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Tantrums and Meltdowns in Kids with Autism Spectrum Disorders

"How can I handle tantrums with my child on the autism spectrum? How should I deal with 'meltdowns'? Should the two be treated differently? If so, how does one know the difference between the two? Sorry for all the questions... but this is all new to me. My son was recently diagnosed with autism spectrum disorder and I want to do the right thing here! Please help. Thank you."

Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified (PDD-NOS), to a much milder form, Asperger syndrome (now called "high functioning autism"). They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.

Some ASD kids are more likely to have tantrums than other kids. Causes that contribute to a youngster's tendency to have tantrums include fatigue, the youngster's age and stage of development, temperament, stress in the child's environment, and whether underlying behavioral, developmental, or health conditions are present such as ADHD or ASD. Also, a youngster may be more likely to have tantrums if moms & dads react too strongly to difficult behavior or give in to the child's demands. Tantrums are normal behavior for most kids and there is no reason why kids with ASD should refrain from this stage of development.
 

Tantrums are one of the most common problems in young kids with ASD. They may appear to go into a state of rage, panic, anxiety or fear for no reason at all. This might involve screaming, crying, resisting contact with others, or pushing others away. Unfortunately for individuals with ASD and their families, ‘tantrums’ and destructive behaviors are especially common, among kids. The problem seems to be that it is more difficult for moms & dads to prevent ‘tantrums’ in kids with ASD, the youngster seems inconsolable during the ‘tantrum’, the episode might last a long time, and consist of more aggressive behavior, such as hitting, biting, and pinching. Most often the satisfaction that typically accompanies the end of the ‘tantrum’ rarely occurs. Similar episodes of panic, anxiety, rage or even aggression might be seen all through childhood, adolescence and even adulthood.

Ignoring the tantrum behavior and helping a young child learn how to handle and express anger and frustration are usually effective ways to deal with the behavior. Also, paying attention to what triggers tantrums can help you act before a youngster's emotions escalate beyond the point where he or she can control them. This is supposed to identify the cause of the behavior and prevent ‘blaming’ the individual. This is very important in ASD, as it is doubtful that any behavior which may cause difficulties for families is intended maliciously or menacing. There is almost always some other, unidentified, trigger that brings on challenging behavior.

It is important to intervene as early as possible so that behaviors are not constant and so that other means of expression and communication are open to kids with ASD.

Causes for Challenging Behaviors—

What causes this? As with such behavior in all kids there may be any number of causes. There might be underlying reasons (such as feeling upset, anxious or angry) and immediate triggers (such as being told to do something). In ASD however there is also a specific pattern of behavior, social interaction and understanding the tantrums are directed by frustration, can help explain some ‘challenging’ behaviors.

Kids with ASD often rely on ritual and structure. Structure is a method that helps define the world in terms of set rules and explanations in turn helps the person function most effectively. Most kids with ASD find their own methods of imposing structure and maintaining consistency. They need this structure because the world is confusing. Other people are complex and almost impossible to understand. The information they receive through their senses might be overwhelming and hard to bring together into a strong whole, and there is likely to be an additional learning disability that makes it hard to apply cognitive skills to all these areas at once.

When some form of structure or routine is disrupted the world becomes confusing and overwhelming again. It might be like losing a comforting toy when feeling alone or homesick. This disruption of structure might be obvious (having a collection of objects disturbed, being made to go a different way to school, getting up at an unusual hour) or it might be hidden (subtle changes in the environment which the youngster is used to for example). Some of these triggers might be out of the control of the individual or his or her family members. Some might be avoidable. Others might be necessary events, which can be slowly introduced so as to limit overt reactions.

Generally one of the most significant causes of ‘challenging behavior’ is a communicative need. For people with profound difficulties in understanding others and in communicating with them it is hardly surprising for frustration, anger and anxiety to build up. It is also quite likely that ‘challenging behaviors’ will directly serve as a form of communication. Natural ‘tantrums’, for example in response to changes in routine or requests to do something the individual does not want to do, may well become usual reactions to those involved.

