A) UNLOADING, ACCOMPANYING,
- It is important not to minimize the fear of the suffering person (nor your own!). For example, avoid phrases such as: "It's okay", "It will pass", "You're strong".Instead, ask questions about the nature of the fear, welcome, and listen without judgment. You can put forward the fact that you understand, that you are afraid too, and offer to transform this together. The person needs to "unload" their fear, at least a part of it, otherwise they will remain stuck in an obsessive circle (ruminations). The ruminations get worse when the suffering person is left alone with their thoughts, or when the discussion around these same thoughts drags on and on.
- Some PASs sometimes use self-stimulating or calming gestures (which we call stimming). These are gestures that any human can do (touching hair, scratching, tapping), to a much more systematic, longer, and less innocuous degree. Some PASs swing back and forth, scratch, clap their hands, need to touch surfaces, and soon. These seemingly mechanical gestures are necessary to regain contact with the tangible (which also means "reconnecting to asensoriality that begins with oneself...") and to relieve strong tension. Don't ask the person to stop stimming, these gestures are highly necessary: think of them as self-accompaniment. Understand that the sensory treatment of PAS is not the same as that of neurotypicals.
- If someone you know is PAS/I/MD (or all three of them!): do not leave them unaccompanied (suggest a daily appointment by video, or by message, to take stock of their possible needs. Offer to do their shopping, for example, to go to the pharmacy for them, to call on their behalf for certain appointments, to help them take care of their derogatory certificate if and only if the situation allows it, etc.). Some PAS/I/MD have difficulty verbalizing their needs or calling for help in an emergency (in many PASs, pain is difficult to feel or assess. Talking on the phone is also an obstacle). If this is true in normal times, confinement can make the situation of these vulnerable people simpler (protection)... but also more complicated and dangerous (isolation).
- Some PAS/I/TD will want to stay home alone. Although it is their choice (or not, depending on government measures), this configuration may expose them to serious consequences. Many use social networks moderately to intensely, while their IRL social activity is particularly reduced; it is in fact advisable to manifest yourself in this way. Do not hesitate to get daily news, ask them how they feel, show them your affection, invite them to confide in you in case of discomfort or need (Many PAS do not have the reflex to ask for help or support. Many IP/MD are "afraid to bother people" as their self-esteem is often fluctuating or low).
- Some PAS have information processing disorders. In these stressful times, their tolerance to the flow of this information may be reduced: avoid, for example, accumulating requests in the same sentence. Don't hesitate to rephrase what is being asked of you: it can happen that, under stress, a PAS/MD has difficulty with syntax, vocabulary, etc. Do not hesitate to make sure that what you have already formulated has been understood. PASs may feel as though they are "absent" during discussions. This also applies to MDPs.
- Some PAS/MDs have difficulty performing dailytasks and may appear "clumsy". If you can, offer to help!
- Some PAS/I/MD have executive function disorders. It is difficult for them to plan certain tasks that may seem easy toneurotypicals, or even to finish tasks in progress. In fact, forgetfulness in the execution of the task or a return to it may be observed. If the PAS/I/MD's state of fatigue is already advanced, they will have more difficulty processing information. If you can,offer your help. Using tables, pictograms or labels, take stock together of the current tasks and those that may have been overlooked.
SHUTDOWNS & MELTDOWNS
- Some PASs are prone to meltdowns. These collapses can manifest as anger, crying, sudden silence and are essential for "discharge". They may occur as a result of sensory overload, cumulative stress or sudden change. If the person is not in danger, it is imperative not to push them into a corner by demanding an explanation, a response or anything else. It is advisable not to intervene. If it is possible to discuss beforehand, do not hesitate to ask what attitude is desired in case of collapses (some PASs will want absolute silence, others will prefer contact and touch textures, etc.).
- Some PMDs, depending on their disorder, may also be prone to specific seizures (different, however, from autisticmeltdowns). To avoid emotional escalations, avoid blaming the person in crisis and avoid making the person feel guilty. While it is never easy to know how to behave during a crisis, it is advisable not to point fingers at the other person's behaviour (especially while the crisis is taking place). Again, you can ask the person beforehand what strategies could be adopted in the event of a major crisis-within the limits of what is feasible!- Postponing a conversation may also be indicated. Inviting the person to their "safe place"-see below- can help them to reconnect with it.
- Some PMDs are subject to de-realization and dissociation. In a borderline person, for example, dissociative crises may cause the person to immediately cut off contact with his or her environment to the point of not being able to respond. You can accompany the person in strong dissociation by gradually bringing them back to something familiar: talking softly about something they like, putting loved, tangible objects, textures in their hands that remind them of pleasant sensations, making them smell something that reassures them. Crises can last several hours. Recovery from a dissociative crisis may last several days.
