Here is my list of meltdown resources. Web addresses sometimes get corrupted when posted on this forum, so if a link doesn't work, try removing any blank spaces in the address. If it still doesn't work, let me know.
http://www.iancommunity.org/cs/about_asds/aspergers_syndrome _meltdowns - Intro to meltdowns and Asperger syndrome.
http://www.irm-systems.com/onottaca/doc.nsf/files/FF972AB5FF AED46B8725712D0052B8A9/$file/May05ConsiderSensoryProcessingD isordersintheExplosiveChild.pdf - case history of sensory issues and meltdowns.
http://www.jambav.com/modules/specialneeds/specialneeds.php? id=8 - Temper Tantrum Report (for documenting and analyzing meltdowns)
http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv -ppiep&msg=2462.1& An unreliable link to an article called "Thoughtful Response to Agitation, Escalation and Meltdowns in Children with Autism Spectrum Disorders." I am copying this article to a separate post below.
http://www.isec2005.org.uk/isec/abstracts/papers_m/myles_b.s html - "The Cycle of Tantrums, Rage, and Meltdowns in Children and Youth with Asperger Syndrome, High-Functioning Autism, and Related Disabilities" which is an article by Professor Brenda Smith Myles, with a list of 7 strategies you can use in the rumbling stage (ie agitation and escalation towards a meltdown/rage).
http://www.autism-pdd.net/forum/forum_posts.asp?TID=16187&am p;am p;am p;am p;am p;am p;am p;am p;am p;am p;am p;am p;KW=inside+scoop - " 'Meltdowns': The inside scoop (or rant)" which is a popular topic on our forum started by Stickboy26.
http://www.autism-pdd.net/forum/forum_posts.asp?TID=23671&am p;am p;am p;am p;am p;am p;am p;am p;am p;PN=1 - Another informative topic by Stickboy26 which touches on meltdowns ("My take - over-compliance/non-compliance").
http://www.mariposaschool.org/programs/Teaching%20the%20Chil d%20To%20Use%20Words%20Instead%20of%20Tantrums.pdf - Teaching the child to use words instead of tantrums.
http://www.ich.ucl.ac.uk/factsheets/families/F050232/A4%20bw .pdf - brochure "Understanding and Managing Behaviour Problems in Children and Young People with Autistic Spectrum Disorders." Highlights include: chart for recording setting, trigger, action, response (STAR) on page 15, questions to establish the function of a type of behaviour on page 16, and golden rules for managing behaviour on page 17 and 18.
http://www.edu.gov.on.ca/eng/general/elemsec/speced/asdfourt h.pdf - "Safety Plan form: Crisis protocol" which is basically a form for a meltdown plan. See p. 32 in the PDF file (page 140 in the actual book).
http://travis-thompson.net/#/meltdowns/4519603010 - article by Travis Thompson, an author/professor who himself has a grandchild with autism. To see the whole article you need to scroll using the arrow down buttons to the left of the text.
http://travis-thompson.net/#/cryingtantrums/4527713888 - another article by Travis Thompson.
http://www.autismspot.com/videos/Managing-Classroom-Meltdown s - Managing Classroom Meltdowns part 1
http://www.attainmentcompany.com/xcart/product.php?productid =16205&cat=302&page=1 - video clips on handling escalation and meltdowns in adults. Their approach is also helpful with children, IMO. More information on a separate post below.
Anyone else have resources to add?
Here's the article I mentioned above:
THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND MELTDOWNS
Part I: Understanding Inflexible-Explosive Children
Part II: Understanding the Stages of Crisis, Leading to Meltdown
Part III: Reacting to Agitation, Escalation and Meltdown
In the literature about working with individuals with Autism Spectrum Disorders, attention is routinely given to proactive or preventive strategies for helping children manage their lives smoothly. These strategies are based on insight into a child¡¦s particular challenges, recognition of their particular strengths, and acknowledgement of their particular communication style and skill level. The strategies that all of us know, and use, are also based on the understanding of sensory differences and the child¡¦s often pervasive need for sameness and routine.