Frequent Tantrums—

If your youngster continues to have frequent tantrums after age 3, you may need to use time-outs. A time-out removes the youngster from the situation, allows him or her time to calm down, and teaches the child that having a tantrum is not acceptable behavior. Time-out works best for kids who understand why it is being used.

Most kids gradually learn healthy ways to handle the strong emotions that can lead to tantrums. They also usually improve their ability to communicate, become increasingly independent, and recognize the benefits of having these skills. Kids who continue to have tantrums after the age of 4 usually need outside help learning to deal with anger. Tantrums that continue or start during the school years may be a sign of other issues, including problems with learning or getting along with other kids.
 

Talk with a health professional if:
  • Difficult behavior that frequently lasts longer than 15 minutes, occurs more than 3 times a day, or is more aggressive may indicate that a youngster has an underlying medical, emotional, or social problem that needs attention. These are not considered typical tantrums. Difficult behaviors may include: kicking, hitting, biting, scratching, hair pulling, or pinching other people, throwing or breaking things, head-banging or inflicting self-injury.
  • The youngster hurts him/her self, other people, or objects during a tantrum.
  • The youngster's behavior does not improve after 4 years of age.
  • The youngster's tantrums frequently last longer than 15 minutes or occur more than 3 times a day.
  • You have concerns about your youngster's tantrums.
  • You have problems handling your youngster's behavior, especially if you are concerned that you might hurt your youngster.
  • You have problems handling your youngster's behavior, especially if you are concerned that you might hurt your youngster.
  • You want help with learning to cope with your feelings during your youngster's tantrums.
  • Your youngster older than 4 years continues to have frequent tantrums.
  • Your youngster's tantrums escalate into violent behavior that endangers others or results in self-inflicted injuries.

Medical treatment for tantrums may be recommended for kids who:
  • Have long-lasting and frequent tantrums.
  • Regularly have tantrums after 4 years of age.
  • Causing self-injury or becomes violent.

This is where support is needed both in the form of direct interventions related to the behaviors, and in advising and helping moms & dads manage episodes in ways which can be applied at home.

These difficulties can be improved slowly through education and other interventions, but particular differences must be respected. Moms & dads can help by making an effort to manage the environment so that the individual is more comfortable (allowing some structure, avoiding distracting information when engaging in tasks, allowing personal space where necessary). The second major area is where ‘challenging behavior’ serves a communicative conduct. In this case the cause for the behavior must first be identified before teaching and developing other means of communicating.

Many young kids have so-called “temper tantrums” at one time or another in their lives. This type of behavior may continue for years in kids with ASD. Kids with ASD have perfectly “normal” appearances. They usually do not have any distinguishing features or characteristics that would make them appear different from any other youngster. Their behavior might be the only thing about them that makes them seem “different.”

People who witness a tantrum tend to make judgments on tantrum behaviors, often without anything to base their judgments on other than their own personal experiences. They will make hasty evaluations about the moms & dads of the youngster, about the situation, and assume that the youngster is a “spoiled brat,” when that may not be the case at all.

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What does a tantrum look like?

An ASD tantrum is different in many ways from the average type of temper tantrum. A regular temper tantrum usually starts at the mall, a grocery store, or other public place. A youngster sees an object such as candy, or a toy, and makes a request. The parent refuses the request. The onset of the tantrum begins with this initial refusal to grant the wish. The tantrum will last until the youngster’s wish is granted or the youngster loses the desire for the wish. In this circumstance, the tantrum is indeed “a violent, willful outburst” performed by the youngster to manipulate the environment for the purpose of obtaining the desired object.
 

Adults have all types of reactions to a temper tantrum. It is very embarrassing to have a youngster kicking and screaming on the floor. Some moms & dads will “give in” to the youngster in order to escape such a scene, which is about the worst thing a parent can do. Other moms & dads will take the youngster to a more private area for an “attitude adjustment,” which works some times. If it is really out of hand, the parent will remove the youngster from the store and go home. These are just some of the more typical reactions, but there are as many ways to deal with a temper tantrum as there are moms & dads. How to react to a temper tantrum is a very personal choice for moms & dads to make.

First of all, when an ASD outburst occurs, many times the triggering event is not obvious. The youngster will just start kicking and screaming for no apparent reason. We have no earthly idea what might have caused the onset of this behavior!

Second, the outburst or episode can last for HOURS! We don’t know what has started it, and we don’t know what we can do to end it! Rocking, comforting, scolding, spanking, and other measures we usually take do not help the situation. If anything, the outburst just escalates and the behaviors become even more extreme. We, as adults, are left feeling helpless and frustrated.

Third, no two ASD tantrums ever look quite alike. Kids with ASD can throw crying tantrums, where they just cry and cry for hours and they cannot be comforted. They might throw screaming tantrums, where they screech at the top of their lungs at such a high pitch that you are sure it can break glass. Kids can also throw giggling tantrums, though I hesitate to call it a tantrum exactly, it is more like a “fit” or a “spell.”

Giggling “fits” are much less annoying than the crying or screaming, but they can occur at the most unusual moments or inappropriate times. Too often, when they start giggling, the event is no laughing matter.

Why does a youngster with ASD have these tantrum behaviors?

The youngster or youth has deficits in developing and using verbal or non-verbal communication systems for receptive or expressive language.

Some kids with ASD can and do have language, but that does not mean that they are very good at communicating. There are people who have a form of ASD known as Asperger’s who are very articulate. Some people with ASD actually talk a great deal, but there is a lack of communication because they often fail to understand the purpose of language. Other people with ASD do not have the ability to speak, but they learn to communicate through other means. Kids may be somewhere in between, they may echo back what you say to them - this is one way that kids with ASD actually develop speech skills. However, just because a youngster can echo your words does not mean that the youngster understands what those words mean.

When a baby is born, its first method of communicating to the parent is by crying. It does not take very long for the infant to figure out that “If I cry someone will come and feed me.” or “change my diaper,” or “rock me and make me feel better.” Crying is a very primitive form of communication. Because ASD is a neurologically based disorder, infants later diagnosed with ASD even have impairments in this area. A youngster who is not developing language often will continue to use crying, or even temper tantrums, to indicate wants and needs.
 

Tantrums are a very primitive form of communication that can be used to indicate “no,” “I don’t want to,” and so on. It is also a way to communicate choices and preferences.

The youngster demonstrates abnormal responses to environmental stimuli.

A youngster with ASD may be hyposensitive (senses may be dulled) or hypersensitive (superman hearing) or anywhere in between. One or all senses may be affected.

Temple Grandin describes her responses to sensory stimuli like “tripping a circuit breaker.” One minute she was fine, and the next minute she was on the floor “kicking and screaming like a crazed wildcat.”

Dr. Grandin states that two things she hated as a youngster were washing her hair and dressing to go to church, because she has overly sensitive skin. She is very “tender headed” and washing her hair actually causes pain to her scalp. The petticoats that her mother made her wear to church felt like “sand paper scraping away at raw nerves.” I am sure that her mother misread her tantrums as not wanting to go to church, when really it was just Temple’s reaction to the clothing.

Other sensory related stimuli that might result in tantrum-like behaviors can include reactions to certain sounds, tastes or smells, bright lights or textures. Think of all the sounds, smells, lights and sensory experiences you have when you walk into a department store. Now imagine what it must be like for a person who is extra sensitive to all of these things! Tantrum-like behaviors in those places just might be a reaction to sensory overload.

Another reason kids with ASD might have tantrum-like behaviors is because they fail to understand social situations. This is certainly one of the criteria for ASD.

The youngster has deficits in social interaction, including social cues, emotional expression, personal relationships, and reciprocal interactions.

Sharing and taking turns are VERY difficult for my son to understand. He also has difficulty in sitting and participating in a large group, but he is getting much better at that. He does not know how to give a reliable yes or no response, but he has learned how to say “No, thank you.” when he does not want something.

One other reason that a youngster might have a tantrum-like behavior is because his or her routine has been upset or changed in some way, usually without advance notice.

The youngster demonstrates repetitive ritualistic behavioral patterns including insistence on following routines and a persistent preoccupation and attachments to objects.

People who have ASD have a very difficult time making sense of their environment. They cannot always rely on their sense of touch, taste, smell, vision, or hearing to give them accurate information. This is one of the reasons why they prefer to have everything exactly the way it was yesterday.

Reality to an autistic person is a confusing interacting mass of events, people, places, sounds and sights. There seem to be no clear boundaries, order or meaning to anything. A large part of my life is spent just trying to work out the pattern behind everything. Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life.
 

What should I do when my youngster has as a tantrum?

When a tantrum occurs it is a good idea for a youngster to have a “renewal area.” A renewal area is just a place for a youngster with ASD to go and calm down. The renewal area should be a quiet area away from any extra sensory stimuli. A spot at the end of a hallway is good. My son has a little tent in his room that he made from a folding card table with a blanket over it. He just crawls in there when things get to be too much for him to handle.

It is sort of like a “time out” spot, but differs in the fact that once the youngster does calm down they can leave that area. In time-out, the youngster is expected to sit in that spot for a set number of minutes. If a youngster is kicking and screaming, you are not going to be able to make them sit in time-out. It is more beneficial to have a spot for them to go when the “lose it.” Then once they are over the episode, you can decide what you want to do about the behavior.

It helps to think of an autistic tantrum more as an epileptic seizure. Just like a seizure, the tantrum has to run its course. It will help the youngster to calm down, if you are able to keep yourself calm. If you become angry or excited, this will make the tantrum worse. Never take an autistic tantrum as a youngster’s defiance of your authority. There might be any number of things at play here, just as I have described.

The first step you should take when you are trying to change a youngster’s behavior is to first figure out what the appropriate behavior is that you want to teach. It isn’t enough to just stop a tantrum-like behavior… you have to replace it with some sort of appropriate behavior. What does the youngster need to learn?

When you are trying to decide how to stop a youngster’s tantrum-like behaviors, you have to become a detective. Negative, punitive measures don’t work very well with kids who have ASD. You can take a youngster’s recess away for the next 100 years, and the kid will still have a tantrum every time he hears a fire truck. Just what do you want the youngster to do when he hears that fire truck coming down the road?

The second step is to analyze the purpose of the inappropriate behavior. You have to try and figure out what the behavior means from the youngster’s point of view. This is not as easy as it sounds, because kids with ASD view the world completely different from the rest of us. According to the Technical Assistance Manual on ASD for Kentucky Schools, we should be thinking about what happens before the behavior occurs, what is the exact behavior of the student, and what happens just after the behavior?

So a fire truck comes roaring down the road past the playground, sirens blaring, strobe lights flashing. This happens just before the behavior occurs.

The youngster grabs his ears and falls to the ground, kicking and screaming. This is the exact behavior of the student.

A teacher’s aid picks the youngster up and takes him back into the building. This happens every time just after the behavior occurs.

What are some possible reasons this youngster throws a tantrum-like fit every time the fire truck comes down the road? (Sensitive hearing, to get away from the noise.)

The third step is to teach the appropriate replacement behavior. What does the youngster need to learn? How about a more appropriate way to ask to go indoors? Instead of writhing on the ground in pain, when he first hears the siren he could go to the aid and give her tug on the sleeve, or indicate by pointing that he wants to go inside for a few minutes. Then after the fire truck is gone, he can resume the usual activities.
 

Points to remember:
  • A youngster with ASD who has tantrums is NOT a “spoiled brat,” “stubborn,” “bad,” “obstinate,” “strong willed,” or even “demon possessed” youngster, the tantrum like behavior is one of the manifestations of the disability.
  • Never take a tantrum as a personal threat against your authority.
  • With appropriate intervention strategies, tantrums do occur less frequently, so hang in there!

