Looking After Your Autistic Self: a Personalised Self-Care Approach to Managing Your Sensory and Emotional Well-being

Overview

Looking After Your Autistic Self is a practical, strength-based guide for Autistic adults on managing stress, Sensory sensitivities, and Emotional regulation through personalized self-care strategies. Written by an Autistic author drawing on both research and lived experience, the book challenges shame-based approaches to neurodivergence and instead provides concrete tools for understanding how Autistic nervous systems work differently, identifying individual triggers and Sensory profiles, and building sustainable well-being through intentional accommodation rather than forced adaptation.

Understanding Autistic Stress Response

Autistic people release higher amounts of cortisol (the stress hormone) than non-Autistic people, and these elevated levels remain in the body significantly longer even after stressors are removed. Research demonstrates that Autistic adults without intellectual disability experience substantially higher stress levels than non-Autistic adults, and critically, when stress increases, social functioning decreases significantly. This means struggling socially under stress is an Autism-related symptom, not a personal weakness or failure.

Unlike non-Autistic people whose stress response is naturally self-limiting, Autistic individuals often hold onto stress long after the triggering situation has passed. This biological reality has profound implications: an Autistic person might experience anxiety about a supermarket visit hours or days afterward, maintaining that elevated stress state which then affects their ability to interact socially with family members later.

Autistic people may perceive danger in everyday situations where no real danger exists—a supermarket intercom might trigger a “flight” response, overwhelming paperwork might trigger a “fight” response, or excessive social demands might trigger a “freeze” response. Understanding this Neurological difference is essential for self-compassion and effective stress management.

The Detective Habit: Identifying Your Triggers

The “detective habit” is a non-judgmental reflection method for identifying specific triggers and developing strength-based coping strategies. Rather than viewing triggers as personal failings, this approach recognizes them as predictable stressors your brain perceives as dangerous, which you can then plan around.

When reflecting on difficult scenarios, ask yourself systematically:

• What happened?
• What did I feel?
• Was there a sensory stressor, information overload, or executive function challenge?
• At what point did the stress begin?
• Were my basic needs met (hunger, thirst, sleep, temperature, comfort)?
• What were my strengths in the situation?
• What would have helped?
• What coping strategies could I use next time?

Common Autistic Triggers

• Sensory stressors
• Sudden demands requiring flexible thinking
• Unexpected events
• Unmet basic needs
• Spontaneity
• New people, places, or things
• Phone calls or negotiations with unfamiliar people
• Confrontation or fear of confrontation
• Language processing confusion
• Being literal and missing social cues
• Social mistakes
• Plan changes
• High baseline anxiety
• Being away from home too long
• Insufficient solitude
• Lack of time for creative pursuits or special interests
• Feeling out of depth
• Time pressure
• Technology failures
• Transitions between environments or tasks
• Changes to home environment

Importantly, having met all basic needs significantly reduces trigger responses, while unmet needs—especially sleep deprivation—dramatically increase vulnerability to smaller stressors. This creates a critical insight: basic needs management is not luxury or self-indulgence but foundational stress prevention.

Executive Function Collapse Under Stress

Research shows 20-30% of Autistic adults have significant difficulty with planning, 20% struggle with flexible thinking, and only 35% have no executive function impairment whatsoever. Counterintuitively, studies show higher IQ does not correlate with better executive function—intelligence cannot compensate for Executive dysfunction.

Stress directly impacts executive function skills in a predictable cascade:

• It can shut down planning ability
• Prevent task initiation
• Reduce flexible thinking
• Decrease time management
• Make task completion impossible
• Impair Emotional regulation throughout tasks

Multiple stress triggers compound this effect exponentially rather than additively. The author describes a vivid example: becoming late (trigger 1), encountering an unexpected road closure (trigger 2), the unpredictability of needing a new plan (trigger 3), and car horns from impatient drivers (trigger 4) created a complete cascade where her flexible thinking entirely shut down despite knowing the area well and knowing alternative routes.

This demonstrates that Executive dysfunction under stress is not a choice or character flaw but a Neurological response that can completely override knowledge and capability.

Five Steps to Managing Triggers

1. the Detective Habit

Identify your specific triggers through reflective questioning to understand what situations predictably create stress for you.

2. Coping Strategies

Learn to manage identified triggers using your personal strengths. Rather than generic advice, develop customized strategies based on what actually works for your neurology and strengths.

3. Rationing

Spread out triggering events and activities to allow recovery time between them. Rather than avoiding triggers entirely (which would lead to agoraphobia and missed life experiences), learn to manage them through strategic spacing and recovery planning.

4. Recovery Planning

Pre-plan time to rest and decompress during and after stress. Anticipate which activities will require recovery and build it into your schedule intentionally.

5. Quick Calm Strategies

Develop immediate techniques to calm down quickly when overwhelmed, which are explored in depth in the Quick Calm Plans section.

Quick Calm Plans: Immediate Relief Strategies

A Quick Calm Plan is a pre-made series of strategies for when completely overwhelmed and unable to function. Recognizing when you need one is the first step.

Physical and Mental Clues You Need Quick Calm

• Body shaking
• Repetitive body movements
• Headaches
• Jaw clenching
• Nausea
• Racing or jumbled thoughts
• Heightened anxiety
• Feeling disconnected from limbs
• Strong desire not to talk
• Broken speech patterns or single-word speech
• Stuttering
• Inability to get words from brain to mouth
• Intense craving for something associated with safety
• Exhaustion
• Sugar cravings
• Wanting to hide under blankets
• Feeling like screaming
• Uncontrollable crying
• Hopelessness
• Feeling everything is too much

Specific Quick Calm Strategies

• Remove yourself from stressful situations
• Check if basic needs are met (eating, drinking, adjusting temperature, resting)
• Controlled breathing (breathing into belly, slow breathing with pauses to prevent hyperventilation)
• Take a drink to re-engage digestive system
• Find solitude
• Lie in bed in a dark room
• Hold hot water bottles or heated pads
• Lie under weighted blankets
• Apply pressure with weighted lap blankets or books
• Smell pleasant scents (soap, lavender, lemon verbena, mint)
• Splash cold water on face, neck, wrists, and palms
• Get fresh air
• Watch familiar TV shows
• Avoid demands
• Listen to music or audiobooks
• Stimming
• Darken rooms or use eye masks
• Reduce visual stimulation
• Take showers or baths
• Singing
• Go into nature
• Have warm drinks
• Disconnect from phones and internet
• Express feelings out loud
• Ask for help
• Gentle exercise like weight lifting or yoga

The Importance of Visual Quick Calm Plans

Visual Quick Calm Plans are essential because under extreme stress, the prefrontal cortex (which regulates thoughts and behavior) stops functioning properly, impairing memory and thinking. However, research shows Autistic people continue processing visual information even under extreme stress when they cannot process spoken information.

Autistic people demonstrate an “Autistic advantage” in visual tasks and visual searches, with strengths in visual thinking. For this reason, visual versions of Quick Calm Plans are critical.

Methods include:

• Text lists on phones
• Handwritten lists to carry
• Phone folders with photos of helpful tools
• Note-taking apps
• Diagrams or mind-maps
• Videos
• Stick figure drawings
• Small notebooks with photos to flip through
• Physical boxes under beds containing calming tools
• Laying out tools on bed before events
• Organizing Sensory tools visually so overwhelmed individuals can see what they need without having to think

Stimming As Essential Self-Regulation

Stimming (self-stimulatory behavior) is repetitive, often rhythmic behavior that Autistic people use for emotional and Sensory regulation. Stimming can involve:

• Body movements: Hand flapping, rocking, spinning, jumping, hair twirling, fidgeting, clicking pens, tapping
• Vocal sounds: Humming, singing, making sounds
• Mental patterns: Rewriting melodies, repeating poems

Historically treated as negative and professionals tried forcing children to stop, stimming is now understood as a coping mechanism that releases overwhelm, distress, over-stimulation, anger, joy, or intense emotion.

