Watching your teen or young adult’s mental health take a dive can be terrifying, and you are not alone in it. In this episode of The Autism Mom Coach, part two of Lisa’s conversation with licensed mental health counselor Janine Herskovitz, they dig into what Janine sees in the autistic teens and young adults she works with: depression, anxiety, panic, and autism burnout. Drawing on Janine’s clinical experience and her own adult daughter’s late autism diagnosis, they explore why feelings are so hard for many autistic people to identify, why “school refusal” is a symptom rather than the problem, and how to give your child permission to name what they can and cannot handle. Lisa notes up front that this conversation centers on verbal teens and young adults, and that the experience of families with nonverbal children may differ.
In this episode, you’ll learn:
- What autism burnout looks like, how “spoon theory” explains the limited energy many autistic people have in a day, and why pushing through (the hustle so many of us were raised on) can lead to a crash that takes a year or more to recover from.
- Why naming feelings is central to mental health, how alexithymia makes it hard to access or describe emotions, and why a dysregulated child who can answer you one moment and shut down the next is not being defiant.
- Practical ways to support a struggling teen or young adult, from asking “how big is this problem?” to giving them permission to say “I can’t do this today” instead of faking sick, and recognizing when it is time to bring in a coach or mental health professional.
About the guest: Janine Herskovitz is a licensed mental health counselor in Jacksonville, Florida, with a private practice specializing in autism and autism families. She is also the parent of an adult daughter with a level one autism diagnosis and a son with level three autism. Her work and podcast can be found at autismblueprint.com.
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Transcript
You are listening to episode 183 of the Autism Mom. Coach
Mental Health and Autism with Janine Herskovitz, part two.
Hello everyone and welcome to the podcast. This episode is a part two of my conversation with of this episode is part two of my conversation with Janine Herskovitz about mental health. As we mentioned last week in Denise’s practice, she sees teens and young adults with autism. And so in this week’s episode, Janine is going to share with us some of what she’s seeing in this population, along with her experiences with her own adult daughter with autism. , But before I turn to Janine, I want to call out something that’s probably pretty obvious. When we’re talking about young adults and teens who are going to a therapist for help, those individuals are verbal
And of course that’s not the case for every autism parent. I want to just recognize that so that. You don’t feel ignored. We are talking about our experience, and so it’s limited in a lot of ways to that. However, if you have experience in this area with nonverbal folks on the autism spectrum and you would like to offer your insight, please let me know. You can email me at Lisa at the autism mom coach.com.
Alright, with that preamble aside, let’s turn it over to Janine.
📍 Janine, welcome back to the podcast. Can you just take a second and introduce yourself before we dive in? Sure.
Thanks so much for having me back on, Lisa. My name’s Janine Hir. I’m a licensed mental health counselor in Jacksonville, Florida, and I have a private practice that specializes in autism and autism families.
Great. Thank you so much. This is such an important topic for parents and caregivers of teens and young adults with autism. I saw my teen’s mental health take a dive around the time he hit puberty and things got scary quickly.
I’ve also seen that in the experience of a lot of my clients. So please tell us what you’re seeing, because people need to know they are not alone.
That’s a fantastic question, Lisa. It’s very scary to be a parent of a child that isn’t doing well, mentally and emotionally and, for the parents out there that have been through their child having suicidality or depression or even just panic attacks. Those are the main ones that we see.
We’ll see kids talking about hating their lives, wanting to end their lives wanting to hurt other people. And, and then the depression, anxiety, and then there’s also what we consider autism burnout, which is not in the DSM. Right now that we use to diagnose people, but I’m hoping eventually that it will be because it is enough of a problem that we are seeing, at least in our office that I feel like it needs more research.
But that being said we can see depression in kids as young as six or seven years old. What you’re looking for are big changes in your child. If they were, a happy-go-lucky child and now they’re not anymore, if they’re crying a lot, if they’re tantruming more than usual.
