I want to start tonight's blog with a disclaimer -
I have a master's degree in education. I am certified to teach N-3/K-6, English K-12, social studies K-12, and I'm "Highly Qualified" in the state of Pennsylvania to teach science K-12 in an alternative setting. In spite of all those fancy credentials, I do NOT consider myself an expert with all the answers. Instead, I would first and foremost consider myself a mother with a teaching background that has gained a lot of experience and knowledge along the way. If my experience and knowledge can help another parent, then I'll feel like I've accomplished something positive. This parenting thing isn't easy. Parenting a child with special needs makes a complicated job even harder. If you're a parent looking for answers and not sure where to turn, you're not in this alone. There are lots of us on the same journey. Maybe we can teach each other something along the way. I know my child has been my greatest teacher.
The number one question I am asked by readers of this blog is "How do you manage a meltdown? What can I do to prevent a meltdown?" I've attempted to answer this question on numerous occasions but it's never a simple answer. There are no right answers when it comes to managing these behaviors. With that said, here's some of my "experience" and "knowledge" on that particular topic.
First, it is helpful if you can identify if the child is losing control because of a behavioral issue or because of an inability to control his/her response to stimulation or a particular situation. For example, there is a clear difference between a child that has thrown herself on the ground and is throwing a screaming temper tantrum in the middle of the store because she was told she can't have candy and a child who has lost control because the lighting, volume, or other sensory stimulation in the store is more than she can tolerate at that moment. In both cases, the behavior needs to be addressed and managed but identifying the source of the behavior may help you better manage the situation.
If your child is prone to meltdown behavior or tantrum behavior, I strongly recommend starting a notebook. Write down the date, time, and location of the meltdown. Who was present? What was the environment like? What was happening prior to the meltdown? Is your child more likely to lose control at home, at school, or in public places? Is your child more likely to lose control with you, with certain family members, with school staff, or with strangers? Is it it more likely to occur in noisy locations? Bright lights? Busy locations? Write down as many environmental factors as you can recall. What did your child have to eat and drink that day? What medications had your child taken? Really take the time to document as much data as you can recall. Hopefully by doing so, a trend will start to emerge that will help you identify a trigger that is setting off the meltdowns.
Okay. In terms of practical, in the moment tools that can be utilized to help manage out of control behaviors, it definitely depends on the level of out of control that we are talking about. Some kids who meltdown, hit themselves or others. Bite themselves or others. Run away or run and hide. Scream and cry. My son's eyes glaze over and lose focus. He loses awareness that we are even there with him. He appears to be lost in his own world. It's hard to witness. It can be hard to manage.
Remain calm. Yeah, right. Easier said than done, huh? But really. Remain calm. Talk a deep breath. Or two. Or three. Remember that this is not about you. It's not personal. This is about your child's inability to manage himself. If you can't remain calm, you can't help him.
Talk very little. If your child is truly melting down, he isn't even processing what you are saying. Talking tends to escalate the situation and keeps you from remaining calm. If you talk, use a calm voice. Short phrases. "Shh. It's okay." "Shh. Let's just breath." Make your voice soothing. Model the breathing.
Touch only to maintain safety or to soothe. If your child will allow you to hold him and rock him, then by all means use that tool to soothe. For some children, the combination of rocking and soothing whispers helps to calm and soothe. If physical touch further escalates your child, then only touch to keep him from hurting himself or others. Touch can be useful as a tool to reconnect once the child is calmer but for some children, touch at that moment feels like a violation, an attempt to control. If your child is prone to frequent meltdowns and physical violence during those meltdowns, I strongly recommend seeking out a course in Safe Crisis Management. These classes teach de-escalation skills and safe ways to help manage your child's physical aggressiveness. Never pin your child to the floor with your body weight. Never tie your child up or attempt to use physical restraints in any way. The child could be injured and the emotional trauma could increase the likelihood of future meltdowns.
