- cross-posted to:
- neurodiversity@lemmygrad.ml
- cross-posted to:
- neurodiversity@lemmygrad.ml
As an AuDHD person, the college dropout story is relatable to me, except for the YouTube career success. I grew up in a madhouse during my traumatic childhood, and going to college free from my backwards, overprotective, overly strict parents was essentially like falling off a cliff. I was already burnt out during my last year of high school, and I was too excited with the freedom and ended up wasting time playing video games and skipping classes regularly because I had little energy to function as an adult. I still struggle with burnout to this day due to being an overworked IT contractor for years.
Unsolicited advice specific to auDHDers:
AuDHDers tend to be more sensitive to stimulant meds, going by anecdotal reports
Stimulants tend to "bring out" a lot more autistic traits, some report that it is more difficult or downright impossible to mask on stimulants
I'm of the opinion that auDHDers are particularly prone to developing posttraumatic symptoms (call it low-grade PTSD or legit PTSD or developmental/C-PTSD - I'm not really concerned about how it gets described tbh, can go into this in more depth if anyone wants)
Most people who have experienced significant trauma and/or unresolved trauma as an ADHDer report finding that going on stimulants can cause a pretty rapid processing of that trauma, so it can be a bumpy ride in the early days
Stimulants can be particularly useful for dealing with executive dysfunction and burnout
Stimulants need to be used carefully with chronic or severe burnout
Stimulants have a complex relationship with autistic catatonia, and catatonia in general, however based on my own personal experience I'm of the opinion that long-term stimulant use can exacerbate autistic catatonia and potentially to precipitate it
I think that auDHDers are particularly prone to having an overworked nervous system, partly due to social factors, partly due to sensory sensitivity, and the ADHD emotional reactivity amplifying some common autistic experiences, amongst other factors. I think it's really important for auDHDers to look at managing this with augmentative ADHD meds (clonidine/guanfacine/certain other meds) either at the same time as starting stimulant meds or soon after. It's not for everyone but I think it's worth exploring to see if it fits your needs.
I recently wrote another comment that goes more into stimulants for ADHDers, which may be of interest. Here's the comment.
Note that I'm far from being opposed to the use of stimulants for ADHDers/auDHDers - I use them myself, I have absolutely relied upon them to get me through so they have been critical for my own wellbeing, and under most circumstances I'd encourage ADHDers to get a prescription for stimulants.
That being said, some people don't need or want stimulants, some people don't play well with them, they don't play well with some people and so on - I'm in full support of people who take non-stimulant meds or who manage ADHD in other ways too. For some people, appropriately-medicated ADHD is unmedicated ADHD and I respect that.
Damn, you have so many great comments on ND. Have you thought about making some posts with all this knowledge? I would love to read it.
Thank you!
I really need to pull my finger out because I need to write a deep dive post on autistic burnout and catatonia, and another one on how ADHD and autism intersect when they are co-occuring. I suppose I could do another one giving a rundown of the main medications used for ADHD and how they tend to work for people too.
I've been struggling with pretty severe burnout. Honestly, it's the absolute worst of my entire life. So at the moment I get brief jolts of inspiration to reply to comments here and there and then I either lapse back into the void or I have life committments to deal with so these sporadic comments are the best I can muster a lot of the time.
I also have crippling posting anxiety and making a genuine post is hard because I invest too much into it and feel overly responsible for replying and stuff. Is that a symptom of grass-deficiency? It's definitely a symptom of grass-deficiency lol
Can't tell, I do so little grass touching.
Hope to one day see some, not trying to put pressure on you though.
Coming back to this to say I'd really appreciate your post on Autistic Burnout. I think I'm going through it right now. Wheeee
I'm sorry to hear that.
I'm in a bit of a slump right now so I'm going to scrape together the barebones advice but it's probably going to be a bit scrappy rather than being a fully-developed effortpost like I can usually produce.
Here goes:
Create structures and schedules etc. so that you aren't using up precious executive function trying to figure out what tocook or what you're supposed to be doing.
Outsource whatever you can, draw on support from loved ones and the community to help you manage things.
Reduce your commitments where possible (study, work, volunteering and organising work etc.)
Opt for the easiest option, wherever possible - takeout, ready meals, getting groceries delivered, protein shakes or smoothies as simple meals etc.