These are probably signs that something’s going on. And it’s particularly difficult for our minimally verbal and nonverbal kids, but for the kids that do have verbal ability, and those are the ones we see mostly in my office it’s often really hard for them to even put into words what they’re feeling and what’s going on, right?
So if you think about it, we feel feelings in our bodies and a lot of adults don’t know this. If I were to ask you, where do you feel it in your body, you might know or you might not know. A lot of people, with autism have difficulty in figuring out how they’re feeling and how it’s manifesting in the body.
For example, excitement and fear take place in the same part of the brain. If the feeling is similar, heart is racing in me, I feel it in my chest, it might even get red up to my ear lobes, my body does that, whether I’m scared or really super excited.
So we then have to look at what are the thoughts that I’m having? And what’s the situation in order to decide? How do I feel? Now for us as neurotypical people, that clicks pretty quickly. But if you have something called alexathymia, which is a clinical term for not really being able to access your feelings, understand your feelings, describe your feelings then that can be really difficult.
So we spend time in the therapy room basically talking about. Different feeling words and being able to label a feeling because if you can label a feeling, then you can deal with it. We give things names in the therapy room in order to be able to deal with them. We have a lot of kids that come in whose parents have never told them they have a diagnosis of autism and in their defense, I get it.
I really do get it. If you have a child who, back in the day we called it P-D-D-N-O-S, right? If your child had a diagnosis like that or had an Asperger’s diagnosis, they may have fallen through the cracks now that their teenagers or young adults, in which case we see a lot of teens and young adults coming in with what we call burnout and autism Burnout has been described in a lot of different ways.
Megan Anna Neff. Dr. Neff, she is a psychologist, I believe, and she wrote an incredible book on autism burnout. And I use it with all of my clients. It’s wonderful. And she really talks about in relation to Spoon theory, if you’ve ever heard of Spoon Theory in relation to what I would call a chronic illness.
You only have so many spoons in a day as far as your energy. And once those spoons are used up, you’re done. So I teach this to my clients a lot in order to say, so if you have to get ready for work in the morning, how many of your spoons does that take? So let’s say I have five spoons for the day. For some people getting ready for work doesn’t even take a spoon.
But for some of my autistic clients who are trying to get used to managing their energy, it could take them a full spoon to just get out the door. So a lot of the mental health issues that are going on are coming from not being able to manage their energy properly, not being able to handle the feelings of others around them.
They say that autistic people don’t feel empathy. They do. Very often they’re sucking up all of the emotional energy in the room. Can they always express effectively what they’re feeling? Not always can they always piece out what’s their feelings and what’s not.
They can’t always do that. So very often I will say to my son, if I’m, maybe teary about something, I make sure to tell him, sweetie, you didn’t cause this. I’m not sad because of anything you’ve done. Because the experience of mental illness in general can be very isolating, but also very self-centered.
Yeah. ‘Cause it needs to be, and I think autism can be a little self centering as well because it needs to be because an autistic person isn’t functioning in the world the way that a neurotypical person is. And so helping a family be able to balance, when your child says, I really can’t go to school today, or I really can’t make it to my job today.
For you as the parent instead of pushing back tell me more about that. What is that like for you to just slow things down?
So being raised in an Italian family in the seventies and eighties, you just did what you were told and you just kept going and you kept pushing through, pushed
through.
That’s it. You did it. And that was valued right? In a family, and it’s still valued in our society, that hustle.
So I had to really relearn a lot of that and I’m still relearning.
For the child who wants to stay home from school or is struggling I think what so many of us find is when they are in a state of, not having any spoons left to give, they’re not able then to articulate to us what’s happening.
So you said ask them some questions and I’m wondering if there’s some things that we could ask them to suss it out that would be helpful. If they’re in a state where they are I don’t even know what I’m feeling. I just know that this is a no.
