helps somebody now incites a funny thing when we're talking about and you know autism and things like that it's really more of a sense that the life that one could live only because of these supports is no longer possible which may create it creates a dissonance a discrepancy a discomfort which then provides the opportunity to actually address that discomfort in a more constructive way but that's a tricky thing to do and I'm certainly not suggesting anyone listening now just go home and stop reassuring and stop accommodating because that will be really that would be unkind to the situation and not very constructive this is something that's done with a lot of thoughtfulness and care but actually could provide tremendous results because if a person's not seeing a problem only because they don't actually have a problem because everybody's doing things for them we have to bring that problem we have to actually make that problem exist you know create a little function in an OCD in OCD exactly we have a term called strategic pressure very associated with dr. John John Grayson that but you can be modified strategic pressure is often used in this particular population just by you know to help parents actually learn how to have the strategies of withdrawal in a loving way just like separating with Lebanon in a funny way that actually creates the situation that now can be addressed where the person has a need that you can help help them help them meet but not in an unhealthy way in a healthy way yeah I would even add like I am working with someone who does have insight and does know that OCD is sort of wreaking havoc on their life and they really are dedicated and they're coming to therapy and really trying hard to approach the exposures but because of the emotional regulation piece and sort of like this hyper arousal like the essential nervous system or it can go from like zero to five so quickly that so many things feel so distressful like it's almost so automatically and they're often the patient themselves is putting the brakes on changes or really fearful and trying desperately to put the brakes on taking away that reassurance or accommodation so one of the things that we've just even been focusing on is looking at all the ways that parents are now doing things that really don't need to be done as sort of like a secondary by of the OCD like oh when OCD really triggers them they get so upset that like they leave their room to go calm down and then they don't clean up like the toy that they were playing with and I just feel like they're so exhausted when I make them clean up their toys I'll go ahead and clean it up after them and the toys being left out has nothing to do with OCD it's now even like the second byproduct of OCD and even saying like these are really easy simple things that OCD has now made all these family members jump through hoops that are unnecessary and again taking away a responsibility from the individual or having them feel like they do have some agency like these are really really easy ways that we can like look at these things that are still within sort of like a zone of tolerance where we are with OCD treatment as you said we're sort of gently and kindly moving there or not just sort of pulling the rug out from people right away so yeah Bob did you have any other thoughts on that John yeah well I would like to say just one thing the earlier in life we could do this pretty much at any time in life but it's much easier to do it when a child in a child and especially in a young child it's a lot harder really the teen and certainly in an adult to make these changes and I think one of the things we I would want to stress and I think my colleagues good as well is that early intervention as much as it can be done or as early intervention as possible is very key because all of these problems tend to to Snowbowl over time and then people can find themselves kind of trapped in somebody's OCD as a family member just as a person themselves is trapped but because of the accommodation they may not really feel particularly trapped they may feel like wow they may be just kind of happy because they're not there during processing of the social world is not the same as would really help them have the best social life and I think we have to say well we could actually argue well why shouldn't we just leave someone alone if they're happy in their symptoms and it is kind of a it is kind of a a moral dilemma but I think if we're going to to have kind of the idea that that there is a better life for people that that's possible without their symptoms sometimes we want to make that decision that it's worth putting up with some difficulty and some struggle in order to achieve that but that's you know for every family and every person who's involved in this - do you make their decisions about and certainly that's not imposed by the professionals working with us yeah so one of the things I think I'm gonna ask this question and then it might lead into a question that I'm seeing pop on the live comments is this idea of I would say like perfectionism or are sort of striving that it's something that I often see in this sort of overlap of the two conditions or the ideas of just right feeling like not being able to either start something until it feels just right or and I think it sort of goes hand in hand with perfectionism or feeling like they have to redo something over and over and over until it seems just right or this idea of they have been especially in the academic realm been like so rewarding and so reinforced for getting the straight A's that when they hit a point in their life where that's not happening we sort of see like OCD and autism I think intersects I wasn't sure if you had any thoughts on that like if you wanted to maybe articulate what I'm trying to say even more eloquently and then like how people start going about approaching that yeah I will also add there that perfectionism