Reacting To Agitation, Escalation And Outburst
By Rebecca Klaw, MS, M. Ed. Owner, Autism Services by Klaw
§ Lack the capacity to manage emotions associated with frustration well enough to think clearly in the midst of crisis; and
§ Lack the ability to shift their thoughts from their agenda to your agenda even when faced with consequences.
Even when the punishment is very meaningful to the child, remembering the consequence in the middle of a meltdown in order to miraculously regain control, remains exceptionally difficult.
Proactive strategies for maintaining a calm, productive learning environment
Strategies for maintaining a learning environment are individualized but often include the following:
§ Access to communication
§ Access to choice
§ Predictability
§ Access to meaningful reinforcers that increase quality of life
§ Environmental adaptations
§ Analysis of common challenging behaviors and the motivation behind these behaviors
§ Utilization of strengths and special interests as a mechanism for teaching
Yet even with these strategies in place, there are times that new learning and growing expectations create frustration and our meltdown cycle begins.
Warning signs of agitation and escalation
While each child is different and has his or her own set of warning signs that indicate mounting stress and frustration, often an episode of agitation starts with refusal. Refusal can be shown in lots of ways: By saying “No!” effectively; falling to the floor; not moving; hitting, kicking, pinching, biting; or hiding under the table. Children with autism may refuse for many reasons and most of these reasons are linked to the universal difficulty with shifting attention.
Intervening
It is important to intervene quickly once agitation is observed. You need to try and find the moment when the child is upset but can still reason and respond. One thing that should be done immediately is to reconsider the demands that you are making on the child. Is the demand a non-negotiable request? Worth pursuing on a good day but not on a bad day? How important is it? One way to prioritize demands is:
A level demands = Non-negotiable
A word about consequences
Treating “out of control”, irrational, incoherent, destructive and sometimes abusive behavior with consequences is not routinely effective in children with autistic spectrum disorders. Children who are developmentally compromised in the areas of flexibility and frustration management usually:
B level demands = Important, but not totally essential, can be put on hold if the child is stressed about other things
C level demands= Non-essential, not important
A-level requests – those that involve health and safety and are non-negotiable - are often the trigger for full escalations and there is no easy way to avoid this. For a child that is inflexible, rigid, and routine-bound (as many of our children with autism are), being told that he/she must or mustn’t do something is often intolerable.
B-level requests – important but not essential - can be withdrawn or changed if you realize that there are too many other variables contributing to your child’s distress. If he/she is sick or tired, if there have been changes in routine, if there is sensory overload, do not choose this moment in time to teach a new skill. Save it for another time when the child is more available for learning.
If you find yourself withdrawing your B-level demand once you note the rising agitation, you can do the following: partner with the child (“Why don’t we both clean up today”), label the emotion and empathize, give the child time and space to absorb your request, use humor to de-escalate the situation and/or teach the child some negotiating skills around the demand that is causing agitation.
C-level requests can simply be withdrawn. Pick your battles thoughtfully. Remember that meltdowns are not good for anyone – not for you, not for others around you, and certainly not for the distressed child.
Meltdown
What do you do?
§ Wait it out safely.
§ Stop talking unless your words have a soothing effect.
§ Have one person manage the meltdown with others nearby to help you (not to help the child).
§ Know the child well. If you are uncertain or overwhelmed or if you have lost your objectivity, hand the job over to someone else.
§ Isolate the child. If he/she doesn’t want to come with you into a safe spot, then move other children and/or other staff away.
§ Use protective strategies so that no one gets injured.
§ Once the child has begun to calm down, you might offer sensory activities such as rocking or deep pressure if, and only if, you know that this is helpful in re-organizing the child.
§ Once the child has begun to calm down, you might offer the child a drink or something to eat if, and only if, you know that eating and drinking is helpful in calming and refocusing this child.
§ Offer the child with calming strategies that he/she has practiced during non-crisis times such as counting backwards, deep breathing or singing a repetitive song.
Recovery
When the child is out of crisis, and the request has been met (medicine has been swallowed, seatbelt has been fastened, etc.), let the child know that even though it was hard, they did a good job complying and you are proud of them.
If the outburst was triggered by an A level or even a B level request, it is likely that that request, in the future, will once again cause the child to escalate and potentially meltdown even if the child has shown remorse and has “talked it through” with you during recovery. The child’s team, then, needs to come up with ways of understanding why this particular request is so difficult for the child and what to do to make it easier on the front-end, proactively. You might try:
§ Gathering more information from the child and the team about why this request was so problematic;
§ Writing a social story that gives the child information and coping strategies;
§ Setting up regular and highly desired rewards for compliance;
§ Reading the social stories, rehearsal and role play;
§ Finding effective calming methods that can be practiced and made readily available to the child even when agitated.
Understanding basic characteristics that cause distress in a child with autism will prevent adults from choosing inappropriate techniques to manage the crisis. Understand what fuels the child’s frustration and select techniques that seem to fit:
§ Responding to basic needs: Proactive strategies for helping to manage stress for the child and optimize functioning and learning are an important part of every child’s treatment, whether it be in the home, the school, the community or in groups. These include enhancing the opportunity for both receptive and expressive communication; adapting the environment; providing predictability; and fulfilling sensory needs.
But if they don’t work on a given day or in a particular circumstance…
§ Responding to agitation and escalation: The strategies for defusing potential meltdowns include: becoming the child’s partner as opposed to adversary; giving the child space and time to process the problem; empathizing and labeling the feelings; and, if possible, helping the child frame and solve the problem in a way that is satisfying to both you and the child.
But if these interventions don’t work…
§ Responding to crisis: The strategies for managing a meltdown in a therapeutic manner include isolating the child for his/her safety and the safety of others, using protective strategies in the event of dangerous and/or aggressive behavior, and waiting for the storm to blow over. As the child begins to calm, you may find that certain sensory activities increase the child’s ability to grow calm and focused again.
After it is over…
§ The learning phase: Although many children with autism have limited insight into their own behaviors, it is important to eventually discuss what happened with the child and to devise, as a team, ways to rehearse similar situations during non-stressed moments. Social stories, rehearsal and possibly desensitization with regular reinforcement are all appropriate post-meltdown techniques.
For a complete training DVD on overcoming difficult behaviors in children with autism related conditions please call (412) 247-0599, email rebeccaklaw@aol.com or visit www.rebeccaklaw.com.
What you always do….
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