Autistic meltdowns: 12 tips for caregivers

“Autism is one word trying to describe millions of stories. Offer support. Not judgment.” –Stuart Duncan, autism advocate

Whether someone you love has Asperger’s or autistic spectrum disorder, it’s likely they struggle with meltdowns — and you’re at a loss.  How do you help them?  Where do you start?  Here are some tips at walking someone (and yourself) through a meltdown.

(1) Okay.  Take a deep breath.  Relax those shoulders.  Everything is going to be alright.  Meltdowns might be exhausting, but they don’t last forever.

(2) Not a temper tantrum.  The first step is to remember about an autistic meltdown is that it’s not a temper tantrum.  That’s key to know, since the intervention for each is very different..

• A tantrum is a purposeful and manipulative tool people use (usually children) to get their needs met; the child is deeply aware of how their behavior affects those around them and uses this control to pursue a specific goal.  The outburst ends as soon as their desires are met.  The caregiver deals with a tantrum by remembering who’s in control, standing their ground, and not giving into demands.
• A meltdown, on the other hand, is a scary, out-of-control, exhausting experience for all involved, including the person having the meltdown.  During the attack, the autistic individual isn’t interested in how their behaviors affect others, and there’s no conscious end goal.  They’re raging, scared, suffering, and unappeasable.  The episode usually has to run its course before it’s over.  For loved ones, getting someone through a meltdown means offering support and reassurance, not setting limits.

(3) Beforehand. Try to identify the triggers that set your loved one off.  Examples include uncomfortable sensations, overstimulation, negative emotions, inconsistency or change of routine, and not getting what they want.  Your next step is to avoid triggers when reasonable and appropriate.  If they can’t be circumvented, prepare in advance.  For doctor’s visits, trips to restaurants, and other upcoming appointments, take along items the person enjoys (like an iPhone with video games) and self-soothing objects (like an MP-3 with music). Distraction can be helpful in many situations.  If it helps, warn your loved one of an upcoming trigger and practice coping skills ahead of time to deal with it.

(4) Early.  Once a meltdown has started, try to intervene as early as possible.  It’s much easier to avert a crisis when you catch it early in the game.

(5) Tranquility.  Do your best to take the person to a quiet place, preferably with dimmed lights.  Get everyone else out of the room in case the meltdown causes aggression.  If you’re at a restaurant, try moving the individual to the car.

(6) Silence.  Keep conversation to a minimum.  Your loved one’s brain is on fire, they’re overwhelmed and unable to reason, and conversation will likely just agitate them more.  Speak only to redirect them, offer help (if they want it), and check in every now and then.  Remind them they can get over this.  Ask them to let you know when they’re ready to speak.

(7) Skills and techniques.  Gently suggest strategies that have been helpful in the past, but keep it simple.  Consider stuff they enjoy, distraction (coloring, pacing, watching a movie), and self-soothing activities (listening to music, resting in bed, running water over their hands).  Offer only one or two coping skills at a time.  Don’t overwhelm them.

(8) Time.  Wait several hours before offering discussion or trying to process what happened.  Give the individual time to calm down.

(9) Conversation.  Once the person is ready to talk, use summary statements before giving them feedback or directions.  Use short sentences.  First, ask them to describe their experience.  Next, summarize what they just said and express understanding.  Be empathetic.  Say, “Wow, that must have been difficult.”  Third, ask what they think might have helped to avoid/decrease the meltdown.  Finally, provide gentle feedback in a way that validates their struggle.

(10) Future.  Come up with a plan for the future, including how everyone should react if this behavior happens again.  Include the autistic person in the conversation, if they’re up to it.

(11) Positive intervention plan (PIP).  If the individual with the meltdowns has highly inappropriate, self-injurious, threatening, or aggressive behaviors, consider writing a PIP.  Your plan should:

• Define what is acceptable or positive behavior (like trying to practice coping skills when frustrated)
• Define what is unacceptable (getting aggressive)
• Reward positive behavior (earning extra attention, stickers, candy, special trips)
• Give appropriate (non-punitive) consequences for unhealthy behaviors  (not earning sticker, candy, or special trip)

Let the autistic person know about the plan in simple, concrete terms. The consequences in your plan should fit the problem behavior (a small problem doesn’t need a major consequence) and match the abilities of the individual (for example, an autistic person functioning at a five-year-old level might not be able to sit down after a meltdown and reason through a behavior).

(12) Kindness.  In the end, remember to treat your Asperger’s or autistic friend with love and respect.

Some of the information in this article was borrowed from my colleague, Karis Pearson-Parham, PhD.  If you’d like to learn more, read For people with Asperger’s or autism: dealing with those meltdowns.