Research with 32 Autistic adults (Kapp et al. 2019) found most participants didn’t dislike stimming and said it creates “a feedback loop that regulates excess emotion,” though many suppressed stimming in public due to negative attention and marginalization. Most said stimming began involuntarily.

The author describes her complex relationship with stimming: childhood stimming (spinning, shoulder twitching, throat sounds) brought relief but attracted negative attention, so she learned to hide it and developed “socially acceptable” stims like hair twirling. She now has three types of unconscious stimming:

1. Calm stimming (subtle movements like foot tapping when concentrating)
2. Excited stimming (fist clenching with “eeee” sounds)
3. Distressed stimming (fast head nodding that causes neck pain)

She’s discovered alternatives that provide the same feedback:

• Making throat sounds stops head nodding
• Applying weight and deep pressure provides soothing
• Pushing against walls creates deep pressure
• Singing provides calming throat vibration

This illustrates an important counterintuitive insight: suppressing stimming doesn’t eliminate the need for it—finding alternative forms that meet the same Neurological need is the practical solution.

The Perma Model of Well-Being Applied to Autistic Life

Dr. Martin Seligman developed the PERMA model identifying five elements needed for well-being:

• P—Positive Emotion (doing things that increase positive feelings, such as smiling and gratitude practices)
• E—Engagement (losing track of time in activities, using your strengths, achieving “flow” state)
• R—Relationships (feeling valued by others, connecting with people at work, with friends and family)
• M—Meaning (belonging to something bigger than yourself, having purpose through community, profession, charity, creative endeavors, or causes)
• A—Accomplishments (setting realistic goals and achieving them, acknowledging your own achievements rather than requiring external recognition)

While some PERMA elements challenge Autistic people (relationships and meaning may be harder), others align naturally with Autism—especially Engagement through special interests. Research shows approximately 66% of Autistic adults have special interests, providing excellent opportunities for flow and engagement. However, balance is essential: too much time in engagement activities might neglect relationships, and prioritizing engagement over accomplishments could lead to task neglect.

The author found she initially lacked all PERMA elements:

• Lacking positive emotion due to anxiety and health problems
• Struggling with engagement because she felt guilty about special interests
• Avoiding relationships
• Finding no sense of meaning
• Rarely acknowledging achievements, instead comparing herself to others and feeling embarrassed about leaving nursing

By brainstorming ideas for each element and building a routine ensuring weekly inclusion of all elements, she dramatically improved her well-being. Special interests appeared in every PERMA element in her brainstorming—positive emotion activities included reading, audiobooks, watching calm TV shows, learning about Autism, sewing, writing, drawing, painting, engaging with Jane Austen and Charles Dickens materials, time in nature, physical activity, gardening, warm drinks, uplifting music, and rest.

This reveals a critical insight for Autistic well-being: special interests are not distractions from life but central tools for building meaningful, engaging, joyful lives.

Special Interests: Pathological or Protective?

Special interests are highly individual and can be any topic—fashion, gardening, knitting, specific historical periods, animals, poetry, physics, religion, or political ideas. They are distinct from Repetitive behaviors: a special interest preoccupies the mind and brings deep joy or meaning, while Repetitive behaviors provide calm without fixation.

According to a 2018 study of 443 Autistic adults, having a special interest improved leisure-time subjective well-being and quality of life. Three key tools to decrease agitation in Autistic people are physical release of energy, solitude, and engaging in special interests.

When Special Interests Signal Underlying Issues

However, special interests can signal underlying mental health issues when they become compulsive rather than enjoyable. Warning signs include:

• Needing the interest engaged constantly to feel calm
• Excessive frustration with everyday demands outside the interest
• Wanting to spend all time on it rather than connecting with others
• Neglecting basic needs (sleep, eating)
• Becoming exhausted by your own obsession

This is a crucial nuance: the interest itself is not problematic, but compulsive engagement signals underlying issues like Depression, Burnout, anxiety, Sensory overwhelm, or identity confusion. The solution is not to eliminate the interest but to identify and address root causes.

A multistrategy approach works better than relying on one self-soothing tool. When taking a break from an overwhelming special interest, it must be replaced with other meaningful activities to maintain emotional balance (the “seesaw” principle).

Activities With Addiction Potential Require Caution

• Calorie counting (eating disorder risk)
• Computer gaming (30-50% higher problematic gaming rates in Autistic people; WHO added “gaming disorder” to ICD-11)
• Harmful political ideologies
• Social media
• Gambling

Research found 20-30% of adults with eating disorders are Autistic. Modern commercialized games are deliberately designed to exploit special interest patterns, creating particular risk for Autistic users.

Understanding the Sensory System

The Sensory system has three core functions:

1. Gathering information from inside the body
2. Gathering information from the external environment
3. Organizing and responding to that information through the nervous system

Eight main senses operate in three categories. When the system works poorly (SPD), information gathering, processing, or responding can fail at any stage. Research indicates 80-90% of Autistic people have Sensory integration difficulties.

SPD is classified as a “disorder” only when the environment is unsuitable; in ideal accommodating environments, it’s simply a difference. This represents a profound reframing: Autistic people often experience the world differently not because something is wrong with them but because we take in and process Sensory information differently—and in accommodating environments, this becomes a difference, not a disability.

The Anchor Senses: Vestibular and Proprioception

The vestibular sense (balance, head position) and proprioceptive sense (body awareness in space) are foundational—like dropping an anchor for Sensory regulation. Without regulation of these senses, other senses are harder to manage.

Vestibular Sense

Vestibular dysfunction in Autistic children can delay milestones (sitting, walking) and lead to coordination problems persisting into adulthood. Dysregulated vestibular sense manifests as:

• Clumsiness
• Poor coordination
• Difficulty with sports
• Need to lean on objects or people
• Housework anxiety
• Gravitational insecurity (anxiety when feet aren’t on solid ground)
• Poor posture
• Spatial disorientation

Vestibular soothing strategies include:

• Chewing and crunching
• Sucking through straws
• Balance exercises (yoga)
• Swimming
• Putting head lower than heart (hanging over bed, headstands, forward folds)
• Gentle head tilts
• Head leaning back
• Spinning with feet on ground
• Swivel chairs
• Rocking chairs (helpful when calm but triggering when anxious)
• Hammocks

Combining proprioceptive strategies with vestibular ones improves tolerance.

Proprioceptive Sense

Proprioceptive dysfunction causes:

• Feeling disconnected from your body
• Poor coordination
• Movement planning difficulty
• Inability to apply appropriate force to objects
• Poor posture
• Spatial awareness problems

Importantly, hypermobility (hEDS, HSD) overlaps significantly with Autism and worsens proprioceptive challenges; female hormones worsen symptoms during puberty, menstruation, and pregnancy—creating a gendered experience of proprioceptive dysfunction that’s often unrecognized in women.

Proprioceptive soothing strategies include:

• Weight lifting (with professional guidance, especially for hypermobile people)
• Weighted blankets (study: 81% of ADHD/Autistic adults improved sleep, 26.5% improved morning waking)
• Deep pressure and tight hugs
• Chair lifts (pushing hands into chair)
• Leaning into walls
• Tight spaces and cozy nooks
• Water resistance (swimming or walking in water)
• Weighted clothing and ankle/wrist straps
• Weight-bearing exercise (press-ups, pull-ups)
• Rolling over gym balls
• Reorganizing room layout to reduce clutter and obstacles

The Basic Need Sense: Interoception

Interoception gathers information about hunger, thirst, emotions, pain, body temperature, nausea, toilet needs, energy levels, tiredness, and internal physical changes (heart rate, breathing). It directly enables meeting basic needs.

