thoughtful response to agitation, escalation and meltdowns rebecca klaw, ms, med

THOUGHTFUL RESPONSE TO AGITATION,

ESCALATION AND MELTDOWNS

Rebecca Klaw, MS, MEd

Based on the work of Dr. Ross Based on the work of Dr. Ross Greene (author of Greene (author of The Explosive The Explosive ChildChild) and many others who ) and many others who contribute to what is known about contribute to what is known about autism and related disorders.autism and related disorders.

Part 1:Part 1:

Understanding the Understanding the inflexible-explosive individualinflexible-explosive individual

WHY?

Common Characteristics of Common Characteristics of Meltdown-Prone IndividualsMeltdown-Prone Individuals

• Difficulty managing and controlling the emotions associated with frustration

• Difficulty thinking through ways to resolve or cope with frustration

Common Characteristics of Common Characteristics of Meltdown-Prone individualrenMeltdown-Prone individualren

• Frustration often leads to cognitive debilitation– Can’t remember how to stay calm– Can’t recall consequences of previous episodes– May not be responsive to reasons– May deteriorate even further in response to limit-

setting and punishment


• Low frustration threshold• Frustrated more easily than others

• Low tolerance for frustration• The experience of being frustrated can be very

intense, disorganizing and sometimes overwhelming


• Tendency to think in a concrete, rigid and black-and-white manner.

• Persist in their inflexibility and poor response even in the face of meaningful consequences


• Explosive episodes can have an out-of-the-blue quality.

• May be particularly inflexible about one or more issues

• May be especially inflexible when tired, hungry or ill

Does this sound Does this sound like anyone you like anyone you

know?know?

If people with an autism diagnosis fit If people with an autism diagnosis fit perfectly into this model of the inflexible perfectly into this model of the inflexible and explosive individual, what gets them and explosive individual, what gets them

there?there?

Bad parenting – no!Bad parenting – no!

Bad teaching – no!Bad teaching – no!

Neurologically determined pathways – yes!Neurologically determined pathways – yes!

Pathways to inflexibility and Pathways to inflexibility and explosivenessexplosiveness

• ADHDADHD• EXECUTIVE FUNCTION DEFICITSEXECUTIVE FUNCTION DEFICITS• LANGUAGE PROCESSING DIFFICULTIESLANGUAGE PROCESSING DIFFICULTIES• MOODMOOD• DIFFICULT TEMPERAMENTDIFFICULT TEMPERAMENT• ANXIETYANXIETY• SOCIAL SKILLS DEFICITSSOCIAL SKILLS DEFICITS• SENSORY INTEGRATION DYSFUNCTIONSENSORY INTEGRATION DYSFUNCTION

CONCLUSION TO PART 1CONCLUSION TO PART 1

If you don’t understand the basic If you don’t understand the basic characteristics that can cause distress characteristics that can cause distress in a individual with autism, you might in a individual with autism, you might

think they are being “bad” or think they are being “bad” or “manipulative”, or “controlling”.“manipulative”, or “controlling”.


You might also choose inappropriate You might also choose inappropriate techniques to manage these crises, techniques to manage these crises,

thinking that if you just keep piling on thinking that if you just keep piling on consequences, you will win the battle.consequences, you will win the battle.


But when you understand the But when you understand the characteristics of the inflexible, characteristics of the inflexible,

explosive and autistic individual, and explosive and autistic individual, and how these characteristics are how these characteristics are

determined by neurological difference, determined by neurological difference, you realize that it is never a battle you realize that it is never a battle

where someone wins and someone where someone wins and someone loses.loses.


Becoming so frustrated that you lose Becoming so frustrated that you lose control of your body and of your control of your body and of your

rational mind is distressing – for the rational mind is distressing – for the individual and for you.individual and for you.

No one ever, ever wins.No one ever, ever wins.

Part 2:Part 2:Understanding the stages of crisis, Understanding the stages of crisis,

leading to meltdownsleading to meltdowns

AGITATIONAGITATION

ESCALATIONESCALATION

MELTDOWNMELTDOWN

RECOVERYRECOVERY

Demand to shift gears

AGITATIONAGITATION

Triggers:

Not getting what he/she wants

Not doing what he/she wants to do

Not being able to regulate to environmental stimuli

Not being able to regulate to internal stimuli

AGITATIONAGITATION

All triggers represent a demand to shift gears…

Shifting to a new activity

Shifting away from a routine

Shifting attention away from something uncomfortable externally

Shifting attention away from something uncomfortable internally

Thought provoking research….Thought provoking research….

Susan Bryson and Reginald Landry at York University and Hospital for Sick Children in Toronto have discovered that in children

with autism, there is a universal problem with visual orienting. This is the most basic form of attention. It describes the ability to move one’s attention in space. It is critical

for survival.

They found that children with autism, even those with normal or above

normal IQs, have marked difficulty in disengaging attention.

When shown multiple TV screens, it is hard for children with autism to stop

looking at one in order to shift attention to the newer visual stimuli.

One of their conclusions….

It is neurologically difficult to shift attention if you are an individual with autism. children with autism aren’t being bad or non-compliant. They are being autistic. This problem is not just a problem for us. It seems to be a problem for the children as well.

Escalating agitation…Escalating agitation…

Vapor lockVapor lock

In cars, vapor lock is caused by excessive heat that creates a bubble in the gas line. This

prevents gas from flowing to the engine and causes the engine to stall. No matter how many

times the driver pushes the pedal or turns the ignition, the car won’t start until it cools down.

Escalating agitation…

When our students are frustrated and their When our students are frustrated and their agitation is growing, they are in vapor lock.agitation is growing, they are in vapor lock.

Frustration causes a breakdown in the capacity to think clearly, causing him/her to become

overwhelmed and irrational.

Escalating agitation…

No matter how many times the adults reasons, insists, rewards, punishes or

whatever, the individual can’t start thinking clearly until someone helps

him/her cool down.

MELTDOWNMELTDOWN

Dr. Daniel Goleman, the author of Emotional Intelligence refers to the meltdown phase

as “neural high jacking”.

MELTDOWNMELTDOWN

Irrational

Incoherent

Destructive

Abusive

Out of control

=

A DEBILITATED STATE

MELTDOWNMELTDOWN

What the individual does and says during

the meltdown is “MENTAL DEBRIS”

MELTDOWNMELTDOWN

An escalating and deteriorating inflexible-explosive individual is not a pretty sight.

Not for you

Not for others around you

And certainly not for the distressed individual

Part 3:

Reacting to agitation, escalation and outburst

A word about consequences…

Individuals who are developmentally compromised in the areas of flexibility and

frustration management usually:

• Lack the capacity to manage emotions associated with frustration well enough to think

clearly in the midst of crisis

individualren who are developmentally compromised in the areas of flexibility and

frustration management usually:

• Lack the capacity to manage emotions associated with frustration well enough to think

clearly in the midst of crisis

• Lack the ability to shift their thoughts from their agenda to your agenda even when faced with

very meaningful consequences

Think about these quotes…

“ For a consequence to achieve its desired effect – that is, for a consequence to make it less likely that a individual will explode the next time he is frustrated – you have to have the faith that the

consequence you administered on the back end the last time (i.e. following the last explosion) is going to be accessible and meaningful to the individual on the front end the next time he

becomes frustrated”

“Consequences can be very effective if an individual is in a state of mind to

appreciate their meaning, but don’t work nearly so well if a individual is not able to

maintain such a state of mind”

Dr. Ross Greene

So we are going to talk about other strategies for managing agitated and

escalating behaviors

First, how do we know when the cycle of agitation escalation MELTDOWN

begins?

What are the typical signs?

REFUSALREFUSAL

NO!