But there are times that no matter how prepared we are for the anticipated challenge of our students, how diligent we are with rearranging the environment, with communicating appropriately and with fulfilling sensory needs, our students get agitated, this agitation escalates and they have a meltdown.
That is the topic of this paper.
PART I: UNDERSTANDING THE INFLEXIBLE-EXPLOSIVE CHILD
It is always tempting to go right to the ¡§How To¡K¡¨ section of any clinical paper. We all want to read that when so-and-so happens, this is what we need to do. However, there should be a high premium on understanding why children behave in certain ways because if you have insight into the roots of behavior, you are more likely to respond with compassion and intelligence and you are more likely to be effective in addressing challenging behaviors. There is no formula I can give you that guides your therapeutic actions during meltdown or crisis. There is no recipe for the perfectly managed outburst. What I can give you is knowledge and tools. It is up to you to use that knowledge to select the right tool for the job or to invent a new tool that fits the child and the situation best.
Common Characteristics of Meltdown-Prone Children
ƒç Inflexible and explosive children have difficulty managing and controlling emotions associated with frustration. They also have difficulty ¡§thinking through¡¨ ways of resolving frustrating situations. In these children, frustration (usually caused by a demand to shift gears) often leads to a state of cognitive debilitation in which the child:
ƒç Inflexible and explosive children have an extremely low frustration threshold. They become frustrated more easily and for seemingly trivial things (we know in autism, however, that what may seem trivial to us is often anything but trivial to our students!)
ƒç Inflexible and explosive children also have an extremely low tolerance for frustration. So not only are they more easily frustrated, but also the experience of being frustrated itself can be very intense, disorganizing and sometimes overwhelming.
ƒç Inflexible and explosive children have a tendency to think in a concrete, rigid and black-and-white manner.
ƒç Inflexible and explosive children persist in their inflexibility and poor response even in the face of meaningful consequences.
ƒç Explosive episodes can appear to have an out-of-the-blue quality.
ƒç The inflexible and explosive child may have one or more issues about which he/she is particularly and repeatedly inflexible (i.e. what to eat, what to wear)
ƒç Even though all children grow more easily frustrated when tired, ill or hungry, the inflexible and explosive child may have even fewer coping mechanisms when already stressed by internal factors.
So now we have a picture of a meltdown-prone child (which sounds very much like most or all of our children with autism). But how does this happen? What creates this cluster of symptoms?
There are many neurologically determined pathways that lead to explosive behavior. Please refer to the chart below.
The Pathways to Inflexibility and Explosiveness ¡V A Few Elaborated
Deficits in executive function are commonly associated with Autism and ADHD. The areas of compromise for our children include the following:
Deficits in social skills, a problem for every child who has been diagnosed with autism, affect the flexibility, complex thinking and rapid processing required for social interactions. Most meltdowns occur when a child with autism is asked by another person to stop what they are doing and do something else. We often assume that the child will be able to do this, with minimal frustration. We also often assume that the child will want to comply because of their wish to please a social partner. This, however, is not always true for children with autism.
Sensory integration dysfunction is another contributing factor to inflexibility and explosiveness. Many of our students cannot consistently sort through incoming sensations. There may be times when they feel overwhelmed by noise and hubbub and cannot tolerate the addition of frustration. There may be times when their bodies feel out-of-sort and they react more emotionally and less adaptively to requests or expectations. If a large part of their brain is coping with uncomfortable sensation, they may have little energy left to adapt to a request to shift gears.
Language processing difficulties are common in autism and this deficit, too, can affect how the child tolerates and/or manages frustration. Children who are less efficient at understanding language, categorizing and storing current and previous experiences (in language), thinking things through (in language) and retrieving language in a timely manner to express themselves, are at great risk for frustration. And when you add the difficulty of understanding and using the language of emotions (a characteristic of autism), your risk of frustration increases.
