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Managing meltdowns in children with autism spectrum disorder

What is a meltdown?

Often meltdowns can be misunderstood as a tantrum.

Tantrum

When a child has a tantrum they are very aware of their surroundings and behave in a way to attract attention and a reaction from others for personal gain.

Children will often shout, scream, throw themselves on the floor and name call. Once they have received a desired response or item their frustrations and behaviour will soon reduce and stop.

Meltdown

When a child has a meltdown they become very self absorbed and are very unaware or uninterested in others reactions.

Meltdowns can last much longer than a tantrum and  have a greater physical effect on the child. Once the meltdown has progressed past a certain point there will be no reasoning with the child until they have completely calmed and regained control. Often children will experience a meltdown as a result of the situation, an inability to cope or lack of understanding a request or desired outcome.

What does a meltdown look like?

Your child can appear very distressed at this stage and although you may want to intervene this will now only aggravate and cause your child more stress.

During a meltdown your child will go into a ‘flight or fight’ mode which will have an impact on how they behave. This can be shown as:

  • hitting
  • kicking
  • spitting
  • wanting to to run or leave
  • avoiding eye contact
  • covering ears or eyes
  • crying
  • screaming

What causes a meltdown?

Finding what triggers a child’s meltdown is vital in order to reduce or avoid them happening again.

  • sensory overloads
    • flashing lights
    • loud noises
    • bright lights
  • cannot cope with new challenges or situations
  • cannot communicate needs with others
  • physical need
    • tired
    • hungry
  • change in routine
  • anxiety
  • loss of control
  • transitions
  • cannot read social situations
  • taking direction
  • poor problem solving skills
  • confrontation
  • feeling embarrassed
  • feeling overwhelmed
  • sense of failure

Every child is individual and so are their triggers so it is important to monitor and record when your child is experiencing times of difficulty so hot spots can be identified.

Signs of a meltdown rumbling

Some symptoms can be very obvious whereas some can be more subtle. All signs will all play an important part in identifying that your child is struggling, and at this stage needs some help. These signs may be:

  • clearing throat
  • biting lips or fingers
  • lowering voice
  • tensing muscles
  • tapping feet
  • grimacing
  • complaining of feeling unwell
  • withdrawing
  • lashing out physically
    • hitting
    • kicking and so on
  • shouting and screaming
  • threatening others

How to diffuse a meltdown

Once you have identified the signs that your child is becoming distressed then it is at this point that you must intervene to try and defuse the situation.

If your child is left for too long then their distress will progress into a full meltdown which will have to run its course.

When your child is in a meltdown it is very difficult to see. Any type of intervention will escalate the situation and your child’s upset.

At this time it is essential that you work with what your child likes, is motivated by or interested in and to be aware of things that cause upset or anxiety as this will have an impact on the success of the distraction.

The distraction has to be strong enough to distract the child from what they are thinking, feeling at that time.

Remove

Distract your child by taking them with you to run an errand, passing on a message or collecting something. Do anything to remove your child from the environment for long enough for them to calm.

Approach

A member of staff may need to provide support by standing close to the child, their presence may be enough to reduce stress or anxiety (this may not work for all children, some children become more anxious if people become too close).

Use signals

Non-verbal gestures can help so that your child’s anxiety or upset is acknowledged. They know that you know they are struggling. This can be reassuring to them.

For older children a secret signal between adult and child can be made. Also this can be used with a quick seat de-stressor such as a stress ball so your child is able to stay in their environment at their desk but reduce their anxiety.

Use routine

Use your child’s visual strategies to alleviate their upset. You can use their timetable or a ‘first and then’ strip to break down and show clearly what will happen. You can also use the symbols you can change with the situation. They can have have a reward or do a task they enjoy to gain a sense of control.

Walk and talk

Try to remove your child from the situation in a controlled way and give them opportunity to get rid of any stress or anxiety they have. While walking, your child can chat all they want but your should stay quiet. At this stage any attempt to converse will escalate the situation.

This strategy can be taught and supported with visuals so your child becomes familiar with the strategy and finds it useful for them.

Redirect

Lead your child’s attention and focus on to something different. Let them do their favourite task and make it more motivating. Use their interests, preferences, strengths and skills.

Provide a base

Give them somewhere at home and school which can be used as a place for your child to escape to if needed. This can be a quiet environment will a few things that will be specific to your child that help them to calm.

What to do during a meltdown

This can be a very upsetting time for the child and adults involved. It is essential to keep the child, other children and adults safe.

Often meltdowns will happen in the classroom, children can be very aware after their meltdown or their behaviour and feel embarrassed or extra sensitive during the recovery stage.

It is advisable if possible to remove the child, if not possible have a system where the other children can go to a safe environment.

What to do

  • be aware, recognise and know your child’s triggers
  • have a knowledge of what calms your child
  • stay calm
  • tell your child what you are doing in a low, quiet, non-confrontational way
  • have a clear concise plan for when meltdowns happen (this will need to be tailored to each individual child)

What not to do

  • use affection, this may upset a child further
  • use raised voice
  • use sarcasm
  • use physical restraint, this will upset a child further
  • ask questions
  • ask for an apology
  • confront

Recovery from a meltdown

After a meltdown children can be sullen, withdrawn or exhausted. During this stage intervention is needed, to help them move on. Children are usually not ready for demanding tasks but need reintegrating back into class and their environment.

The meltdown cycle

If not diffused your child will increasingly become upset and anxious. During this stage children may start acting impulsively and emotional. These behaviours can be expressed:

  • externally:
    • screaming
    • kicking
    • biting
    • hitting
  • internally:
    • withdraws
    • unresponsive

Rumbling

Your child will start exhibiting signs of stress and anxiety.

Intervention

At this stage your child will need intervention with the tips above.

Meltdown

At this stage your child will have to ride out their meltdown. All you should do now is to keep themselves and others safe and wait for the meltdown to finish.

Recovery

Children need time to calm back down. If you intervene too early they will become anxious again. Children can be very tired after a meltdown.

Useful equipment and resources

Each child is an individual and what they like and dislike is unique to them.

Their triggers are also personal and each child will have specific strategies or activities which help to calm. These may be useful:

  • trampoline
  • body sock
  • heated pad
  • massage
  • weighted blanket
  • beanbag
  • tent
  • sunglasses
  • ear defender
  • videos
  • DVDs
  • music
  • books
  • rocking
  • swinging
  • sliding
  • climbing

What can be learnt from a meltdown?

You should review the situation, look at what the triggers were, who was involved what was the outcome, could meltdown have been avoided.

If the meltdown has been a result of your child not understanding or having skills, then these can be explored and taught at a separate time in the appropriate way to aid the child in the future.

For older children, work can be done to help your child recognise and acknowledge their anxiety and stress levels. They can learn some strategies and coping techniques so they can have more control and avoid such situations reoccurring.

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: NDS7

Resource Type: Article

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