"I read your article on preventing meltdowns, but what can be done when a child is already in a meltdown? My autistic son (high functioning) will experience meltdowns that can literally last for an hour or more."
There are a number of ways to handle a meltdown in a child with high-functioning autism once it has started.
Some simple strategies include the following:
1.You can positively distract the youngster by getting him focused on something else that is an acceptable activity. For example, you might remove the unsafe item and replace with an age-appropriate toy.
2.You can place the youngster in time away. Time away is a quiet place where she goes to calm down, think about what she needs to do, and, with your help, make a plan to change the behavior.
3.When possible, hold the youngster who is out of control and is going to hurt himself or someone else. Let the youngster know that you will let him go as soon as he calms down. Reassure the youngster that everything will be all right, and help him calm down. Parents may need to hug their youngster who is crying, and say they will always love him no matter what, but that the behavior has to change. This reassurance can be comforting for a youngster who may be afraid because he lost control.
4.Unlike a meltdown, you can ignore a tantrum if it is being thrown to get your attention. Once the youngster calms down, give the attention that is desired.
5.Try to intervene before the youngster is out of control. Get down at her eye level and say, “You are starting to get revved up, slow down.” Now you have several choices of intervention.
6.Think before you act. Count to 10 and then think about the source of the youngster’s frustration, his characteristic temperamental response to stress (e.g., hyperactivity, distractibility, moodiness), and the predictable steps in the escalation of the meltdown.
7.Talk with the youngster after she has calmed down. When she stops crying, talk about the frustration she has experienced. Try to help solve the problem if possible.
8.For the future, teach her new skills to help avoid meltdowns, such as how to ask for help. Teach her how to try a more successful way of interacting with a peer or sibling, how to express her feelings with words and recognize the feelings of others without hitting and screaming.
9.Remain calm and do not argue with the youngster. Before you manage him, you must manage your own behavior. Spanking or yelling at the youngster will make the meltdown worse.
10.If the youngster has escalated the meltdown to the point where you are not able to intervene in the ways described above, then you may need to direct him to time-away (not to punish, but to remove him from the current environment). If you are in a public place, carry your youngster outside or to the car. Tell him that you will go home unless he calms down. In school, teachers can warn the child up to three times that it is necessary to calm down and give a reminder of the rule. If the youngster refuses to comply, then place him in time-away for no more than 1 minute for each year of age (again, not to punish, but to remove him from the current environment).
Do not reward the youngster after a meltdown for calming down. Some kids will learn that a meltdown is a good way to get a treat later.
Explain to the youngster that there are better ways to get what he or she wants.
Never let meltdowns interfere with your otherwise positive relationship with the youngster.
Never, under any circumstances, give-in to a temper tantrum (which sometimes looks like a meltdown). That response will only increase the number and frequency of the tantrums. Also, when the youngster on the autism spectrum has become accustomed to successfully manipulating parents with tantrums in the past -- but then doesn't get his way with today's tantrum -- it can often escalate into a meltdown. Now the parent has two distinctly different problems (that may look the same) to address.
Teach the youngster that anger is a feeling that we all have and then teach her ways to express anger constructively.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"Is it common for children on the autism spectrum to react strongly to one or two things (certain noises for example) - yet not react at all to other things that ordinary kids would react strongly to (such as a broken bone)?"
Many young people with High-functioning Autism (HFA) have a dysfunctional sensory system. Oftentimes, one or more senses are either over-reactive or under-reactive to stimulation. Such sensory issues may be the underlying reason for certain behaviors associated with autism spectrum disorders (e.g., rocking, spinning, hand-flapping, etc.). Although the receptors for the senses are located in the peripheral nervous system, the problem appears to stem from neurological dysfunction in the central nervous system.
Sensory integration refers to the accurate interpretation of sensory stimulation from the environment by the child’s brain. Conversely, sensory integrative dysfunction is a disorder in which sensory input is not organized appropriately in the brain, thus producing varying degrees of problems in development, information processing, and behavior.