SENSORIALITY AND A SAFE PLACE
- Some PAS/I/MD have an important sensory relationship, both in its disruptive potential and in its soothing properties. For example, anxiety in a PMD may promote sensitivity to certain stimuli. In a PAS, assume that this hypersensoriality is already a daily struggle, and that a comorbidity will therefore amplify it and lead very quickly to autistic meltdown. It is also very important to insist on the fact that a PAS will not necessarily be sensitive to a volume of sound, but can be sensitive to an accumulation of sounds over a given period of time, and to the fact that a sound can appear unexpectedly (for example, the sound of a falling glass). Therefore, it is advisable to act in two steps:
- ANTICIPATE : Organize the environment by favouring moderate to low luminosity, reduce sound stimuli (avoid television + chatting with two children +vacuuming...) and olfactory stimuli.
- ACCEPT : Accept collapses without intervention unless the PAS/I/MD is in danger. According to the agreements established between the PAS/I/MD and you, adapt, accommodate, contain, etc. Set up a neutral, non-hazardous room that is not a communal living space, where the PAS/I/MD (and you too!) can isolate themselves without being disturbed by a third person. It is advisable to furnish this room with very soft and containing textures (voluminous cushions, plaids, fluffy textures, ball rolled duvets, etc.) and to favour low to moderate luminosity. Offer comforting sound banks (cat purring, white noise, drones, sea noise, etc.) that can be easily accessed via a computer, telephone application, etc., to accompany the soothing effect.
NB : This neutral room solution can also be a valuable solution in case of conflicts between children during containment. Name this room together (the "Cuddly Room", the "Quiet House", anything goes!). It is advisable to add a home-made urn (another activity!) in which the child who is going through a contrariety is invited to put a "letter-journal". This letter-journal can be inserted into the urn (provided that confidentiality is respected: the solution is to tape the urn down completely, except for the opening, of course), destroyed (the child may not wish to put it in the urn), read after appeasement if the child expresses the desire to do so.
- If it is difficult to find a safe place, a visualization exercise can be set up: in a quiet place, ask the person to close their eyes and imagine a place that would reassure them and that could be their refuge in case of anxiety. What is that place like? What do they see? What is the environment like? With the help of a relaxing accompaniment (deep breathing exercises, for example), guide the person until they feel calm.
ANXIETY AND COMPULSIONS
- PAS/I/MD are generally more prone to anxiety and compulsive behaviours than others. One can believe that one is doing the right thing by moving in the direction of possible compulsions, or by focusing on anxiety-provoking subjects; although it is difficult to distinguish between a compulsive need for reassurance and a fully adapted anxiety, it is advisable not to fuel anxiety.
° If the PAS/I/MD asks you a question whose subject (anxiety-provoking) has been raised several times, remind them that they have already answered this question, and lead the discussion towards something new or constructive.
° If the PAS/I/MD is performing an OCD ritual (not a routine ritual!), do not make a derogatory remark, but invite them to do something they might enjoy.
- PASs (and some PI/MDs) are reassured by routines and familiar topics. If there is no justification for not following these routines, it is not appropriate to relax or modify them, especially in the case of containment.
- Sometimes the PAS/I/MD just needs... to be alone. To be sure, just ask them.
- If a PAS shows the need to verbalize something (in a meltdown or basic conversation) but fails to do so and requires your help, proceed with simple questions or an alternative.
"I suddenly don't feel well. I'm...
- Physically or morally?
- Are you able to identify what you're feeling?
- I don't know, it's confusing. I don't know how to say it.
- Are you feeling anxious?
- Do you want to share this with me?"
This also applies to a PI/MD.
PREMENSTRUAL SYNDROME (PMS)
PMS is not an uncommon phenomenon. Many people experience its physical and/or psychological effects from moderate to intense degrees. Breast tension, abdominal pain, back pain, digestiveproblems, headaches and migraines, but also irritability, gloom, etc.In cases of PMD, there is an intensification of mood disorders, compulsions, meltdowns and suicidal behaviour. Many PMDs suffering from obsessive disorders report an increase in intrusive thoughts, both in frequency of onset and content, and greater anxiety (and response to that anxiety) is noted. It is important to note that although the scientific literature refers to PREmenstrual syndrome, the symptoms may be observed during the menstrual period.
- If a PAS/I/MD shows symptoms during this period, do not hesitate to offer your help: does the PAS/I/MD need to beaccompanied during the anxiety? Do they need to drink? Can you assist them in case of disabling symptoms (help them walk to the toilet, arrange a bed near the bathroom, offer to buy them disposable sanitary pads or share yours if an outing is impossible, help them wash their reusable pads, etc.)? If the PAS/I/MD manifests the need for isolation, make sure that they are sufficiently hydrated and that they have not forgotten to change their internal intimate protection (just ask them, when possible. If you observe a longer than usual withdrawal without going to the toilet, you can try to mention this,for example by asking if the PAS/I/MD has enough protection ahead of time). Do not offer painkillers: they may aggravate the symptoms of COVID-19.