I would, one, you wanna educate your kids that their bodies give them signals and that we need to listen to those signals, but also figure out how to interpret them. So let’s say for example, my daughter who has shared her story on the podcast and has recently been diagnosed at Level one Autism, which she didn’t get until she was 25 years old.
For her, it’s going to look really different than it would for my son who is a level three. She would have sometimes what they call school refusal. I don’t like to call it school refusal. I like to call it Your kid is having a really hard time. Let’s get to the bottom of it.
Yeah.
Because school refusal, just the symptom of whatever’s going on. Yeah. And a lot of times it’s fear over having a panic attack. It’s fear over, I’m not gonna be able to take this test today because I studied, but I don’t remember any of the material. It could be, sometimes the most.
Random things that you just wouldn’t even think of. Oh, my teacher said she was gonna be out today and we’re gonna have a substitute. They don’t know me, they’re not gonna do well with me. And these are very valid concerns and I tell parents all the time, I can’t tell you whether or not you should keep your kid home from school, but try to make a child that has autism do something they don’t wanna do.
Good luck.
Yeah. For sure.
I know that with my daughter her biggest issue was the anxiety and the panic and until we could get meds situated and things like that I would every once in a while say, if you get to a point of burnout and you need to stay home, tell me rather than fake being sick, because you don’t have to lie to me to say I can’t do this today.
Yeah, that makes a lot of sense.
So I establish that with your child in the beginning. It’s not, we, when we were growing up, there was such a top down approach. Mom and dad know everything. We tell children what to do. Children obey and do I think that you still need to set boundaries?
Yes. Of course. Boundaries and limits with your kids. Your kids are like ping pong balls. And they wanna know where the limits are. Yeah. And so I think one of the biggest issues that I see with parents, particularly parents that are being coached on pathological demand avoidance right now is there’s a difference between not making a lot of demands on your child and then not putting any structure at all.
We need both. We need a balance of both. And very often the kids that are struggling the most when they come in to see us, are kids that don’t feel like they’re being heard. And that might or may not be from their parents. A lot of times it’s from their friends, it’s from their teachers.
Most of these kids feel completely misunderstood by everybody around them, and they don’t trust a lot of people. So I’ve had kids that have, after I developed trust with them, which takes a really long time to tell me things that they could never tell their parents, and then I help them get the, the words right in their head to be able to express themselves to their parent.
That really resonates with me because, I had a very open, talkative relationship with my son, but there came a point where I did not understand him because he was coming home and saying things like he felt really lonely. And I would get on the phone with the school and they were like, he sits with the boys.
At lunchtime, they play football on the, he’s always surrounded by people. And I’m like, okay. And or he would say he felt scared to go this to school. And I’m like, what do you mean you this at the time he really likes school. What do you mean you’re scared? Until someone said to me a counselor anxiety feels scary in your body.
And once I started to like tap into that my own emotions and what they felt like for me, I tried to imagine that whatever I’m feeling is 10 times more for him. I’ve had points where my anxiety has gotten really high, where it does, it feels like you’re about to have a panic attack and that, and it’s like it panics you.
And I just imagine like maybe his experience of these feelings is. Is like that. And of course like that would be really disconcerting. And it’s interesting because like my son would be like yelling help me. And if, if he had a bee on him, I would swap the bee away.
But what’s happening is internal and I can’t fix that, so to speak.
Yes. So if you were a parent in my practice, I would want you and your child to come in and have a conversation about what is helpful. Have your, you tell me what have you seen is helpful and have your child say what is helpful that mom does what is not helpful that mom does.
And then, and to really listen. And I know that a parent always has their child’s best interest and I know why you’re trying the methods that you’re trying that aren’t working. But I’m curious, Lisa, what helped you in that situation? What did you end up doing?
What helped you to identify in your son, like how would you help him in those moments?
So we actually did have those conversations and it was probably facilitated by a therapist at some point where, my son likes to chit chat and debrief and break things down. So we would always be doing that.
