This past Saturday, I was given the opportunity to speak at the Autism Society of East Tennessee’s Autism Educational Conference.
I felt a bit out of place (most of the people there were neurotypical), but that’s okay. My topic that I presented on was the management and prevention of meltdowns, as well as how to better support healthy emotional regulation. Considering how many meltdowns I had preparing for this session, the irony has not been lost on me.
Since I know a lot of people are unable to afford attending the conferences, I figured it would be helpful to post the information on here. I want to make sure the information is as accessible as possible.
Meltdowns are easily one of the most difficult parts of being autistic.
I love being autistic (something a lot of people don’t hear often!), but meltdowns are honestly the worst.
The best way I can personally describe a meltdown is like a Blue Screen of Death crash on a computer. Of course, I am a human being and not a computer – but I think it gets the point across. Others have also compared it to a more intense and painful panic attack.
Meltdown or Tantrum?
A question I have often been asked by parents and caregivers is “how do I tell the difference between a meltdown and a tantrum?”
For someone raising a toddler, that’s a fairly valid question. Neurotypical or autistic, children are going to throw tantrums sometimes. Adults do, too. It happens. For this, keep four questions in mind:
- Does it happen regardless of an audience?
- Is it goal-driven?
- Can you ‘reason’ with them to stop?
- What led up to the event?
In most cases, meltdowns are not goal driven. A meltdown does not occur because the kid wants the chocolate bar in the checkout lane – unless they expected to get it prior or it was promised. And if they do, that may be a sign that something else is going on. I’ll go more into depth with that later. Meltdowns also can occur with or without an audience, because it’s not seeking a goal- it’s a sign of distress.
When a child has a tantrum, ignoring them or giving in are ways that people deal with it. You can bribe or reason with them, whereas someone facing a meltdown has way too much input going in already. They will struggle to process more of the information. Another way to tell is to analyze the situations that led up to the event. Were you in a crowded supermarket and the intercom came on? Did your child get a bad grade on an assignment? Were they bullied on the playground that day? A lot of different factors come into play with a meltdown.
The same applies for teens and adults who are autistic as well. There may be different situations from homework or playgrounds, such as relationship problems or stress. It’s important to remember meltdowns happen at all ages. It’s not just a “kid” thing. It’s an in-built response to distress.
Remember that meltdowns are different for each person.
Meltdowns can be presented in different ways. Some autistic people have more outward meltdowns, which may look like throwing things, hitting ourselves, biting others, etc. I’ve had my share of ducking to avoid objects being thrown, but always remember that it’s not necessarily personal. The individual needs you to be calm, not angry. Individuals may also “lose their words” or become nonspeaking during this time, which is important to note.
For myself personally, I am much more inward with my meltdowns. I tend to exhibit self-injurious behavior such as scratching my skin and other things. Of course, prior to my diagnosis, my providers thought this was simply just self-harm – not a product of meltdowns. After learning I was autistic, I was able to implement things that have helped bring the self-injurious behaviors to a much less severe state. I also tend to cry, rock, or have my head buried in my hands. I remember being very young and telling myself to “hold on” until I was alone. Of course, holding back meltdowns will also make them worse. Typical, really. The more you try to fight the meltdown/ push through, the worse it tends to be. Some autistic people are able to do this, while others are not – and that’s okay. We’re all different! Sometimes though, it’s impossible to do that at all. I have found that trying to hold back a meltdown is also very unhealthy and detrimental to your mental health.
There are several factors that can cause meltdowns.
Meltdowns can be very complex. Sometimes it isn’t necessarily just one factor but a mixture of several. For example, a child who has a meltdown over choosing a marker may not be having the meltdown over just the marker itself. She may have already had a stressful day, might be sick, or even just already overstimulated. While the marker situation alone could trigger a meltdown, many times it’s the “final straw.”
Meltdowns can be caused by:
- Emotional build-up
- Sensory Overload
- Not Enough Processing Time
- Fatigue or illness
- Cortisol overload
- Change in routine
I’ve had meltdowns that were triggered by each of these things. It’s important to note that it could also be more than one thing. For example, I had a very particularly awful meltdown my freshman year of college. While I thought it was just because of emotions and sensory issues, it turned out that I also had pneumonia and hadn’t even noticed. I wasn’t even able to communicate that I was sick – I just felt “off” and didn’t know how to describe it. It wasn’t until I went to the doctor that they figured it out.
On a side note, there is also something related called ‘shutdowns.’ When this happens, the individual may be unable to cope with their surroundings and has to “check out.” This can present in derealization/dissociation, becoming unable to speak or move, and feeling so drained that you can’t function. I have these far more than I have meltdowns, and they’re just as difficult to deal with.
When an autistic person has a meltdown, there’s a few things to keep in mind.
First, remember to keep calm. Your goal is to de-escalate and support the person – not agitate and stress them out further. It’s also better for your own coping skills to remain calm in crisis when possible. When I’m in the middle of a meltdown, the absolute last thing that will help me is someone yelling at me.
Another important thing to note is the necessity of self-care. Your mental health is important, just as the individual’s is. Take some time to decompress and relax later – and make sure that the autistic person does too! Meltdowns aren’t fun for anyone, especially the person having them. After a meltdown, I feel incredibly drained and unwell. It takes time to recover from such an emotional and distressing experience. Just as you’d unwind with a nice book or a glass of wine after a rough day at work, the same principle applies.
Make sure that you consider all the different aspects and causes. If it isn’t emotional or sensory, keep in mind that there may very well be a medical issue going on. This is especially true if the individual isn’t able to tell if they’re unwell or if they don’t have access to effective communication tools to describe the problem.
