2023 American Academy of Neurology Abstract Website

Objective:

We present a case of Autistic Burnout successfully treated with stimulant medication and behavioral interventions.

Background:

Autistic Burnout is a phenomenon that adults with Autism Spectrum Disorder (ASD) describe as chronic fatigue, often accompanied by a loss of skills, and that seems to be distinct from the type of burnout prevalent in the neurotypical population. Importantly, many of the treatments employed for neurotypical individuals with burnout have not been effective in treating Autistic Burnout. Attention Deficit Hyperactivity Disorder (ADHD) co-occurs with ASD in over 50% of patients. The current Diagnostic Statistical Manual of Mental Disorders (DSM) Fifth Edition allows for comorbid diagnoses of ADHD and ASD; however, prior versions of the DSM precluded diagnosing both conditions within the same patient.

Design/Methods:

A 24-year-old man with ASD was referred to outpatient neurology for “brain fog” and chronic exhaustion. His recent onset symptoms included forgetfulness and an inability to keep his work organized. While he had been a straight-A student in high school, he struggled to meet deadlines and demands in college, eventually taking a leave of absence. He worked with a psychologist and psychiatrist but did not improve despite trials of eight different psychotropic medications.

Results:

In consultation with outpatient Behavioral Neurologist specializing in Neurodevelopmental Disabilities, he started dextroamphetamine, cognitive behavioral therapy, and an exercise regimen. He showed strong improvement within 2 months as rated by standardized ADHD symptom measurement forms. Fatigue and self-reported “brain fog” also improved. After 18 months, he returned to college with great success.

Conclusions:

Many of the symptoms ascribed to autistic burnout, such as fatigue, withdrawal, and reduced functional abilities are also present in individuals with untreated ADHD. The success of this case report suggests that treatment for ADHD, including medication management and behavioral interventions, may be effective for autistic burnout.