It is perfectly possible to reduce both the frequency and
violence of student meltdowns, which will, in turn, reduce the need for
restraint and seclusion in schools.[1] However,
this requires a change in attitude on
the part of educators, towards seeing autistic children not as willfully
naughty or manipulative, but as overwhelmed and frightened. Teachers, aides and other educators also need
to be willing to observe these children’s behavior carefully and make “meltdown
plans” in advance. Given the already
heavy burden carried by educators today, this may seem like a lot to ask, but dealing
effectively with meltdowns will certainly reduce educators’ stress in the long
run.
The best practical advice for teachers on this subject that I have found comes from three books. Deborah Lipsky and Will Richards’ Managing Meltdowns: Using the S.C.A.R.E.D. Calming Technique with Children and Adults with Autism focuses on interventions that can be used during a meltdown. Deborah Lipsky’s From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively, and Geoff Colvin and Martin Sheehan’s Managing the Cycle of Meltdowns also offer guidance on ways to prevent (or at least limit the number of) meltdowns in the first place.[2] Lipsky is herself autistic, has experience working as and for first responders (EMTs, firefighters, police officers), and writes from the perspective of her own personal experiences and those of other autistic people she has worked with. Her collaborator for the first book, Will Richards, is a clinical psychologist, with extensive experience treating autistic clients. Colvin and Sheehan are professional educators who have spent decades working with autistic children in schools. Despite their very different backgrounds, their conclusions are remarkably similar.
All these writers clearly distinguish meltdowns from temper
tantrums.[3] And
all of them describe melting down as a process, which can be interrupted by an
observant and skilled teacher or first responder. Colvin and Sheehan propose a six-phase model
of the “meltdown cycle,” in which a student who had been in a state of calm is subject to one or more triggering events, which then lead to
increasing agitation until the point
of no return is reached and he or she melts down. Once the meltdown
has played itself out, there is a period of re-grouping
during which the student is beginning to recover but may easily melt down again
if pushed too hard. Finally, the student
becomes calm enough to start over,
although with some lingering anxiety, uncertainty, and irritation.[4] Lipsky
does not present her observations in quite the same way, but a careful reading
of her book shows that she holds a very similar view of the meltdown as a process.[5]
“Avoiding it in the first place is the most effective way of
preventing a meltdown.”[6] Both Lipsky and Colvin and Sheehan offer
extensive advice on how to maintain a student with autism in the calm phase,
which essentially comes down to using best practices for teachers of autistic
students: providing sensory diets as
needed, using visual supports, having clear rules (systematically taught to the
whole class), planning ahead, and adjusting the curriculum as needed. The three authors also encourage teachers and
aides to identify and limit as much as possible triggers that may disrupt a
student’s calm participation in class—whether these are sensory issues, unexpected
breaks in routine, or something else.[7]
Teachers must also learn how to recognize the signs of
increasing agitation, and how to intervene to de-escalate the situation with
reassurance, comfort, and support.
According to Colvin and Sheehan, agitation is “normally an observable
manifestation that something is wrong with the student.”[8] While some students move very quickly through
the agitation phase to a full-blown meltdown, offering little time for
intervention, much more often there is a period of agitation during which an
observant teacher will notice increased stimming, wriggling, pacing and
noise-making, or decreased interaction with others, including partial or total
loss of the ability to communicate, non-compliance with directions, covering
eyes or staring into space, hiding hands or even seeking isolation.[9] Training
teachers to recognize these signs can have a huge impact on the frequency and
violence of meltdowns in their classrooms.
When an autistic student is becoming agitated, the teacher or classroom
aide can step in to provide reassurance and empathy, offer opportunities for
breaks or for movement to quiet spaces, and encourage self-management (if the
student already has some skills in this area).
Reducing an autistic student’s agitation is the key to preventing
meltdowns. It is essential that school
personnel not become agitated themselves during this phase, as this will simply
increase the student’s agitation and make a meltdown more likely.[10]
If a teacher misses or ignores the signs, the student’s agitation will continue to increase until they reach a “point of no return,” after which a meltdown is going to occur no matter what.[11] And once the meltdown begins, it will need to run its course, which typically ends when the child is too exhausted to continue. School personnel and school police officers must recognize that at this point the student cannot control her or his behavior, and neither can they. Shouting commands at a frightened child in the middle of an instinctual fight-or-flight reaction can only make the situation worse. Instead, the school should already have decided on an action plan and included it in the student’s IEP. (Obviously, if a child is having meltdowns in school, he or she should have an IEP). Staff should be trained in advance in ways of providing support for the melting-down student, by limiting additional sensory input, remaining calm, staying nearby (but not too close), and saying encouraging things in a low-pitched, slow voice.[12] According to Lipsky, the calm and sympathetic use of the student’s name during a meltdown can be especially helpful.[13] Educators should know how to calmly and quietly guide the student to a safe place and the meltdown plan should always ensure that someone observes the child while he or she is there. If there is an immediate threat of injury to the student or those nearby, strategies should be in place for using (and later reporting) safe forms of restraint as a last (not first) resort. Under some circumstances it may be better to clear the classroom of other students, until the meltdown is over. [14]
When the meltdown is past, it is cruel and counterproductive
to criticize the student—who is physically and emotionally exhausted, and probably
already deeply embarrassed about/ashamed of what happened.[15] It should be unnecessary to say that police
involvement after the meltdown is ended can only be counterproductive. Neither is it useful to interrogate the
student about why the meltdown happened.