Conclusion to Part I:
So now we know the characteristics that increase the likelihood of meltdowns. We also know what parts of the child¡¦s neuropsychological profile contribute to these characteristics. Why is this important? Because we cannot figure out how to respond to moments of escalation in our students without knowledge and understanding about what it is that makes a child susceptible to rages or rapid escalations. If you don¡¦t understand the basic characteristics that can cause distress in a child with autism, you might think they are just ¡§being bad¡¨, or ¡§manipulative¡¨, or ¡§controlling¡¨. You might also choose inappropriate techniques to manage these crises, thinking that if you just keep piling on consequences, you will win the battle. But when you understand the characteristics of the inflexible, explosive and autistic child and how these characteristics are determined by neurological difference, you realize that it is never a battle where someone wins and someone loses. Becoming so frustrated that you lose control of your body and of your rational mind is distressing - for the frustrated child and for you. No one ever, ever wins.
PART II: UNDERSTANDING THE STAGES OF CRISIS, LEADING TO MELTDOWN
Many things can trigger agitation in children with autism:
All of these triggers represent a demand to shift gears: shifting to a new activity; shifting away from a routine; shifting attention away from something uncomfortable externally; and, shifting attention away from something uncomfortable internally. Why is this shifting so hard for children with autism? This is a complicated question for which the answer is only emerging through research.
What happens when you do ask a child with autism to shift gears? Sometimes nothing ¡V they simply comply. Sometimes, however, this simple request can be a trigger for increased agitation and escalation. Because we are working with children who are inflexible and have significant problems with the management of frustration, these early phases of a potential meltdown are aptly described by Dr. Greene as ¡§vapor lock¡¨. In cars, vapor lock is caused by excessive heat that creates a bubble in the gas line. This prevents gas from flowing to the engine and causes the engine to stall. No matter how many times the driver pushes the pedal or turns the ignition, the car won¡¦t start again until it cools down. Similarly, Dr. Greene suggests, frustration causes breakdown in our student¡¦s capacity to think clearly, causing him/her to become overwhelmed and less rational. No matter how many times the adult reasons, insists, rewards, punishes, or whatever, the child can¡¦t start thinking clearly until someone helps him/her cool down.
You might think of it as brain-lock.
Dr. Daniel Goleman, the author of Emotional Intelligence, refers to the meltdown phase, in which the child seems to be ¡§out of control¡¨, irrational, incoherent, destructive and sometimes abusive, as ¡§neural high jacking¡¨. What does this mean? It means all coherent, rational thought has been stolen and what is left is a debilitated state of incoherence. What the child does and says during meltdown is simply mental debris (a phrase used by a number of professionals in the field) and all attempts to teach, reason or reconcile are lost.
An escalating and deteriorating inflexible-explosive child is not a pretty sight. Not for you, not for the others around you and certainly not for the distressed child.
As parents, teachers, therapists and consultants, we need to find the crossroads of every potential meltdown and intervene at that critical moment with strategies that calm and focus the child so that he/she can slowly learn to adapt to whatever is causing the frustration.
PART III: REACTING TO AGITATION, ESCALATION AND OUTBURST
Before we begin¡K a word about consequences
Children who are developmentally compromised in the areas of flexibility and frustration management usually:
So, think about these quotes from Dr. Greene:
¡§Consequences can be very effective if a child is in a state of mind to appreciate their meaning, but don¡¦t work nearly so well if a child is not able to maintain such a state of mind.¡¨
Treating ¡§out of control¡¨, irrational, incoherent, destructive and sometimes abusive behavior with consequences is not routinely effective in children with autistic spectrum disorders. Even when the punishment is very meaningful to the child, he/she probably won¡¦t be able to access that looming consequence in the middle of a meltdown and miraculously regain control, stop flailing around and return to the world of the rational. This is a very important concept in working with your explosive students.
Proactive strategies for maintaining a learning environment (ongoing):
Every time we work with a student, we begin our session with strategies already in place. The strategies we use are individualized but often include the following:
Yet even with these in place, there are times that new learning and growing expectations create frustration and our meltdown cycle begins.
Warning signs of agitation and escalation:
Each child is different and each child has their own set of warning signs that indicate mounting stress and frustration. However, we can be pretty sure that an episode of agitation starts with refusal. Refusal can be shown in lots of ways: By saying ¡§No!¡¨ effectively; by falling to the floor; by not moving; by hitting, kicking, pinching, biting; or by hiding under the table. Children with autism may refuse for many reasons and most of these reasons are linked to the universal difficulty with shifting attention.