Meltdowns--

One of the most misunderstood autistic behaviors is the meltdown. Frequently, it is the result of some sort of overwhelming stimulation of which cause is often a mystery to moms & dads and teachers. They can come on suddenly and catch everyone by surprise. Autistic kids tend to suffer from sensory overload issues that can create meltdowns. Kids who have neurological disorders other than ASD can suffer from meltdowns. Unlike temper tantrums, these kids are expressing a need to withdraw and slowly collect themselves at their own pace.

Kids who have temper tantrums are looking for attention. They have the ability to understand that they are trying to manipulate the behavior of the others, caregivers and/or peers. This perspective taking or "theory of mind" is totally foreign to the autistic youngster who has NO clue that others cannot "read" their mind or feelings innately. This inability to understand other human beings think different thoughts and have different perspectives from them is an eternal cause of frustration.

A temper tantrum is very straightforward. A youngster does not get his or her own way and, as grandma would say, "pitches a fit." This is not to discount the temper tantrum. They are not fun for anyone.

Tantrums have several qualities that distinguish them from meltdowns:
  • A youngster having a tantrum will look occasionally to see if his or her behavior is getting a reaction.
  • A youngster in the middle of a tantrum will take precautions to be sure they won't get hurt.
  • A youngster who throws a tantrum will attempt to use the social situation to his or her benefit.
  • A tantrum is thrown to achieve a specific goal and once the goal is met, things return to normal.
  • A tantrum will give you the feeling that the youngster is in control, although he would like you to think he is not.
  • When the situation is resolved, the tantrum will end as suddenly as it began.

If you feel like you are being manipulated by a tantrum, you are right. You are. A tantrum is nothing more than a power play by a person not mature enough to play a subtle game of internal politics. Hold your ground and remember who is in charge.

A temper tantrum in a youngster who is not autistic is simple to handle. Moms & dads simply ignore the behavior and refuse to give the youngster what he is demanding. Tantrums usually result when a youngster 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 youngster to youngster. When kids decide this is the way they are going to handle a given situation, each youngster's style will dictate how the tantrum appears. Some kids will throw themselves on the floor, screaming and kicking. Others will hold their breath, thinking that his "threat" on their life will cause moms & dads to bend. Some kids will be extremely vocal and repeatedly yell, "I hate you," for the world to hear. A few kids 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 kids who pull out all the stops and use all the methods in a tantrum.
 

Effective parenting -- whether a youngster has ASD or not -- is learning that you are in control, not the youngster. This is not a popularity contest. You are not there to wait on your youngster 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.

If the tantrum is straightforward, the meltdown is every known form of manipulation, anger, and loss of control that the youngster can muster up to demonstrate. The problem is that the loss of control soon overtakes the youngster. He needs you to recognize this behavior and rein him back in, as he is unable to do so. A youngster with ASD in the middle of a meltdown desperately needs help to gain control.
  • A youngster in a meltdown has no interest or involvement in the social situation.
  • A youngster in the middle of a meltdown does not consider her own safety.
  • A meltdown conveys the feeling that no one is in control.
  • A meltdown usually occurs because a specific want has not been permitted and after that point has been reached, nothing can satisfy the youngster until the situation is over.
  • During a meltdown, a youngster with ASD does not look, nor care, if those around him are reacting to his behavior.
  • Meltdowns will usually continue as though they are moving under their own power and wind down slowly.

Unlike tantrums, meltdowns can leave even experienced moms & dads at their wit's end, unsure of what to do. When you think of a tantrum, the classic image of a youngster 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 youngster after she begins experiencing meltdowns. Does the meltdown have a brief period before onset where your youngster "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.

When your youngster launches into a meltdown, remove him from any areas that could harm him or he could harm. Glass shelving and doors may become the target of an angry foot, and avoiding injury is the top priority during a meltdown.

