Navigating Neurodivergence: Tips for Managing Asperger's Brain Fog

Our understanding of autism spectrum disorder (ASD) has grown significantly over the years, leading to important changes in how we diagnose and describe its various presentations. One of the most significant changes to the ASD diagnosis is the inclusion of Asperger’s syndrome as part of the autism spectrum.

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Asperger's syndrome was added to the DSM-IV in 1994 but was moved underneath the diagnostic umbrella of “Autism Spectrum Disorder” in the DSM-V in 2013. Though Asperger’s syndrome is considered to be part of the autism spectrum, it presents symptoms that are similar to ASD but may be less severe or pervasive. Asperger’s is typically marked by:

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• Impaired social interaction and nonverbal communication
• Restricted interests
• Repetitive behaviors
• Lack of awareness about how their actions may impact others

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The main difference between Asperger’s and autism is that people who were formerly diagnosed with Asperger’s may have less severe symptoms and no speech delay. In fact, those who have been diagnosed with Asperger’s may have advanced speech and language skills. 

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So, while Asperger’s used to be its own diagnosis, the current diagnostic standards for autism spectrum disorder include Asperger’s. Those who may have, in the past, been diagnosed with Asperger’s syndrome are now likely to be diagnosed with level one autism or to be classified as having low support needs. 

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While it’s true that diagnostic standards have been updated due to the fact that Asperger’s and autism have a large overlap of symptoms, Asperger’s is no longer used also due in part to its controversial namesake. Asperger’s syndrome was first formally named by Hans Asperger after he conducted a comprehensive study on a group of children with autistic traits in 1944. Though Asperger was never an official member of the Nazi Party, he worked closely with them and cooperated with their policies, which targeted neurodivergent individuals. Asperger’s ties to nazi policies, and the harsh language he used to describe his patients is among the reasons that the term “Asperger’s” is no longer widely used.

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However, even though the term is largely outdated, many neurodivergent people were originally diagnosed with Asperger’s syndrome and still resonate with it. Therefore, it’s important to approach the controversy surrounding the name with nuance.

Brain fog is difficult to describe, especially when someone is actively experiencing it. Medical terminology aside, brain fog physically feels…weird. It makes people feel fuzzy or exhausted, like they have to drag thoughts through sludge to get them to the front of their brains. It’s a strange sensation, but no matter how someone describes it, the fact remains the same: it’s unpleasant and, at times, distressing. 

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According to one study, most people use the term “brain fog” to colloquially describe fatigue, forgetfulness and increased cognitive effort. Cognitive effort refers to the amount of mental energy and time people use to accomplish a task. It may be helpful to think of cognitive effort as how hard a brain works to do something.  Brain fog may occur on its own or in relation to other causes, like long COVID, sleep deprivation, or medication side effects.

Many people will experience brain fog throughout their lives due to several causes. However, the brain fog that accompanies Asperger’s syndrome is distinct due to its severity and potential causes. 

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Signs of Asperger's brain fog include:

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• Difficulty concentrating or maintaining focus
• Slower information processing
• Lapses in memory and forgetfulness
• Being unable to think clearly
• Difficulty “finding words” or verbally expressing thoughts and feelings
• Feeling especially fatigued, particularly after social interactions or mental exertion

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Potential causes of brain fog in autistic individuals or individuals with Asperger’s include sensory overload, shutdowns and meltdowns. Additionally, co-occurring conditions like anxiety and chronic fatigue syndrome are also linked to brain fog. Though neurotypicals can also experience brain fog as a result of medical conditions, they likely will not experience brain fog as a result of meltdowns or sensory overload.   

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How does Asperger’s brain fog manifest in autistic adult women?

Autistic women may experience brain fog differently from men. Not only can heightened sensory experiences and co-occurring conditions cause brain fog, but hormonal fluctuations can also contribute. Research suggests that perimenopause and menopause contribute to brain fog, too. 

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Further, camouflaging or masking behaviors can contribute to autistic burnout, which is marked by intense brain fog. Because hormonal fluctuations and masking impact autistic women more than autistic men, women with autism or Asperger’s are especially vulnerable to brain fog. 

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Because autistic women are more likely to be high masking than their male peers, their manifestations of brain fog may be much more tied to social behavior, even though they will show cognitive signs, as well.