Sensory integration focuses primarily on 3 basic senses: (1) proprioceptive, (2) vestibular, and (3) tactile. Their interconnections start forming before birth and continue to develop as the child matures and interacts with his environment. These 3 senses are also connected with other systems in the brain, and even though they are less familiar than other senses (i.e., taste, smell, sight, and hearing), they are critical to basic survival.
Dysfunction within these 3 senses manifests itself in many ways. For example, the child:
has an activity level that is either unusually high or unusually low
is in constant motion or fatigues easily
is over- or under-responsive to sensory input
becomes impulsive, easily distractible, or shows a general lack of planning
experiences gross and/or fine motor coordination problems
has difficulty adjusting to new situations and may react with frustration, aggression, or withdrawal
has speech and/or language delays
Let’s look at each of these 3 senses in greater detail...
Proprioceptive—
The proprioceptive system refers to components of muscles, joints, and tendons that (a) provide the child with a subconscious awareness of her body position, which is automatically adjusted in different situations (e.g., sitting properly in a chair, stepping off a curb smoothly, etc.), and (b) allow the child to manipulate objects using fine motor movements (e.g., writing with a pen, using a spoon, buttoning a shirt, tying shoe laces, etc.). In addition, proprioception involves motor planning, which is the ability to plan and execute different motor tasks.
Some common signs of proprioceptive dysfunction include the following:
tendency to fall
resistance to new motor movement activities
odd body posturing
minimal crawling when young
lack of awareness of body position in space
eating in a sloppy manner
difficulty manipulating small objects (e.g., buttons, snaps)
clumsiness
Therapy may include:
bouncing on a trampoline or a large ball
skipping or pushing heavy objects
wearing weighted belts
weighted blankets
weighted vests
Vestibular—
The vestibular system refers to structures within the inner ear that detect movement and changes in the position of the head (e.g., tells the child when his head is upright or tilted, even with the eyes closed).
Dysfunction within the vestibular system may manifest itself in two different ways:
Hyposensitivity: The HFA youngster may actively seek very intense sensory experiences (e.g., excessive body whirling, jumping, spinning, etc.). This type of youngster demonstrates signs of a hypo-reactive vestibular system (i.e., he is trying constantly to stimulate himself).
Hypersensitivity: The youngster may (a) be extremely susceptible to vestibular stimulation; (b) have fearful reactions to ordinary movement activities (e.g., swings, slides, inclines, ramps. etc.); (c) have trouble learning to climb or descend stairs or hills; (d) be apprehensive about walking or crawling on uneven or unstable surfaces; and (e) appear clumsy.
Therapy can include:
cartwheels
dancing
hanging upside down
rocking chairs
rolling
somersaulting
spinning
swings
All of these actions involve the head moving in different ways that stimulate the vestibular system. The therapist will observe the youngster carefully to be sure the movement is not over-stimulating. The most stimulating movement tends to be rotational (i.e., spinning) and should be used carefully by the therapist. Merry-go-rounds, being tossed on to cushions, or jumping on trampolines can be favorite activities with some HFA kids. Back and forth movement is typically less stimulating than side-to-side movement. A rocking motion will usually calm a youngster, while vigorous motions like spinning will be stimulating. Ideally, therapy will provide a variety of these movements.
The tactile system includes nerves under the skin's surface that send information to the brain (e.g., light touch, pain, pressure, temperature, etc.), which plays an important role in perceiving the environment – and protective reactions for survival.
Dysfunction in the tactile system can be seen in the following:
complaining about having one's hair or face washed
refusing to eat certain textured foods
refusing to wear certain types of clothing
using one's finger tips rather than whole hands to manipulate objects
walking with heels of the feet off the floor
withdrawing when being touched
A dysfunctional tactile system can lead to a misperception of touch and pain, and may lead to self-imposed isolation, general irritability, hyperactivity, and distractibility. Tactile defensiveness is a condition in which the child is extremely sensitive to touch, which can result in behavior problems, inability to concentrate, and negative emotional response to touch sensations.