So what can you do to de-escalate a refusing child?
First, it is important for you to think about the demand that you are making on the child. Is it one of those completely non-negotiable requests? Is it one that on a good day is worth pursuing but on a bad day is not? Or is it something that is simply not really important? You must prioritize your demands.
A level demands = Non-negotiable
So now you know that every time a child becomes agitated when requested to shift gears from what they are doing to what you want them to do, you need to make sure that your request is essential (A level) or you should consider deferring or delaying your request (C level). Do they really need to put on their shoes? Does it really matter if they eat dessert before their pretzels? If it is really a C level request (not important), give them a choice (modeling appropriate, non-agitated communication) and accept their selection.
If you decide that it is a B level request that is fueling their refusal and subsequent agitation/escalation, you need to decide if this is the day and time that you want help this child learn new skills and new coping mechanisms. B level skills can provide you with the opportunity to teach more constructive and more effective ways of dealing with stress, inflexibility and difficult feelings. Agitation and escalation don¡¦t have to be seen as avoidable at all costs. They can and should be seen as teachable moments.
But a B level request can be removed if you realize that there are too many other variables that are contributing to your student¡¦s distress. If he/she is sick or tired, if there have been changes in routine, if there is sensory overload, do not choose this moment in time to teach your student about managing stress and frustration. Back off the request, give the student true choices, and accept their response.
If, however, it is a fine day to work for growth and the development of new skills and you proceed with your B level request, you still need to be wise about how you intervene so that you help the child with problem solving before the agitation escalates and a meltdown ensues.
„X At the first signs of agitation, you need to demonstrate to your child that you understand how hard it is to shift gears. You need to become his/her partner in this, not his/her adversary. As Dr. Greene says,
If, however, your request that requires them to shift gears is an A level request (not negotiable), you have a slightly different situation. There are some limits that can¡¦t be bent or rearranged. Children have to be safe and healthy, clothed and fed. They also need to take medicine, go to school, and go to bed. They can¡¦t hurt other people or pets, hurt themselves or destroy property. These are all A level requirements.
Many of the strategies for A level requests are the same as previously described for B level. We still want to help a child calm down and shift their attention to the request. We still want to empathize, to provide time and space for de-escalation and compliance, to use visual supports while decreasing the amount of language being used, to use humor if appropriate, and to offer help. What we can¡¦t do however is change the limit that we are setting. We can¡¦t compromise. If you find that you can and do compromise in the end, then that was not an A level request.
A level requests are usually the trigger for full escalations. For a child that is inflexible, rigid, and routine-bound (as many of our children with autism are), being told that he/she must or mustn¡¦t do something is often intolerable. When the child finds that this limit can¡¦t be changed or altered or negotiated but simply needs to be accepted, it can be very difficult. As the adult proceeds to follow-through with the requirement, the child becomes enraged. Now he/she can¡¦t reason, his/her body often goes out of control and he/she becomes incoherent. This is the meltdown.
What do you do?
„X You need to wait it out safely.
When the child is out of crisis, and the request has been met (medicine has been swallowed, seatbelt has been fastened, whatever), it is important to let the child know that even though it was hard, they did a good job complying and you are proud of them. The recovery phase is short for children with limited insight. For those who can and do have insight, it is important to talk about how hard it was and how bad they felt and what can be done next time so that everyone feels better.
If the outburst was triggered by an A level or even a B level request, it is likely that that request, in the future, will once again cause the child to escalate and potentially meltdown even if the child has shown remorse and has ¡§talked it through¡¨ with you during recovery. This is what we have been discussing throughout this training ¡V that inflexible and explosive children cannot access previous experience during escalating agitation and meltdowns. The child¡¦s team, then, needs to come up with ways of understanding why this particular request is so difficult for the child and what to do to make it easier on the front-end, proactively. You might try:
„X Gathering more information from the child and the team about why this request was so problematic;
Conclusion to Part III
What you always do¡K.
