COPING WITH "MELT DOWNS"...

WHY DOES SHE DO THAT? When I see a delightful little girl like the one pictured on the right in such distress it breaks my heart. I want to do whatever I can to relieve her unhappiness. But sometimes your first impulse isn't necessarily what will help her most, especially in the long run. Most of the time children with ASDs have melt downs it is in response to an unexpected change in routine or interrupting a highly preferred activity. If you watch the behavior of the television inspector Adrian Monk, you will understand more about why your child does what s/he does. (See #3 below). There is no single remedy for tantrums, aggression or self-injury in ASD. One needs to determine what is leading the child to behave the way they do in order to reduce these problems. Most melt downs, with crying, screaming, aggression or self-injury by a child with ASD causes adults to stop making demands or requests. In other words its away of escaping or avoiding a situation they don't like or don't understand, or for which they have no other coping mechanism. The solution depends on the reason. 1.They don't really understand what you are saying to them. a.Teach more adequate receptive communication b.Teach them a way of asking for help c.Use visual rather than verbal requests, such as pointing to a visual schedule 2.They lack the skill to do what youre asking them to do, or it is very difficult for them to do it (e.g. put on your shoes) a.Teach them to ask for help b.Teach them how to improve their skill in doing what you are asking them to do in a series of small step; use lots of reinforcerment for small gains. c. Don't ask them to do it in the first place. Maybe its not important, at least not right now, 3.The adult request comes at a time they are occupied with a preferred routine (e.g. playing a video game, spinning objects, other repetitive routine) a.Wait until they stop the routine before asking them b.Give them a warning 10 seconds before you are going to make a request. Count to five holding up your fingers one at a time, 2 seconds for each finger. When the last finger is up, say "Now were going to..." Some people use a visual count down clock the same way that turns a different color when its time to stop one activity and start another. c.Negotiate with them. C1. Offer to collaborate i.e. I'll do one then you do one C2. Well do it this way this time, and your way next time C3. Tell the child they can return to their preferred activity as soon as X is done. d. Practice making requests only before a highly preferred activity, such as meal-time, watching a preferred video, etc. or another activity which is part of your normal daily routine. 4.They lack the ability to request that they be allowed to do it later. a. Teach them to make a "Later" request, either verbally, gesturally or with a picture Icon (e.g. a clock icon) b. Always follow through by providing a delay, and then gently returning to the requested activity c. Lavishly praise and reward the child for starting the activity you have requested them to do after the delay, "Great job, you're a good helper!" Some melt downs are maintained by parental attention. Remember, scolding or negative attention is still attention! A. AGGRESSION EXAMPLE: We were asked for assistance with a 4 year old boy with high functioning autism who aggressed against his little brother and mother nearly 100 times per day. He had no way to request that his mother give him attention other than hurting his brother. We taught him to make first a beckoning request with his hand (come here) and later a verbal request "Mommy please come". We subsequently taught the child to verbally request items or activities he wanted and to request that he be allowed to delay activities that he didnt want to do. He was always asked to do them at a later time. His mother was encouraged to positively interact with the boy with ASD more frequently with praise, hugs, and holding on her lap when he was behaving appropriately, especially before she was going to pick up, change a diaper, or otherwise attend to the little brother. We encouraged his mother to selectively attend to the child with ASD whenever he was playing positively with his brother and to ignore minor pushes, shoves and actions that were not physically harmful. Within several months his aggression had decreased to near zero and he was speaking 3-4 word sentences to make requests. Today he is in a regular education kindergarten and doing very well. B. SELF INJURY EXAMPLE: An older boy with severe autism who was non-verbal engaged in self injury and aggression in school. Whenever his teacher or aide turned their attention away from him and to attend to another child, he pinched or hit the instructional staff, or if that didn't lead to staff attention, he engaged inself-injury (hand biting, hitting his head). He also engaged in self-injury when he was given a task that was too difficult for him, like pointing to printed letters and numbers when they were verbally cued by his teacher. He was taught to lightly touch his teacher's or aide's arm between the elbow and shoulder as a request for attention. Hitting, pinching or scratching were ignored. He learned very quickly to request attention appropriately. He entirely stopped hitting, pinching and scratching his teacher and aide. When the task was too difficult we either made it simpler and more doable, increased the reward for small steps toward the instructional goal, or taught him to request a break from the activity. His self-injury stopped over several months. MEDICATIONS: Some doctors prescribe medications that have been helpful in adolescents and adults with ASDs for reducing emotional outbursts to younger children (off label) in response to changes in expected routines, or task demands that exceed their tolerance. For some children, the intensity and duration of outbursts can be reduced by treating them with Beta Blockers (e.g. Atenolol) or Catapres (clonidine) a blood pressure medicine that works diferently. Younger children and school age youngsters often respond favorably to SSRI antidepressant medications (e.g. Luvox or Zolft), and older youth are occasionally given tricyclic antidepressants (e.g. Tofranil) or atypical antipsychotic medications (e.g. Risperdal). There have been no well controlled studies with younger children with ASDs with these medications however, and they have considerable side effects. Medications are seldom sufficient alone. NO SINGLE SOLUTION: Parents and teachers often ask what is the best medication or behavioral treatment for meltdowns. In our experience there isn't any single best treatment. Solving the problem requires understanding the reasons for the emotional outburst, and methodically teaching the missing skill or changing the conditions giving rise to it. Some medications can help but they rarely solve the problem alone.

During the first phase of a meltdown a child is furious, striking out and screaming angrily. During the second phase, sadness follows with tears and sobbing. Children with ASDs have difficulty resolving a tantrum due to lack of communication and social skills.