Do gentle exercise if and when you have the energy to, but don't push yourself
Engage in the things that excite you and give you energy - hobbies, deep interests, spending time with good people and pets
Try to spend some time in natural environments if possible
Meditation and other mindfulness activities can be helpful
Allow yourself the opportunity to do less, don't beat yourself up over needing to recharge
Try to get vegetables into your diet where possible
Try to maintain a regular sleep schedule and good sleep hygiene (lots of info online about this)
Try to reduce/avoid alcohol and most drugs, with the exception of prescription drugs and maybe cannabis if you feel that it is helpful. Try to reduce your caffeine intake as much as possible too.
Try to engage in stims, especially calming or soothing stims. Schedule this in if you need to. Try to double up on stims at the same time to make the most of it - go for visual, auditory, tactile, gustatory/olfactory, and vestibular if you know what works for you in these domains.
It might be autistic catatonia. Don't have it in me to write out a post that this topic deserves right now. Here's the basics:
If you want to test to see if it's autistic catatonia, taking most benzodiazepines (especially lorazepam) should cause a rapid and noticeable lift in the symptoms. This can also be achieved through zolpidem and zopiclone, which are usually much easier to get your hands on.
Lorazepam and zolpidem/zopiclone are not necessarily going to resolve the catatonic episode but there will be at least a temporary improvement while the drug is working in your system.
If you take zolpidem/zopiclone and you fall asleep then that's a pretty surefire indicator that you aren't experiencing catatonia at that time.
(I would anticipate that valerian extract would also work in this respect but to a lesser extent. As it's a herbal supplement it is easier to access.)
Longer-term management of autistic catatonia requires reducing your levels of stress, especially anxiety, and not pushing yourself too hard.
For longer-term maintenance and prophylaxis of catatonia you want to aim for NMDA antagonists:
Ketamine therapy
Topiramate
Amantadine/memantine (given a choice I'd opt for amantadine as the preference)
Dextromethorphan (especially combining dextromethorphan and together bupropion but ensure that you're doing this under medical supervision from your prescribing doctor, or just get your hands on Auvelity through a prescription)
Tramadol
Gabapentin
Nitrous oxide therapy (you would need to find out if there are any clinical trials going on in your region. If you opted for self-administering nitrous, there are risks involved.)
For supplements there are a few options:
Magnesium
Zinc
Vitamin C
Creatine
Phenylalanine (aspartame sweetener contains phenylalanine)
Agmatine
Guanosine
Some of these things are going to be easier to get your hands on than others. Some are relatively safe at recommended doses, especially magnesium, zinc, vitamin C, and creatine. If it's within your means there's little risk of throwing them at yourself (at the recommended dosages) and seeing if there's any improvements, especially if you have identified that you are experiencing catatonia. Even if you haven't identified catatonia as a cause, there's minimal risks associated with those and you may get other benefits from them anyway so you don't have much to lose.
Dextromethorphan is probably available over the counter where you are. This puts it much more within reach than some of the other medications. Unfortunately it gets metabolised very rapidly for the purpose of treating catatonia and this is why taking it with bupropion is ideal. (There are lots of other CYP2D6 inhibitors out there though and this is getting beyond the scope of the reply and squarely into the territory of needing to do extensive research and, ideally, getting professional advice but fluoxetine, paroxetine, venlafaxine, duloxetine, sertraline, and others also inhibit this enzyme to a certain extent but at the very least if you're going to take DXM with one of these then make sure that your pharmacist gives it the greenlight first.)
Also some of the medications listed are going to vary with regards to side effects and accessibility - Ambien isn't that hard to get your hands on, lorazepam is probably going to be a lot harder, most doctors will be baffled if you try to get amantadine but there's minimal risk of abuse, interactions, and even side effects so if you can make a compelling case then you've got a decent shot of them agreeing to it whereas trying to get benzos is probably going to be a lot harder (and rightfully so - I'd strongly recommend avoiding benzos for anything beyond a couple of one-off doses as they are extremely addictive and are very hard to kick once you become dependent).
If you get relief of catatonia be careful not to throw yourself right back into the conditions that produced your catatonia or you risk exacerbating the problem.
Try to treat catatonia as the product of a lifestyle that is unsuitable and unsustainable over the long-term, with medication and/or supplements being a measure to help you get out of the worst of the catatonic symptoms, so that you can start making positive changes to address the root cause(s). Don't do the equivalent of yo-yo dieting - swinging from catatonic episodes to treating the catatonic episodes to going straight back into a lifestyle that causes catatonia only to relapse into another catatonic episode. Easier said than done though.
Let me know if you want more information about anything and I'll do my best to elaborate or to point you in the right direction for more info.
Thank you so much ❤
Damn, this is a good effortpost
I read that comment when you posted it! Doing my best to learn I guess, even before I accepted this might be a thing lol
I have no idea if stimulants will work well for me. I've definitely used caffeine to self medicate most of my adult life so maybe? But either way I know it won't be a magic bullet, just one thing to try if a doc recommends it I guess. I honestly don't know what not being able to mask would look like for me, but I work from home on a computer and have very accepting friends so hopefully the adjustment wouldn't be too rough? I try not to downplay (or play up) my own struggles but all things considered I've lived a pretty chill life I feel like. Lots of self-repression and some serious struggles socially at times but you know, not outright horribly traumatic? So maybe that helps idk.
Thanks for your prolific support and advice all over the site! I just got new insurance so I'll have to see what it will cost to see someone this summer. I hate to say it but I want to see if I can get the ball rolling on this diagnosis stuff without telling them I'm trans... (is that a horrible idea?) Let's just say I don't want to be on that list given the way the US is going lately... My gender is none of their business and even barring government action, telling your doctor you're trans unfortunately seems like an excellent way to get subpar medical care. Or maybe I'm needlessly paranoid but I'd rather be paranoid and wrong than the target of fascist repression or plain ol discrimination.
Oh cool, I'm glad that it got to some of the right people.
The take from one of the foremost global experts in ADHD is that stimulant meds cover about 80% of ADHDers - methylphenidate/ritalin works well for about 40% with amphetamine-based stimulants (Adderal, Vyvanse etc.) working for about another 40%, so there's a good chance that they'll work for you. Honestly I suspect those numbers are a bit low because there's probably another 5 or 10% at least who find that stimulant meds do work but that they can't continue using them because of certain side effects (e.g. weight loss, insomnia etc.)
If we throw in stimulants that aren't the classical ones, like modafinil, I think that number would probably get bumped up a bit higher too.
That's the right attitude to approach stimulants imo.
Cool, that's one less thing to worry about then.
If you're in a customer-facing job or you're in social circumstances that require high masking it can be really difficult for some people because they often find themselves stuck between choosing to be functional and choosing to be a socially-palatable disaster.
I think not being able to mask often presents as being less concerned or less focused on determining the emotional state of others and attempting to match it, along with stimming more, and being less inclined to put a lot of flair into the way you speak and use gestures and stuff like that. There's probably some other stuff that I can't think of at the moment which I'm overlooking too.
That's good to hear. It's definitely going to make things easier for you if you do end up being prescribed stimulants.
Though it's worth keeping in mind that often the self-repression and masking comes due to experiencing a lot of hard knocks socially. This is not to diagnose you or to pathologise what you've been through or anything but sometimes when it's the background noise you just get so accustomed to it being there that it becomes your normal. Stimulants often bring that stuff to a head; I am diagnosed with PTSD and I legit have this condition so this is me just hypothesising but if the stimulants bring that stuff to a head for me then I suspect that it would do the same thing, to a lesser degree, for people who are sub-clinical or who have had some tough battles but where they don't have symptoms of PTSD/they only have milder ones.
All of this is speculation though. This is a massive blind spot in research and as far as I'm aware there's no efforts to really understand this from academia yet. We need more neurodivergent folks in research asap.
Ah no worries. I'm just glad to help and to do my bit to contribute to the knowledge base on these topics because there's such a gap that exists currently.
Honestly it's one of those things where being cautious is something that I'd recommend, if someone were to ask me.
A lot of things stick with your medical records and, although I'm somewhere in the non-binary spectrum (meaning that I'm not cis so therefore that means I'm trans) I've never really hashed this one out with myself because I have had more urgent priorities so I am happy to sit this stuff out since I'm barely even an expert in my own experience. That means this next bit is just me making an educated guess here but I suspect that if you're trans in the sense of being opposite to your assigned gender and you're open about it with medical professionals then you're probably going to receive less quality of care and you run the risk of having anything you present with as being considered a "trans issue". Idk if I'm making sense here but for people with chronic mental illness they very often report that medical professionals just get locked in on the mental health stuff to the exclusion of everything else, so it's hard to get physical issues considered and often it just gets lumped in as being caused by mental illness or brushed off as a side effect of medication. I have no knowledge about this for trans people but I have a suspicion that, in a similar way, a lot of doctors would be quick to blame ADHD symptoms on a person being trans or on hormone therapy side effects and stuff like that. Hopefully a trans person who is knowledgeable about this stuff might chime in with their experience to let us know what it's been like for them.
Then, as you've mentioned, there's the overarching concerns about politics and long-term safety to consider as well.
So my general advice would be to try and go for an ADHD diagnosis first, if you're able to prioritise it, and go from there. Honestly an autism diagnosis probably only provides you with about the same study and workplace accomodations as an ADHD diagnosis would, and given the cost of an autism assessment it might not be worth the price of admission.
To be clear, my childhood wasn't severely traumatic, but stressful enough that I had forgotten most of my childhood.
I have been diagnosed with Autism and ADHD at an early age. Of course, the doctors said at that time that I would never be able to experience any emotion besides anger and sadness for my entire life, so I would be careful with the information you give to them and try to find a good psychologist/psychiatrist. I have had to jump between multiple as often they were on a grift to get me on a particular med that didn't work for me. This was during the med change after dropping out of college, but I had other doctors before that wanted to use me for profit when I was younger. Others were just backwards and refused to update themselves in their profession.
I have been on the max dose on methylphenidate since middle school. It does work for me, but I have taken it so long that I believe the effects are not enough to overcome my severe burnout. When I quit my job, I am considering going off meds for a week and sleeping all day. When I have had breaks with my stimulant, its effects have improved again for another period of time until the burnout overcomes it again.
I went on antidepressants for situational depression after dropping out of school, and then I continued going through a med change and ended up back on a stimulant again, but this time Vyvanse. It's effects were the same on me, but I believe I felt a bit weird (tingly in the brain?), so I think the side effects were worse on me. I went back to methylphenidate because I was poor and it was cheaper at the time. Going back on stimulants after around a year made me feel much more functional again.
I have also been drinking a lot of caffeine on top of my stimulants, sometimes even 600-1000 mg, because I have been struggling to do work. Once I drink around 900+ mg, I get a terrible headache and stomach ache, so I try to avoid that range.
Rant incoming
I haven't been able to take a vacation for so long, and I feel a 6 month vacation would be necessary for me to recover.
A lot of the people in my job are quitting and moving to other positions as my workplace, a $200 billion indie company, refuses to invest in more IT people even though they spent millions on an IT audit only to find out we are more than 50% understaffed, meaning we would have to over double our IT team, including contractors. My coworkers say one day we are going to be all just contractors.
Meanwhile we have problematic higher-level IT teams that treat production as the testing environment and constantly break things. They're a bunch of dinosaurs that were grandfathered in to higher positions and have no experience outside of the company, thus they are a bunch of egotistical morons that refuse to hold themselves accountable or admit they made a mistake, turning every email that could have been 5 minutes to resolve a user's issue to an hour long argument. They also make decisions such as "let's delete Visual C++ off of everyone's computers because it is a sEcUrItY vUlErNaBiLiTy!1!", and then everyone's softphone stops working, which I called way beforehand and no one listened to me.
A script was requested to disable settings on a network adapter that have been causing disconnects and reconnects in our environment, and an old contractor in our team that was hired to be in the networking team with no experience mentioned they attempted a small script. I then added to the email that I already have an improved version already in production to run on new machines, and they congratulated the networking guy, circlejerked each other exclaiming how well they are communicating, meanwhile completely ignoring me.
These glorious geniuses also use ChatGPT (prohibited at our workplace) to create scripts without any modification to match our environment needs. We have also had scripts from the higher level IT teams that are completely broken and that have been running in our environment. I didn't even know PowerShell starting my job, but I managed to quickly learn to write scripts at a professional level and had to fix all of these broken scripts made by our lovely Newtons who had a frozen apple fall on each of their heads.
The company also uses the worst software ever because they buy everything a shell company tries to sell them. Meanwhile they are harping on us regarding tickets and making every project a number one priority, so honestly what's a priority at this point.
I honestly feel the work I have to do would be very difficult for even neurotypicals, and it's amplified due my neurodivergence and ongoing, worsening burnout. I'm going back to college next year in a last ditch effort to turn my life around.
