When I began working with autistic adults, there was only one book I could find on the topic. It held a very narrow perspective on what autistic adults needed. Over the last 10 years, autism advocates have utilized social media to have their voices heard, and their voices have shaped the research and literature about autism. One of the things that is frequently discussed on social media is BIMS periods (Phung et al., 2020). These are periods of autistic burnout, inertia, meltdown, and shutdown that shape many autistic people’s lives. Although autism self-advocates talk about BIMS periods often, the lack of clinical research is noted by many clinicians and often leaves many clinicians and autistic people at a loss for how to deal with BIMS (Welch, 2023).

In my practice, one of the things that causes the most distress in autistic adults' and teens' lives and leads to the most lost time at work and school are BIMS periods. So what are BIMS periods?

BIMS states are the most destructive part of an autistic adult’s life. As a clinician, helping my clients cope with BIMS and working with their neurotypical employers and spouses to create coping strategies for BIMS is one of the largest parts of my job. The neurotypical world is not understanding of neurodivergence, and workplaces that aren’t supportive of neurodiversity often push autistic adults to the edges of their sensory and emotional capacity regularly. Relationships with neurotypical partners and friends who don’t try to understand and help their autistic partners can also push autistic people to the edge.

It has been found that autistic adults have quadruple the suicide rate of the normal population (South et al., 2021). This frightening statistic is contributed to by BIMS states. Autistic people’s brains do not function like neurotypical people's brains (Gandal et al., 2022). Autistic people have many strengths and can do remarkable things. We are amazing humans; however, we can’t do things the way neurotypicals can.

When I speak about autism, I often use the children’s book Stellaluna to describe what it feels like to be autistic. Stellaluna (Cannon, 1995) is the story of a baby fruit bat who accidentally falls into a bird's nest. The bat is raised by birds and spends its entire life feeling like a failure. Stellaluna can’t perch right and doesn’t eat the right food. She can’t do anything the way she should. One day, she leaves the nest and finds other fruit bats and realizes that she is different, not wrong. This is what it is like to be autistic. We are different, and pushing us to try to be birds when we are fruit bats pushes us into BIMS states.

As an autism advocate, what I fight for the most is the understanding, acceptance, and accommodation of BIMS state. I frequently help autistic adults who are normally high-performing in their jobs apply for short-term disability when they have entered a BIMS state. I advocate for autistic adults and teens to have disability accommodations at schools and work to prevent BIMS states and reduce their negative impact when they occur.

As we move forward in our advocacy, understanding BIMS states is critical. It is critical to know that a fruit bat that is forced to live in a bird’s world will need breaks and support, and, if they don’t get these things, the world will break them.

References

Gandal, M.J., Haney, J.R., Wamsley, B. et al. Broad transcriptomic dysregulation occurs across the cerebral cortex in ASD. Nature 611, 532–539 (2022). https://doi.org/10.1038/s41586-022-05377-7

Phung, J., Penner, M, Pirlot, C., and Welch, C (2020) What I wish You Knew: Insights on Burnout, Inertia, and Shutdown From Autistic Youth. Front. Psychol., 02 November 2021 Sec. Developmental Psychology Volume 12 - 2021 | https://doi.org/10.3389/fpsyg.2021.741421

South M, Costa AP, McMorris C. Death by Suicide Among People With Autism: Beyond Zebrafish. JAMA Netw Open. 2021 Jan 4;4(1):e2034018. doi: 10.1001/jamanetworkopen.2020.34018. Erratum in: JAMA Netw Open. 2021 Feb 1;4(2):e210724. doi: 10.1001/jamanetworkopen.2021.0724. PMID: 33433593.

Welch (2023). Understanding autistic burnout. Bloorview Research Institute Presentation.

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