Therapy may include the following:
For HFA kids who enjoy the feel of sticky textures, the therapist may use certain materials (e.g., glue, stickers, play dough, rubber toys, sticky tape, water, beans, rice, and sand). On the other hand, kids who are very sensitive to touch may go through a brushing program that attempts to desensitize them to touch by systematically brushing their body at regular intervals throughout the day.
Some HFA kids enjoy a sense of firm overall pressure. This can be provided by weighted blankets, weighted belts, being squeezed by pillows, and firm hugs. Also, making tunnels or tents from blankets over furniture can be soothing to these “special needs” children.
Other therapeutic approaches for HFA children with dysfunctional sensory systems may include the following:
Difficulty with using both sides of the body simultaneously can occur in some of these young people. The therapist may encourage the youngster with hopscotch, crawling, skipping, playing musical instruments, playing catch, or bouncing balls with both hands to help with bilateral integration.
Hand and eye coordination can be improved with activities such as popping bubbles, hitting a ball with a bat, beanbags and balloons, and throwing/catching balls.
Skills such as riding a bike or tying shoe laces can be difficult for some HFA children, because they involve sequences of movements. Therapy to help in this area may include obstacle courses, swimming, mazes, constructional toys, and building blocks.
Evaluation and treatment of sensory integrative dysfunction is performed by an occupational and/or physical therapist. The therapist's general goals are to:
assist the youngster in inhibiting and/or modulating sensory information
assist the youngster in processing a more organized response to sensory stimuli
provide the youngster with sensory information which helps organize the central nervous system
Sensory processing functions on a continuum. Everyone has difficulty processing certain sensory stimuli (e.g., a certain touch, taste, smell, sound, movement etc.) – and everyone has sensory preferences. Processing difficulties only become a Sensory Processing Disorder when an individual is on extreme ends of the continuum or experiences disruptive, unpredictable fluctuations which significantly impact developmental skills and everyday functioning.
If you believe your HFA child may be experiencing some form of sensory integration dysfunction, ask your child’s doctor for a referral to an occupational and/or physical therapist for treatment.
Resources for parents of children and teens on the autism spectrum:
More articles for parents of children and teens on the autism spectrum:
Social rejection has devastating effects in many areas of functioning.
Because the ASD child tends to internalize how others treat him,
rejection damages self-esteem and often causes anxiety and depression.
As the child feels worse about himself and becomes more anxious and
depressed – he performs worse, socially and intellectually.
Meltdowns are not a pretty sight. They are somewhat like overblown
temper tantrums, but unlike tantrums, meltdowns can last anywhere from
ten minutes to over an hour. When it starts, the Asperger's or HFA child
is totally out-of-control. When it ends, both you and your child are
totally exhausted. But... don’t breathe a sigh of relief yet. At the
least provocation, for the remainder of that day -- and sometimes into
the next - the meltdown can return in full force.
Although Aspergers [high-functioning autism] is at the milder end of the
autism spectrum, the challenges parents face when disciplining a
teenager on the spectrum are more difficult than they would be with an
average teen. Complicated by defiant behavior, the teen is at risk for
even greater difficulties on multiple levels – unless the parents’
disciplinary techniques are tailored to their child's special needs.
Your older teenager or young “adult child” isn’t sure what to do, and
he is asking you for money every few days. How do you cut the purse
strings and teach him to be independent? Parents of teens with ASD face
many problems that other parents do not. Time is running out for
teaching their adolescent how to become an independent adult. As one
mother put it, "There's so little time, yet so much left to do." Click here to read the full article…
Two traits often found in kids with High-Functioning Autism are
“mind-blindness” (i.e., the inability to predict the beliefs and
intentions of others) and “alexithymia” (i.e., the inability to
identify and interpret emotional signals in others). These two traits
reduce the youngster’s ability to empathize with peers. As a result, he
or she may be perceived by adults and other children as selfish,
insensitive and uncaring. Click here to read the full article...