Problems Caused by Poor Interoception

Poor interoception causes cascading problems:

• Not recognizing hunger leads to under-eating (nutrient deficiency, poor concentration) or binge eating after blood sugar crashes
• Difficulty recognizing fullness increases overeating risk
• Unrecognized thirst causes dehydration, constipation, sluggish digestion, grumpiness
• Not feeling cold (but experiencing mood dysregulation and physical symptoms like goosebumps and blue skin)
• Not recognizing heat (dehydration, dizziness, crankiness)
• Delayed toilet recognition (bedwetting, constipation)
• Pain perception differences (conflicting research: some Autistic people underreport pain, others overreport; one study found Autistic people more sensitive to pain with higher pain-related anxiety)
• Difficulty recognizing tiredness or heart rate and breathing changes
• Alexithymia (difficulty naming emotions)
• Confusion between emotional and physical body signals

Interoception Strategies

• Occupational Therapy (work with OTs specializing in Sensory processing)
• Mindfulness and meditation
• Exercise (paying attention to physical sensations)
• Regular body check-ins (phone alarms, sticky notes)

Creating routines around eating, drinking, sleep, and basic needs to bypass reliance on interoceptive signals is often more effective than training interoception itself:

• Set alarms for eating and drinking
• Prepare lunch boxes
• Bring food when traveling
• Use portion guidelines

For temperature management:

• Observe what others wear
• Notice effects of temperature on your mood and skin
• Distinguish temperature from tiredness or anxiety
• Wear multiple thin layers

The Famous Five Senses: Sound, Smell, Taste, Sight, Touch

The Famous Five Senses primarily gather information about the external environment and directly impact social participation, relationships, career choices, daily navigation, identity formation, and social acceptance. Sensory differences can cause social rejection (due to appearance, hygiene, or “odd” behaviors deemed socially unacceptable).

However, Sensory strengths often go unrecognized: strong smell discrimination helped the author notice patient deterioration early in nursing; keen visual pattern detection aids early intervention; heightened auditory awareness detects subtle changes. Strong Sensory perception of nature—seeing individual grass blades, color patterns, detecting birdsong—brings profound joy.

The author now advocates expressing Sensory needs directly (suggesting alternatives like coffee walks instead of loud pubs) and proactively accessing quiet spaces at social events.

Sound (auditory) Sense

Strengths:

• Enhanced pitch discrimination and pitch memory (beneficial for musicians, singers, composers)
• Excellent “good ear” for learning languages
• Ability to impersonate voices (comedians, tribute artists)
• Heightened hearing for safety-critical roles (firefighters detecting danger)
• Excellent auditory discrimination for identifying individual sounds within noise (beneficial for musicians, sound engineers, orchestra conductors)

Challenges:

• Sound sensitivity causes social difficulty (avoiding pubs, restaurants, cinemas due to eating sounds like chewing and slurping)
• Inability to enjoy music or media due to poor audio quality
• Difficulty focusing on one sound among many
• Overwhelming everyday noise (shopping centres, traffic, household appliances like vacuums)
• Hearing high-pitched sounds others don’t (computer charging whines)
• Inability to filter background noise (keyboard tapping, gum chewing, pen clicking)
• Sensitivity to certain voices or accents making audiobooks and media unwatchable

Strategies:

• Warn people before making loud noises (“Loud noise!” warning system), giving time to leave or prepare
• Block out sound with ear buds, noise-cancelling headphones, ear defenders, ear plugs, or thick hats
• Drown out bad sounds with good sounds (music, audiobooks, white noise, meditative sounds)
• Seek silence after overstimulation to reset
• Manage sound layering (don’t use extractor fan and TV simultaneously)
• Use flexible thinking to solve sound problems (changing ward routines to avoid vacuuming)
• Meet people outdoors where nature sounds are calming
• Prepare phrases in advance for consent withdrawal during intimacy to avoid embarrassing body sounds

Smell (olfactory) Sense

Strengths:

• Ability to detect odor information quickly before others (nursing application: noticing wound infections, patient hygiene needs)
• Smell discrimination (breaking down individual scents in complex odors—useful in forensics, perfumery, chefs)
• Scent creativity (designing perfumes, candles, scented products)
• Strong smell-memory links (smells trigger vivid memories, functioning like “taking a photograph with your nose”)
• Smell-emotion connections (research shows odors significantly impact mood and emotion regulation)

Challenges:

• Multiple scents in social settings cause nausea and dizziness
• Strong reaction to individual people’s odors may force social avoidance
• Physical gagging or vomiting from bad smells
• Inability to attend events due to odor sensitivities (air fresheners, perfumes)
• Social avoidance develops despite actual desire to socialize

Strategies:

• Carry pleasant scents (rose soap, bergamot oil) for grounding
• Integrate loved scents into daily routine
• Plan ahead for smell-heavy environments (sit near windows and doors for fresh air, away from kitchens)
• Use scarves to block nose
• Choose unscented hygiene products
• Smell products before purchasing
• Use gradual exposure only when self-directed and controlled
• Take breaks for fresh air
• Layer pleasant smells over unpleasant ones
• Communicate smell preferences with intimate partners regarding timing (after showers and teeth brushing) and preferred products

Taste (gustatory) Sense

Strengths:

• Advanced flavour discrimination (wine and alcohol tasters, chefs, food critics)
• Enhanced ability to detect food quality changes
• Creative cooking skills with advanced taste pairing ability

Challenges:

• Food aversion leads to extremely limited diets
• Research shows Autistic people have higher rates of vitamin and mineral deficiencies (vitamins A, D, B; iron; calcium) due to restricted diets
• Fear of new foods due to gagging or feeling unsafe
• Difficulty eating food prepared by others
• Challenges taking necessary medicine due to taste
• Aversion to toothpaste taste leading to poor oral hygiene and social consequences
• Over-eating specific tastes (salt and sugar) leading to obesity
• Under-eating and low weight
• Pica (compulsively eating non-food objects) which can cause serious harm

Strategies:

• Identify foods you seek and keep them available for Emotional regulation (salty foods when tired or anxious, strong flavours like pickles for focus, creamy foods for calm)
• Check restaurant menus online in advance and call ahead to arrange suitable food
• Experiment with warm drinks as comfort
• Keep zero-effort frozen meals for times of overwhelm
• Bring food when going out
• Experiment with texture and temperature to make foods more palatable
• Challenge inflexible thinking about food aversions
• Keep trying foods (masked with flavours you like)
• Find alternatives to problematic products (flavour-free toothpaste)
• Supplement with vitamins and minerals if deficient
• Try different foods occasionally to prevent sudden aversions
• Calm other senses before trying new foods
• Seek professional help from dieticians or occupational therapists

Sight (visual) Sense

Strengths:

• Advanced ability to spot visual patterns (helpful in careers like nursing where pattern recognition in vital signs enables early intervention)
• Excellent visual detail spotting (design, data analysis, quality inspection)
• Advanced colour understanding (artists, designers, architects)
• Visual categorization and organization skills
• Strong visual memory supporting exam success and information recall
• Visual thinking using pictures rather than words (enhancing memory, problem-solving, visualization)

Challenges:

• Overwhelm and nausea from multiple or clashing patterns
• Preoccupation with patterns (unable to focus on tasks, compulsive counting on carpets or wallpaper, noticing asymmetry)
• Difficulty with bright lights (shopping centres, driving at night with glaring headlights, workplace fluorescent lighting; headaches and eye strain)
• Difficulty with specific light frequencies (fluorescent bulbs)
• Moving or flashing lights cause focus problems (Christmas lights, strobe lights causing nausea)
• Stress from unexpected visual changes (furniture moved without warning)

Strategies:

• Use dimness or darkness (close curtains, turn off lights, blackout blinds)
• Wear eye masks during rest or car journeys to block light and patterns
• Use calm lighting (lamps, candles instead of bright lights)
• Use coloured lights or lava lamps
• View images of beautiful things or special interests
• Wear sunglasses or light-blocking hats
• Use desk screens to reduce glare
• Use Dark Mode on devices
• Create one visually calm corner or space at home
• Use sparkling objects or light-reflecting items (fairy lights, crystals, prisms, glitter globes) for visual seeking

Touch (tactile) Sense

Strengths:

• Sensitive hands useful for gathering information (physiotherapists, massage therapists, doctors, nurses)
• Heightened fabric sensitivity enabling creative material use (fashion designers, interior designers)
• Advanced ability to manipulate materials through touch (sculptors, jewellery makers)
• Strong link between touch and memory (converting 2D to 3D memories)
• High emotional connection to touch
• Navigating in low light
• Reading emotional states through physical touch (hand grip, skin temperature, body tension during embraces)