is also a can be pathological as a personality trait the DSM calls it obsessive-compulsive personality disorder please don't confuse that with OCD they're they're nothing related I use the term perfectionistic personality disorder as a better descriptive term even though it isn't official but perfectionism can can be a problem that way too so can be again a problem with OCD can be a personality issue can be a problem with just right it can be a problem with autism kind of thing this is where we get back to what what dr. Hoffman and I were saying at the very beginning quite frankly it really doesn't matter to me if you're having a problem with perfectionism rigidity meeting things a certain way that's interfering with your life using these standard OCD treatments we can get you better and I don't really care a whole lot about where the where those particular symptoms are coming from because regardless of which of those illnesses it's coming from the treatment works the patients get better and you don't necessarily do a lot of modifications of the therapy on the basic symptom not not for the person themselves or if you know if they're not neurotypical if they're I have autism or something but but but the therapy itself the outline of therapy is pretty much the same with these individuals you got it you got to do the the the treatment and get them better and it helped improve the symptom again I don't really care what it's called all of this group of ups of up conditions they have a certain cruelty to them and the cruelty is that almost everything that people do to immediately feel better generally makes them worse and that's very hard because hey we all want to feel better and we want to make other people we care about feel better but I think it's very important to communicate that a lot of these things are are traps being just right is so wrong for the remainder of your life because actually the skill isn't to death things the way you want what OCD and ASD have in common that a person is trying to fix the world and that is impossible they're trying to get all their ducks in a row except they're live ducks and they walk around so by the time you get one the other will change I know that was a kind of a strange example but they use things are always these are it these are impossibilities and a lot of times people think they're doing well or child is doing well or maybe it's the kind of person with ASD and OCD who's a really good student or as a particular talent and there can be lots of illusions that they're doing well one because of the support but two because they are engaged in kind of go arounds get arounds strategies that actually will not work in the long run again I will stress that the sooner a person can learn to feel really wrong and learn how to function that's the life skill actually and I think helping parents and people who are able to really understand that they're not trying to get their ducks in a row they're trying to actually be able to function a world where the Ducks are never in a row to actually understand that concept if possible and that concept can be made in very many different ways for different different levels of functioning but that's the general idea that it's all about managing discomfort proceeding when things are wrong learning how to inhibit that perfectionism that just right and learning how to persevere with behavior toward a more desirable goal no matter what one is feeling now the beautiful thing about that is that it actually increases ability it's an exercise all CBT is kind of an is is a series of exercises in this way all these exposures that actually put pressure on a system to change but just like you'd workout in the gym or do any other kind of exercise when you put pressure on this system well hopefully the system improves so that was what was really hard I felt wrong one day now it's wrong but I couldn't do this anyway and that again is our overarching goal here and and I I would like that dr. sacks and dr. Hoffman the comment on this so one of the areas that I see a lot that happens with our autism patients their perfectionism and they're just right feelings come out in different ways than a lot of our other patients for example one of the ways it comes out is trying to be overly overly exact and wanting to describe symptoms exactly perfectly so these are the people who when they described their sons to you they say I dr. saxy I doing this exposure my sons is an eight point seven three I think I know it's dropped point seven two when you're trying to get them to not check their paperwork seven times well aren't I supposed to check it twice I'm can I can I spend a minute doing it can I can I spend a minute 33 seconds doing it do you think a minute 34 a minute is a minute 33 appropriate III it's almost like they get into the phone to the rabbit-hole of what are the rules on how do I be perfect yeah that's a that's a great question one of the recommendations that we tend to give up for people especially with ASD is to get out of the suds rabbit-hole I know it's very classic to actually ask people to rate but then the treatment becomes part of the problem and you get into the end this is a seven point seven six or anything and that's what we're focusing less under this trumpet you feel but more on the ability to function despite the discomfort being being much more important than getting caught up in in the rating you know and I think that's important good the question that I tend to ask a lot more in therapy instead of like how are you feeling what's your son's as I say are you willing to do blank and if they say no then I'm curious why like you know reading and if why don't think they'll writing and I bring the exposure down and do I have the target readiness in some way or do they not feel motivated they're like I don't see the point of it so I'm not willing to and then I have to address sort of motivation or find out what is