Monday, June 28, 2010

Anatomy of a Meltdown Part III

I am sorry to interrupt this nature study but there was a loose thread from my series on meltdowns that is hanging and must be wrapped up . . .

I pointed out in my previous post how many of Pamela's meltdowns revolved around fear, anxiety, or unexpected change. Parents have to develop their own set of priorities in handling meltdowns. One reason why we focused so heavily on prevention was to avoid harming others (or ourselves) with an out-of-control child. We chose to leave an event early rather than ruin the enjoyment of others. When prevention failed, people generally welcomed us back because they saw how hard we we worked to avoid meltdowns in the first place. While it seemed unfair that we missed out on so much at first, in the long run, our efforts worked. Pamela has lived a rich and interesting life, including travel to some unusual places.

Another priority was to build up a bridge of trust between Pamela and us, so we picked our battles. Pamela was five the last time we rode an elevator in her early childhood. When forced, she not only cried, screamed, and fell onto the floor, but she also grabbed the doors as we hauled her inside. Not a pretty picture. Since every building with elevators must also have stairs, we opted to for the latter. It was inconvenient at times but offered us exercise. Rather than destroy her trust with unnecessary tests of the will, we tried to compromise when it seemed reasonable. We could have forced the issue but we hoped to avoid filling Pamela's memory with the two of us digging in our heels over something insignificant. Why build the habit of obstinacy when it might be unnecessary?

Sometimes, I had to trust Pamela. During a field trip exploring a grocery store, she refused to go to the storage areas that customers never see. She was absolutely adamant. I passed David off to one of my homeschooler friends, and, when they came back, my friends told me that a huge box-crushing machine made an awful racket and they wished they had stayed with Pamela! After that incident, nobody questioned Pamela's sensitive hearing. When we couldn't avoid a situation, I focused on calming her and consoling her.

In retrospect, I am glad we didn't force her into scary situations. In time, she learned to conquer her own fears. Toy Story 2 helped her learn to ride an elevator back in 2003, and she has had no problems ever since. Last spring, she desensitized herself to balloons. Because Pamela learned to trust that we would only push her through fearful situations when we couldn't avoid it, she willingly followed our lead. I think it is one of the reasons why Pamela is a really good apprentice. In fact, the first time we saw our RDI consultant she said we were the first family to walk in her office with solid co-regulation and a working master-apprentice relationship. What does that mean? During activities in our first assessment, Pamela modified her actions based upon my actions, even if they changed or seemed unexpected, and followed my lead in learning new tasks without trying to control the situation or refusing to try.

When facing meltdown central, it can be hard to decide whether to prevent, guide, or persevere. For us, it boiled down to context. If we had control over the setting, we focused on prevention. If we had plenty of time and flexibility, we tried guiding her thoughts and calming her fears. If we had no alternatives, then we did the best we could and let go of the guilt. Sometimes, we assessed the cause and focused on Pamela's needs. Does she need more structure? Is it too noisy? Is there an easy way to set limits and boundaries? Does she need time alone in a quiet place?

Another thing to avoid is adding fuel to the fire and making it worse. When eyes of the nosy people of Walmart are glued to you, it is easy to flip out and join in the meltdown. It's not fair and you didn't ask for a child with autism, but those busybodies are too ignorant to get it even if you had all day to explain it. While remaining calm may not calm your child, losing it usually increases the heat. Since our children are not processing very well, talking, asking questions, and threatening punishment are typically ineffective. Demanding eye contact is also a waste of time because they won't be able to understand your nonverbals either.

Over the weekend, I had explained to David that it is like when he was a little boy and used to argue for the sake of arguing, even when he was spouting nonsense. If we try to explain, discuss, or console with words, Pamela ends up shooting off her mouth without saying much, "Super spies! Be kind rewind!" He was skeptical until today. Pamela started blubbing about something really minor and rather than engage, I let her vent and looked at her calmly with my eyebrows arched, waiting for her to finish. She stopped after fifteen seconds and, at that point, we had a conversation. Typically, an episode will last five minutes because David tries to reason with her, which only adds fuel to the fire.

Once the firestorm is over, it is perfectly alright to give authentic and consistent feedback about the situation. "I was so sad about your crying at Wal-Mart. People were staring at me. Next time, I can take you out of there if you need a break." Tone, facial expressions, and gestures ought to match what you are saying. If your child is verbal, after they have calmed down and recovered, you might talk about what happened to find out how you could have prevented it.

Our children can learn from these situations when everyone is consistent in setting limits. In our case, Steve has a soft spot for Pamela, who can be sweet and charming when she's not acting like Fidelita. When she wants to test limits, she invariably hits him up because she knows that I am the iron lady. Both children knew my shopping rules when they were little. The cart stops until the whiny "It's taking too long" child zips it, thereby making the long trip even longer. All requests for candy, toys, videos, etc. must be negotiated before we leave the house. If a child comes close to embarrassing me, we will leave a full cart at the store and said child will miss the next couple of outings. My tough love policy only worked with Pamela because I coupled it with prevention.

Here is a quick summary:
  • Know your child: social, emotional, and language abilities; what causes physical, mental, and emotional dysregulation; difficulty filtering in what is important and filtering out what is not; what triggers outbursts.
  • Be prepared before you walk into a potentially volatile situation: have a plan of action; locate an escape route or a quiet room; come in two cars; bring a bag of special toys to keep your child preoccupied; preview the setting with the child in advance to help you develop a plan.
  • Take steps to prevent a meltdown: avoid potential triggers if it’s one of those days; watch for stressed-out body language; leave the setting; apply any sensory strategies until you and your child relax.
  • Understand what a meltdown means: lack of awareness of others; overwhelming stress; inflexible, confused thinking;
  • Stop, look, and listen; breathe; ignore the bystanders; apply any sensory strategies that you know calm your child down.
  • Do a post mortem on every meltdown to figure out what happened and what you can do in the future. Keep what happened in perspective: autism isn’t easy on anyone.
  • Think about what your child may be like in ten years when he is bigger and stronger. Focus on teaching self-awareness, self-calming strategies, and prevention.


Bonnie said...

Excellent post Tammy!

Kathleen said...

Awesome information! Thanks! passing it on.

Prince Andrew and the Queen Mum said...

best post i have read anywhere in awhile. thanks

The Glasers said...

Thanks, Queen Mum . . . garnered and polished in the school of hard knocks!