„X Responding to basic needs: Proactive strategies for helping to manage stress for the child and optimize functioning and learning are an important part of every child¡¦s treatment, whether it be in the home, the school, the community or in groups. These include enhancing the opportunity for both receptive and expressive communication; adapting the environment; providing predictability; and fulfilling sensory needs.
But if they don¡¦t work on a given day or in a particular circumstance¡K
„X Responding to agitation and escalation: The strategies for defusing potential meltdowns include: becoming the child¡¦s partner as opposed to adversary; giving the child space and time to process the problem; decreasing language; using visual supports; and, if possible, helping the child frame and solve the problem in a way that is satisfying to both you and the child.
But if these interventions don¡¦t work¡K
„X Responding to crisis: The strategies for managing a meltdown in a therapeutic manner include isolating the child for his/her safety and the safety of others, using protective strategies in the event of dangerous and/or aggressive behavior, and waiting for the storm to blow over. As the child begins to calm, you may find that certain sensory activities increase the child¡¦s ability to grow calm and focused again.
After it is over¡K
„X The learning phase: Although many children with autism have limited insight into their own behaviors, it is important to eventually discuss what happened with the child and to devise, as a team, ways to rehearse similar situations during non-stressed moments. Social stories, rehearsal and possibly desensitization with regular reinforcement are all appropriate post-meltdown techniques.
„g Fouse, B. and Wheeler, M. A Treasure Chest of Behavioral Strategies for Individuals with Autism. Future Horizons. 1997.
„g Greene, Ross W. The Explosive Child. Harper Collins. 2001.
„g Hewett, Dave. Challenging Behaviour; Principles and Practices. Taylor & Francis Group, 1998.
„g Hodgdon, Linda A. Solving Behavior Problems in Autism ¡V Improving Communication with Visual Strategies. Quirk Roberts Publishing. 1999.
„g Kaiser, B. & Rasminsky, J. Challenging Behavior in Young Children: Understanding, Preventing and Responding Effectively. Allyn & Bacon, 2002.
„g Moyes, Rebecca A. Addressing the Challenging Behavior of Children with High Functioning Autism and Asperger Syndrome in the Classroom: A Guide for Teachers and Parents. Jessica Kingsley, 2002.
„g Myles, Cook, Miller, Rinner and Robbins. Asperger Syndrome and Sensory Issues. Autism Asperger Publishing Company. 2000.
„g Myles, B, and Southwick, J. Asperger Syndrome and Difficult Moments. Autism Asperger Publishing Company. 1999.
(Originally posted by spectrummum)
Challenging Behaviors and Meltdowns
Unfortunately for children with autism and their families and careers, meltdowns and destructive behaviors are common .The term challenging behavior is controversial but it is intended to suggest that behaviors present a challenge to professionals and services. This is supposed to prevent internalizing the cause of the behavior and blaming the child i question. This is very important in autism, as it is unlikely that any behavior which causes difficulties for families and professionals, is intended maliciously or vindictively. There is virtually always some other unidentified, trigger that ignites challenging behavior. Some vital function that it serves. It is worth noting that in most cases (although not all) individuals do not enjoy being challenging. This alone should suggest that there is some significant need or impetus for the behavior. Unfortunately it would appear that the majority of cases of challenging behaviors occur by children in the presence of their families. If such behavior is a challenge for professionals then it can have a debilitating impact on parents and siblings. It is therefore very important that behavior are dealt with in way which allows both the secure functioning of the family, and the opportunity for the individual to develop skills and communicate effectively.
Good information on meltdowns Lanette
Here are some helpful videos clips about preventing and handling meltdowns in a developmentally disabled adult:
I thought their chart was really helpful, showing escalating behavior and the appropriate response:
Appropriate behavior - You should reinforce it.
Signs of tension - You need to respond, or escalation will continue. The video mentioned the following common signs: Changed expression, less eye contact, tense voice, muttering.
Emotional outburst - You should help diffuse it.
Physical outburst - Your main focus is to protect. The video lists these steps you can take: decrease/stop talk, request help, maintain a safe position (distance), be a neutral presence, safeguard others, remove hazards, and talk to contain.