I have been going very late to my job, and I use the restroom a lot out of anxiety and stress. It's a 35+ min drive to work and a 45+ min back home, and it absolutely sucks. I think I have managed to keep my job as I have made a lot of PowerShell scripts that have helped the company immensely, which I even received a large pay raise and multiple gift cards for. I feel as I have always relied on my ability to do work at a perfectionist quality to make up for my shortcomings.
I went on Jornay during my current job, which seemed to help me get to work on time a little easier, but I had to go back to my old meds because it was very expensive, and it would really suck when I forgot to take it the previous night.
question: does it mean anything if caffeine can have varied, random effects? sometimes it makes me jittery, to the point of anxiety like i'm being chased. other times it makes me blackout tired. there's a spectrum here, and i rarely land in the 'wakeup' zone that most neurotypicals seem to be in it for. it doesn't seem to matter what my energy level is beforehand.
also, i want to thank you so much for your post in the other thread and this one. i've been taking notes since i'm starting on my third journey for treatment.
There's a lot of moving parts in that question lol
So different people seem to be more or less sensitive to caffeine and medications or sometimes even other things like diet or especially supplements can affect how caffeine affects you - for example L-theanine with caffeine seems to really smooth the rough edges of caffeine and it's something that naturally occurs in tea so a person might notice that the caffeine from tea doesn't affect them in the same way that coffee does. Likewise different ways of processing coffee changes the amount of caffeine you get so two coffees of the same volume can have different effects due to their respective caffeine levels.
Then there are certain things that can inhibit the way your body processes caffeine so if you drink an energy drink with taurine or guarana in it, for example, then that can interfere with how your body metabolises caffeine, making it feel stronger and making its effects last longer.
Then there's other factors associated with lifestyle that impact this. If we take an ADHDer as an example then it's well known that poor sleep quality really fucks with ADHDers and they might find that caffeine doesn't seem to have much of an effect when the have been struggling with sleep.
There's more that I could go into with this but I'll wind it up there so this reply doesn't drag on unnecessarily.
Without knowing more, at a guess that sounds like you might be on the far end of the arousal curve. Don't take this graph as being the be-all end-all but:
Any stimulant is going to push you further to the right on that curve. (I don't think that anxiety belongs strictly in one part of the curve but it'll do as a rough guide.) If you're already feeling fatigue, especially if it's a chronic sort of fatigue then caffeine might push you into hardcore anxiety. Or it might push you beyond that point into the complete exhaustion/burnout zone where you are just ready to collapse.
It gets more complicated with ADHDers because for some ADHDers they find that the stimulating effects of caffeine to help them feel centred and relaxed, so often ADHDers will report that caffeine can put them to sleep. Though that's not the case for all ADHDers, certainly not for myself except in rare occasions, so I wouldn't use this to rule anything in or out especially without knowing a whole lot more about what's going on for you.
General advice?
Sounds a lot like burnout, which can affect anybody. I would do recommend trying out the general advice for burnout management and see if that improves things for you - focus on improving your sleep quality, try to avoid additional stress, opt for light exercise that isn't too prolonged where it's within your capacity to do so, cut some corners where possible so you have fewer demands on yourself, go easy on caffeine/alcohol/other drugs, regular mindfulness and relaxation are good habits to cultivate etc.
Worst case scenario from gradually integrating burnout management advice into your lifestyle?
You end up feeling more relaxed and less overwhelmed so the risks from trying this stuff out are pretty minimal and even if it's not the answer that you're looking for it's probably going to be of minor benefit to you. The risks of not addressing burnout early enough, on the other hand, can be pretty disastrous.
I'm always glad to share info, especially when it's helpful for others.
Good luck with the treatment!
Keep at it, even if you feel disheartened, because the more treatments you try the more you will be able to narrow down what works for you and what doesn't. Over time this can form a picture of what's going on for you so that you are able to get to a diagnosis/treatment/lifestyle that fits your circumstances.
yeah, that tracks. my current journey started because of more than half a decade of being in a constant state of burnout.
i have, and have been, for about three years now. it's made the bad less bad, but it hasn't made the good any more good (or stopped or slowed my semirapid decline).
what i already know is that i have autism and cPTSD. i've been in a constant state of stress for over a decade.
in my first journey: i was tentatively diagnosed with ADHD in another country, but i wasn't granted autonomy yet, and the stigma and cost of ADHD treatment didn't make it an option for my owners.