I personally love the H.U.R.T.S. method for narrowing down the medical issue. I learned this particular concept from Clarissa Kripke, MD, FAAFP. I provided a link to the bottom of this page if you want to read a much better worded and in-depth document.
- Migraines, ear infections, vision/hearing changes, sore throat, etc.
- Urinary Tract Infections
- Also includes kidney stones, gallstones, or gastrointestinal issues.
- Heartburn is common.
- Thyroid or Traumas
- Thyroid issues may be occurring. Physical traumas such as a broken arm or sprained ankle could also be the culprit. Psychological trauma is also valid.
- Some individuals with ASD will have co-occurring conditions such as Epilepsy.
Behavior is communication – although not necessarily direct communication.
Almost everyone involved in this field has heard the old adage “behavior is communication.” Technically, this is very true. However, keep in mind that sometimes the ‘behaviors’ are reactions that are completely involuntary. React kindly and keep this in mind.
Now for the big issue: what’s the best thing to do when someone has a meltdown?
For this one, I recommend the S.C.A.R.E.D. Method. From what I’ve read, this is attributed to an autistic first responder named Deborah Lipsky.
- Focus first on getting people out of the way or getting the person out of the room. Safety is a priority.
- Breathe; this will pass. Use simple instructions and short sentences. The individual may struggle to process information during this time.
- Positive and calming words should be used. You have to de-escalate, not agitate.
- If you know of any calming routines or activities that the person deems safe – help guide them to it. Examples include using a weighted blanket or even playing a preferred calming song that they have chosen and asked you to use.
- Remember to be kind and empathetic. Work from a trauma-informed perspective.
- Make an intervention plan BEFORE the meltdowns happen.
The best way to manage a meltdown is to prevent them from happening or lessening the negative impact on the individual.
Everyone has had one of those bad days, right? Where everything is so stressful that you just have to cry it out?
Similar to a meltdown, you have to have positive coping skills. Things such as stimming, a favorite fidget, coloring, mindfulness, and other activities can be helpful. If you’re going into a more stressful or new situation, make sure the person knows what to expect – whether you use social stories or even Google Maps. Using AAC can also be beneficial if someone is nearing a meltdown or recovering from it. Speaking and communicating can be very difficult during meltdowns.
Other ideas include helping the autistic person adapt to a difficult situation. For example, if you have to go grocery shopping (something I despise), ear defenders or headphones and sunglasses might be a good middle ground. If people are judgmental about it – too bad for them. Your kid (or yourself, if you’re an autistic teen/adult) deserves only good people in their life, and humans that are cruel or not understanding do not deserve the time of day. Sensory aspects are incredibly important to keep in mind for preventing meltdowns. Weighted wraps, fidgets, pressure vests, anything to help with self-regulation.
Also: always presume competence. Even if a child is completely nonverbal, I’m quite confident that they’re taking in everything. I know someone who did not get the opportunity to use appropriate AAC until they were much older. And when they did – they had a LOT of stories to tell about caregivers and teachers that didn’t presume competence at all. Everyone should have access to communication, in whatever method is most comfortable and natural for them. You’ll find that a lot of meltdowns (especially in younger kids) are often related to difficulty expressing their thoughts and emotions.
Autistic people often have difficulties in emotional regulation, whether that be identifying, describing, understanding, separating, or showing emotions. This presents in different ways. It’s also important to note that autistic people are at higher risk for mental illness – especially anxiety, PTSD, and depression. This is often due to a lack of appropriate and quality supports, the denial of autonomy or self-determination, and many other factors.
Related to the subject of emotions, many autistic people are not lacking empathy – a very common misconception. Myself, I am hyper empathetic to the point where I can’t watch something too dramatic without having an emotional reaction that may be deemed as exaggerated or at inappropriate levels. It also affects my blood pressure, so I have to be careful. Despite the stereotypes though, it’s important to note that people who may have low empathy still have emotions and feelings; all autistic people are valid and important, regardless of empathy levels.
A note on therapies: I personally do not recommend Applied Behavioral Analysis whatsoever. Honestly, I would avoid it like the plague. From personal experiences, research, and seeing what my friends have gone through – I do not like ABA, especially as it has been shown to be traumatic. I’ll write up a post at some point, but that’s for another time. Good alternatives, however, are occupational therapy, speech therapy, talk/play therapy, and other things that are more based on providing self-determination and autonomy. I’ve also found that therapies that involve animals can be wonderful – if the autistic person is interested in this. Sports and activities can also be helpful in facilitating self-regulation, but again, this depends on the individual and their own preference.
What tools are available?
One of my favorite tools for emotional regulation that I’ve come across is the Five Point Scale.
It’s often used for emotional identification, communication, and regulation. It provides a visual and more tangible way to describe emotions – and can be simplified for younger children and toddlers. I’ve actually attached some that I made at the end of this post, and you’re more than welcome to print them off and use them!
Other things that may come in handy include the use of color code badges or wristbands. These are often used in autistic-run events, such as conferences or conventions. They use Green, Yellow, and Red. I have this explained in more detail in the PowerPoint, and you can also read more about it here on the Autistic Self Advocacy Network’s website.
I hope this information is helpful! Feel free to message me or ask questions!
My presentation and supplemental materials are provided below:
- Managing and Preventing Meltdowns
(Please don’t use this in a presentation without my permission. Thanks!)
- Minecraft 5 Point Scale – this one is courtesy of Jacobs Family Blog.
- Behind the ‘Misbehaviors’ – I’m still looking for the original behind this one.
- Emotions Wheel
The following are ones that I created myself!
Resources Used and Further Information:
- Understanding Autism, Aggression and Self-Injury: Medical Approaches and Best Support Practices
- 5 Point Scale
- ASAN: Color Communication Badges
- ASAN: Autism and Safety Toolkit
- Judy Endow, MSW, LCSW