And so he would, I found a note he wrote and he said before responding to my question, ’cause these are his anxiety loops, mom should ask me, how big is this problem? Is this an emergency? Is this a little problem, a big problem? To put it into perspective. And again, that makes so much sense because if you feel everything at a 10.
It’s hard to cognitively separate that. And so it’s like you’re asking someone whose nervous system is always on high alert to be cognitively present enough to distinguish and as I think about that now, I’m like, wow, that’s really hard thing to do. Yes. And just really more appreciation for how much pressure and how intense that must feel for our kiddos.
Oh, I’m so glad you said that because if there’s something I want every parent to remember in autism, something is off with the fight or flight system. So the fight or flight system in your body is what happens when evolutionarily, if the saber tooth tiger were coming after us, we would be able to run without our conscious brain going, I need to run right now.
It would just happen. So the blood flow goes to all the extremities. Your heart starts beating really fast so that you can do that in our kids and in people with post-traumatic stress disorder, that system is not working the way that it’s supposed to. And you get a lot of false alarms.
Yeah, you get a lot of, this is an 11 when it really should be like a two. What we need to look at is why is it that high for that person? It could be something cognitively they’re telling themselves, but most of the time in people with autism, it’s just a fight or flight response. So if your child can answer you in one situation, but is completely shut down and not answering you in another, they’re not being defiant.
They’re shut down. Yeah. And what happens in the brain when we’re in that fight or flight is that our prefrontal cortex that helps us to plan and make, logical decisions is completely offline. And then amygdala is working overtime
and that’s what happens to every human being.
And then you layer on it that these are people with autism. So there is some more complexity, and then you layer on that you’re dealing with somebody who is younger, so their brain isn’t developed. And maybe biologically they’re 18, but developmentally they’re 14. There’s so many different layers.
So many. So the thing I find so challenging, I mean like the thing that I have found challenging, and I know that many of my clients have found challenging, is that in some situations they do seem to be able to handle it. And I know as a parent it can be confusing. It’s wait a minute. Everything was going fine. And it really takes a lot to check yourself with that because it’s like we see a kid who we think should be able to handle something, maybe because they’ve handled it up to this point or in a certain way, and then when they don’t, our brain goes to this is a problem.
This is just defiance, this is manipulation, this is laziness. And not just say that it can’t be any of those things because our kids are human, I don’t think that’s primarily what’s happening ever.
A hundred percent. I can tell you with my adult clients, I have several clients in their thirties who were late diagnosed level ones and twos, and they were able to get the college degree.
They were even able to hold down a job for a little while and get married, have children. But it gets to a point where they have pushed so hard for so long and not taking care of themselves the way that a neurodivergent person needs to care for themselves. And they’ve crashed and burned as I like to say.
And then what ends up happening is I’m trying to get them disability because they did have a full-time job and now it’s going to take me, honestly, and in my experience with autism burnout, it takes at least a year, at least a year for me to get them back. To functional.
I’m just curious what do you see after high school with some of your, the clients that you see?
Yeah, so that’s a great question. We see a lot of different things. Some if they’re very high achieving or even gifted, they will go through college, graduate, and then, if you think about it from the time that you’re most kids start in preschool, going to school, right?
So by the time, from the time you’re a toddler till college you are told what to do and where to be and how to learn and how to, everything is mapped out for you. Most of us take that experience and then we adapt it. We go, okay, here’s what my schedule’s gonna look like now that I have to make it for myself.
For somebody like me, not a problem. I did it for our kids on the spectrum who are either just going into college or just coming out of college. And in my daughter’s case, it was after she came out of college that she was just like, I don’t know what to do. I don’t know how to do this. And when I would talk to her about what do you want your schedule to look like?
I don’t know. It was just like this big unknown. Like
all this unpaved road ahead.
Yes. And they almost have to learn how to do life again, but in this different circumstance. Yeah. I know that for some people really just need that downtime.
