Meltdowns I

Meltdowns are few and far between in our house now.  This post is actually in response to someone requesting help with a child having regular severe meltdowns.  I thought it would be good to share the information.  I doubt I'll get to everything in one post.  And if you have thoughts to share, please do.

First off let me explain meltdowns.  Most parents have seen their toddler have a meltdown.  Typically you can quickly shift your child's attention and pull them out of it and move on with your day.  That is not a typical autism meltdown.  First off, autism meltdowns can build up for hours or days before they blow.  Second, autism meltdowns can have physical, mental, or emotional triggers that take lots of time to recognize.  Third, the triggers do not necessarily occur immediately at the start of the meltdown.  Fourth, once the meltdown starts it is normally very, very difficult to stop until it burns itself out and redirection can be problematic.

Sounds like fun doesn't it?

By the way, before I get into the rest of this let me share one tip.  If your child goes into meltdown in public, stop and help your child.  View it the same way as you would a severe body injury.  What other people think doesn't matter.  What you were doing doesn't matter.  What needs to be done to heal your child is what matters.  If you have to leave - drop everything, grab your purse/wallet, and walk out with your child.  For your child, whatever is triggering the meltdown is the equivalent of a severe body injury.  It's just unseen and occurring in their nervous system or brain.  If you need a point of view, imagine you suddenly got struck with a migraine that made your entire head scream in pain and blinded you.  What would you want someone with you to do?  I can guarantee you wouldn't want them telling you to shut up or wasting time explaining to strangers what was going on.

Now if you're a parent dealing with this on a regular basis, you may or may not have discovered a lot of these things for yourself.  My first point of advice for parents dealing with this is to view their child as someone who is extremely stressed out.  I tell them to look for things that stress the child and work on eliminating them.  I also tell them to look for things that calm the child and start using them before the meltdown. 

Okay so you are going to do this, but for right now you still have meltdowns to deal with.  First, when a meltdown occurs, clear the room.  Everyone leaves except for the parent who is dealing with it.  That right there will eliminate a whole level of continuing meltdown triggers.  Note - do not move the child having the meltdown if it is at all possible.  Move the other children/people.  If you must move the child, try to move them as little as possible to get them to a safe zone.  Otherwise create the safe zone where the child is.  After people are gone, move easily shifted furniture and other objects out of reach.

Okay, now you've just kicked the entire family out of the living room and handed off a whole bunch of stuff to your SO or another child through the door.  (or preferably they took it automatically)  While you are doing this your SO is quietly trying to determine what happened if neither of you saw it.  If you don't have an SO, then teach your other children to quietly, calmly, with NO upset tell you what happened from the doorway.   You can listen but your focus, at that moment, needs to be on the child who is melting down.  And you need to be the picture of calm.  Yup, I know, it's nowhere near as easy to do as say.  I mentally have a box that everything else gets shoved in for this length of time.  If it's not life threatening, it's in the box.  Nobody ever said life was fair.  And imagine how boring it would be if it was.  And I know, if you are a single mom with just your one child, that safe zone isn't very big because you've got to focus on the child, not the objects.  My house is permanently kid proofed up to 7 feet because of this. 

So your child is screaming, hitting, banging, shrieking and you have boxed everything mentally.  And you had all of 2 seconds, maybe to do that.  When my child was younger I was taught safe holds to use so that he could vent yet not hurt himself or me.  The one I used most commonly was a variant of a bear hug from behind.  (watch for the head).  These are things that you need to get a professional to show you if you are going to use them.  I'm not going to do it here.  You can also just let them blow it out until they calm.  I've done that as well.  Your call. 

Whatever you do, you need to start watching and trying to figure out what the triggers were and how to defuse them.  At this point, unless your child is being very specific, go down that checklist you learned when they were a baby.  Are they hungry?  Are they thirsty?  Are they dirty?  Are they hurt?  You know the one.  Each mom/dad has variants for their kids.  Eliminate each item, not by asking, but by offering.  I have spill proof sports cups for drinks and snack size bags of treats.  If they get tossed it's no biggy.  But if that's part of the problem, then it's eliminated and the meltdown comes down a level.  Is there a favorite shirt?  or a blanket they can burrow under?  At this point you are focused on calming.  And realize that even when they get to a calm level, you may trigger a new outburst very, very easily.  Try very hard to eliminate every single little thing that could be wrong within reason.  Once you've done this, try to move the child to their safe place.  Don't push, don't force - offer and make sure everyone else is out of the path.  For the next while you are treading on thin ice so move carefully and slowly.

And actually, even if your child is being very specific, go down the checklist.  Your child may recognize the final trigger but still not realize what built up to that being such a trigger.  A lot of time they end up confused as to why it was a trigger if it's not a normal one for them.

Now, it sounds like I'm telling you to let your child rule your life.  And for a short period, you would be right.  How long your child needs the delicate treatment depends on your child.  When I first started out with Munchkin it could be days depending on the level of meltdown.  Nowadays, I'm surprised if it's hours.  Normally we can get past something as soon as the triggers are settled, although I'll avoid overt stressors if it was particularly bad.  Actually, nowadays, I normally catch on to the triggers before they pile up enough to trigger a meltdown and use calming measures quickly.  It makes life much easier on both of us.  And other, broader life changes have brought his base stress level down a lot, as well as mine.