motivating to that change the more they willing and the willingness is to do something that makes them feel uncomfortable that's challenging that's new that I know in the end that willingness to do those types of things is gonna sort of open like I it seemed like wow we're already over halfway through our time and there's some like really good interesting questions on here so Maria at 7:46 is asking about four nonverbal or I would say non speaking individuals with autism so approaching treatment I would say how do you approach a treatment or how would you approach treatment a little differently and even with this most specific question for Maria at 7:46 is when they're engaged in sort of like a ritual that seems far more like OCD ritual or it could be a preferred interest ritual that then if they can't get it just right and so then like we add in an ASD sort of ritual layered with OCD just right that they'll start to have like what we would say like a meltdown it could get aggressive so there's like a lot of different questions in that one just in general what are some things for people to keep in mind with non-speaking individuals and then - for like this specific idea when an autistic person sort of has a preferred way of routine or ritual of doing things that isn't necessarily OCD but then just right OCD takes over how do you address that so I actually saw a patient yesterday she as a nonverbal OCD and her her staff has been able to get her to stop doing her rituals of perfectionism which usually occur after an outing which she likes so they've been able to get her to the outings which she likes we've been able to I I was able with medication to reduce those symptoms so she didn't do the outings but then how did they get her to stop the outings and and go back home because of course if she is stuck in rituals and can't finish then they can't bring her out so you know it's you can't just start a task that you enjoy you have to get them to stop it and with her actually the simple motivation to get her to stop was a cup of tea they give her a cup of tea and then she's willing to go ahead and finish up stop the ritual and and go back home so I guess my insight on the nonverbal person is find out what motivates them and what will what what they like and what will get them to go ahead and and do what they need to do yeah I totally agree I think that using contingency management and somebody who is not with somebody who's nonverbal is very important and doing kind of an analysis of that of the rewards and trying to use something even though it might be trading off a tea ritual for a different ritual it's the one that's less interfering you know that can that can help a little bit more and it's constantly making these trade-offs but with all with people who general have ASD when we talk about exposure and response prevention generally we're heavier on the response prevention side yeah now again we're talking about a young child the opportunity with a nonverbal child and I think this is so important is actually from the family or the professionals that are involved or actually to prevent the response if possible now that that is easy to say and very hard to do a lot of it boils down to well how much your Halle what type of pushback are you willing to get through in order to get a desired result it's certainly possible to change most behaviors but sometimes it means enduring aggression enduring screaming and yelling and that's you know it's not easy to do that so I think a lot of it is a question of technique and a lot of question is willingness and a lot of it is resources to be able to get through the storm at our Center we will when we have children who are in that way of functioning oftentimes with a lot of professionals involved we will withdraw the ritual we will will withdraw access to reinforces we actually will I hate to say it sometimes provoke that push back a little bit because we want someone to do that with us or with coaching the family how to manage it because if they can be stay in that OCD OC behaviors world at ASD world by creating tantrums then of course we're going to see more Canton's in the future so it is again every with everything I say I'm going to say it's a tall order to do but you know as has been pointed out these techniques will work if they're implemented but they're not perfect because nothing is of course but they will be very effective implemented at the right dosage for the right amount of time and you know sometimes when a child is what thing that I will say is that one child is very just upset verbal or nonverbal there's a there's a desire sometimes to rescue them and pull out pull them away from the cruel therapist so I think it really needs to be understood what we're trying to do very very clearly and what will and why we're willing to put up and why family but we willing to see a child and a who's whose are having difficulties in other ways experience a lot of distress for the hope of a better functioning life in the future yeah so I'm gonna actually add a couple different things there's like one thing that always hits me when I'm working with a family with a non-speaking or minimally speaking child is making sure also does this child have the technologies available to communicate or an adult to the best of their ability because we do know that there are things out there like pecs boards and assistive communication devices and some of these things is you know if I woke up and all of us you guys all know me I'm a talker and for some reason I had all these inner things that I wanted to share and communicator in the moment communicate and I just couldn't I think on a scale of 1 to 10 I'd probably be like at baseline somewhat dysregulated right and then if I have OCD you know it's opening up the door for even more dysregulation so one intervention that I would just like to say that's out of a RP is like let's make sure we have as much assistive