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Autistic women struggling with brain fog may:

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• Have difficulty processing information: They may be more forgetful or become overwhelmed easily when presented with new information––whether that information is cognitive, sensory or social. They may appear slow or sluggish when responding to input.
• Have increased difficulty with executive functioning: They may have trouble multitasking or meeting workplace or educational expectations.
• Have​​ difficulty regulating their emotions: They may become easily overwhelmed by them and have trouble expressing or processing them.
• Struggle to navigate social situations: Because women with Asperger’s are typically high masking, they are constantly decoding social cues to navigate social situations successfully. When brain fog is present, it may be harder for them to do so, leading to “unsuccessful” social interactions or increased fatigue after being social.

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Though these things are symptoms of Asperger's syndrome alone, they are more pronounced when an autistic woman is experiencing brain fog.

Executive function is the group of cognitive skills that control the skills that allow people to achieve goals or complete tasks. Impulse control, reasoning and memory are all parts of executive function. Some research suggests that as many as 70% of autistic people struggle with executive function, which leads to difficulties staying on task, managing day-to-day duties and suppressing potentially harmful impulses. 

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The link between impaired executive function and brain fog

There is an overlap between symptoms of impaired executive function and symptoms of brain fog. Both brain fog and executive dysfunction manifest as forgetfulness, lack of productivity, difficulty staying on task or trouble multitasking.

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It is important to be aware that both executive function difficulties and brain fog are common amongst autistic adults, and that they have similar symptoms. When a person already has executive function difficulties, those difficulties exacerbate brain fog, and vice versa.

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Improving executive function may improve brain fog

Though working to improve executive function may not, on its own, completely cure brain fog, it will give autistic adults a stronger foundation to lean on when they’re struggling with brain fog.

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To improve executive function, an autistic individual should aim to strengthen the mental processes commonly associated with poor executive function, including:

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• Selective attention: Neurodiverse individuals with poor executive function may struggle to pay attention to something for long periods. To improve this, individuals can listen to audiobooks and recall details from the story, or listen to a friend tell a story and then repeat details back to them.
  
  • Practicing fine motor skills will improve not only those motor skills but selective attention as well. This can even be accomplished by doing something fun, like crocheting or beading. 
• Impulse control: Impaired executive function can manifest as poor impulse control. Individuals can practice recognizing impulses, naming them, and then brainstorming actions to take that might eliminate the impulsive urge. For example, impulse control issues may lead someone to snap at their spouse when they’re angry. Practicing better impulse control would lead them to recognize what they’re feeling (anger), name the impulsive behavior they want to engage in (I want to yell at my spouse because I’m feeling angry), and then come up with a healthier solution (I’m going to step away, take some deep breaths, and then approach them). 
• Working memory: Working memory is how we process, remember and use information daily. Simply holding information in the brain without interacting with it is short-term memory, not working memory. An example of working memory is remembering a phone number or following step-by-step directions. To improve working memory, an autistic individual can do mental math problems, try to memorize multi-step instructions and do them in the correct order or recite poetry or stories from memory.

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When you do exercises to improve executive function, you can also improve the mental processes that are impaired during periods of brain fog. So, while the “cure” to brain fog may not lie in good executive functioning, improving executive functioning skills may make brain fog less impactful when it does occur. 

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Social anxiety is not simply shyness or introversion. It’s the intense fear of being observed or judged by others. In the neurotypical population, around 7-13% of people struggle with social anxiety. In the autistic population, however, that number may be as high as 50%. Social anxiety and brain fog are both prevalent among autistic adults, and they play off of one another.

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The link between social anxiety and brain fog

Asperger’s brain fog can make social anxiety worse, and vice-versa. Someone with Aspeger’s brain fog may feel as though they are living in a haze. They may be more exhausted and have a harder time navigating social situations. 

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Socializing already requires more cognitive effort for neurodiverse adults than for neurotypical adults. To make sense of social interactions, people must analyze body language, tone of voice and subtextual meanings. For a neurotypical person, those analyses happen instinctually or with minimal effort. For an autistic individual, it’s a conscious process, and it’s not foolproof. Autistic people make missteps or social blunders more often than neurotypical people, which is anxiety-inducing. It makes social interactions nerve-wracking and contributes to co-occurring social anxiety.

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When brain fog enters the mix, social anxiety is exacerbated. Socialization, for autistics, uses a lot of brain power. When cognition is slowed, or someone is struggling to find the right words or suffering from memory loss, they may feel like they lack the brain power to interact successfully. Combined with an ever-present awareness of their own social shortcomings, brain fog can make social anxiety feel much worse.