Now if you've been doing all the above and it's not working, well without professional help all that's left is the next part.  This part everyone should do, not just those who aren't getting the above to work.  Because we don't want to spend great chunks of our lives treading on thin ice.  That's just no fun.  And it can get dangerous as they get bigger and older.  It may be something you can handle at 3 years old, it's not something you can handle at 13 or 16 or 18.

The meltdown is past, one way or another, and you are now going to do the follow up work.  First, what was the apparent trigger?  Second, what were other things occurring at the same time that could have made it worse (loud music, screeching, arguments, etc)?  Third, what things on the checklist helped to calm the child down, and how much?  Fourth, what things from the above lists did the child try to signify were an issue?  In any way!

Going to the first item - the apparent trigger.  Is this something that has triggered meltdowns in the past or was this the first time?  Is it something that would be an irritant typically?  For example, the trigger was you telling your child "no" when he reached for something of yours.  Does your child typically go into meltdown when told no?  Have you been dealing with the child wanting this item for a while?  Is the child normally allowed to have the item and this was an exception?  You have to think of all of these variables and more.  And then answer them.

Going to the second item - surrounding environment.  Was the TV on loud?  Was it on a show the child can't stand?  What about the radio?  Were your other kids fighting with each other?  Or with that particular child?  Think back on what the area was like and then think about your worst most horrible day when you couldn't tolerate anything and put the two together.  Then list anything that would have set you off.  And list anything that would have calmed you.  Then consider how to reduce the irritants on a permanent basis.  And increase the calming items.  And yes this is something typical parents do.  My folks had volume limit controls on the TV and radio, even in our bedrooms.  And on how loud we were allowed to be in the house, argument or not.  There were time periods that we were not supposed to be in certain areas.  These seem so small but they can actually make big changes for everyone, not just the child with autism.  Not all irritants can be eliminated or reduced, but the more that you can get rid of the easier it becomes for everyone.

Now the third item - the check list.  That's a no brainer folks.  If something on that list calmed them, make sure it's easily on hand for next time.  And the more positive effect it had, well then the more easily accessible and ready that item should be.  But be aware that over time the things that work will change.  Especially if you start changing things in their environment.  Regardless of change though, I always fall back on that checklist if other measures don't work.

And lastly, number four - what did your child try to do to warn you?  Did they plug their ears?  Did they bring you an empty cup?  Did they try to drink your drink (or someone else's)?  Did they try to take a snack?  Do they have a stim behavior that they started doing?  Anything?  These are the behaviors that you want to start keeping an eagle eye out for.  By identifying these items, and responding to them, you will start to eliminate the meltdowns.  If they are plugging their ears, make sure the volume levels are reasonable.  If the volume is good, offer to go do something with them somewhere that is quieter.  If they are thirsty or hungry, give them something.  It doesn't matter if there is going to be a meal in 10 minutes.  They don't have the mental tools to get to that point.  Keep small portions of items on hand to settle the appetite and hold them over while explaining that there will be more in X number of minutes.  Use a visible timer.  Eventually they will learn and be able to wait.  Remember, to your child this is an immediate emergency.  Learning that it is not takes time.  And they don't learn it as quickly as typical children.

As far as stim behaviors, that is going to depend on you.  If my child is stimming, I automatically go down the checklist and start doing things to eliminate those items.  Then I check on the rest.  Sometimes stimming is triggered by the environment, sometimes by something internal.  In our experience, as long as I stay on top of the environment stuff, stimming tends to reduce and doesn't lead to meltdowns.  There have been exceptions, such as when he was developing an ulcer.  So keep your eyes open.  But stimming is their way of dealing with an overload, so it's a good warning sign that's something is wrong.  And if your child continually stims, well it won't hurt anything to try to eliminate environmental issues so that they may not need to continually stim.

Over time, as you guide your child into avoiding triggers and removing themselves from situations, they will learn to do it for themselves.  If an environment is too loud for my son now, he will get his noise canceling headset and put it on.  That's a heads up for me and I keep an eye out to make sure that it's under control.  If lights are bothering him, he will shut them off or burrow under a blanket or make a fort.  If he can't do that, he will let me know to move quickly through a store.  By learning the triggers and helping your child deal with them, you are also teaching them how to do it on their own.  And they are most definitely motivated to learn this.

Now, a point to make - while I have a child with autism and I've used all these methods over the years, I'm not a professional.  If your child's doctor tells you to do something differently, do so.  If you choose not to then that is your choice and decision.  I have chosen not to medicate my child if I can avoid it.  That is my choice and decision.  That may not be yours.  I'm not in your shoes so I'm not judging.  All of our children are different.

And there's more on meltdowns.  I'll try to do some posts using Munchkin's issues as examples so that you can have ideas of what to look at.  And hopefully others will share their experiences as well.

Oh, and by the way, now that it's over and your Munchkin is, hopefully, in bed asleep, you can open that box and climb in a hot bath before you get back to the rest of life.  Well, maybe keep the box closed, until after the bath.  ;-)