communication devices as possible so that we're understanding what this person wants to communicate as best as possible because in some ways if a person is able to communicate when they haven't been for so long that actually maybe the antecedent or the what's happening before this ritualistic behavior that if we can just address that then we may see some of these rituals on sort of wash away in a different way I would also say is we want to look at then again what is going on with this ritual is this ritual seem more like a preferred interest and enjoyable and then sort of OCD capitalizes on it or is this ritual really more of an escape behavior from the very very beginning and it's not something that's preferred we can really conceptualize the entire ritual as OCD and that's where it seems like a like a fine point but we're gonna want to do ERP like dr. Hoffman said we're wanna do response prevention but we want to sort of figure out where the response prevention comes in is it at the beginning of the ritual or is it more this is something fun that somebody enjoys doing and then OCD takes over and it's at that point when it was CD takes over is when we want to do the response prevention and it seems like a small point but I think it's important because this will generalize to other situations this will generalize see there are other OCD rituals or other things that give this child pleasure in life and that OCD might then try to capitalize on so yeah those are just be sort of be additions that I would make it really really important an excellent point I don't appoint that that sometimes a strategy with a verbal person is to actually ask them to not speak because a lot of their verbal communications are actually ways of escaping the building with their feelings and they lack nonverbal communication or other ways so and try to figure out how somebody is going to try to perpetuate on CD or avoid dealing with it and we try to actually get them to as much as possible try to take away that avoidance strategy and sometimes that avoidance strategy is and probably some of you out there of experiences are debating every point is make it is just a focus on the granny details of things so if we can actually remove that and sometimes I will play a game like Zen monastery if a person had the functional level to understand that we will just have a silent day and all all all expression has to be done non verbally or in writing we try to always change the channels so that a person has to develop another area of skill where their weekend and you can usually tell which where that is because it's the one they don't use so when I want to get two more questions but I wanted to just emphasize one thing that dr. sacks said about assistive communication devices I encourage everybody to make sure when they're doing that they're doing things that are professionally done and professionally guided a lot of people will do idiosyncratic type things that kind of make things up on their own families make it up on their own that does more harm than good Erin asked a question at 7:48 she has a highly gifted son always suspected he was on the spectrum anxious around things like change and when things are different has flapping behaviors since when he was a baby when he's excited how can she help him with anxiety from perspective of autism so Erin was asking about at 7:48 well this is first of all I like how dr. sacks is saying 7:48 and you know I think that's very specific so I've been no actual reason for that okay action reason is it allows it allows the people who are doing the virtual voodoo behind the scenes to be able to pop it on the screen so we have the visual forces this is a perfect example of misinterpretation which often happens with these symptoms and I'm happy to demonstrate but I actually like that you asked me about it and you were willing to rather than just you know making a fool of oneself is actually prerequisite for working in this field because we have to be able to put ourselves on the line and we don't know everything and we want to be right in there as collaborators of imperfection and we're taking taking social rests like like that so in response to the gifted question about gifted I always cut it's a kind of a near and dear to my heart because I think it's I think like in this context redefining what gifted means is very very important if gifted means you can do really well in school and you have a real well on an IQ test or you have a particular talent well that's well and good but without the social functioning without the ability to navigate one's emotions self-regulate tolerate uncertainty unfortunately a families can wind up very very disappointed because they are banking on this one area function to compensate for the other and that can be a very questionable idea I think we see and I asked Rebecca good Bob too about this see some very very tragic cases of unbelievably gifted people who can get from here to there with their intellect with ASD but can't get to the next step which is an independent self-sufficient life or viable job or relationship or whatever they hope to do because those other areas actually have not been prioritized so my suggestion would be to to ruin the definition of gifted and and and actually if you fortunate enough to have that that gifted level of intellectual function I wouldn't worry about it so much I would actually focus the attention on the social and psychological functioning of the person and and reprioritize and that can be very hard for families because they it's so it's so noticeable and it creates so much of a sense of hope to see someone who's gifted and for but for every person who's super gifted that we could see in the world who probably as ASD and is phenomenally successful in technology or movies or something I do want to say those are very very rare cases and often they have some social abilities that may be better than the average person