"A jar of jam on the dinner table set him off."
"Her chicken nuggets were cut in half and not whole."
"The teacher wore a baseball hat into the classroom that day and he absolutely lost it!"
Sometimes an autistic child (or any child) has a huge emotional reaction to a "seemingly" simple and unimportant change.
As bystanders we believe that a change that happened isn't a big problem. Yet, the reaction that a child has to the change seems over-the-top and their reaction may involve screaming and crying and "carrying on" for an hour or more.
This situation is difficult for everyone: the child, the parent or grandparent, the teacher.
HOW do we manage when this happens?
HOW can we prevent this from happening in the first place?
How to Manage in the Moment:
You have heard of "Fight or Flight". This is also called, "Fight, Flight, Freeze". And technically it is called a "Stress Response".
This intense emotional reaction (Fight or Flight) is outside of a person's control . . . and this is vital to realize. When a person has a stress response they no longer have volitional control of their emotions. Why is this the case? Let's look at the neuroscience behind Fight or Flight so that we can really understand why this is the case.
When a person, or a child in our scenarios, perceives information which is upsetting to them for any reason, this information is sent to the amygdala, which is the emotional center of the brain. The amygdala interprets the information and may act on it, sending a distress signal to the hypothalamus. The hypothalamus acts like a command center and communicates to the sympathetic nervous system and then to the rest of the body that danger is upon us and it is literally time to run away or turn and fight.
Putting the brakes on this reaction is not an easy task. And as mentioned above, stopping the stress response is outside of a person's volitional control. So, the priority at this point is to keep everyone safe and provide access to sensory input that may work to calm the nervous system.
If you find that a child or teen is in the midst of a stress response, try these approaches:
* Keep Everyone Safe - Clear the room. Clear pets and items from the room.
* Validate the child's feelings with one simple sentence. "I can see you are upset and I will give you time to feel better." Then no more.
* Provide access to regulating sensory input - Are there pillows the child can burrow into? Is there something they can aggressively manipulate like tearing paper or squishing figits? Does a full body hug from a trusted adult regulate them?
* Wait it Out - Give the young person time while making no demands on them. Time heals all, and time is needed for the stress response to resolve. So, no talking, no staring, no touching (unless the child welcomes touch and if you do touch them, deep pressure to the back or arms and legs is likely to be more regulating to the distressed nervous system).
How to Prevent the Meltdown in the First Place:
The situations above (jam on the table, cutting up chicken nuggets, the teacher wearing a baseball cap) are examples of a child becoming terribly upset and dysregulated from situations that often a parent or teacher could never predict, as they are quite random.
We can't predict when a child may have an intense reaction to some event. But we can begin to teach scaffolded coping strategies which are proactive and align with a child's ability to manage and understand themselves.
So, what to do to stop these reactions in the first place?
1- Always start with considering a child's "physiological regulation" when they have a meltdown.
Physiological regulation simply reflects how our body is feeling at the time just before the meltdown. Was the child exhausted, overly hungry (hangry?), was he feeling sick, was he constipated and cranky because of that? There are many factors that can trigger an intense response to something. This is the straw that breaks the camel's back, so to speak. So, when a child has a big reaction, take a moment afterward to ask yourself and others around you and the child himself how their body may have been feeling. Could physiological regulation have played a minor or major part in this child's actions?
Once you recognize physiological triggers, then you can become proactive: Reduce demands if a child had a terrible night's sleep. Keep the child well fed. Take note that a child may do poorly and may not cope well if they might be getting sick and seem to have arunny nose. You get the picture!
2- Next, think about "emotional regulation".
Was the child in a bad mood from something else? Had he just gotten home from another activity where maybe he had a hard time. Maybe there was something that was eating at him from some other event earlier in the day, that again made the particular situation the straw that broke the camel's back.
3- Assuming the child was feeling pretty good in their body and was not emotionally upset, we can think about this overreaction more.
When a young autistic person (or any child) becomes overly upset at seemingly random things, it is difficult for parents or teachers to understand this "over-the-top" level of distress - it is completely unpredictable and it is distressing for us as well. But I would starting with the assumption that there IS a reason they got so upset.
Why was a child upset by chicken nuggets being cut? Perhaps they like to look at the similarities and differences between the nuggets. Or maybe they do not want to eat this branc of nuggets. What if they saw a picture of chicken nuggets in front of a little boy and they want to pretend they are this boy. These are honestly, simple and random reasons to not cut chicken nuggets, but children and adults can have their own perspectives, which are valid.
So, assume and accept that there is a reason for an intense reaction from a child.
4- Ask the child about a situation when they are calm
I suggest asking the child at a time when they are very happy and calm, "Hey, Jonah, I want to help you to feel better next time you eat chicken nuggets. Why do you want them whole and not cut? This is totally fine. I just want to understand you better."
This asking may trigger an emotional response, and if it does, then I would not push it. But maybe see if the child comes out with anything now that they have moved on and is not actually upset about it anymore.
5- Consider Using Social Stories
Another approach is something called, "Social Stories". These can be created on the spot by anyone and there are some social stories that people have already written and you can find on the internet.
These are specific simple stories that were developed by a woman named, Carol Grey. There are simple rules for writing them and they are more to give kids information about the world rather than to tell them exactly what they should do.
When kids become very upset by simple changes in their day to day as described in the scenarios above, they may benefit from being read a social story about how sometimes there are "surprises we like" and sometimes there are "surprises we don't like".
I like this terminology because all of us face surprises we like and surprises we don't like every day, and we have to learn to cope with them as they happen. Clearly, some children may not be able to cope by themselves yet when they face an unexpected change. And that's okay. Kids are learning.
So, a social story about surprises and how to cope may really help children.
Also, I recommend that parents and teachers model this idea of there being "surprises we like" and "surprises we don't like". For example, if a dad runs out of half and half for his coffee he could say, "Oh no, I ran out of cream. I thought I had some. This is a surprise I don't like." (Then add how you will cope.) "I will pet the dog to calm me down. Tomorrow I will buy more half and half at the store."
If a mom gets a work call or email in the evening, she could say, "Oh no, I am home now. I want to relax and talk to my family but I have to work for a few minutes. This is a surprise I don't like. Well, I will sit in my comfortable chair so I feel relaxed and get this work done quickly."
These are silly examples, but they may help coping with unexpected and unwelcome changes (like chicken nuggets being cut) more concrete and manageable over the next several weeks and months for a child as they builds better coping skills.
6- Never turn to or use "Size of the Problem" scenarios and thinking.
Size of the problem is an approach that was well meaning in its intention, as it attempts to teach children that some problems that they perceive to be "big" are actually "small". Yet, we are moving away from this teaching perspective because it invalidates a child's experience. Also, we are learning more and more about the brains and neurobiology of autistic people and learning that the way they experience the world are genuinely different and should be honored.
More from Dr. Lisa Marnell and Kids Master Skills . . .
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I would love to hear about your successes, your struggles, your feedback, and any questions or comments you have! Let me know if this post was helpful.