Become an expert in helping your child cope with his or her
“out-of-control” emotions, inability to make and keep friends, stress,
anger, thinking errors, and resistance to change.
A child with High-Functioning Autism (HFA) can have
difficulty in school because, since he fits in so well, many adults
may miss the fact that he has a diagnosis. When these children display
symptoms of their disorder, they may be seen as defiant or disruptive.
"Is there a way for parents of children with ASD to prevent meltdowns from happening in the first place? I ask because once my autistic son (level 1) gets up a head of steam, there's no way of getting him to calm down."
It is much easier to prevent meltdowns than it is to manage them once they have erupted.
Here are 16 tips for preventing meltdowns and some things parents can say to their high-functioning autistic children:
1.When visiting new places or unfamiliar people explain to the youngster beforehand what to expect. Say, “Stay with your assigned buddy in the museum.”
2.Signal kids on the autism spectrum before you reach the end of an activity so that they can get prepared for the transition. Say, “When the timer goes off 5 minutes from now it will be time to turn off the TV and go to bed.”
3.Reward them for positive attention rather than negative attention. During situations when they are prone to meltdowns, catch them when they are being good and say such things as, “Nice job sharing with your friend.”
4.Provide pre-academic, behavioral, and social challenges that are at the youngster’s developmental level so that the youngster does not become frustrated.
5.Make sure that kids on the spectrum are well rested and fed in situations in which a meltdown is a likely possibility. Say, “Supper is almost ready, here’s a cracker for now.”
6.Keep off-limit objects out of sight and therefore out of mind. In an art activity keep the scissors out of reach if kids are not ready to use them safely.
7.Keep a sense of humor to divert the youngster’s attention and surprise the youngster out of the meltdown.
8.Increase your tolerance level. Are you available to meet the youngster’s reasonable needs? Evaluate how many times you say, “No.” Avoid fighting over minor things.
9.Give them control over little things whenever possible by giving choices. A little bit of power given to the youngster can stave off the big power struggles later. “Which do you want to do first, brush your teeth or put on your pajamas?”
10.Establish routines and traditions that add structure. For teachers, start class with a sharing time and opportunity for interaction.
11.Do not ask them to do something when they must do what you ask. Do not ask, “Would you like to eat now?” Say, “It’s suppertime now.”
12.Distract them by redirection to another activity when they begin to meltdown over something they should not do or cannot have. Say, “Let’s read a book together.”
13.Create a safe environment that kids can explore without getting into trouble. Childproof your home or classroom so kids can explore safely.
14.Choose your battles. Teach these "special needs" children how to make a request without a meltdown and then honor the request. Say, “Try asking for that toy nicely and I’ll get it for you.”
15.Change environments, thus removing the youngster from the source of the meltdown. Say, “Let’s go for a walk.”
16.Avoid boredom. Say, “You have been working for a long time. Let’s take a break and do something fun.”
Resources for parents of children and teens on the autism spectrum:
Kids and teens with Asperger’s (AS) and High-Functioning Autism (HFA) often have difficulty understanding social situations, which can cause stress and anxiety. Social situations that seem to be most problematic include:
Interpreting nonliteral language (e.g., idioms and metaphors)
Knowing how and when to use turn-taking skills (e.g., focusing on the interests of peers)
Recognizing that others' intentions do not always match their verbalizations
Understanding facial expressions and gestures
Understanding the “hidden curriculum” (i.e., those complex social rules that often are not directly taught)
Even when a youngster with AS or HFA receives effective instruction in social skills, situations will arise that require “interpretation.” Unless interpreted, these situations become a source of stress and do not support future learning. However, with interpretation, perceptions of seemingly random actions can be altered into meaningful interactions. Interpretive strategies include:
the Situation-Options-Consequences-Choices-Strategies-Simulation (SOCCSS) strategy
One interpretive technique, the Situation, Options, Consequences, Choices, Strategies, Simulation (SOCCSS) strategy, was developed to help AS and HFA kids with social interaction problems put interpersonal relationships into a sequential form. It helps them understand problem situations and lets them see that they have to make choices about a given situation, with each choice having a consequence. The steps of SOCCSS are:
1. Situation: When a social problem arises, the parent or teacher helps the youngster to understand the situation by first identifying:
who was involved
what happened
the date, day, and time of occurrence
reasons for the present situation
2. Options: The youngster, with the assistance of the parent or teacher, brainstorms several options for behavior. At this point, the parent or teacher accepts all of the child’s responses and does not evaluate them. This step encourages him or her to see more than one perspective and to realize that any one situation presents several behavioral options.