with their diagnosis as well and I think this question was also about like the anxiety that she's seeing in her son so two things that I would say is you've said is you've always suspected that your son is on the spectrum I would say we don't have a lot of data on it but there is some emerging research and I can also talk just about my own sort of clinical experience and I don't know if Bob and John your clinical experience is the same I would say like adolescence teenager especially more high school age seems to be the age where individuals take getting a diagnosis of autism the hardest and I would say this makes sense a adolescence and the high schooler's are even typically grappling with these issues of identity and fitting in and questioning themselves and self doubts and if you layer on sort of this difference it can feel really really disorienting but for a lot of kids either they sort of know that they're different again because their brain is processing information differently in all these different ways and they're having the social difficulties or the organizational difficulties that if they start to really feel the pressure often in high school or in college or in young adulthood and so there often is a need like hey if they really are on the spectrum it's gonna come out so I actually one of the things I would encourage this parents is if you can get that question answered get it answered your son's at an age right now where I think he's going to take that label far more positively than in four years five years and the label isn't this is are just to slap a label on a person I would say it's like get that question answered but even more focus on like how does his brain process information differently what are his strengths in those processing differences the other thing that I just also encourages there's a beautiful autistic community out there and isn't it amazing like if there's this community of other people who can share their experiences for your son to have the choice if you wants to be in that additionally you get a you know part of Education you're mandated by law to maybe have some things that as part of your son's educational plan that could come along with that diagnosis I just think it's a powerful piece of information so that would be one piece of advice I would give but they've been more specifically with the anxiety I think it's teaching him how to interface with his anxiety in the way that we would have from for a typical twelve-year-old so maybe sometimes that includes relaxation strategies but also that includes understanding emotions and the mind-body connection and then even most specifically doing approach behaviors so if changes and transitions are difficult for him him understanding sort of all those three things and also I would even add in the fourth thing problem solving so one of the really cool things is there is a most CBT therapy does this but there's even a manual I CBT for kids this age called coping cat and there's a lot of great research on coping cat and one of the things that cope and cat shows is even without any modifications coping cat goes really really nicely for kiddos on the spectrum without any modifications whatsoever so to me knowing that that really sort of lets me know like find a good CBT provider who understands anxiety and I think you can start to address it that way the last thing is the stemming the flapping I would say is don't try to change that in your kid that right now that's sort of from a sensory motor perspective it's there's it's probably bothering other people more than its bothersome to your son he may get to a point where he learns does it turn some people off and he wants to know when he wants to like stim or not but I don't see such a big deal with this swimming so I don't know if you guys wanna yeah just a couple of you know related comments one if as a parent you're suspecting often parents know more than anybody else and if this is your belief I think that it's very important to to go with your belief it as Rebecca said to do some testing and find an answer and to ask yourself as well is this an answer that for some reason that you worried yourself about finding because it is it is something you know to actually they even admit to oneself that there is a problem like this there's a fear of telling or not telling but sometimes it boils down to just being willing to face one's own fears even as a parent and one's own one own image and and really examine that and think monter about where is the best thing for for all concerned especially your son I would differ a little bit with Rebecca on certain things here yeah give son so so I totally so gifted I think explaining to him the model of anxiety of being a false alarm and help them understand the physiology of it and not use escape mechanisms relaxation can be helpful in immediately controlling anxiety but it actually is another form of escape there's really no substitute for being able to actually persevere have the willingness to face of fear and understand that with that your body doesn't always tell you the truth your mind and your body actually are or can be very very faulty and helping somebody understand that it could be actually game-changing for them yeah great there are a couple of questions sort of scattered out asking there's nothing specific asking about medication but just saying I wish you talk a little bit more about medication any new medications out here again knowing that we're not being therapists and not prescribing Bob is there anything that you either want to give like a one-minute quick overview yeah what time is that question being asked it was a couple different question to graded here how about this Paula at 7:55 p.m. if we want to put that any new meds yeah yeah yeah yeah I think people just what I'm sort of I'm synthesizing and so I'm saying Rebecca Saxe at 8:15 is asking Bob could you give a one-minute overview on how