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Writer's pictureCynthia Toh Xin Ru
Sep 22, 20207 min read

Autism Explained Summit 2020 Day 1: Common Co-Occurring Conditions

Updated: Apr 15, 2021



The Autism Explained Summit 2020 was a 5-day free online conference which aimed to improve caregivers' relationships and ability to support their autistic children. The conference featured more than 20 speakers with first-hand knowledge and experience across the autism spectrum. The summit was hosted by Paul Micallef, who discovered he was on the autism spectrum 4 years ago.


Organisation Website: https://www.autismexplained.com.au


Day 1 focused on common co-occurring conditions.


Dyspraxia and Anxiety - Tim Chan


Dyspraxia affects fine and gross motor skill, motor learning, balance, and coordination issues. Examples of difficulties include physical activities like ball games, writing and drawing, speaking, hand-eye coordination, planning and organisation, as well as independently doing tasks like personal care and household chores. It is particularly challenging to plan and carry out actions involving multiple steps, due to a lack of body awareness and control. Navigating social life is tiring because social situations call for multi-tasking and appropriate responses to coordinate the event and people.

People with dyspraxia tend to have high levels of anxiety due to difficulties in acting on their intentions or finding timely responses. This anxiety can in turn interfere with their ability to think straight and respond appropriately. According to polyvagal theory, the body reacts to increasing danger with a fight, flight, or freeze response. There are 3 major brain systems involved in an instinctual physiological response when a person is anxious, starting from the lowest brain region.

  1. The brain stem controls our core functions such as the heart rate, body temperature, respiration, and blood pressure. Hence, his heart rate increases, he breaks out in cold sweat, and his breath is shallow.

  2. The mid-brain handles emotional responses. According to trauma expert Peter Levine, he may experience urgent and negative emotions such as fear, rage, hatred, and shame.

  3. The cortex state regulates the most complex functions, such as speech and language, abstract thinking, planning and decision making. As more complex cortical functions are impaired, this leads to helplessness, numbness and depression. He may also have sensory overload, and have difficulty processing information.

Helpful strategies:

  • Educate the person on how his body and anxiety function.

  • Practise yoga and increase body awareness.

  • Establish familiar places and people.

  • Let the person know what is in store in advance.

  • Give support in carrying out tasks.

  • Speak briefly with gestures and visual supports.

  • Be patient instead of giving pressure.

  • Calm the person down by humming or singing in a soft and soothing manner.

  • Provide alternative modes of communication such as typing using assisted technology, if the person has oral motor dyspraxia and cannot rely on spoken language. Facilitators can provide support by allowing the person to have control and time in typing, giving encouragement, directing focused attention, and prompting the next stage of action. Facilitators should not interrupt by using predictive text or filling in the blanks for the person, which can be distracting and discouraging.


Alexithymia and Emotional Dysregulation - Prof. Tony Attwood


Alexithymia refers to a difficulty in identifying and describing feelings. A person with autism may feel a negative emotion, but have difficulty knowing what emotion it is and how to explain it to others. This results in challenges in regulating his own emotions, and challenges in communicating his emotions to others. Hence, the person might cross the limit and have a meltdown in a way that appears sudden when it has actually been building up inside. Prognosis is usually not so good for someone who has autism plus anxiety, depression, or anger management.


People with autism usually have heightened sensitivity to external signals, such as sounds, aroma, and light intensity. However, they usually lack sensitivity

to internal signals, such as needing to go to the toilet, being hungry, and body temperature. Thus, they may not be aware of their emotions physiologically. People with autism may also have trouble putting thoughts and feelings into words, and therefore cannot express their emotions verbally.


Helpful strategies:

  • Teach emotion education. What are emotions? Why do we have emotions? How can we identify emotions in ourselves? How can we identify emotions in other people? How can we regulate emotions?

  • Allow the person to learn emotional literacy via indirect ways, such as listening to music and reading fiction.

  • Encourage the person to express themselves in ways other than speech, such as art therapy, music therapy, poetry, and photography.

  • Give the person a number system to describe his emotions like, ‘On a scale of 1 to 10, how happy are you?’ This is in contrast with questions that are too open-ended like, ‘How do you feel?’

  • Use neutral or compassionate listening when the person shares his intense feelings and allow him to get the feelings out of his system. Say supportive things like, ‘I can see your perspective.' This is in contrast with asking for a logical, cohererent, sequential explanation of why the person is upset, or giving negative evaluations of the person’s feelings.

  • Learn to read the person’s emotional state by looking at his body language, his tone of voice, and his conversation topics.

  • Provide a sports watch for the person to become aware of internal physiological signals, such as heart rate and perspiration. This can warn him of an impending meltdown. This can also help him to sit comfortably, concentrate on breathing, and make the numbers fall.