so, the second journey was of course court-ordered applied behavioural analysis and institutionalisation for suicidal depression. i've been on just about every single antidepressant and antipsychotic and been thru every CBT-derivative psychotherapy you could probably name. y'know: treating symptoms (chronic depression, 'conduct disorder') rather than causes (horrible environment, trauma, executive dysfunction). the consistent effect was that it made everything worse (and in some ways: permanently).
now, in my current country, the barrier is that my doctors are suspicious of how direct and articulate i am with what evaluations and treatment options i'm considering. they're all either incompetent or their knolwedge is 40 years behind, and they've seemingly decided that i seem too introspective and too selfaware to possibly be feeling like shit. their prescription? join a book club and go back to work. and of course postcovid and burnout and shit sleep are making it hard to find the energy to argue with these people. so, that's cool.
i understand being direct can make doctors get defensive, but i've tried the coy social engineering approach and it got me involuntarily hospitalised. *shrug*
anyway, thanks for the information and support.
Ah that makes a lot of sense then.
I think that's a really positive sign. I know how badly it sucks. Intimately. I've reached depths of burnout that I didn't realise I was capable of.
Imo the worst parts have to be reduced in severity before you start seeing glimpses of improvement in the good.
Hang in there.
This makes a ton of sense.
This is a familiar story. Any therapist I see, I basically tell them straight-up that I'm allergic to CBT and that I ain't fucking with that shit anymore.
I'm not opposed to CBT if it works for someone but I've heard so many bad reports about CBT from autistic people, not to mention having things made a whole lot worse for me because of it. It might be confirmation bias but if someone is autistic and thinking about CBT-based treatment I'm always going to tell them to approach it with extreme caution.
Also CBT I think is pretty bad for people who have CPTSD. Put CPTSD and autism together and CBT is horribly counterproductive.
Also antidepressants tend to be pretty garbage for autistic people generally. I can't tolerate most of them. I've had some degree of success with mirtazapine, which is an unusual antidepressant in how it works, and same with agomelatine, which is a particularly unusual antidepressant (although I believe that it isn't available in the US). Otherwise? I've only had awful experiences with antidepressants.
I feel this. "You've got a lot of insight" is like a trigger phrase for me lol. I had to find a really good psychiatrist before I could make progress - one that was genuinely interested in working in partnership with me, and it's only since that point that I've developed an understanding of psychopharmacology, because I've been able to bounce ideas off of them and we've been able to talk about targeting specific things and to assess the effects of medication to be able to hone in on particular symptoms to find better medications.
Even then, my psychiatrist isn't very knowledgeable about ADHD or autism and yet they're better on these matters than any other doctor, psychiatrist, or psychologist that I've ever come across.
It sucks that it has to be like this. It sucks that I had to become my own amateur psychiatrist. But this is something that motivates my posting, especially in this comm - it was really fucking hard for me to bootstrap myself into understanding these things (I never paid any attention in science class) but I'm lucky that I have enough of the right factors that I can approach this subject and understand it to some degree. Not to shit on anyone else but I think I am extremely privileged to have the circumstances I do (e.g. I have a stable home life, I don't have to work 3 jobs to make ends meet, I can bend a special interest to my will enough to learn things sorta on demand, I've done a lot of groundwork to learn how to do autodidacticism properly, I have a psychiatrist who I can bounce ideas off of and who's willing to prescribe me most things if I can provide a decent case for it etc.) that make it possible to be knowledgeable about this stuff. And if I can make this stuff a little bit more accessible to other people who need it then I feel like it's really important work since so many of us are just caught in a massive drought of services, support, and information.
That double bind really sucks, doesn't it?
I think two things that have been really useful in this situation is to come off as jaded - I've been stuck in this damn system for years and I've been through so much of it, so I'm going to let clinicians know that I'm a veteran. If that makes them feel threatened or defensive then I know I need to find someone willing to work with me on my level.
The other thing is that I'm just extremely honest - if I have misgivings about a treatment I'm going to voice them, if I think a clinician is wrong I'm going to tell them. This rubs some people up the wrong way but that's fine because if they can't deal with me unfiltered then we won't be able to make much progress.
If that puts some clinicians off from working with me then all the better. I'd rather identify the shit ones so I can move them along than to be stuck long-term with a clinician who I only realise is shit after investing a lot of time and effort.
No worries.
Sorry for rambling so much. I've started drafting a post on autistic burnout/catatonia in my head so I'm hoping that I'll be able to produce something on this topic soonish. I should be able to put some stuff in there that will be useful to you which will be more than the boilerplate advice about managing burnout.