(Discussion of the meltdown can occur sometime later—perhaps even the
following day.) Autistic children are
still emotionally labile during the “regrouping” phase and may escalate into a
second meltdown if pushed too hard.
Rather, the teacher or an aide should continue to offer quiet support
and can encourage the student to use a stim toy or pursue their special
interest as a way of bringing them back from the fight for survival into the
ordinary world.[16]
Eventually, the student will return to a non-agitated,
relatively normal state during the “starting over” phase, and can return to the
classroom (if they left it during the meltdown). Nevertheless, they may still be feeling some anxiety,
irritability, or uncertainty, and should not be pushed too quickly to engage in
normal learning activities. Concrete
tasks, which the student has already shown he or she can perform, are the best
activities for this period; engaging in such tasks can help the student gain
confidence and eventually return to their original state of calm.[17]
Good teachers here and there throughout the United States
have already learned how to manage meltdowns successfully, using these or
similar techniques. It is time for such
techniques to become standard practice in all of our schools. But it all starts with changing the attitudes
of the adults involved towards the autistic students they serve.
[1]
Grafton Integrated Health Care, a for-profit behavioral health organization,
has claimed that its proprietary “Ukeru model” has reduced incidents of
restraint by 99% and incidents of seclusion by 100% over the course of 14 years
(2003-2016), in community as well as institutional settings. They claim that staff injuries from restraint
have declined by 100% in community settings, and 97% in institutions: Jason Craig and Kimberly Sanders, “Evaluation
of a Program Model for Minimizing Restraint and Seclusion,” Advances in Neurodevelopmental Disorders
2 (2018), 344-352. The authors of this
paper are affiliated with Grafton, and I have not been able to discover any
corroborating analyses conducted by unaffiliated scientists.
[2] Deborah
Lipsky and Will Richards, Managing
Meltdowns: Using the S.C.A.R.E.D.
Calming Technique with Children and Adults with Autism (London: Jessica Kingsley, 2009); Deborah Lipsky, From Anxiety to Meltdown: How Individuals on
the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums,
and How You Can Intervene Effectively (London: Jessica Kingsley, 2011) and Geoff Colvin and
Martin Sheehan, Managing the Cycle of
Meltdowns for Students with Autism Spectrum Disorder (Thousand Oaks,
CA: Corwin, 2012). Another excellent book on this subject is
Judy Endow’s Outsmarting Explosive
Behavior: A Visual System of Support and Intervention for Individuals with
Autism Spectrum Disorders (Shawnee Mission, Kansas: Autism Publishing
Company, 2009).
[3] Lipsky
and Richards, Managing Meltdowns, section
entitled “Are Meltdowns and Temper Tantrums the Same Thing?” (I am using the
Kindle edition of the book, which has no page numbers); Lipsky, From Anxiety to Meltdown, p. 108, 135-42,
and especially 149-52 (on determining whether behavior is a tantrum or a
meltdown). Incidentally, Lipsky also
offers some very useful suggestions for dealing with tantrums, even though her
main focus is on meltdowns: see pp. 142-49Colvin
and Sheehan, Managing the Cycle of Meltdowns,
pp. 22-25.
[4]
Colvin and Sheehan, Managing the Cycle,
pp. 29-30.
[5] Lipsky,
From Anxiety to Meltdown, see
especially, p. 127. Judy Endow has a similar
model: Outsmarting Explosive Behavior: A
Visual System of Support and Intervention for Individuals with Autism Spectrum
Disorders (Shawnee Mission, Kansas: Autism Publishing Company, 2009), pp.
11-46.
[6] Lipsky, From
Anxiety to Meltdown, p. 229.
[7] Colvin
and Sheehan, Managing the Cycle of Meltdowns, pp. 63-108; discussion of
potential triggers is a particular strength of Lipsky’s book, From Anxiety to Meltdown, pp. 161-214.
[8] Colvin and Sheehan, Managing
the Cycle of Meltdowns, p. 39.
[9]
Colvin and Sheehan, Managing the Cycle of
Meltdowns, pp. 40-43; Lipsky and Richards, Managing Meltdowns, section on “What Are Some of the Warning Signs
of a Potential Meltdown?”
[10] Colvin
and Sheehan, Managing the Cycle of
Meltdowns, pp. 109-22.
[11]
The phrase “point of no return” is used by Judy Endow, Outsmarting Explosive Behavior, pp. 35-40. She uses it to emphasize that once a child
has reached this point they are no longer in control of their behavior; making
a meltdown inevitable.
[12]
Lipsky and Richards, Managing Meltdowns;
Lipsky, From Anxiety to Meltdowns,
pp. 216-22; Colvin and Sheehan, Managing
the Cycle of Meltdowns, pp. 135-36
[13]
Lipsky, From Anxiety to Meltdown, p. 221.
[14]
Colvin and Sheehan, Managing the Cycle of
Meltdowns, p. 123-41; compare Lipsky, From
Anxiety to Meltdown, p. 221.
[15]
Lipsky, From Anxiety to Meltdown, pp.
110, 126, 141.
[16]
Colvin and Sheehan, Managing the Cycle of
Meltdowns, pp. 142-53.
[17]
Colvin and Sheehan, Managing the Cycle of
Meltdowns, pp. 49-51, 154-68.