  • Impart mindfulness strategies such as yoga and meditation.


ADHD - More Than Just Attention - Jessica McCabe


Common challenges:

  • Severe difficulty in regulating attention, such as being distracted by multiple things or being hyperfocused on one particular thing. The person may be blamed for not trying hard enough, but it is because the brain has impaired working memory and executive function. A person who has both ADHD and autism may have an even more intense and long-term focus on a special interest due to a preference for familiarity, especially in an unpredictable world during the COVID-19 pandemic.

  • Emotion dysregulation, such as getting angry or crying easily.

  • Exhaustion due to the high level of energy invested in doing things or the constant seeking out of stimulation.

  • Inability to fit in with peers due to neurodevelopmental delay.

Helpful strategies: (Try different, not try harder)

  • Understand how the ADHD brain works and the tools that can help.

  • Focus on 1 task or switch between only 2 tasks, instead of multitasking which is ineffective and unproductive.

  • Set deadlines for tasks to introduce a sense of urgency.

  • Add fidget toys.

  • Do something in an unusual way to stimulate the brain with the interest it needs, such as wearing a fun study hat or studying in the bathtub or reading upside down on a couch.

  • Gamify tasks, such as by rolling dice and doing the preassigned exercises.

  • Use Zones of Regulation. When in the green zone (feeling comfortable), it is an appropriate time to make plans and have difficult conversations, as well as practise self-care such as exercising and meditating. When in the yellow zone (starting to feel uncomfortable), slow down and practise mindfulness. When in the red zone (feeling upset), resist the impulse to engage in difficult conversations as cognitive ability has declined, and instead participate in calming activities such as petting a dog.

  • Ask clarifying questions instead of assuming that what others say or do means what you think it means.

  • Learn to stop working or transition to a different task before hitting the limit.

  • Take medication to help with focusing, though this only works for certain problems and for a limited number of hours a day.


Auditory Processing Difficulties - Ebony Birch-Hanger

A central auditory processing disorder refers to a deficit in how people process information at the neural level. This is a problem with attaching meaning to what we hear at the neurological level, despite having normal hearing and normal intelligence. People can have auditory processing difficulties in different steps in the information processing loop, which can affect their ability to process language and contribute to conversations in everyday life.


Common challenges:

  • Filtering out background noise. This is because the person has difficulty with selective auditory attention, which makes it hard to pick out the most important sound and focus on one auditory signal at a time.

  • Monitoring who is speaking in group conversations. This is because the person has difficulty with localising sounds, which makes it hard to differentiate between different sounds and work out where the sounds are coming from.

  • Processing new information. This is because the person does not have existing information stored in the mind that the new information can be easily matched to.

  • Listening continuously. Examples are listening to long phone / teleconferencing calls, or keeping up with several ongoing side conversations. This is because the person has to use a lot of energy to sustain auditory attention

  • Responding immediately. This is because the person faces a temporal delay in processing sound, and therefore needs time to think and respond. This is made worse when others repeat themselves soon after asking their first question, or rephrase the question such that it sounds like new information.

Main signs: (Can be a slightly different presentation at different ages)

  • Asking for repetition. When given instructions or asked questions, the child might constantly say things like, 'What? Sorry? Pardon? Say that again? I didn't hear you.'

  • Not following instructions. The child might get halfway through the process and then forget what the rest of the instructions were, due to impaired auditory memory which makes it hard to remember and recall what has been heard.

  • Mispronouncing words. This should be checked with a speech pathologist as it might be due to a speech need or an auditory processing difficulty.

  • Fatigue. The child might be tired from continuously investing additional energy into processing information.

  • Distractibility or inattention. The child can sometimes be misunderstood as having ADHD.

  • Fidgeting. The child might use fidgeting as a strategy to help with auditory processing, as the auditory system is strongly supported by the vestibular system which is regulated by movement.

Helpful strategies: (Can be beneficial for all children in general)

  • Wait and count 10 seconds before repeating a question to the child. This gives the child time to think and respond.

  • Provide opportunities to fidget and do not force eye contact. Fidgeting regulates the vestibular system, while looking away reduces the amount of visual information.

  • Reduce background noise when giving instructions to the child, especially background noise involving language. Examples are turning off the TV, radio, or iPad, as well as closing the doors or windows.

  • Improve the listening environment by introducing soft and thick materials to absorb the echo of sounds. Examples are bean bags, cushions, table cloths, carpets, and curtains.

  • Provide visual supports to assist the processing of information. Examples are using key word signs, gestures, drawings, writing, timetables.

  • Allow breaks from listening. Examples are a quiet car ride home after school.

  • Observe the child’s behaviour and ask if there is anything that helps them to listen. This helps to develop the child’s awareness of strategies they can put in place for themselves throughout their learning life.


All blogposts on Autism Explained Summit 2020:

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