Challenges:

• Uncomfortable touch sensations disrupt focus and cause distress (wet clothes feeling like torture)
• Difficulty touching certain things (raw meat, slime, insects, soil, sand)
• Food texture difficulties (shellfish, sauces, lumps; specific temperatures)
• Seams and tags on clothes making clothing selection challenging
• Difficulty finding appropriate clothes that feel comfortable while meeting social norms (uniforms, suits, formal wear)
• Fabric aversions (velvet causing stress, wool causing bodily tension, denim causing claustrophobia when stressed)
• Extreme difficulty with creams and lotions (sunscreen, medicated creams) risking health
• Medical treatment challenges
• Dental touch sensitivity
• Pregnancy-related touch changes and strangers touching pregnant bellies
• Dislike of being touched by others
• Crowded spaces causing stress (fear of unexpected touch)
• Elevator anxiety
• Aversion to shoulder-taps
• Difficulty with physical affection and intimacy

Strategies:

• Try clothes on before buying and note your mood
• Assess pleasing materials (smooth stones for desk use during calls)
• Prepare for disliked sensations (water to rinse sand, talc to dry feet)
• Communicate touch difficulties to healthcare staff requesting warnings before touch and examination over clothes
• Use music, sunglasses, comfortable clothes, and mantras (“it’s a sensation not pain”) during dental treatment
• Communicate fabric preferences with hotels and environments
• Alter clothes (cut tags, wear inside out, line uniforms with soft material)
• Use barriers (coats on chairs, plastic gloves, kitchen tongs)
• Arrive early to social events to choose comfortable seating
• Bring spare socks
• Wear warm clothes when near cold air
• Use hot water bottles for warmth
• Use water (warm showers to calm, cold wrists and face to focus)
• Experiment with medical creams and alternatives
• Use Wilbarger Protocol (occupational Therapy brushing technique) for tactile defensiveness
• Control touch from others through environment setup (armchairs vs couches, blankets as barriers, cordoned desks)
• Link arms yourself rather than letting others link yours
• Increase proprioceptive feedback (weighted blankets, lifting weights) and vestibular regulation (yoga, crunchy vegetables) to improve touch tolerance

Factors Affecting Sensory Sensitivity

Sensory reactions are not fixed and vary based on:

• Accumulation of Sensory stress (multiple triggers without recovery time increase sensitivity to usually-tolerated triggers)
• Cognitive stress (preoccupied mind reduces ability to recognize and manage Sensory buildup)
• Unmet basic needs (hunger, tiredness, pain increase Sensory reactivity)
• Hormonal changes (estrogen and progesterone affect smell, sight, sound, taste; menstrual cycle changes proprioception)
• Anxiety (dramatically reduces Sensory tolerance, turning normally-manageable stimuli into unbearable ones)
• Aging (affects taste, hearing, sight, smell, proprioception through joint changes)
• Health changes (autoimmune flares worsen proprioception and vestibular sense; diabetes affects touch and sight; vertigo increases sound and light sensitivity; smoking changes taste)

The Three-Step Sensory Regulation System

Step 1: “how Full Is Your Cup?”

Visualize the Sensory system as a water cup. Each trigger adds water; soothing empties water. An overflowing cup means overwhelm, shutdown, or meltdown.

Empty your cup when:

• Approaching overwhelm
• One sense is stressed
• Before new environments
• Before high-Sensory-trigger environments
• Before social events (less cup-fullness means more energy for socializing)
• During social events (maintains social functioning)
• After Sensory exposure (prevent cascading effects)
• After social events (address accumulated Sensory stress that hits after socializing stops)

Step 2: Identifying Which Sense Needs Soothing

Ask:

• Is one obvious trigger?
• Are multiple things triggering the same sense?
• Are multiple senses stressed simultaneously?

Look for clues if unsure (dizziness suggests vestibular, nausea suggests smell, throbbing head suggests sound). If overwhelmed and brain won’t work, soothe as many senses as possible simultaneously:

• Bed with blackout blinds and hot water bottle
• Outdoor fresh air with sunglasses
• Car alone with music and eyes closed
• Wall-leaning for proprioception
• Head-down squatting for vestibular

Pre-emptively soothe senses before known trigger environments.

Step 3: Using Sensory Soothing Strategies

Apply specific strategies for the identified sense as detailed throughout this guide.

Recording and Pattern Recognition

Paying attention to how you feel and recording reactions and causes helps identify patterns and triggers. The “detective habit” involves looking for physical clues to identify which sense is triggered. Over time, this builds understanding of your unique Sensory profile, which changes with health, hormones, stress, and age.

Intimacy and Sensory Safety

Intimacy requires feeling safe across all senses, not just emotionally safe with your partner. Each sense needs deliberate accommodation:

Proprioception

• Use weighted blankets before and during intimacy
• Try pillows to create feeling of being cocooned
• Use weighted ankle and wrist straps or drape weighted blankets over shoulders for grounding and increased safety tolerance

Vestibular

• Discomfort with certain positions (lying flat, leaning head back) or feeling ungrounded requires trying different positions or using pillows to prop body parts for stability

Smell

• Natural body odours, bodily fluids, breath (alcohol, cigarettes, unbrushed teeth), food smells, perfumes, and hygiene products can be overwhelming in close proximity
• Solutions: ensure both partners are clean and fresh; open windows slightly; use scented candles or loved scents in room; choose deodorants, perfumes, and colognes together; use fresh sheets; communicate politely about smell preferences in advance to avoid rejection

Sight

• Light comfort is critical—experiment with daylight, lamps, candles, darkness, lava lamps, or coloured lights to find what feels safe and comfortable; ensure candles are secure

Taste

• Kissing, oral sex, and bodily fluids carry taste sensations; food eaten that day affects body taste and smell (garlic, onion, asparagus); communicate respectfully about food preferences affecting intimacy timing

Interoception

• Meet basic needs (not hungry, thirsty, too cold or hot, in pain)
• Check emotional state before consenting to activities

Sound

• Sexual sounds may be unsettling (materials rubbing)
• Embarrassing body sounds (farts) cause anxiety preventing relaxation
• Use music or white noise
• Prepare a funny phrase in advance to laugh off embarrassing sounds

Touch-Specific Strategies for Intimacy

• Reduce skin-to-skin contact using clothes, sheets, cushions if overwhelmed by touch
• Increase skin-to-skin contact if clothes rubbing is difficult (improved emotional connection helps Sensory tolerance)
• Experiment with fabrics (personal preferences vary widely—silk and satin may feel awful; synthetic fabrics difficult for some; fleece comforting or unbearable)
• Deal with perspiration (use absorbent sheets between partners or absorbent towel to wipe; talc can reduce clamminess but not for intimate body parts or inhalation)
• Experiment with environments (discomfort varies by location—sofa vs bedroom, water and bath settings often more relaxing)

The Critical Role of Consent

Everyone has the absolute right to give or withdraw consent at any time, which is essential for Sensory safety. Consent challenges specific to Autistic people include:

• Difficulty reading Body language and Facial expressions (requiring explicit alternative communication methods established before sexual activity)
• Communication challenges (needing prearranged verbal or non-verbal methods to give or withdraw consent since stress impairs ability to improvise phrases)
• Need for continuous consent (consent to one activity doesn’t mean consent to progression; must be continuously sought as activity changes)

Methods of Communicating Consent and Withdrawal

• Prepared verbal phrases: “Let’s take a break,” “I’m not comfortable with that,” “Stop”
• Hand gestures: Guiding hand away, “Stop” or “Time Out” signals
• Visual signals: Turning on lamp, holding up colored objects in traffic light system—green/orange/red
• Written systems: Flashcards saying “Stop” or “Not That,” bedside notebook listing consents and non-consents
• Color objects: Pillows, scarves, ribbons held up to communicate orange (change activity) or red (complete stop)

Critical point: asking for consent improves mood, not kills it; it demonstrates value for partner’s safety and comfort, increasing attraction.

