MELTDOWNS: BEHAVIOR MANAGEMENT; PREVENTING & COPING
Most of the time children with ASDs have melt downs it is in response to an unexpected change in routine or interrupting a highly preferred activity. If you watch th
e behavior of the television inspector Adrian Monk, you will understand more about why your child does what s/he does. (See #3 below). There is no single remedy for tantrums, aggression or self-injury in ASD. One needs to determine what is leading the child to behave the way they do in order to reduce these problems. Behavior management approaches depends on reaching an understanding of the reasons the child his having repeated meltdowns.
Most “melt downs”, aggression and self-injury by a child with ASD causes adults to stop making demands or requests. In other words its away of escaping or avoiding a situation they don't like or don’t understand, or for which they have no other coping mechanism. The solution depends on the reason.
1.The child doesn’t really understand what you are saying to them.
a.Teach more adequate receptive communication
b.Teach them a way of asking for help
c.Use visual rather than verbal requests, such as pointing to a visual schedule
2.The child lack the skill to do what youre asking them to do, or it is very difficult for them to do it (e.g. put on your shoes)
a.Teach them to ask for help
b.Teach them how to improve their skill in doing what you are asking them to do in a series of small step; use lots
of reinforcers for small gains.
c.Don't ask them to do it in the first place. Maybe its not important, at least not right now,
3.The adult request comes at a time the child is occupied with a preferred routine (e.g. playing a video game, spinning objects, other repetitive routine)
a.Wait until they stop the routine before asking them
b.Give them a warning 10 seconds before you are going to make a request. Count to five holding up your fingers
one at a time, 2 seconds for each finger. When the last finger is up, say "Now were going to..." Some people
use a visual count down clock the same way that turns a different color when its time to stop one activity and
C1. Offer to collaborate i.e. I'll do one then you do one
C2. Well do it this way this time, and your way next time
C3. Tell the child they can return to their preferred activity as soon as X is done.
d. Try to make requests only before a highly preferred activity, such as meal-time, watching a preferred
video, etc. or another activity which is part of your normal daily routine.
4.The child lacks the ability to request that they be allowed to do it later.
a. Teach them to make a "Later" request, either verbally, gesturally or with a picture Icon (e.g. a clock icon)
b. Always follow through by providing a delay, and then gently returning to the requested activity
c. Lavishly praise and reward the child for starting the activity you have requested them to do after the delay,
"Great job, you're a good helper!"
Some “melt downs” are maintained by parental attention. Remember, scolding or negative attention is still attention.
MEDICATIONS for MELTDOWNS
Some doctors prescribe medications that have been helpful in adolescents and adults with ASDs for reducing emotional outbursts younger children (off label) in response to changes in expected routines, or task demands that exceed their tolerance. For some children, the intensity and duration of outbursts can be reduced by treating them with Beta Blockers (e.g. Atenolol) or Catapres (clonidine). Younger children and school age youngsters often respond favorably to SSRI antidepressant medications (e.g. Luvox or Zolft). and older youth are occasionally given tricyclic antidepressants (e.g. Tofranil) or atypical antipsychotic medications (e.g. Risperdal). There have been no well controlled studies with younger children with ASDs with these medications however, and they have considerable side effects. Medications are seldom sufficient alone.
NO SINGLE SOLUTION
Parents and teachers often ask what is the best medication or behavioral treatment for meltdowns. In our experience there isn't any single best treatment. Solving the problem requires understanding the reasons for the emotional outburst, and methodically teaching the missing skill or changing the conditions giving rise to it. Some medications can help but they rarely solve the problem alone.
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