medication might look different for autistic people and if there's anything new since probably last year's conference okay there's a couple of things number one as I said before what what works or doesn't work some kids is different than what works and doesn't work in adults so you have to separate that out just because something does not work as a child does not mean it won't work later on research in this area is is unfortunately lacking quite a bit to deal with the anxiety and the obsessions for adults I still recommend SSRIs so the serotonin selective reuptake inhibitor medications like velocity mr. Alleyne really are and really should I think at this point remain the mainstay of treatment there is increasing looking at drugs that are called glutamatergic drugs one that's being looked at a lot nowadays is memantine and interestingly memantine seems to have some interesting effects and may help with anxiety and OCD symptoms and adults in kids again maybe not not not not so good i I had like at last year's conference I don't know that I emphasize this enough and even if I did I'm going to emphasize it again today I don't think it can be emphasized too much a lot of the meds that are classically used in these patients with autism in general don't work and I really don't recommend that they're used on medications but especially like the anticonvulsant generally don't work antipsychotic medications can be helpful but they are really kind of a third line type medication and that's a little bit maybe odd for some people to hear because the only two medications that are approved to treat symptoms of autism are both anti are both antipsychotics and yet they they don't really work much except by sedating people and we don't use them a first-line here in our clinic so the antipsychotic medication III really recommend kind of not not going to that first when I see patient have big side effects there they are significant side effects and I sometimes I think that it seems like some psychiatrists look at autism as if it's an anti-psychotic deficiency uh you have autism you need to pump in the antipsychotics in and that doesn't work I've noticed there isn't a single question on medical marijuana or CBD oil on the list there so I'm not going to dress that at all because I know no one's interested in them okay that's just a joke I'm waiting for that right now I think there's new comments I just okay there there was a study from Israel that was published on CBD oil they did show some benefits in in people with autism it's important to know that that study was it was a pretty well-done study the benefits were decent not great the type of CBD oil that they used in that study was is not available in the United States so basically what little we know about CBD oil is not at all took able to people in the US I may only be applicable to a certain small group of people in Israel and that's about it I get asked about CBD oil all the time excuse me all the time I I tell people that that I do not recommend it there really is no there really is no good evidence to recommend it at this point I have concerns that it can make things worse if anyone wondering the difference from medical marijuana and CBD oil marijuana contains a compound THC that makes you high contains other compounds CBDs which may have other psychoactive effects in the brain that don't make you high and there's a lot of interest being paid to the CBD aspect of marijuana rather than the THC III I'd like to just throw in and get Rebecca Bob's comments about this too we do see especially in some people who are more out in the social world with ASD and OCD the use of marijuana or and I do I do also want to mention that this sometimes as an additional condition that goes along with ASD and OCD sometimes they can be aspects of thought disorder as a person is getting older and marijuana and get especially you know it gets both of your comments on this can actually accelerate the process in certain people now it's hard to know which ones I guess there's not really great research about that but there is a risk factor of introducing something like THC into an OCD ASD brain which is very important to consider yeah I'm there I'm very concerned about THC in an OCD brain I mean I see if you look at the pure OCD world I have very very few OCD patients who smoke marijuana because I think most people with OCD recognize that when you smoke marijuana it makes your symptoms worse I worry about that in my OCD ASD patients even doubly so I would say I when I do see people using it I usually see people using it more as like a escape strategy like I'm feeling socially anxious so in order to be able to feel not as anxious I'll use it or fit in with other people fit in or the other thing that I would say is you know for a lot of my patients I find their circadian rhythms are sort of mismatched for the rest of the world they're like night owls if we just and that's where I think even in covent we found now that there aren't the same pressures to have to leave or be on certain schedules a lot of my autistic patients are almost like reverting to a like a more natural clock for them or their afternoon up at night and then sleeping during the day and I think they're eat but I've noticed pre Kovan is that marijuana was often used as a way to sort of like relax or wind down and/or looks like get them to go to sleep but again I don't know the literature on it I can only speak from clinical experience the whopping majority of times I found there was like a rebound effects to this that what it actually ended up doing is either created a dependency so go to sleep and then sleep became even more dysregulated or people were feeling groggy and not so great the next day emotionally or that if people were using it more as a relaxation we are finding even more like a rebound of intrusive thoughts and other things like that the other thing that I would just say is like in general not