Saturday, March 31, 2012

Tantrums vs. Meltdowns








If you care about someone with Autism and you've never heard of a "Meltdown", then this post is for you.

Meltdowns are often viewed/discussed as being a typical tantrum times 50.

To most of us, a tantrum is about a power struggle. You tell the child “No” when they expected to hear “Yes”. Or you gave them milk, when they wanted juice. Crying, whining, throwing things, stomping feet, and collapsing to the ground begin to occur. If you have ever witnessed a 2 year old having a tantrum, that seems to be the prototype. Despite the age of the child a tantrum usually looks like a 2 year old who didn’t get their way.

Meltdowns are often defined as when a typical tantrum goes off the deep end, and starts including property destruction, aggressive acts, maybe self-injurious acts,  and extended yelling/screaming that can go on and on.

What is important to know about the "tantrum" vs "meltdown" discussion is that they are both behaviors. Thats the good news. ABA provides a vast array of strategies for reducing or extinguishing behaviors. So why are tantrums and meltdowns often discussed as if they are 2 completely separate events? It seems like most people think a tantrum is something that can be dealt with but a meltdown is out of everyone's control.

I think one reason can be the varied use of terminology when describing what is really a group of behaviors. If I say to you that an individual is "crying, rolling around on the floor, and screaming", you could decide that I am describing a "tantrum" or you may decide I am describing a "meltdown". It just depends on your interpretation, and your opinions. The problem with that is the consequence you come up with may vary depending on if you think the individual is having a meltdown or not.....but it shouldn't. Why would the consequence change? Behavior is behavior. Once the function of a behavior is determined, you as the parent or caregiver are now equipped to intervene on the behavior. You could call it a "tantrum", "meltdown", or "outburst", and that wouldnt necessarily mean the function of the behavior is any different. Make sense?

This is similar to the conversation around "sensory" vs "behavior". If someone decides a child is let's say...... climbing furniture for "sensory reasons" and not to do a "behavior", then maybe things like a sensory diet, weighted vests, or time in a sensory room may be given to that child every time they start to climb furniture. Here's a  few problem that this viewpoint can lead to:
- A "behavior" is what you can observe and measure, which means that if you are looking at your child exhibit "sensory issues" such as toe walking or vocal stims, you are looking at a behavior.
-Since you are dealing with a behavior, the most effective way to reduce or change it requires first determining the function. What I usually see to be true is that people don't try to determine the function of "sensory issues". I am usually told "oh we know WHY she does it, its sensory!"
-This is when it gets a bit tricky...another problem that can happen when multiple behaviors get lumped together and called something is this: How do you know if the behaviors all have the same function? Maybe the child began crying to gain mom's attention, but maybe they then started trying to climb onto the coffee table to escape dad (who is now walking over). If we call the entire episode a "meltdown" or a "tantrum" and lump all the behaviors together, the intervention we come up with might not work.
-Probably the biggest problem I see is when people think a behavior is really "sensory", they tend to only use reactive strategies. This means that when little Alice begins to headbang in the classroom she's quickly put in a quiet hallway with a helmet to wear, or sometimes taken straight to a sensory room. Unfortunately, this often ends up increasing the behavior because from Alice's perspective she just left boring math class to go to Disneyland. 

See, this terminology stuff is actually pretty important :-) When it comes to ABA, you have to be realllllly clear on what you are targeting.


 So now that its clear the best way to manage the behavior is by not getting hung up on terminolgoy or labels, and instead putting on your trusty Behavioral Cap, then what do you do next?

Glad you asked!

  1. Determine why the target behaviors are happening (the function).
  2. Using the function, create an intervention (I recommend consulting a professional)
  3. When designing the intervention,  be sure to think about what to do both BEFORE and AFTER the behavior occurs. You dont always want to be just reacting to behavioral episodes, you want to also be preventing them. Also, teaching replacement behaviors is important too. A good way I focus on this is by asking parents "Okay, what do you WANT him/her to do". For example, if a parent says to me "He gets angry and starts breaking things and slamming his bedroom door" I then respond with "What do you WANT him to do". Have you thought about that? Many times, the parents I consult with have not. Dont focus on just stopping behaviors, also think about what behaviors need to be taught/are currently lacking. 
  4. Putting the intervention in place is not the last step. It will be important to track the behavior (to determine if the intervention is working) and to "feed" or reinforce the appropriate behaviors. "Feeding" the behaviors you want to see will make them happen more frequently. 

The following are some general tips I have found to be successful with previous clients, when it comes to managing what some may call "tantrums" and some may call "meltdowns". Keep in mind, ABA is not paint-by-numbers. For best results, an intervention needs to be individualized to your child.

Helpful Parent Tips

  •       First, check-in with yourself-- are you calm?  Have you lowered your voice?  Are you remembering to breathe slowly?  Allow yourself to pause and not be in a rush. The more upset the child is, the more calm you should be. Minimize direct eye contact and remove any expression from your face (your feelings should not be flickering across your face).
  •    Count & Mand Procedure can be very helpful for managing behavioral episodes, particularly in public. Avoid things like bargaining, pleading, begging the child to behave, making threats, or bribery. 
  • Each time a behavioral episode kicks off, remind yourself that learning is occurring. Your child is taking note of what happens when they do a particular behavior, and determining if the behavior is a "keeper" or not (from the child's perspective). 
  •    Harmful behaviors are not ignored. If your child begins to hit, headbang, bite, kick, etc., block these attempts and use restraint if necessary to maintain safety (if this is an ongoing issue, please seek professional help).
  •  Look for opportunities to provide reinforcement, also known as "Catch 'em being good". If you are using hand over hand prompting to get the child to finish making the bed, step back every minute or so and see if he will comply independently. If he does, provide specific praise such as “Awesome making the bed!".
  • Pay close attention to what is usually happening before these episodes happen--Is the child being told to do a task? Is no one interacting with them?, and what is happening when these episodes stop--- Does the child get attention? Hugs? Quiet time in their room? This is key information that will help determine possible triggers and motivation for the behavior, from the child's perspective.

**Tip: For more information on this topic, I recommend the book "No More Meltdowns" by Jed Baker.

2 comments:

  1. Hi Tameka,

    I am a parent of a twelve year old with autism. He was a premie born at 25 weeks. I know he has some sensory issues. My biggest challenge is the vocalizations they are increasing and I do not know what to do to reduce them effectively. Help me! - mommy

    ReplyDelete
    Replies
    1. Hi there, :-)

      My FBA post may be helpful for you (http://www.iloveaba.com/2012/08/fba-part-ii-function-of-automatic.html), but I would definitely recommend pursuing intervention or working with a BCBA. This post is more general tips, but working with a professional will give you individualized strategies.

      Good luck!

      Delete