Not only can brain fog worsen social anxiety, but social anxiety can also contribute to brain fog. Anxiety impacts the cognitive processes that contribute to brain fog, notably working memory. So, brain fog will worsen social anxiety, which will worsen brain fog, and so on. It’s an exhausting cycle that many autistic adults may find themselves stuck in. 

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The importance of addressing social anxiety to improve the quality of life for autistic adults

Not only does social anxiety lead to isolation, it can also exacerbate brain fog. Even when autistic adults are more introverted, they still need socialization to thrive. Everyone needs to feel like they are part of a community and have meaningful relationships. If an autistic individual can manage their social anxiety, then the prospect of building and maintaining connections might be less daunting. 

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Further, addressing social anxiety might be the first step to breaking the fatiguing cycle of anxiety and brain fog. Social anxiety can be treated with cognitive behavioral therapy (CBT), support groups, or medications such as antidepressants, most commonly SSRIs.

Autistic people experience and process sensory input differently than neurotypical people. An autistic adult’s sensory experience is much more intense and overwhelming and can lead to sensory overload. Sensory overload is thought to be a cause of brain fog in adults with Asperger’s or level one autism.

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Improving sensory processing to improve brain fog 

Because sensory overload can contribute to brain fog, improving the ability to process sensory information may decrease the frequency or intensity of brain fog. Sensory processing can be improved through sensory integration therapy.

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During sensory integration therapy, a trained therapist stimulates a client's sensory responses so that the client can learn to manage this sensory input more healthily.

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One common sensory integration technique is using weighted blankets to apply deep pressure. Deep pressure is grounding and calms the nervous system. Other techniques are rocking back and forth to improve bodily awareness, which helps an autistic person better process sensory input.

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If autistic individuals can process sensory input better, they may be less inclined to experience the sensory overload that contributes to brain fog.

Autistic meltdowns and shutdowns are thought to be a potential cause of Asperger’s brain fog. Meltdowns and subsequent shutdowns occur when an autistic individual is overwhelmed and dysregulated. 

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Mindfulness exercises to help combat Asperger’s brain fog

Mindfulness is the practice of grounding oneself in the present moment. It helps calm the nervous system, preventing meltdowns and leading to mental clarity.

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Mindfulness exercises can be practiced almost anywhere and don’t require a huge time commitment. Deep breathing and meditation are two exercises that can be done anywhere and in just a few minutes each day. Mindfulness practices can lead to long-term improvements in attention span, concentration and cognitive function––all things that are negatively impacted by brain fog.

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Therefore, leaning into mindfulness practices can prevent brain fog-induced meltdowns and strengthen the cognitive processes that are often impacted by the brain fog that does occur. 

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Emotional regulation and its role in managing Asperger’s brain fog

Because meltdowns occur when an autistic person is dysregulated, it is important for them to learn strategies for regulating emotions.  However, emotional regulation––a state of appropriate processing and expressing of emotions––is difficult for neurodiverse people. 

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Because emotional regulation is tricky, autistic individuals should do things that can help improve regulation. Below are some strategies that serve as a starting point:

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• Deep breathing exercises: Breathwork is a great tool. One easy example is “box breathing,” which is breathing in for four counts, holding for four counts, breathing out for four counts, and holding for four counts before repeating. 
• Stimming: Stimming can help with regulation, such as rocking, using a fidget toy or engaging with a comfort item. 
• Learning to manage sensory input: This is best done through sensory integration therapy.
• Avoiding stress: Autistic individuals can avoid or exit overwhelming situations if possible. Or, they can try to make these situations more manageable. For example, maybe large, crowded stores are overwhelming to someone. It may not always be possible for them to avoid going to the store but they can opt to go during early morning or evening hours when the crowds are smaller and the situation is less overwhelming. 

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Becoming more emotionally regulated will decrease the frequency of meltdowns and shutdowns. Because Asperger’s brain fog may be caused by meltdowns, lessening their frequency may also improve an autistic individual’s brain fog.

If you are autistic (or suspect you might be) and you’re struggling with brain fog, Prosper Health is here to help.

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We offer neurodiversity-affirming therapy and adult autism evaluations covered by insurance. Our expert clinicians incorporate evidence-based therapies into our sessions, tailoring all care to the unique needs of autistic and neurodivergent adults. 80% of our clinicians identify as neurodivergent or have a close connection with a neurodivergent individual, so they truly understand the unique experience of neurodiverse people.

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Therapy can help you learn emotional regulation skills, mindfulness tools and more to reduce brain fog and help you feel your best.