I remember my daughter she would come home for breaks from school. She was in theater school in New York, and she’d come home and she’d say, God, I just want, I’d love to have just a month of doing nothing. I’m like wouldn’t we all not even yeah, that’d be nice, but that’s not gonna happen and Right.
And here I am, someone that should know better. So just in case any parents out there beating themselves up, I
didn’t know.
Yeah. We all know in theory when it comes to other people, but applying it to your own child in real time. Yeah. That’s why it’s very helpful to have a professional who’s standing outside of your experience that you can bounce these things off of
a hundred percent. And that’s I do parent coaching and I do psychotherapy I have clients that just need to know they’re not alone and that somebody else is doing this or has done it.
Yeah.
And I just, and I would say to all of your listeners is, if you’re a parent and have a child with autism, you have what you need to do this. You really do. You know your child. I think the biggest thing that I run into with parents when I coach them is them telling me I thought I had to do it the way that everybody else was telling me I had to do it.
Yeah. And so that’s why I feel like I’m not doing enough. And once they realize, no you’re doing okay. Let’s just tweak this or let’s just tweak this, try this, and I’m the last person in the world to say that I know what’s best for your child. I don’t, but you do. Yeah.
I completely agree.
So now as we wrap up, if you could just give us, some suggestions that you have for parents as we identify this in our children.
Yeah, sure. So if your child already has a diagnosis, be aware that burnout is a thing and could happen. Make your child aware of that too, because if your child is, 10 and older, they can grasp that concept of if we push ourselves too hard for too long, without enough rest for someone on the spectrum is gonna look different from rest of someone that is not.
I might be able to take a nap and bounce back. Someone else might need three days to recuperate after a social event. So I would say start gauging with your child. What does it look like? At what point do they start to burn out?
So for my daughter, for example, she’s given me permission because she is in her mid twenties to say to her, is this too much right now? So if we’re out to lunch or something, great example. We went out to lunch the other day and I said, where would you like to go?
What kind of day are you having? And she said, actually, we can go to, cheesecake Factory. ’cause I’m doing okay today. I can handle it and I really want their cheesecake. And I’m like, super. So in that instance we did, in another instance, she might be like, we gotta go someplace where I can sit outside, or I can only do takeout and then let’s eat it at home.
But I’ve given her permission to check in and say, what can you handle today? And so just those little shifts, and so for your child it might be, Hey, I know you have this test coming up next week. Do you need a little bit of help planning how to study for it? Or are you okay?
And give them the choice, especially if they’re a teenager. Teenagers in general want autonomy and want choices that’s always a good idea. If your child is in their twenties and has graduated from college and just can’t seem to figure it out, then it’s probably time for either a coach or a mental health professional.
For sure. Janine, thank you so much for coming on and sharing these experiences. This is so helpful, and I think it’s a great reminder for parents, to really educate ourselves more on this so that we’re able to give our children the space to be who they are and to manage their own burnout.
It’s like giving ourselves the permission slip, because I see so many of my clients, and I struggled with the, you’re not doing anything. You should be being productive. Recovery is productive.
Yes. Recovery is productive and rest is resistance.
Yes.
Yes. For us too. For us too, for
everybody. That’s right. That’s right.
All right, Janine, again, remind everyone where they can find you and learn more about you and what you do.
Sure you can find everything that I do@autismblueprint.com and our podcast is on both YouTube and Spotify and Apple at Autism Blueprint.
Great. Thank you again for joining us for these two wonderful and much needed conversations.
Thanks again everyone, for listening to this week’s episode of the podcast. If you are struggling. If you are struggling with your emotions and how to manage all of the feelings and anxieties that you are having as your teen or young adult is transitioning, or maybe you feel like they’re masking, you don’t know how to connect with them, reach out to me.
This is something that I help my clients with in my one-on-one program, and it is certainly something that you can get support with in our small. Our small but mighty community of parents to get started schedule your consultation with me. You can do that by going to the episode notes or to my website, the autism mom coach.com. All right. That’s it for this week. I will talk to you next.
