How to support an Autistic child with meltdowns

Autistic researcher, Sara Meyer discusses how to support an Autistic child with meltdowns.

Autistic people sometimes experience states of overwhelm where they lash out at others, become rigid and unable to follow directions, run away, hit or hurt themselves or others, or protest by crying or screaming. These reactions are sometimes known as meltdowns. Meltdowns are usually a sign that the Autistic person is under a lot of stress and their nervous system has gone into overdrive. They may arise from feelings of overwhelm, frustration around communication challenges, and sensory overload or discomfort. This kind of behaviour is a sign that the Autistic person is in distress and is not coping with what is happening to them.

It is easy to assume that a person is “behaving badly” when they hit, scream, run away or refuse to cooperate. But this is an over-simplification that does not take the individual’s experience and perspective into account. Often, their behaviour means that they are struggling with something that we are not even aware of, or something that we don’t understand. If we start by exploring why the Autistic person may be behaving in this way, we can begin to make changes to support them, such as adjusting our expectations and modifying the environment.

The Iceberg Model provides a useful illustration of this.

In this analogy, the behaviour is the tip of the iceberg that is visible above the waterline, while a much larger part of the iceberg remains hidden below the waterline. The larger, hidden part is made up of the underlying factors that influence behaviour—factors that are beyond the Autistic person’s control. These factors could include anxiety, pain, tiredness, loneliness, trauma, fear, sensory overload, frustration, or a lack of appropriate skills to complete a required task. These things may not be immediately obvious to others, but the behaviour serves as a signal to alert us that the Autistic person is struggling and in need of support. In this sense, behaviour functions to communicate the person’s deeper feelings and experiences to the outside world.

How to manage outbursts

Start with prevention

Try to identify signs that a meltdown is coming. Look for increasing levels of agitation and distress. Signs of escalating distress will be different for everyone, but some common ones include negative self-talk, irritability, argumentativeness/tension in interactions with others, rapid breathing, tense body posture, racing thoughts or speech, increased energy/activity, difficulty focusing on tasks or activities, feeling short of breath, tight in the chest, or having a red or hot face or body. Write down the signs you observe and try to remember to look out for these in future.
Try to identify triggers. Write down the times and circumstances (contexts and triggers) that are regularly associated with the occurrence (or non-occurrence) of meltdowns or other outbursts. (Is there a pattern? What happens just before the outburst? What happens a few minutes before that?). This can help you work out patterns and learn what to avoid.
Try to structure your child’s life to maximise wellbeing and minimise demands and disruptions. This could look like managing the environment to reduce noise, bright lights, and other sources of stimulation, following a predictable routine, and ensuring there is regular access to special interests and preferred activities.
Think about practices and activities that help your child regulate their emotions. These could be special interests or things like giving lots of praise when things are going well, spending time together as a family, or offering more choice and responsibility in the family environment when they are calm. Try to build these into their daily schedule
When things are calm, consider working with your child to develop emotional regulation strategies. Dr. Emma Goodall’s Interoception Kit is full of helpful resources for learning to understand and manage emotions. It is a big resource; the activities start on page 31.

Managing a meltdown

If a meltdown does occur, try to remain calm. This does not mean that you have failed as a parent, or that your child will never stop having meltdowns.

Focus your attention on the present. Ensure you and others in the situation are safe.
Remove (or reduce) triggers or demands, at least for the moment.
Use a simple and consistent statement to explain what is happening, such as “You can’t drink Pepsi now”, or just “No Pepsi.” It may help to reinforce this message with visual supports, such as a picture depicting “No” or “Wait”. Cards like these might be a useful template. You can also use them to suggest alternative options, such as first eating something else, then having Pepsi.
Provide a safe space for your child to calm down. This may require some thoughtful consideration and preparation at a time when things in the home are calm. Depending on preferences, your child might like to go into their own room, relax on some soft cushions or bedding, jump on the trampoline or go for a walk to release some energy. Remove objects that can be thrown or used to hurt others, such as sharp or heavy objects, and try to keep the environment minimalistic and relaxed. You may need to go to extremes with this and remove a lot of items from the home or lock them away Identify a place in the house where you can escape to if you feel you are in danger, such as a locked bathroom.