Planning and Explicit Language

Research found Autistic adults benefit from:

• Scheduling intimacy in advance (allowing preparation of Sensory Accommodations, meeting basic needs, grounding senses beforehand, managing expectations)
• Literal declaration of intentions, agreements, and feelings explicitly (avoiding innuendo and euphemism when negotiating activities and Sensory barriers)
• Understanding that pre-planning doesn’t prevent consent withdrawal (agreeing in advance doesn’t prevent either partner changing mind and withdrawing consent at any point)

Managing Sensory Overload, Shutdowns, and Meltdowns

What Is Sensory Overload

Sensory overload occurs when one or more senses become overstimulated and the nervous system cannot process incoming Sensory information. Autistic people are more prone to Sensory overload due to Sensory processing difficulties.

Critically, Sensory overload is NOT psychological or “all in your head”—it’s a physical nervous system response in the body. Like a twisted ankle, accumulating Sensory stress worsens the condition. Ignoring Sensory stress leads to anxiety, cognitive shutdown, Executive dysfunction, emotional distress, and eventual shutdown or meltdown. Sensory stress must be treated like any other physical health issue.

Shutdowns Vs. Meltdowns

A shutdown (“freeze” response) means the brain feels like it has shut down; the person loses ability to communicate or seems detached from environment; appears to be “hiding in shell”; functioning ability switches off.

The author’s experience shows mini-Shutdowns last ~1 hour with rest needed; full Shutdowns last days requiring complete rest in bed. Postponing shutdown until safe (pulling over car, turning off stove, waiting for childcare) requires enormous effort, increases stress and tension, and makes shutdown more intense and longer-lasting—an important insight for understanding that attempting to “push through” a shutdown creates worse outcomes.

A meltdown represents intense response to overwhelm: loss of control of emotions or body functions manifesting differently per person—may include uncontrollable crying, shouting, screaming, running or hiding, physical changes (shaking, repetitive rocking), or “fight” response (lashing out verbally or physically).

The person may not recognize they’re exhibiting these behaviors during meltdown but will remember afterward, often causing guilt and shame. The author experiences uncontrollable crying with dread and doom, difficulty breathing or hyperventilation, nausea, dizziness, fainting feeling; also experiences “laughing Meltdowns” (uncontrollable escalating laughter switching to crying) triggered by emotional stress or exhaustion—terrifying despite sounding funny, requiring weighted blanket and rest.

The Nuanced Reality of Meltdowns

The “sweet side” includes:

• Release of pent-up emotion and Sensory stress (“clears the air”)
• Huge relief after meltdown if not chastised
• The more acceptance, the greater the release

The “bitter side” includes:

• Feeling loss of control
• Embarrassment, shame and guilt
• Physical pain (headaches, jaw, neck, shoulder pain from shaking)
• Self-harm potential
• Uncharacteristic behavior (screaming, hurtful words, aggression)

Past fear during Meltdowns manifested as anger; now the author sees Meltdowns as waves that pass.

Five Steps to Managing Sensory Overload

1. What Sensory soothing strategies and tools can help (ear plugs, eye mask, squeeze ball, soft scarf, favorite song)?
2. Are basic needs met (food, water, pain relief, sleep)?
3. Do you need to remove the Sensory stressor from the environment?
4. Do you need to remove yourself from the environment?
5. Are you heading toward shutdown or meltdown? If yes, what is your Sensory Soothing Plan?

Sensory Soothing Plans

Customized recovery plans created before engaging in Sensory-challenging activities, with plan size matching event size.

Small outing (local shopping) might use a small plan like home tea and rest or weighted blanket on lap.

Medium event (social gathering, multi-shop trip) needs a medium plan with 1-2 hours recovery (bed with audiobook, favorite show, fresh air walk).

Major event (wedding) requires a major plan requiring full afternoon plus next day recovery (pre-prepared dinner, no appointments, favorite entertainment ready, housework completed, novelty toys for children or babysitting arranged).

Sensory Soothing Plan Elements

• Changing into comfortable clothes (pre-lay out post-event clothes to avoid decision-making)
• Lying under weighted blanket
• Holding hot water bottle (especially for cold, shivers, gut clench, racing heart)
• Eating and drinking prepared easy foods
• Closing curtains
• Listening to music and audiobooks (same audiobooks repeatedly when overwhelmed)
• Showering or bathing
• Turning off phone
• Engaging in special interest
• Watching favorite TV shows (same 3 shows repeatedly)
• Reading beloved books and poems
• Maintaining Sensory box under bed with soaps, beautiful images, eye mask, soft scarf, song list

Portable Sensory Toolkit

Bring Sensory tools when going anywhere, remembering that both seeking and avoiding sensations matter.

Visual

• Avoidance: Sunglasses, tinted glasses, hat
• Seeking: Keyring torch or fidget with light, photo, postcard, or video of special interest or beautiful/calming image

Smell

• Avoidance: Scarf to breathe through
• Overpowering: Strong smell like eucalyptus to overpower bad smells
• Seeking: Unopened soaps, body wash, mandarins and oranges, menthol and eucalyptus scents

Taste

• Own food if unsure about availability (seeking)
• Salty and peppermint items (seeking)

Sound

• Avoidance: Ear buds, noise-cancelling headphones, over-ear headphones, thick hat
• Seeking: Earphones for music, audiobooks, podcasts

Touch

• Avoidance: Barrier items for disliked textures—coat for disliked chair, spare socks, long sleeves, gloves
• Seeking: Fidgets (keyrings, dice, smooth stones, squeeze balls, Chinese meditation balls, tennis or baseballs, fidget cubes and spinners, spinner rings, pocket bean bags), materials to touch (silky scarf, fleece or satin coat pockets), hot water bottle in car, warmth: pocket hand warmers

Vestibular

• Crunchy food, sucking bottle, sugar-free chewing gum, chewable jewellery (seeking)

Proprioception

• Heavy backpack, heavy boots, weighted ankle and wrist straps, coat squished between body and chair sides, pocket bean bags (seeking)

Interoception

• Prepared snacks and water bottle
• Set phone alarms for eating and drinking reminders
• Wear layers for temperature regulation

Emotional Regulation Strategies & Techniques

Recognizing and Naming Emotions (alexithymia)

Many Autistic people struggle to recognize and name their own emotions despite being able to read others’ emotions. Alexithymia—inability to recognize, describe, and understand emotions—affects approximately 50% of Autistic people on some spectrum (not exclusive to Autism; found in Depression and other conditions).

It manifests as:

• Difficulty recognizing you’re feeling an emotion
• Difficulty naming the emotion
• Not recognizing early warning signs (only realizing emotion at extreme levels—“0 to 90” effect)
• Difficulty reading others’ emotions

The critical consequence: without recognizing emotions, regulation is nearly impossible. Building awareness of physical sensations accompanying emotions (racing heart, jaw clench, gut knot) helps catch emotions earlier. Professional help through psychotherapy can be transformative—teaching how past affects present emotions, emotional recognition, and regulation strategies.

The Emotional Domino Effect

When an uncomfortable emotion arrives and isn’t validated or managed, secondary emotions follow in a cascade. The initial emotion often becomes the weakest feeling, while secondary emotions become dominant and cause larger social problems.

Example: embarrassment (primary) → shame (secondary, stronger) → anger at self → guilt → anxiety lasting days.

The inability to manage the first emotion doesn’t just affect the moment—it has long-term consequences including recurring shame, anxiety, and avoidance behaviors.

Four-step Strategy for Emotional Regulation

Step 1: Name the Emotion

Simply stating to yourself “I feel sad” or “Right now I feel angry” acknowledges the emotion’s presence. This “Name It to Tame It” strategy (developed by Dr. Dan Siegal) validates emotions by having them be heard and recognized first by yourself.

Start by practicing with comfortable emotions throughout the day, then progress to slightly uncomfortable emotions, and finally stronger uncomfortable emotions. The more you name emotions, the more you recognize how they fluctuate, which helps you realize you won’t feel stuck in any uncomfortable emotion forever.