B) PANIC ATTACKS
- If a PAS/I/MD contacts you during an anxietyattack, or you are in the presence of this person, several solutions are possible.
°A PAS/I/MD will feel as if they are dying. A panic attack or an anxiety attack may, at worst, cause vagal discomfort (if so, lie down and raise the person's legs to a square until they are comfortable again) and nausea, but nothing fatal or dangerous. For a PAS/I/MD, an anxiety attack or panic attack can bevery substantial. You can work with them to neutralize the seizure,and then later do some neuroeducationtogether to better understand what an anxiety attack is all about.
*Offer them a glass of cold water and/or a cold, wet washcloth to put on their neck, face, etc.
*Invite the PAS/I/MD to slowly inhale (4 to 5 seconds) and then slowly exhale for 4 to 5 seconds, focusing on the second count. If the PAS/I/MD is synaesthetic (which is the case with many PASs), ask the person to focus on the color of the numbers, their smell, character, spatial arrangement, etc., depending on the type of synaesthesia the PAS/I/MD person is experiencing. Alternatively, depending on the type of synaesthesia, ask the PAS/I/MD to recite from A to D/E, inviting the PAS/I/MD to focus on the appearance of their A, their B, the character they associate with the letters, etc. Then ask them to invert and imagine a "line" between each number or character.
*Invite the PAS/I/MD to reconnect to the real world by asking them to name several objects in the room. Ask them to describe these objects, their texture, colour, volume, size, etc.Then, ask them to isolate the sounds in the room, to indicate their origin and intensity. Do the same with smells and shapes.
*In PSA, the resolution of an anxiety attack may involve an autistic meltdown. If the PAS is unable to verbalize, do not force them, this can reinforce their muteness (and the meltdown).
°In case you are in the virtual presence of the anxious person :
- If the PAS/I/MD has contacted you in the middle of a crisis, it is because they are in need of support.
*Ask them how they feel, what caused the anxiety, if and how you can help them.
*Explicitly mark your understanding: if speaking is not easy for the PAS, the "vague"written word can be experienced in a confusing way. Inaccuracies, double meanings and innuendo can sometimes lead to confusion. If anxiety is high, comprehension may be further impaired. Invite thePAS/I/MD, if they feel able, to video chat with them, or offer to speak to them by voice message. If they live alone, a familiar voice can bring them back to reality and to a state of calm more quickly.
*Gradually get the PAS/I/MD to reconnect to their physical sensations and focus their attention elsewhere.
C) TRANSFORMING TOGETHER
It is often said that PASs are devoid of empathy. The popularization of empathy terminology and questionable diagnostic methodologies make them seem like cold people unable to accept the words of others. While it is true that many PASs have difficulty determining the feelings of the other person (and their own!) and make "social missteps", it is not uncommon to find PASs among psychologists, social workers, and among your closest friends. Better still, some PASs (especially those in Asperger's women) have overly violent and confused feelings when faced with a situation exposed to them and are unable to express them in an appropriate way: their response is therefore often very pragmatic, sometimes clumsy.
Transforming this fear, this crisis, this unpleasant state together requires of accompaniment and cooperation. Contrary to popular belief, PASs are not necessarily disconnected from social ties. On the contrary, some PASs are very talkative when they are passionate about subjects; however, managing social codes requires a certain effort. Being in the presence of other individuals can generate a great deal of fatigue, due to the need for adaptability and the accumulation of information. Transforming together will induce the setting up of this cooperation to bring thePAS/I/MD towards a calming and reinforcing the link by a positive management of the crisis. The psychological consequences of confinement on PAS/I/MD can be heavy. It is therefore important to promote social bonding by taking into account the functioning of PASs, communication and exploration of the specificities of PAS/I/MDs in order to foster resilience and adaptation to the measures.
A section to help you set up creative activities in the short and medium term is available. The feasibility of the proposed exercises is to be assessed according to the specificities of the PAS/I/MD.
D) TAKING CARE OF YOURSELF
Accompanying the other must not involve neglecting one's own needs or leading to sacrifice. You can also be subject to moments of exhaustion, and it is advisable to listen to your feelings and your limits.
- Give yourself moments of silence and comfort as much as possible: hot showers, reading, time slots for isolation are precious facilities that will promote the dynamics of the bond. Don't hesitate to also communicate with people you trust who can listen to you if needed: you are also affected by events and their impact on your daily life is not insignificant.
- If you witness an autistic meltdown or a PAS/I/MD crisis, try as much as possible not to take the event personally: you are not responsible for the other person's reactions. Meltdowns and crises can be overwhelming. Do not try to reason with the PAS/I/MD, they may not be able to hear or listen to you.
- Taking care of yourself does not mean rejecting the other: if your limits have been reached, you may manifest your difficulty in being able to receive requests.