Try to validate your child’s feelings. Show that you understand why they are upset. You might want to say something like, “You really want to drink Pepsi right now. You really want it,” or something to that effect.
Pay attention to your own body language, facial expression, tone, and body position. Make sure you are not doing anything that could be perceived as threatening. This includes yelling, getting too close, scowling, frowning, glaring, clenching your jaw, or putting your hands on your hips. Try to use a neutral facial expression and open, calm body language.
Give increased personal space where possible.
Be non-judgemental. Don’t judge your child’s emotional reaction. Take steps to keep yourself safe, but otherwise, try to accept that this is where they are at right now.
If your child physically hurts or tries to hurt you, hold a strong, simple boundary. Say something like, “Stop” or “No hurting.” Continue to repeat this phrase in as calm a tone as possible. Try not to react. Again, if the behaviour becomes unsafe, consider retreating to a locked bathroom until your child has calmed down.
Do not use threats or punishments at this time.

Here are some other useful resources that might help you:

Recovering from a Meltdown

After a meltdown or outburst, the Autistic person may be exhausted and need time to recover. Try to provide time and space for them to calm down and feel like themselves again. Demands should be reduced or removed, expectations should be kept very low, and time and energy should be redirected towards comforting sensory experiences or special interests. Both of these can be highly restorative. This should be a time of no judgment and increased autonomy.

Some individuals may feel shame, fear or regret following a meltdown or outburst. They may have feelings inside that they are unable to express or verbalize. Avoid moralising or trying to correct behaviour at this time. Instead, try to focus on collaborating with the person to help them recover. You can just say nothing, or you could try saying something like, “You were really upset. That was scary for you,” or something to that effect.

When everyone feels calm again, this is the time to gently communicate about expected routines, challenging situations, and future plans. Do not try to communicate about these things when the Autistic person is in a heightened state— it is not possible for the brain to learn when the body is in distress.

When managing and recovering from meltdowns, make sure you take care of yourself too. To be able to support your child, you need to be in a good place yourself. It might help to reach out to a support parent (Parent to Parent provide a Support Parent Network), spending time in support groups with others who understand, speaking to a friend or a therapist, or practicing mindfulness or meditation.

Further Resources

If you are struggling to cope with your child’s meltdowns, you might want to look into getting extra support from professionals and disability services. There are a range of options that you can look into to access this support, including:

A needs assessment with your local NASC provider: If you haven’t already had a needs assessment, there may be disability supports or funding that your family is eligible for that you don’t know about. If you have had a needs assessment but your situation has changed since your last assessment, visiting the NASC again may result in changes in the level and type of support you are eligible for. Each region in New Zealand has its own NASC (or NASC equivalent, as is the case in Mid Central), most with different names. The NASC is funded by Whaikaha. Visit this webpage to find your local NASC: https://www.whaikaha.govt.nz/assessments-and-funding/needs-assessment-services/.
You can find a list of disability supports and services here: https://www.whaikaha.govt.nz/support-and-services/. In particular, Carer Support payments which go towards regular respite for carers, and Individualised Funding, which can be used to access disability-related supports might be of interest.
Support from a positive behaviour specialist service like Explore. Explore is a New Zealand based service that offers behaviour support to children and adults with aggressive or violent behaviour. Their services deploy a Positive Behaviour Support model, which fosters positive, functional behaviour to improve quality of life. They also offer programs for families to help them support behaviour at home. Here is a link to their website:https://explorewellbeing.org.nz/our-services/behaviour-support/positive-behaviour-support/. You can also try calling 0800 605 001. Bear in mind, however, that these services are in high demand and there may be a waiting list before you can receive support.
Speak with the Autism Coordinator at your local hospital.
Support from a private clinician or doctor.
In some cases, children experiencing violent or aggressive outbursts may benefit from medication. If you feel your child would benefit from medication, contact their GP. Risperidone is often the drug of choice in these situations.

Altogether Autism also have free workshops to support parents / whānau and professionals with behaviour the challenges.

References

Altogether Autism. (2024). The iceberg [image].

He’s Extraordinary. (n.d.) The escalation cycle [image]. Retrieved from https://hes-extraordinary.com/de-escalation-techniques

Hughes, L.M. (n.d.) [Visual supports] [image]. Pinterest. https://nz.pinterest.com/pin/69805862956985453/

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