As your child loses steam and starts to calm down, help her to continue to calm herself. This is NOT the time to give consequences or discuss what started the episode. Instead, help the child to bring herself back under control. This may be a good time to sit beside her and talk calmly and quietly. "That's right. We're calming down. Take some nice slow breathes." If she finds it soothing, rubbing her back or giving a loose hug may reassure her that she is still loved in spite of her loss of control. Focus on slow breathing. Focus on calming down completely. Some children will fall asleep afterward. Allow her to rest. There is plenty of time to follow up after she is in a better state of mind.
I'll get into prevention in a minute but first, follow up after a meltdown is vital. When a child loses control, it is important to follow up to discuss what happened, to reconnect as family members, and to problem solve how to repair the situation. These conversations should be calm and loving. Keep the facts short and to the point. Try not to use accusatory words and tone of voice. When your home and life are disrupted by these episodes it's not easy to keep it impersonal but it needs to be. The focus should remain on helping the child identify what went wrong and how to fix it. "Before we talk, I need you to know that I love you and I'm always going to love you. When we went to the store today, we needed to leave early because you became overwhelmed by the situation. Let's talk about what we can do differently next time." Take the time to listen to what your child has to say. Offer suggestions or ideas. See how they react. If your child is younger or lower functioning, this step may need to be kept very simple. "I love you. I'm sorry we had a hard time at the store today. It hurts to see you that upset. How does it make you feel when that happens? I wonder what we can do differently next time to make it easier for you to go to the store and help me." The follow up conversation is critically important to re-establish the bond that may feel bruised after an explosive episode.
In terms of preventing meltdowns, that brings us back to our earlier conversation about identifying triggers. If you can identify what triggers your child's meltdowns, it gives you something to work with. The intensity of some triggers such as smell or noise aversions may be reduced by slow and careful exposure in a supportive way. You may need the assistance of professionals such as occupational therapists, therapists, learning support teachers, etc. Some situational triggers may need careful behavior modification training. Again, professionals may be able to assist you in identifying the best methods and techniques to achieve success.
In our experience, medication had little to no impact on reducing the frequency or intensity of our son's meltdowns. Matter of fact, two medications that his neurology team tried actually increased his tendency for meltdowns. We have had the greatest success with traditional behavior modification techniques. I personally put a lot more faith in the power of prevention than in medication. We have taught our son relaxation and calming techniques. Through preventative conversations, we have problem solved how he should calm himself when he feels himself losing control. Our son is a runner. When he becomes agitated, he tends to run in circles or run and hide while repetitively muttering the same couple phrases over and over. At one point, his desire to flee an undesirable situation would cause him to run out the door and run outside. Our fear was that he would run out onto the road or hurt himself in his desire to flee. We needed to problem solve as a family a better alternative to running. Over a period of time and many, many conversations, we have increased the likelihood that our son will go crawl in my bed or go to his room until he feels calmer. Going to his room is less successful than going to my bed because he tends to mutter to himself and work himself up when he flees to his room. I think he associates my bed with crawling in bed with us early on a Saturday morning and cuddling. At least I think that's why it works better. Maybe it's a smell. The feel of the bed. The colors in the room. Who knows.
This transition from melting down and/or running away didn't happen over night. It's not a hundred percent fool proof yet but it's a step in the right direction. This journey for self-regulation has been a work in progress. As he has grown, the need for him to self regulate has increased. Our son has always been big for his age. As he continues to grow, it is evident that he will be a large man. He must learn to regulate his emotions in order to avoid hurting himself or others. This is part of the conversation that we as a family have frequently had with him.
Read everything that you can find from reliable resources. Websites ending in .edu are associated with a school and .gov are associated with the government. These websites are most likely to be vetted and reliable. Nationally recognized and respected organizations such as Autism Speaks may be a good source of information. Consult with school and medical resources. Join a parent support group. Finally, if you are struggling with meltdowns, know that you are not alone.
http://www.childcarequarterly.com/pdf/winter12_eci.pdf
http://www.autismspeaks.org/docs/100_day_kit_for_school_age_children_final_small.pdf
*Your child may not have autism but this resource shares some great information and other valuable resources.
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