Managing behavioural crisis situations in autism

Managing behavioural crisis situations in autism

Behavioural crisis, a severe and or prolonged outburst of behaviour when the child becomes too upset, angry or aggressive, creates a difficult situation for parents and carers. Knowing the situations or reasons that may precipitate such a crisis and ways of managing it may be helpful in dealing with the situation without making it worse.

There are two main types of behavioural crisis:

A: Severe and prolonged tantrums 

Tantrums occur either when the child wants something that they don’t get (because they can not express their needs or it is denied to them) or they don’t want to do do something they are asked to do. Basically, a tantrum is a learnt behaviour that the child uses to get his/her own way, giving in to it is never a good idea as it only reinforces the tantrum behaviour. Sometimes, the situation gets out of the child’s control because of their poor emotional regulation and even they don’t know how to turn off the tantrum! 

B: Meltdowns

Meltdowns happen when the buildup of anxiety and stress crosses the limit of what the child’s system can put up with, and their pent-up stress boils over causing prolonged crying and aggression. There is no particular purpose to this behaviour apart from releasing stress. 

Recognising

In the heat of the moment, it can be difficult to tell between the two, but the following may help:

Severe tantrum Meltdown
  • Started when demand was denied or when the child was asked to do something
  • Started with some stress, for example, a change of situation or after a stressful day
  • The child seems to be aware of or watching others reactions
  • The child does not show any awareness of others’ reactions 

 

Managing the situation

There are some similarities and some difference in the way tantrums and meltdowns are managed:

Severe tantrum Meltdown
  • Stay calm. Your panic will only make the situation worse. Don’t cry or yell and keep your voice firm and steady; children are reassured by firmness. 
  • Catch it early: read early signals and try:
    • Distracting the child to something of the child’s interest and is calming for the child.
  • Show that you are aware that the child is upset by saying in a calm voice: “I know you are upset”
  • Help the child communicate the demand better by using some practised way of communicating, for example, visual symbols. Praise the child for communicating.
  • Help the child by removing demands from the child and reducing any sensory overload such as noise, such as moving to a calmer place. 
  • Suggest alternative behaviour for the child to do: saying ‘stop’ to not wanting to do something. Praise the child as soon as the child does that.
  • Use some practised calming method, such as a sensory toy or listening to music
  • DO NOT criticise the child 
  • DO NOT reason or argue
  • Remove attention, unless doing so would put the child at risk
  • Use a soothing method that you know works on your child, for example, hugging, touching, holding, singing, 
  • DO NOT give in or bribe the child
  • Some children may just need to be left alone, removing stimulation and demands,  in a safe and calm place, to calm down
  • Remain aware of the child’s and others’ safety, act promptly if anyone is at the risk of getting hurt
  • Remember, preparing and preventing is the best way of dealing with both these behaviours. Work on:
    • Improving communication using symbols required
    • Practising alternative behaviours or favourite activities that could be used as replacements of demands, such as a sensory toy, music, reducing noise with headphones. Using a predictable plan will help the child too.
    • Reducing stressful situations such as noise or crowd and creating frequent breaks or relaxing times.
    • Teaching, practising and rewarding positive behaviours, such as asking, giving, showing, sharing 
  • Talk about the incident after the child has settled, and only about how the child calmed down and settled, what would be unacceptable (hitting others or breaking things) and what she/he could do better in the future. Build a reward programme (giving stickers) for the child showing good behaviour in future. Don’t criticise the child. 

 

You need to think through the above and individualise it to your child. Share it with others and have it ready to use in the event of a crisis. 

 

Taking the child to a hospital in such a situation may only make things worse; children with autism don’t react well to hospital environments. Medicines have almost no role in managing such situations. Trying to medicate children with autism by giving sedatives often makes them irritable and aggressive. If you have tried the above plan, worked on the behavioural improvement plan (see Managing behaviour difficulties) and still have serious issues with your child’s challenging behaviour then take advice from a child psychiatrist.