Step 2: Scan the Body

Body scanning provides three pieces of information:

• Helps identify the emotion through physical clues (e.g., light-headedness and nausea indicate anxiety; heat, clenched jaw, tense fingers indicate anger)
• Gauges intensity (slightly faster heartbeat = minor fear; racing heart, sweating, light-headedness = intense fear)
• Identifies which body areas need soothing

Using Sensory strategies targeting specific body areas (e.g., holding something hot against an anxious gut) helps soothe the emotion.

Step 3: Identify the Cause

Determining what triggered the emotion isn’t always immediately necessary—sometimes it’s better to wait until you’ve calmed down. However, knowing triggers helps build understanding of emotional patterns and Sensory sensitivities.

If you can’t identify the cause, skip this step rather than ruminating, which prevents reaching Step 4. Persistent unexplained emotions warrant discussion with a psychotherapist.

Step 4: What Can You Do About It?

Ask yourself:

• Do I need to address the cause?
• Which Sensory soothing strategy will calm physical reactions?
• Is a Sensory trigger causing this, and should I avoid it or use Sensory tools to stay?
• Am I comfortable continuing to feel this emotion, or do I want it to stop?

Understanding Shame and Its Consequences in Autistic Adults

Autistic people experience shame at significantly higher rates than non-Autistic people (Davidson et al. 2017), stemming from social exclusion, bullying, or difficulty fitting into society.

The distinction between guilt and shame matters profoundly:

• Guilt is the uncomfortable feeling of having done something wrong against one’s values
• Shame is a painful feeling of being fundamentally flawed and unworthy of belonging or love

This distinction is critical because shame leads to destructive emotions like anger, blaming others, aggression, and hostility—making it particularly problematic when unmanaged. Understanding that you’re experiencing shame (rather than guilt) and developing specific shame-management strategies is essential for Autistic well-being.

Emotional Regulation Plans for Specific Emotions

Anger

• Feel it without fueling it (acknowledge vs. Amplify)
• Avoid social media venting (increases rather than releases anger)
• Take deep breaths (widens chest, reduces muscle tightness)
• Listen to angry music
• Sing an angry song
• Write it down
• Write angry letters without sending them
• Practice not acting in haste (count to 10 or use breathing)
• Exercise vigorously
• Symbolize letting it go (light candle, write and burn, blow thoughts away, punch cushion)
• Use Sensory soothing (shower, weight lifting, weighted blanket)

Sadness

• Go into nature (woods, ocean, garden)
• Talk about it to lift the heavy weight
• Cry (natural body response to sadness)
• Exercise to get out of your head
• Get creative (drawing, coloring, writing)
• Laugh (watch comedy, read funny books)
• Use Sensory comfort (wholesome foods, pleasant smells, soft clothes, fluffy blankets, beautiful visuals)

Emptiness

• Connect with nature to feel more “whole”
• Help others or do kind acts for fulfillment boost
• Engage in creativity (writing, painting, sewing)
• Force yourself into special interests for 10 minutes using a timer
• Seek social connection (meetings, quick chats with librarians or shopkeepers)
• Use visual Sensory strategies (beautiful things, cheerful clothes, special-interest items)
• Strong flavors and crunchy snacks
• Comfort foods from childhood

Nostalgia

• Read poetry that validates the feeling
• Keep a diary to remember past reality wasn’t “all sunshine”
• Let nostalgia flow away rather than holding it
• Meditate and visualize releasing it (e.g., throwing it into the ocean)
• Recreate Sensory elements from that time (music, smells, foods) without over-indulging in nostalgic thoughts

Loneliness (with Others)

• Plan what you’ll do alone after leaving; look forward to TV shows, nature, or special interests

Loneliness (genuine)

• Connect with like-minded people (painting class, hobby groups) where shared interest reduces social pressure
• Plan events to look forward to (conferences, webinars, workshops)
• Cautiously explore online communities (check if they increase comfort vs. Discomfort)
• Use interoception work and proprioceptive grounding (exercise, hugs, weighted blankets, leaning into walls)

Shame

• Connect with someone who loves you to be reminded you’re worthy
• Talk about it to see it clearly and logically
• Get physically active to beat shame away
• Use proprioceptive Sensory activities (weighted blankets)
• Do activities you’re good at (special interests, hobbies, parenting successes) to feel capable

Anxiety

• Use a Quick Calm Plan
• Soothe gut knots with hot water bottles and warm drinks (not caffeinated—caffeine spirals anxiety)
• Create safety with Sensory tools (blankets, music, flowers, fidgets)
• Drink warm non-caffeinated drinks
• Take walks alone in nature
• Create pros and cons lists for decision anxiety
• Imagine ridiculous worst-case scenarios to break obsessive thinking
• Watch comedy
• Enter creative flow
• Use breathing techniques (belly breathing, “breathe in, breathe out, pause”)
• Engage special interests to interrupt intrusive thoughts

Disappointment

• Practice gratitude—name things you’re grateful for to shift focus from what you lack to what you have
• Use comfort Sensory strategies (wholesome food, comfortable clothes, soft blankets, rocking chairs, hugs)
• Watch comforting movies or read beloved books
• Talk it out
• Remind yourself of facts (identify actual restrictions rather than blaming yourself)
• Cry to release disappointment physically

Excitement/extreme Happiness

• Dance (start with giddy songs, progress to calmer)
• Exercise to focus and release energy
• Use cold water on neck and inner wrists to shock yourself calm
• Feel fresh air on different body parts
• Massage jaw and cheeks to release tension from intense laughter
• Channel excited energy into creative projects with time boundaries (set alarms to stop)
• Engage special interests for calming
• Avoid creative work right before bed

Embarrassment

• Say out loud “I’m embarrassed” to shrink it
• Laugh about it with supportive people
• Change the subject
• Take a moment alone (bathroom) to name the feeling and think through recovery
• Use cold water on face, wrists, and neck
• Ask for tight hugs
• Use special interests for prolonged embarrassment

Creativity as Essential Emotional Regulation

Autistic people show higher levels of originality and detail in creative work compared to non-Autistic participants (Pennisi et al. 2021). Creativity encompasses far more than traditional art—it includes creative writing, visual art, drama, building (Lego, models), gardening, creative coding, design, gaming with design elements, music, fashion design, house decoration, flower arranging, jewelry making, carpentry, metalwork, graphic design, knitting, sewing, quilting, and DIY projects.

Engaging in creative flow stops ruminating thoughts, gives the brain a break from emotional fluctuations, and provides satisfaction and joy. Many Autistic people feel better in themselves when being creative and feel something is “missing” when they’re not creative. Creativity also provides social outlets (workshops, classes) where connection happens around shared interests without constant conversation pressure.

Long-term Uncomfortable Emotions and Mental Health Support

Some emotions, like grief, last for extended periods and can return unexpectedly. Long-term uncomfortable emotions require long-term plans and shouldn’t be allowed to “drag on indefinitely”—acknowledge them, then take action through activities like nature time, walking, painting, trying new creative endeavors.

When sadness or emptiness won’t lift despite efforts, it may indicate Depression. When anxiety affects functioning ability, it may be an anxiety disorder. Mental health professionals exist for these situations. Looking after mental health is as important as physical health.

Professional Support is warranted when uncomfortable emotions reduce quality of life.

Talk Therapies and Adapted Approaches for Autistic Adults

Types of Mental Health Support

Psychotherapy uses psychological methods to help understand emotions, change unhelpful behaviors, improve coping skills, and find solutions. Different psychotherapists use different techniques (EMDR for traumatic memories, CBT for unhelpful thought patterns).

Clinical psychology involves Diagnosis of psychological, emotional, and behavioral disorders and creation of treatment plans.

Counselling provides space to talk about problems, express feelings, and explore thoughts while learning coping strategies.

Note: Psychotherapists and clinical psychologists cannot prescribe medications—psychiatrists (medical doctors specializing in mental health) can.

For Autistic people with verbal communication challenges, alternative formats include phone or computer sessions, typing responses, or using writing—all allowing accommodation of individual communication styles.

