Autism and Brain Fog
Guideline: NICE CG142 Autism; DSM-5-TR criteria
What Is Autism-Related Brain Fog?
Autistic burnout is NOT depression — and treating it with antidepressants alone doesn't work. A 2024 study validated the first measurement tool (Autistic Burnout Measure) and confirmed it's a distinct syndrome: cognitive collapse from prolonged masking, sensory overload, and demand exceeding capacity. The 'brain fog' in burnout is loss of previously mastered skills — not inability to learn new ones. A 2023 Neurology case report showed a patient failed 8 psychiatric medications before the correct diagnosis led to rapid improvement.
What to Do This Week
Seven actionable steps you can start today — free, evidence-based, and designed for when you're foggy.
Body
20-minute walk outside today. Evidence supports this for virtually every cause of brain fog. Start with 10 if that's all you can do.
Food
Eat a proper meal with protein, vegetables, and good fat (olive oil, nuts, avocado). Skip the ultra-processed snack. One meal upgrade today.
Water
Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it — just drink regularly.
Environment
Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.
Connection
Reach out to one person today. Text, call, walk together. Isolation worsens every cause of brain fog. Connection is a biological need, not a luxury.
Tracking
Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.
Avoid
Don't change everything at once. One new habit per week. Don't compare your progress to others. Don't spend money on supplements before nailing sleep, food, and movement.
What to Eat: The Steady Meals — No Fasting Approach
For conditions where blood sugar stability or regular energy intake is critical. Anti-crash eating.
Sample Day
- breakfast: Eggs + avocado + sourdough toast (within 1 hour of waking)
- midMorning: Greek yogurt + handful nuts
- lunch: Chicken + sweet potato + mixed salad + olive oil
- afternoon: Apple + cheese or nut butter
- dinner: Fish + rice + roasted vegetables
- preBed: Small handful almonds + banana (if needed)
For Autism: Food preferences are VALID — don't force sensory-aversive foods. Work WITH safe foods, not against them. Steady protein meals support blood sugar stability. If diet is very restricted, check for nutrient deficiencies (B12, iron, zinc, vitamin D). Dietitian experienced in autism is worth the investment.
This is about STABILITY, not restriction. Eat enough. If you have POTS, ME/CFS, or migraine, fasting is harmful, not healing. Ignore intermittent fasting trends if you crash.
When to Seek Urgent Help
STOP — Seek urgent medical evaluation if: sudden onset of cognitive symptoms (hours/days), new focal neurological symptoms (weakness, numbness, vision or speech changes), seizures, fever with confusion, or rapidly progressive decline. These may indicate a medical emergency requiring immediate care, not lifestyle modification.
Tests and Investigations
Autism + Burnout Assessment
- Autistic Burnout Measure (ABM — Mantzalas et al., 2024)
- AQ-10 or RAADS-R (autism screening if not yet diagnosed)
- Rule out thyroid, B12, iron, sleep disorders (these compound burnout)
- ADHD screening (co-occurs in 50-70%)
- CRITICAL: differentiate from depression — burnout has skill regression and sensory amplification that depression doesn't
Evidence-Based Lifestyle Changes
Demand Reduction
Audit all demands on your time and energy. Categorize: essential (food, hygiene, safety) vs non-essential (everything else). Eliminate or reduce non-essentials for minimum 2 weeks. This is the equivalent of bed rest for a broken leg.
Evidence: Moderate — emerging consensus. Mantzalas et al., 2024; Raymaker et al., Autism in Adulthood, 2020
Sensory Sanctuary
Create one physical space that is optimized for YOUR sensory needs: correct lighting (no fluorescent), sound (noise-cancelling headphones or silence), temperature, textures. This becomes your recovery base.
Masking Reduction
Identify your top 3 'masks' (social performances that drain you). Find contexts where you can reduce or eliminate them. This might mean changing social circles, workplaces, or setting boundaries.
Evidence: Moderate — Pearson & Rose, Autism in Adulthood, 2021
Energy Budgeting (Spoon Theory)
Assign 'energy points' to each activity. You have a fixed daily budget. When it's spent, it's spent. Plan high-demand activities with recovery time after. Never schedule 2 high-demand days in a row.
Holistic Support
Morning sunlight
Strong — resets circadian clock, improves mood, supports vitamin D.
10-15 min outside within 1 hour of waking. No sunglasses needed.
Cyclic sighing breathwork
Strong — Balban Cell Rep Med 2023.
5 min daily. Double inhale nose, long exhale mouth.
Nature exposure
Moderate — cortisol reduction, attention restoration.
20 min in green space weekly minimum.
Medical Treatment Options
Discuss these options with your prescribing physician. This information is educational, not medical advice.
ADHD Treatment (if co-occurring)
If ADHD co-occurs: stimulant medication may help cognitive symptoms significantly. 2023 Neurology case: patient improved markedly with dextroamphetamine + CBT + exercise after failing 8 other medications.
Evidence: Strong for ADHD component; Neurology, 2023 case report
Autism-Informed Therapy
If therapy is needed: ensure the therapist understands autism. Standard CBT may need adaptation. Avoid ABA-based approaches for adults. Acceptance and Commitment Therapy (ACT) often better suited.
Supplements — What the Evidence Says
Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.
None specific to autistic burnout.
Psychological Support and Therapy
Neurodivergent-affirming therapist (not ABA for adults). Executive function coaching. Burnout-specific counseling. If masking is exhausting → support for authentic living.
What People With Autism Brain Fog Say
What Helped
- • Demand reduction — cancelled everything non-essential for 3 months. Cognitive function slowly returned as burnout lifted.
- • Getting diagnosed — understanding autism reframed 30 years of struggle. The fog wasn't random, it was burnout from masking.
- • Sensory management (noise-cancelling headphones, lighting, textures) — more effective than any medication
- • ADHD treatment in dual-diagnosed individuals — treating ADHD component helped fog significantly
What Didn't Help
- • Being told to just try harder or push through — pushing through is WHAT CAUSED the burnout
- • Standard depression treatment for autistic burnout — 8 different psychiatric medications before someone considered autism
- • Social skills training during burnout — don't teach someone to run while they have a broken leg
- • Mindfulness meditation (for some) — interoception is different in autism. Traditional mindfulness felt disconnecting.
Common Mistakes
- • Treating burnout as depression (antidepressants alone won't resolve skill regression)
- • Increasing demands during recovery
- • Not considering autism because of outdated stereotypes about what autism looks like
Surprises
- • How different autistic burnout is from depression — lost skills, not just motivation. Could not do things they COULD do before.
- • Late diagnosis is incredibly common — especially in women, people of color, and anyone who doesn't fit stereotypes
- • The relief of diagnosis — expected devastation but felt liberation. Everything finally made sense.
"Autistic burnout is not depression with extra steps. It's cognitive collapse from running in survival mode too long. The treatment is LESS, not MORE. Less masking, less sensory input, less demand. Recovery takes months. Be patient."
Quick Reference
Quick Win
Demand reduction audit: for the next 2 weeks, eliminate ALL non-essential demands. Cancel optional commitments, reduce social obligations, simplify meals, lower the bar on everything that isn't survival-critical. This is therapeutic rest for a system in cognitive collapse — not laziness. Track how your fog responds.
Mantzalas et al., Autism Res, 2024 — Autistic Burnout Measure validation