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.