even with autistic and OCD individuals most people do not use marijuana even medicinal marijuana if it's prescribed in a way that they would use any other medication you know you wake up in the morning you take a certain dosage you take it at the same time of day and you take it every day and I don't see people using marijuana in actually as a medicine in that way or CBD what I would say it's more like an as-needed maybe using it more like a benzo I would say than anything um like but not necessarily even with a cap of how much they're using it so I would say for people out there who like really do believe again that marijuana or CBD oil is helpful I would say at the very least you should be taking a scientific perspective I would encourage people to do because I think most people are not using it in like a medical scientific kind of way and then we really don't know is it this placebo effect are there rebound effects yeah and it's to me that's just a little concerning about not even the what's but the how people are using this as an aid yeah that's really an excellent point I think it brings us back to an overall overall point in our discussion that lots of quick fix create long-lasting problems and and looking at all of these symptoms are across the board here whether they're OCD sensory rigidities all the things that create that immediate well let's get through tonight let's get through today all of those kind of those things and they're understandable because when people are suffering or creating distress and or just or chaos in a system it's very understandable why people will do that but unfortunately they do all tend to backfire in the long run and to me marijuana all of these kinds of things would just be just in that category as well yeah there's one comment up here that I want to make sure we acknowledge before we end then we only have a couple minutes it's Yvonne at 8:16 she said she single parents with OCD raising an autistic child that with kovat and my father passed away a week ago it's been the worst time of my life and I think you know we've been talking about things but in the sort of idea of what we're experiencing right now with the pandemic I think there are a whole lot of different pressures pressures for autistic individuals and I mean for individuals with OCD and like parents who are either autistic parents so like you know not just ought to see people or children they can also be parents or parents with OCD in sort of what the pressure is like right now with kids being home kids going through their own challenges what that must be like to be a parent with these enormous pressures and then yeah I mean we haven't talked about it at all with this idea of like this enormous loss loss for so many different things but then loss of individuals in life so Yvonne we're sending you a virtual hug what I would say is there are some support groups that I think like definitely a a and E is an organization it's based out of Boston but they also have lots of virtual support groups for individuals with autism parents of autistic individuals like siblings so that just might be something like for as a parents raising an autistic child I think if we go to the IO CDF directory there might also be some support groups for individuals with OCD and I also know at the conference it's not going to be support groups per se but like sort of community things so I would encourage you to definitely use a support network I don't know what state you're in or other people but I do know I can speak for New York State New York State has these things called coping circles that if you just go to if you actually go to my Twitter I've tweeted about it but also if you go to New York's OMH office of mental health there's free therapy or there's free coping circles where you can be with other people I don't know if Florida or Pennsylvania for instance is providing sort of free mental health resources but just so people who are dealing with kovat people who are dealing with loss and death that they sort of have other people so it feels a bit more normative there know if you guys want to share thoughts or resources as we wind it up I wanted to say one thing it hasn't maybe most people here know this it hasn't been exactly forefront in the coverage of Kovac but just having a diagnosis of autism puts you at higher risk of morbidity mortality from so you know be careful please yeah and we haven't even talked about yet separation of hospitals and what that might mean yeah yeah I guess we do need a part too so yeah John sorry so I just wanted to extend our condolences and they're sorry about your loss and I think the big thing is to figure out how to take care of yourself and trying to be the best parent you can be under circumstances is a lot of pressure this is a very hard time to just do everything right and I think you know we talk a lot about in the world of psychology about self compassion and about just trying to and taking care of yourself through this and and not feeling like there's so much pressure on you to make everything right in a situation that is beyond anyone's control yeah thank you well thank you all I really appreciate John and Bob everything all your comments are great I've also learned stuff tonight and I appreciate everybody's questions and comments and just for tuning in so thank you yeah and thank you back and out as well and everybody who came who participated and thank you for the wonderful questions as well I will look forward to seeing you another time and I guess Bob yeah yeah good all right I think we're good I don't know if the the people who like we said are doing the technical voodoo if they ended or something like that somebody along I was I was hoping that we would be with separate out

Channel: International OCD Foundation

Views: 6,102

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Id: wTsGWNuqb2Y

Length: 87min 38sec (5258 seconds)

Published: Thu Jul 16 2020