3. Consequences: Then the youngster and parent or teacher work together to evaluate each of the options generated. The parent or teacher is a facilitator, helping the youngster to develop consequences for each option rather than dictating them.
4. Choices: The youngster selects the option(s) that will have the most desirable consequences for him or her.
5. Strategy. Next the youngster and parent or teacher develop an action plan to implement the selected option.
6. Simulation: Finally the youngster is given an opportunity to role-play the selected alternative. Simulation may be in the form of:
writing a plan
visualization
talking with a peer
role play
The SOCCSS strategy offers many benefits to the AS or HFA child. It allows him or her to:
understand that many options may be available in any given situation
realize that each option has a naturally occurring consequence
develop a sense of empowerment by acting on the environment (i.e., these children realize that they have choices, and by selecting one, they can directly determine the consequences of their actions).
The Power Card—
Figure 1 - Click to enlarge
The Power Card is a visual aid that helps AS and HFA kids and teens make sense of social situations, routines, and the meaning of language. The Power Card uses their “special interests” to help them make sense of a specific situation and motivates them to engage in a targeted behavior.
In using this strategy, the parent or teacher develops a brief script written at the youngster's level of comprehension, which details a problem situation or a target behavior and its relationship to the youngster's special interest. Power Cards also provide a solution, relying on the youngster's special interest. This solution then is generalized back to the youngster. A card the size of a business card or trading card containing a picture of the special interest – and a summary of the solution – can be carried with the youngster to promote generalization.
The Power Card can be carried in a pocket, purse, or wallet, or it can be velcroed inside a book, notebook, or locker. It also may be placed on the corner of the youngster's desk. Figure 1 provides an example of a Power Card for a 6-year-old female student with HFA who had problems focusing. Her special interest was Dora the Explorer.
Social Autopsies—
Figure 2 - Click to enlarge
This technique was created to help AS and HFA children with severe learning and social problems to develop an understanding of social mistakes. In the traditional sense, an autopsy is the examination and inspection of a dead body to discover the cause of death, determine damage, and prevent recurrence.
Similarly, a social autopsy is an examination and inspection of a social error to discover the cause of the error, determine the damage, and prevent it from happening again. When a social mistake occurs, the youngster meets with the parent or teacher to discuss it.
Together, in a non-judgmental way, they identify the mistake. Then they discuss who was harmed by the error. The final step of the autopsy is to develop a plan to ensure that the error does not occur again. Figure 2 is an example of a social autopsy worksheet.
Cartooning—
Figure 3 - Click to enlarge
The visual area is a strength for kids on the autism spectrum. Therefore, visual systems often enhance their ability to understand their environment. One type of visual support is cartooning. This strategy has been implemented by speech/language pathologists for many years to enhance their clients’ understanding.
Cartoon figures play an integral role in a number of other intervention techniques (e.g., pragmaticism, mind-reading, and comic strip conversations). Each of these strategies promotes social understanding by using simple figures and other symbols (e.g., conversation and thought bubbles) in a comic strip-like format. This visual representation of a conversation helps AS and HFA kids analyze the social exchange.
Although cartooning has limited scientific verification, some evidence suggests that learners with AS and HFA may be good candidates for social learning based on using a comic format to dissect and interpret social situations and interactions. Figure 3 provides a cartoon depicting a social interchange.
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