Monday, May 20, 2013

Five Things about Autism Meltdowns

One of the most unnerving aspects of autism spectrum disorder, both for the individual with autism and the caregiver or bystander, is the meltdown.  Taken at face value and out of context, a meltdown resembles a tantrum.  You might observe loud vocalizations, an out-of-control body, and perhaps even some physical aggression, directed toward self or others.  While there are some interventions that are the same for both a meltdown and a tantrum, many more would be contraindicated for meltdown resolution versus tantrum extinction.

As the parent of an adolescent with both ASD and mental health issues, I have benefited from a number of articles, books, and trainings over the years regarding the autism-driven meltdown.  Here are my five key takeaways:

  1. A meltdown and a tantrum are NOT the same!  A toddler's tantrum has a manipulative function, intended to change an outcome.  A preschooler's tantrum is more emotionally driven, which is nearer to the meltdown, but is largely outgrown as the elementary school student learns to regulate emotions.  A meltdown is not an "acting out", but a cessation of knowing how to act, given the overwhelming environment and lack of readily available coping mechanisms.  Because we neurotypicals don't struggle with the same sensory challenges that people on the spectrum often describe, we have an empathy deficiency in this area.  We need to remember that when we're stressed out, we can't access our coping mechanisms, either.  The storm raging in our brains impacts our entire body.
  2. There are always triggers to meltdowns.  You might not recognize them, but this is where the super sleuth in you needs to take over.  Practice "whole-body listening" consistently, taking data, if possible, to watch for patterns.  Consider starting by noting the time of day the meltdown takes place and the duration.  If it's at school, perhaps the meltdown takes place just before or during a particularly challenging subject.  Or maybe it's environmental: the grocery store, the doctor's office, a relative's house.  As you get better at identifying when and where they're happening, maybe notice some physical hints of anxiety (a common antecedent): facial or whole body tension, increased self-regulating behavior (rocking, vocal "stims", etc.), change in speech intensity (louder voice, more rapid speech, extra questions, etc.).
  3. Once a meltdown has started, there is no talking.  Verbal processing skills generally go out the window when someone with autism is experiencing a meltdown.  If you've gotten good at recognizing those physical hints, maybe you can help your person with autism get to a safe place to go through the impending meltdown in as dignified a manner as possible.  Perhaps you can have in that space (or with you, as a support person) some cards or a book with images that are soothing or evoke positive associations for your person with autism.  Slipping that quietly within the person's sphere of reference might offer a tool for decompression.  While there are some great emotional regulation apps out there, it might not be safe to put the tablet or smartphone in front of someone seemingly held hostage in that moment by his dysregulated neurology.
  4. People with autism in meltdown mode should not be held accountable for their meltdown-related behavior in the moment.  There will be lots of "verbal vomit", and some of it may seem quite personal.  Don't take it personally.  No amount of disciplining destructive behavior during a meltdown will stop the destruction.  This is not to say that there shouldn't be a debriefing and reparative process well after the meltdown.  Your person with autism might not be recovered enough five minutes after a meltdown, but maybe five hours later, or two days later, you will be able to revisit the incident during a stress-free, private moment.  Ask if the person remembers the meltdown, and perhaps what triggered it.  You may have to point out that the person made some mistakes during that time (left a hole in the wall, hurt someone's feelings, etc.), and allow him or her to come up with a plan to "fix" it.  Maybe that's drawing a picture or writing a note.  Maybe it's going to the store and picking up the supplies to fix the wall.  Always be sure to suggest alternative ways of coping with anxiety or anger, and practice these during periods of calm.
  5. Avoid escalating a meltdown; or better yet, try to prevent it.  Direct eye contact can be threatening to any person in crisis.  So avoid "getting in the face" of someone exhibiting those physical hints.  Get "low and slow" -- consider sitting down versus standing over people in crisis.  Instead of matching their speech intensity, do the opposite.  Talk quietly, perhaps even a whisper, using few words with concrete, easily-understood meanings.  When possible, present a visual support such as a card with a strategy or a couple words on a piece of paper in lieu of spoken language.  None of those are "giving in" to the escalating behavior.  If anything, they're taking fuel off the burn pile.  And remember, this crisis behavior isn't a display for you -- though you can learn A LOT from it.

A couple books I've benefited from: Jed Baker's No More Meltdowns and Ross Greene's The Explosive Child.  Do you have a favorite article, book, or other resource about autism-driven meltdowns?


rufers54 said...

This relates to adults with Autism/Asperger too. I wish I had known how to handle it before it blew my world apart.

Chelsea Budde said...

Found this Friendship Circle blog by Karen Wang very helpful as well:

Chelsea Budde said...

Even more on meltdowns: