THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND MELTDOWNS

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THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND
MELTDOWNS
...for individuals with autism spectrum disorders
Rebecca Klaw, MS, MEd
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• Based on the work of Dr. Ross Greene (author of
  The Explosive Child) and many others who
  contribute to what is known about autism and
  related disorders.

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Part 1Understanding the inflexible-explosiv
e individual

• WHY?

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Common Characteristics of Meltdown-Prone
Individuals

• Difficulty managing and controlling the emotions
  associated with frustration
• Difficulty thinking through ways to resolve or
  cope with frustration

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Common Characteristics of Meltdown-Prone
individualren

• Frustration often leads to cognitive debilitation
• Cant remember how to stay calm
• Cant recall consequences of previous episodes
• May not be responsive to reasons
• May deteriorate even further in response to
  limit-setting and punishment

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Common Characteristics of Meltdown-Prone
Individuals

• Low frustration threshold
• Frustrated more easily than others
• Low tolerance for frustration
• The experience of being frustrated can be very
  intense, disorganizing and sometimes overwhelming

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Common Characteristics of Meltdown-Prone
Individuals

• Tendency to think in a concrete, rigid and
  black-and-white manner.
• Persist in their inflexibility and poor response
  even in the face of meaningful consequences

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Common Characteristics of Meltdown-Prone
Individuals

• Explosive episodes can have an out-of-the-blue
  quality.
• May be particularly inflexible about one or more
  issues
• May be especially inflexible when tired, hungry
  or ill

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• Does this sound like anyone you know?

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• If people with an autism diagnosis fit perfectly
  into this model of the inflexible and explosive
  individual, what gets them there?

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• Bad parenting no!
• Bad teaching no!
• Neurologically determined pathways yes!

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Pathways to inflexibility and explosiveness

• ADHD
• EXECUTIVE FUNCTION DEFICITS
• LANGUAGE PROCESSING DIFFICULTIES
• MOOD
• DIFFICULT TEMPERAMENT
• ANXIETY
• SOCIAL SKILLS DEFICITS
• SENSORY INTEGRATION DYSFUNCTION

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CONCLUSION TO PART 1

• If you dont understand the basic characteristics
  that can cause distress in a individual with
  autism, you might think they are being bad or
  manipulative, or controlling.

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CONCLUSION TO PART 1

• You might also choose inappropriate techniques to
  manage these crises, thinking that if you just
  keep piling on consequences, you will win the
  battle.

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CONCLUSION TO PART 1

• But when you understand the characteristics of
  the inflexible, explosive and autistic
  individual, and how these characteristics are
  determined by neurological difference, you
  realize that it is never a battle where someone
  wins and someone loses.

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CONCLUSION TO PART 1

• Becoming so frustrated that you lose control of
  your body and of your rational mind is
  distressing for the individual and for you.
• No one ever, ever wins.

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Part 2Understanding the stages of crisis,
leading to meltdowns
MELTDOWN
Demand to shift gears
ESCALATION
AGITATION
RECOVERY
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AGITATION
Triggers Not getting what he/she wants Not
doing what he/she wants to do Not being able to
regulate to environmental stimuli Not being able
to regulate to internal stimuli
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AGITATION

• All triggers represent a demand to shift gears
• Shifting to a new activity
• Shifting away from a routine
• Shifting attention away from something
  uncomfortable externally
• Shifting attention away from something
  uncomfortable internally

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Thought provoking research. Susan Bryson and
Reginald Landry at York University and Hospital
for Sick Children in Toronto have discovered that
in children with autism, there is a universal
problem with visual orienting. This is the most
basic form of attention. It describes the
ability to move ones attention in space. It is
critical for survival.
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They found that children with autism, even those
with normal or above normal IQs, have marked
difficulty in disengaging attention.
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When shown multiple TV screens, it is hard for
children with autism to stop looking at one in
order to shift attention to the newer visual
stimuli. ? ? ?
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One of their conclusions. ? It is
neurologically difficult to shift attention if
you are an individual with autism. children with
autism arent being bad or non-compliant. They
are being autistic. This problem is not just a
problem for us. It seems to be a problem for the
children as well.
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• Escalating agitation
• Vapor lock
• In cars, vapor lock is caused by excessive heat
  that creates a bubble in the gas line. This
  prevents gas from flowing to the engine and
  causes the engine to stall. No matter how many
  times the driver pushes the pedal or turns the
  ignition, the car wont start until it cools
  down.

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• Escalating agitation
• When our students are frustrated and their
  agitation is growing, they are in vapor lock.
• Frustration causes a breakdown in the capacity to
  think clearly, causing him/her to become
  overwhelmed and irrational.

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• Escalating agitation
• No matter how many times the adults reasons,
  insists, rewards, punishes or whatever, the
  individual cant start thinking clearly until
  someone helps him/her cool down.

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MELTDOWN

• Dr. Daniel Goleman, the author of Emotional
  Intelligence refers to the meltdown phase as
  neural high jacking.

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MELTDOWN

• Irrational
• Incoherent
• Destructive
• Abusive
• Out of control
• A DEBILITATED STATE

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MELTDOWN

• What the individual does and says during
• the meltdown is MENTAL DEBRIS

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MELTDOWN

• An escalating and deteriorating
  inflexible-explosive individual is not a pretty
  sight.
• Not for you
• Not for others around you
• And certainly not for the distressed individual

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Part 3Reacting to agitation, escalation and
outburst

• A word about consequences

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• Individuals who are developmentally compromised
  in the areas of flexibility and frustration
  management usually
• Lack the capacity to manage emotions associated
  with frustration well enough to think clearly in
  the midst of crisis

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• individualren who are developmentally compromised
  in the areas of flexibility and frustration
  management usually
• Lack the capacity to manage emotions associated
  with frustration well enough to think clearly in
  the midst of crisis
• Lack the ability to shift their thoughts from
  their agenda to your agenda even when faced with
  very meaningful consequences

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Think about these quotes

• For a consequence to achieve its desired effect
  that is, for a consequence to make it less
  likely that a individual will explode the next
  time he is frustrated you have to have the
  faith that the consequence you administered on
  the back end the last time (i.e. following the
  last explosion) is going to be accessible and
  meaningful to the individual on the front end the
  next time he becomes frustrated

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• Consequences can be very effective if an
  individual is in a state of mind to appreciate
  their meaning, but dont work nearly so well if a
  individual is not able to maintain such a state
  of mind
• Dr. Ross Greene

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• So we are going to talk about other strategies
  for managing agitated and escalating behaviors

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• First, how do we know when the cycle of agitation
  escalation MELTDOWN
• begins?
• What are the typical signs?

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• REFUSAL

NO!
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Interventions

• Proactive
• Access to communication
• Access to choice

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Interventions

• Proactive
• Predictability

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Interventions

• Proactive
• Environmental adaptations

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Interventions

• Proactive
• Analysis of common challenging behaviors and the
  motivation behind these behaviors
• Understanding that meltdown behavior doesnt
  happen out-of-the-blue but happens for reasons
  that are extremely important to the individual

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Interventions

• Proactive
• Utilization of strengths and special interests as
  a mechanism for teaching
• ? quality of life

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• But sometimes, no matter how well you set the
  stage, your students become agitated

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Reacting at the Crossroads
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Interventions

• Reacting at the crossroads
• Prioritize your demands
• Level A demands
• Level B demands
• Level C demands

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Level A Demands

• Non-negotiable
• Safety of self and others
• Health
• Basic life expectations

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Level C Demands

• Not important
• May fly in the face of convention, but not really
  matter
• Not important for that particular student
• Doesnt impact the a big picture

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Level B Demands

• Important but not essential
• Level B demands are the stuff of teaching
• Level B demands are most effective when a student
  is available for new learning

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Level B Demands

• Level B demands can and should be withdrawn or
  compromised if this is not a good teaching
  moment.
• If you decide not to follow through with a Level
  B demand because it is a rough day for this
  student and you see him growing agitated, that is
  a wise choice. It will not cause the student to
  regress or backslide.

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Interventions

• Reacting at the crossroads
• Empathize. Be the individuals partner, not their
  adversary.
• I know you are mad. You are really mad that it
  is time to go! It is hard to stop playing with
  that toy. I understand.

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When children are stuck in the red haze of
inflexibility and frustration, they respond a lot
better if they perceive adults as potential
helpers, rather than as enemiesDr. Ross
Greene, The Explosive individual, p. 104
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Interventions

• Reacting at the crossroads
• Give time and space.

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Interventions

• Reacting at the crossroads
• Offer visual instead of auditory information.

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Interventions

• Reacting at the crossroads
• Provide support in a calm, non-threatening manner.

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Interventions

• Reacting at the crossroads
• Offer to do the activity with the individual.

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Interventions

• Reacting at the crossroads
• Try humor or surprise as a way of helping them to
  switch gears

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Interventions

• Reacting at the crossroads
• For our more able students, try framing the
  problem and getting them to help with a solution
• UH-OH WE HAVE A PROBLEM. I WANT YOU TO GET
  READY TO GO HOME AND YOU WANT TO CONTINUE TO
  PLAY. WHAT CAN WE DO ABOUT THIS THAT MAKES BOTH
  YOU HAPPY AND ME HAPPY?

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• But sometimes, no matter how well you react at
  the crossroads, your students continue to
  escalate into a full-blown meltdown

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Interventions

• Beyond the crossroads, reacting to crisis
• Wait it out safely.

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Interventions

• Beyond the crossroads, reacting to crisis
• Have one person manage the meltdown with others
  nearby to help you.

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Interventions

• Beyond the crossroads, reacting to crisis
• Isolate the individual. If he/she doesnt want
  to come with you into a safe spot, then move
  others away.

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Interventions

• Beyond the crossroads, reacting to crisis
• Stop talking unless your words have a soothing
  effect.
• Really.

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Interventions

• Beyond the crossroads, reacting to crisis
• If the person is attempting to hurt himself or
  others, including you, you need to use protective
  measures so that you dont get hurt.

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Interventions

• Beyond the crossroads, reacting to crisis
• Once the individual has begun to calm down, you
  might offer sensory activities if you know that
  this is helpful in reorganizing the individual.

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Interventions

• Beyond the crossroads, reacting to crisis
• Once he or she has begun to calm down, you might
  offer something to drink or something to eat if,
  and only if, you know that this will help to calm
  and focus them.

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Interventions

• Beyond the crossroads, reacting to crisis
• You might offer to help the individual with
  calming strategies that he/she has practiced
  during non-crisis times.

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Interventions

• Recovery (the long-term response)
• Asking the question What can we do next time?
• Review the individuals needs.
• Review your proactive strategies.
• Review the crossroads strategies.

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Interventions

• Recovery (the long-term response)
• Setting up regular and highly motivating rewards
  for the behavior you want to see.

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Interventions

• Recovery (the long-term response)
• Social stories

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Interventions

• Recovery (the long-term response)
• Practicing calming/coping techniques

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Kari Dunn Burons books
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Don't Pop Your Cork on Mondays! The Children's
Anti-Stress Book Written by Adolph
Moser Illustrated by Dav Pilkey
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Don't Rant Rave on Wednesdays! The
Children's Anger-Control Book Written by Adolph
Moser Illustrated by David Melton
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Conclusion to Part 3

• What you always do
• Respond to basic needs
• Communication
• Safety
• Predictability
• Sensory differences

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Conclusion to Part 3

• But if these dont work on a given day or in a
  particular circumstance
• Respond to agitation and escalation
• Prioritize your demands
• Be the individuals partner
• Give space and time
• Decrease language
• Increase visuals
• Help the individual frame and solve the problem

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Conclusion to Part 3

• But if these interventions dont work
• Respond to crisis
• Isolate the individual for safety
• Use protective strategies
• Wait, quietly, for the storm to blow over
• Assist the individual with calming/coping
  strategies

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Conclusion to Part 3

• When it is long over
• Team process
• Regular reinforcement for replacement behaviors
• Social Stories
• Teach calming strategies

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