Non-Talk-Based Therapies

Mindfulness-based therapies teach present awareness and reduce reactive thought patterns; mindfulness focusing on interoception helps alexithymia.

Occupational Therapy helps develop interoception (recognizing body sensations indicating emotions) and regulates Sensory systems supporting Emotional regulation.

Animal Therapy (equine or horse Therapy, dog Therapy, pets) reduces stress, improves emotion, and increases social interaction in Autistic people.

Art Therapy uses psychotherapy through creative art without needing prior art experience.

Drama Therapy and music Therapy use their respective mediums for psychotherapy.

Adaptations for Autistic Clients in Therapy (nice Guidelines 2021)

• Set explicit rules and explain them clearly
• Use simple language, avoiding extensive metaphor (for literal thinkers)
• Emphasize behavioral change over over-explaining cognition
• Provide visual and written information (many Autistic people are visual thinkers)
• Include family members and carers if client agrees
• Provide regular breaks to maintain attention
• Use special interests when possible

Additional Recommendations for Therapists

• Avoid scented candles, perfume, air fresheners (highly distracting; ask client preference first)
• Avoid overly bright lights (use lamps or natural light for safety and calm)
• Angle chairs to allow natural Eye contact avoidance without effort
• In first session, explain Therapy structure: frequency, expectations, payment, session length, confidentiality rules for public encounters
• Prepare visuals for clients to take home and process
• Ask preferred contact method (phone, text, email—phones may cause anxiety)
• Give warning before calling (e.g., “I’ll call later to reschedule”)
• Balance environment: have items to rest eyes on (paintings, curtains) but avoid clutter that causes obsessive focus on symmetry or missing items
• Write out agreed strategies and plans
• Consider offering weighted lap blanket for proprioceptive grounding (hygiene: use pillowcase changed between clients)
• Allow processing time for questions; don’t assume immediate answers
• Don’t presume Autistic clients remember previous sessions when emotionally challenged
• Ask clear questions and give permission to request rephrasing
• State Autistic clients can question techniques without offending therapist

Medical Interventions for Mental Health

Anxiolytics (anti-Anxiety Medications)

Benzodiazepines are the most commonly prescribed anxiolytics, used for sedation, muscle relaxation, and acute anxiety relief. However, they are habit-forming and carry addiction risk, requiring careful medical supervision. Side effects include sleepiness and drowsiness that can impair driving and daily functioning. These medications must only be used under direct doctor’s instructions.

Melatonin: the Sleep Hormone

Sleep difficulties are extremely prevalent in Autistic people—90% of Autistic adults in one UK study of 288 participants reported significantly poor sleep quality. Autistic individuals often have lower melatonin levels than non-Autistic people. Melatonin supplementation has been found to improve sleep onset and sleep quality for Autistic people.

However, melatonin should not be the first intervention; good sleep hygiene should be established first, including:

• Consistent bedtime routines
• Avoiding screens and blue light
• No large meals before bed
• Consistent sleep times
• Daily exercise
• Natural light exposure during the day
• Complete darkness at night

Only after optimizing sleep hygiene should melatonin supplementation be considered with professional guidance.

Serotonin and Antidepressants

Serotonin is a hormone and neurotransmitter critical for mood, digestion, and sleep regulation. Insufficient brain serotonin availability causes mood disturbances, poor sleep, and Depression.

SSRIs (selective serotonin reuptake inhibitors) are among the most common antidepressants, thought to work by increasing available serotonin in the brain.

Female Menstrual Hormones and Mental Health

Fluctuations in female body hormones significantly affect mental health. Premenstrual dysphoric disorder (severe PMS) and post-natal Depression are directly related to hormonal changes. Tracking mood and mental health across menstrual cycles can reveal hormonal contributions to mood disturbances.

The peri-menopausal years (typically ages 45–54) present severe mental health challenges, with Ireland reporting the highest female suicide rate in this age group. Depression rates double in peri-menopausal women, and women with anxiety histories frequently experience recurrence. Hormone replacement Therapy can reduce peri-menopausal symptoms and Support mental health.

Nutritional Deficiencies and Mental Health

Nutritional imbalances directly impact mental health and should be identified through blood testing when mental health challenges exist. Addressing nutritional deficiencies is essential for managing mental illness effectively:

• Iron deficiency causes tiredness, exhaustion, and lack of energy and motivation—symptoms easily mistaken for Depression
• Low B vitamins reduce energy and cognitive function, including memory
• Vitamin B12 and folate deficiencies impair serotonin and dopamine production, causing Depression-like symptoms
• Low vitamin D produces Depression symptoms
• Omega-3 oils (fish oils or algae-derived) improve mood management and cognitive function

Practical Strategies & Techniques

Rationing Triggers to Manage Stress

Rather than avoiding triggers (which would lead to agoraphobia and miss life’s joys), the author advocates learning to manage them through rationing—spreading triggering events across time to allow recovery between them.

Specific rationing strategies include:

• Spreading out socializing, especially during busy times like Christmas
• Alternating social venues (home versus cafés)
• Scheduling rest days after major events
• Taking creative Sensory breaks during work shifts
• Prioritizing which triggering activities to do first while energy is highest
• Limiting weekend activities to one social event and filling other time with rest
• Avoiding multiple evening activities in a row
• Researching quiet recovery places in unfamiliar towns (libraries, galleries, churches)
• Planning recovery strategies both during events (coffee break walks, listening to calm songs, using eye masks, engaging special interests) and after them (small solo walks, audiobooks, solitude, or engaging special interests)

Building Visual Support Systems

Creating visual Support systems throughout your life—from phone apps with strategy lists, to handwritten cards, to physical boxes of Sensory tools—enables you to access help without thinking or remembering during high-stress moments.

This external cognitive scaffolding is not a crutch but a necessity for Autistic Neurological functioning under stress. Visual Quick Calm Plans, visible weekly PERMA routines, Sensory tool boxes organized so you can see what’s available, and written Emotional regulation plans transform abstract strategies into concrete accessible Support.

Creating Structure Through Routine

Autistic well-being depends on external structure and routines as cognitive scaffolding. A weekly routine ensuring all five PERMA elements, consistent sleep and meal times, Sensory breaks built into work shifts, and pre-planned recovery time after stressful activities all Support baseline functioning and prevent cascading dysregulation.

Routines reduce decision-making burden, create predictability (reducing anxiety), and ensure important self-care isn’t neglected when overwhelmed.

Multistrategy Approach to Emotional Regulation

No single strategy works for all emotions or all people. Building a diverse toolkit of Sensory strategies, creative outlets, physical activities, social connections, and meaning-making activities provides flexibility to address different emotions and situations.

The “seesaw” principle—replacing one soothing tool with other meaningful activities rather than relying on one—prevents problematic special interest engagement and supports balanced well-being.

Key Takeaways

1. Autistic stress response is fundamentally different and involves higher, longer-lasting cortisol levels; this biological reality means struggling socially under stress is a symptom, not a character flaw. When stress increases, social functioning measurably decreases. Understanding this Neurological difference enables self-compassion and appropriate accommodation rather than shame and self-blame.

2. The detective habit—non-judgmental reflection on difficult situations—identifies personalized triggers and strengths, enabling customized coping rather than generic shame. Your triggers are not personal faults; they’re simply stressors your brain perceives as dangerous. Once identified, you can plan around them rather than experiencing repeated overwhelm.

3. Executive function collapses under stress; 20-30% of Autistic adults struggle with planning, and high intelligence doesn’t help. Multiple triggers create cascading dysfunction where flexible thinking entirely shuts down despite knowing solutions. This requires pre-planning and strategic trigger spacing rather than relying on in-the-moment problem-solving.

4. Visual Quick Calm Plans work when thinking fails because Autistic people retain visual processing under extreme stress when unable to think or listen. Pre-making visual plans means accessing calming strategies without thought or memory during overwhelm.

5. Well-being requires intentional balance across PERMA elements; Autistic adults naturally gravitate toward Engagement but often neglect Relationships, Meaning, and Accomplishments while struggling with Positive Emotion. Creating weekly routines ensuring all five elements prevents the spiral where ignoring relationships and meaning deepens anxiety and reduces positive emotion.