Recovery - You should talk it out.
I thought I'd bump this, since it hasn't been active since August.
I really liked this one, posted today by spectrummum:
Autistic Meltdowns Vs. Temper Tantrums
A temper tantrum in a child who is not autistic is simple to handle. Parents simply ignore the behavior and refuse to give the child what he is demanding. Tantrums usually result when a child makes a request to have or do something that the parent denies. Upon hearing the parent's "no," the tantrum is used as a last-ditch effort.
The qualities of a temper tantrum vary from child to child. When children decide this is the way they are going to handle a given situation, each child's style will dictate how the tantrum appears. Some children will throw themselves on the floor, screaming and kicking. Others will hold their breath, thinking that this "threat" on their life will cause parents to bend. Some children will be extremely vocal and repeatedly yell, "I hate you," for the world to hear. A few children will attempt bribery or blackmail, and although these are quieter methods, this is just as much of a tantrum as screaming. Of course, there are the very few children who pull out all the stops and use all the methods in a tantrum.
Effective parenting, whether a child has autism or not, is learning that you are in control, not the child. This is not a popularity contest. You are not there to wait on your child and indulge her every whim. Buying her every toy she wants isn't going to make her any happier than if you say no. There is no easy way out of this parenting experience. Sometimes you just have to dig in and let the tantrum roar.
Unlike tantrums, meltdowns can leave even experienced parents at their wit's end, unsure of what to do. When you think of a tantrum, the classic image of a child lying on the floor with kicking feet, swinging arms, and a lot of screaming is probably what comes to mind. This is not even close to a meltdown. A meltdown is best defined by saying it is a total loss of behavioral control. It is loud, risky at times, frustrating, and exhausting.
Meltdowns may be preceded by "silent seizures." This is not always the case, so don't panic, but observe your child after she begins experiencing meltdowns. Does the meltdown have a brief period before onset where your child "spaces out"? Does she seem like she had a few minutes of time when she was totally uninvolved with her environment? If you notice this trend, speak to your physician. This may be the only manifestation of a seizure that you will be aware of.
Another cause of a meltdown can be other health issues. One example is a child who suffers from migraines. A migraine may hit a child suddenly, and the pain is so totally debilitating that his behavior may spiral downward quickly, resulting in a meltdown. Watch for telltale signs such as sensitivity to light, holding the head, and being unusually sensitive to sound. If a child has other health conditions, and having autism does not preclude this possibility, behavior will be affected.<end quote>
I assume this is the original source: http://momofautistic.proboards30.com/index.cgi?board=Behavio r&action=display&thread=1086908775Here are some tips on avoiding public meltdowns, from the book Freedom from Meltdowns: Dr. Thompson's Solutions for Children with Autism by Travis Thompson, Ph.D
"I need a break" cards which a child can be trained to use before a meltdown hits:
Inspired by a book on meltdowns by Brenda Smith Myles.
http://networkedblogs.com/7nh3M - Rage and recovery stage
http://networkedblogs.com/7kZJU - rumbling stage
This blog summarizes a book called Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. It is written by Lipsky, who has been diagnosed with high functioning autism herself, and Richards.
About autistic escalation and meltdown.
short video on the difference between a tantrum and a meltdown
Article by Ellen Notbohm. See page 33.
Here's a great excerpt from Ellen Notbohm's book, "1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders." The excerpt is called "Game plan for meltdowns"
How to prevent meltdowns, written by an author with autism. She uses a train analogy to explain the phases of a meltdown.
Under another topic, amie tipped us about this book, called "The Way to A: Empowering Children with Autism Spectrum and Other Neurological Disorders to Monitor and Replace Aggression and Tantrum Behavior".
It has laminated pages that you can write on and wipe off.
The book is from Autism Asperger Publishing Company. Their website is worth a visit:
Today I found an article about meltdowns written by Cathy Budman, who specializes in rage and Tourette syndrome.
Ellen Notbohm is releasing an expanded second edition of her book "1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders."
The Amazon "Look Inside" function includes an excerpt with 12 warning signs of an impending meltdown. Click on "look inside" then "first pages." It's on page 6.