Another cause of a meltdown can be other health issues. One example is a youngster who suffers from migraines. A migraine may hit a youngster 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 youngster has other health conditions, and having ASD does not preclude this possibility, behavior will be affected.

Practical steps to reduce ASD tantrums and meltdowns:

1. Address your youngster's sensory issues. Many kids with ASD have issues with sensory integration. This means your youngster is constantly bombarded with sensory information and lacks the ability to filter out the unimportant things. Loud noises, bright lights and large crowds are enough to cause a tantrum. Sensory integration therapy and occupational therapy help address the issue. However, these therapies are most effective if you start them while your youngster is really young. Learn more about sensory integration therapy at Healing Thresholds.

2. Get your youngster on a communication system. Sometimes tantrums occur because your youngster lacks the communication to adequately express herself. This is especially important if your youngster is non-verbal or only slightly verbal. Communication systems, like visual schedules, consist of objects, pictures or words. Sometimes a system as simple as a basic choice board really helps to reduce tantrums.

3. Make your youngster a visual schedule. Visual schedules provide structure to your youngster's day, through the use of visual supports. Whether the schedule consists of objects, pictures or printed words, it provides the youngster with a visual road map of his day. When your youngster knows what to expect next, it alleviates anxiety which reduces his potential for tantrums.

4. Use transition tools. Some kids with ASD have great difficulty with transitions. This means asking your youngster to switch from one activity to the next can cause a tantrum. Something as simple as a two columned "First, Then," card will alleviate anxiety . Divide a half sheet of paper in half by drawing a line down the middle. Label the first column, "First," and label the second column "Then." Place a picture card of the activity you youngster will do first in the "First," column and a picture card of the activity your youngster will do next in the "Then," column. When you transition your youngster to an activity, show them the card. Say, "First, we'll do homework, then we'll play outside." Point to each picture as you speak. 

Resources for parents of children and teens on the autism spectrum:
 

 
COMMENTS:

•    Anonymous said... Keeping a diary of the temper tantrums is very important and will serve as a useful tool to you in determining times of the day that the tantrums occur and what type of situations may set him off.  As far as dealing with what's occurring the tantrums and meltdowns you can try time outs, or, how about speaking in a low tone voice. There's a book called 1-2-3 magic that discusses the whole time out program. You are smart to ask questions and you are seeking resources which is so important and your seeking answers. I want you to know that I'm here for you if u ever want to talk please just inbox me here. I will search additional resources for you. Don't know if you know about the CHADD organization you can search them online they are an excellent source of information.
•    Anonymous said... Oh wow... Lots of questions, lots of new worries.. I feel for you, sweet parent. Welcome to the "club", I suppose? No, really... You are on the right track. Asking questions, research, other parents advice, this is all the best things you can do for you and your child. I am proud you are striving to help your child by educating yourself, so many people just try to bend the child back towards "normal", rather than bend with the child. Yes, there are marked differences between a meltdown and a regular old spoiled tantrum... What those clues are for you and your child, unfortunately, may be different than mine, or anyone else on here dealing with Autism meltdowns. The best resource you will have for the next coming years, will be your mind, eyes, ears and heart. Watch the child, there will be "triggers" that you may not have ever noticed before... (Does he start grabbing his face or hair right before, does she grind her teeth, does his eyes start getting watery and his voice get shakey?) these are all signs the storm is about to hit. I've learned to stave off most meltdowns by watching for the signs and avoiding most triggers. This sounds like a LOT of work, and believe me... It is... But it's so worth it when you don't have to hold your screaming, thrashing child down, and instead get to watch the storm dissipate and no meltdown occur.
Good luck mommy and daddy... It's a rough road ahead of you... But by asking these questions and really really learning your child, I know you will be fine. smile emoticon thinking of you all!
•    Anonymous said... Try keeping a diary/record of tantrum and meltdowns see if there's a pattern this can help with noticing triggers and help nite the differences between the two. .. good luck x

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