6. Special interests are not indulgences but essential self-regulation tools that should be integrated into all five PERMA dimensions; when they become compulsive, they signal underlying mental health issues requiring multistrategy intervention. A 2018 study of 443 Autistic adults found having a special interest improved leisure-time well-being and quality of life. However, compulsive engagement signals Depression, Burnout, anxiety, or Sensory overwhelm that must be addressed.

7. The Anchor Senses (vestibular and proprioception) must be regulated first; without grounded balance and body awareness, managing sound, smell, taste, sight, and touch becomes exponentially harder. Hormonal changes, aging, and health conditions progressively worsen these senses, requiring extra Support during vulnerable periods.

8. Interoception failure (not recognizing internal body signals) cascades into unmet basic needs, which then drives higher stress reactivity, Executive dysfunction, and Sensory sensitivity. Creating structured routines around meals, sleep, and movement removes cognitive load and prevents cascading dysregulation.

9. Sensory differences are physical, not psychological; Sensory stress accumulates like a twisted ankle and requires genuine accommodation, not forced tolerance. Ignoring Sensory stress leads to shutdown, meltdown, and anxiety. The Sensory system needs treatment like any other body system.

10. Context-specific desensitization only works when self-directed and controlled; forced exposure to unpleasant stimuli is torturous and ineffective. The author desensitized to nursing smells but had to completely re-desensitize when becoming a mother and never desensitized to animal bodily function smells—showing individual variation and the importance of self-direction.

11. Autistic people experience emotions at more extreme levels than non-Autistic people, with higher rates of shame, guilt, anxiety, and fear; this is Neurological, not a personal failing. Research shows Autistic adults experience shame more frequently than non-Autistic adults, and this can spiral into destructive secondary emotions like anger and aggression. The emotional domino effect—where initial mild emotions escalate to destructive secondary emotions—is preventable through early emotion management.

12. The four-step Emotional regulation strategy (name, scan, identify cause, take action) provides concrete, accessible framework even when dysregulated; Sensory soothing strategies are essential complements to emotional acknowledgment because Autistic people experience intense physical reactions to emotions. Addressing both the emotional and bodily response prevents overwhelm and cascading dysregulation.

Critical Warnings & Important Notes

When to Seek Professional Help

If uncomfortable emotions persist despite self-regulation strategies for extended periods (weeks to months), it may indicate clinical Depression or anxiety disorder. Mental health professionals should be consulted when:

• Sadness or emptiness won’t lift despite nature time, creativity, social connection, and other strategies
• Anxiety significantly affects ability to function
• Shame becomes overwhelming
• Meltdowns become more frequent or intense
• Suicidal thoughts emerge
• Self-harm urges increase

Looking after mental health is as important as physical health.

Understanding Shutdown Vs. Meltdown Management

Shutdowns involve complete loss of functioning ability and speech. Postponing a shutdown until a “safe” place to shut down (pulling over a car, turning off stove, ensuring childcare) requires enormous effort, dramatically increases stress and tension, and makes Shutdowns more intense and longer-lasting.

This is important for people and employers to understand: allowing shutdown when it comes is less disruptive than forcing the person to delay it. Full Shutdowns can last days and require complete rest in bed.

Pica and Non-Food Ingestion Requires Medical Treatment

If compulsively eating non-food items, medical attention is essential as this can cause serious harm. This is particularly associated with certain mental health conditions and nutritional deficiencies.

Self-harm During Meltdowns

Some Autistic people experience pinching, hair pulling, wall-banging, or head-banging during Meltdowns. This requires professional mental health Support to identify underlying causes and develop prevention strategies.

Medication Safety and Supervision

Benzodiazepines (anxiolytics) are habit-forming with addiction risk. Melatonin should only be considered after optimizing sleep hygiene; timing and dosage matter. Any medication must be used under direct doctor’s supervision. Mental health medication should be paired with psychotherapy for optimal outcomes.

Nutritional Deficiencies Impact Mental Health

Nutritional status directly drives mental health outcomes. Blood testing should be conducted when mental health challenges exist to identify deficiencies. Treating nutritional deficiency often dramatically improves mood and functioning.

Some Autistic people have extremely restricted diets due to taste aversions, making supplementation important. Others over-eat specific tastes (salt, sugar) or may have eating disorders, requiring professional dietary Support.

Forced Desensitization Is Ineffective and Harmful

Never pressure an Autistic person to desensitize to smells, tastes, or textures. Forced exposure is torturous and doesn’t work; it causes trauma and doesn’t improve tolerance. Only self-directed, controlled exposure at the person’s pace is effective.

References & Resources Mentioned

• NICE Guidelines 2021 - Guidelines for adapting psychotherapy and counselling for Autistic clients
• Dr. Martin Seligman’s PERMA Model - Framework for well-being including Positive Emotion, Engagement, Relationships, Meaning, Accomplishments
• Dr. Dan Siegal’s “Name It to Tame It” Strategy - Emotional regulation technique based on neuroscience of emotion recognition
• Kapp et al. 2019 - Research on stimming in Autistic adults (32-participant study)
• 2018 Study of 443 Autistic Adults - Research on special interests and quality of life
• Pennisi et al. 2021 - Research showing Autistic people demonstrate higher originality and detail in creative work
• Davidson et al. 2017 - Research on shame in Autistic adults
• Brown 2013 (Brené Brown) - Distinction between shame and guilt
• Temple Grandin - Visual thinking and Autistic cognition pioneer
• Wilbarger Protocol - Occupational Therapy brushing technique for tactile defensiveness
• WHO ICD-11 - Includes “gaming disorder” classification (higher rates in Autistic people)
• Occupational Therapy Services - For Sensory processing Assessment and intervention
• Psychotherapy/Counselling - Talk-based mental health Support
• Specialized therapies: EMDR (Eye Movement Desensitization and Reprocessing) for traumatic memories; CBT (Cognitive Behavioral Therapy) for thought patterns; animal Therapy; art Therapy; music Therapy; drama Therapy; mindfulness-based therapies
• Psychiatry Services - Medical doctors who can prescribe mental health medications
• Dietician Services - For addressing food aversions and nutritional deficiencies
• Sleep Hygiene Practices - Consistent bedtime routines, avoiding screens/blue light, no large meals before bed, consistent sleep times, daily exercise, natural light exposure, complete darkness at night
• Online Autistic Communities - For connection (use cautiously to ensure supportive rather than harmful communities)
• Special Interest Clubs and Classes - For social connection around shared interests reducing social pressure

Who This Book Is For

This book is ideal for:

• Newly diagnosed Autistic adults exploring what Autism means for their daily life and well-being
• Undiagnosed adults exploring their neurodivergence seeking practical strategies that align with Autistic experience
• Autistic adults struggling with Sensory overwhelm, Emotional dysregulation, or Burnout seeking concrete, actionable strategies grounded in both research and lived experience
• People in relationships with Autistic individuals (though better resources exist specifically for partners and carers)
• Occupational therapists and mental health professionals working with Autistic clients seeking to understand Autistic perspective on Sensory needs and Emotional regulation

The book assumes basic familiarity with Autism but doesn’t require prior knowledge. It prioritizes lived experience alongside research, making it accessible to people at various stages of understanding their Autism. The author’s nursing background and mental health training ground the advice in both professional knowledge and personal experience.

Level of prior knowledge assumed: Understanding that Autism is a Neurological difference (not illness or deficit to be cured), basic knowledge of executive function or willingness to learn, comfort with discussing emotions and Sensory experience explicitly.

What different readers will gain:

• Newly diagnosed people will develop concrete understanding of how Autism affects their neurology and actionable strategies for self-care
• Established Autistic adults may discover new frameworks (PERMA model, Three-Step Sensory Regulation) or validation that their experiences are Neurotypical for Autistic people, not personal failings
• Mental health professionals will gain insight into Autistic-specific needs in Therapy and Sensory accommodation requirements for effectiveness
• People exploring undiagnosed neurodivergence will find descriptions of Autistic experience that may resonate with their own neurology