InterventionsInterventions

Proactive:

• Access to communication

• Access to choice


Proactive:

• Predictability


Proactive:

• Environmental adaptations

InterventionsInterventionsProactive:

• Analysis of common challenging behaviors and the motivation behind these behaviors

• Understanding that meltdown behavior doesn’t happen “out-of-the-blue” but happens for reasons that are extremely important to the individual


Proactive:

• Utilization of strengths and special interests as a mechanism for teaching

• quality of life

But sometimes, no matter how well you set the stage, your students become

agitated

Reacting at the CrossroadsReacting at the Crossroads


Reacting at the crossroads:

Prioritize your demands

Level A demands

Level B demands

Level C demands

Level A DemandsLevel A Demands

• Non-negotiable

• Safety of self and others

• Health

• Basic life expectations

Level C DemandsLevel C Demands

• Not important

• May fly in the face of convention, but not really matter

• Not important for that particular student

• Doesn’t impact the a big picture

Level B DemandsLevel B Demands

• Important but not essential

• Level B demands are the stuff of teaching

• Level B demands are most effective when a student is available for new learning

Level B DemandsLevel B Demands

• Level B demands can and should be withdrawn or compromised if this is not a good teaching moment.

• If you decide not to follow through with a Level B demand because it is a rough day for this student and you see him growing agitated, that is a wise choice. It will not cause the student to regress or backslide.



Empathize. Be the individual’s partner, not their adversary.

I know you are mad. You are really mad that it is time to go! It is hard to stop playing with that toy. I understand.

“When children are stuck in the red haze of inflexibility and frustration, they respond a lot better if they perceive adults as potential helpers, rather

than as enemies”

Dr. Ross Greene, The Explosive individual, p. 104



Give time and space.



Offer visual instead of auditory information.



Provide support in a calm, non-threatening manner.



Offer to do the activity with the individual.



Try humor or surprise as a way of helping them to switch gears



For our more able students, try framing the problem and getting them to help with a solution

UH-OH… WE HAVE A PROBLEM. I WANT YOU TO GET READY TO GO HOME AND YOU WANT TO CONTINUE TO PLAY. WHAT

CAN WE DO ABOUT THIS THAT MAKES BOTH YOU HAPPY AND ME HAPPY?

But sometimes, no matter how well you react at the crossroads, your students continue to

escalate into a full-blown meltdown


Beyond the crossroads, reacting to crisis:

Wait it out safely.



Have one person manage the meltdown with others nearby to help you.



Isolate the individual. If he/she doesn’t want to come with you into a safe spot, then move

others away.



Stop talking unless your words have a soothing effect.

Really.



If the person is attempting to hurt himself or others, including you, you need to use protective

measures so that you don’t get hurt.



Once the individual has begun to calm down, you might offer sensory activities if you know that this is helpful in reorganizing the individual.



Once he or she has begun to calm down, you might offer something to drink or something to eat if, and only if, you know that this will help to

calm and focus them.



You might offer to help the individual with calming strategies that he/she has practiced during non-

crisis times.


Recovery (the long-term response):

Asking the question: What can we do next time?

Review the individual’s needs.

Review your proactive strategies.

Review the crossroads strategies.



Setting up regular and highly motivating rewards for the behavior you want to see.



Social stories



Practicing calming/coping techniques

Kari Dunn Buron’s books

Don't Pop Your Cork on Mondays! The Children's Anti-Stress Book

Written by Adolph MoserIllustrated by Dav Pilkey

http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-author-exact=Adolph%20Moser&rank=-relevance%2C%2Bavailability%2C-daterank/103-6305168-0043833

http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-author-exact=Dav%20Pilkey&rank=-relevance%2C%2Bavailability%2C-daterank/103-6305168-0043833

Don't Rant & Rave on Wednesdays! The Children's Anger-Control Book

Written by Adolph MoserIllustrated by David Melton

http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-author-exact=Adolph%20Moser&rank=-relevance%2C%2Bavailability%2C-daterank/103-6305168-0043833

Conclusion to Part 3Conclusion to Part 3

What you always do…

Respond to basic needs• Communication

• Safety• Predictability

• Sensory differences

Conclusion to Part 3Conclusion to Part 3But if these don’t work on a given day or in a

particular circumstance…

Respond to agitation and escalation • Prioritize your demands

• Be the individual’s partner• Give space and time• Decrease language

• Increase visuals• Help the individual frame and solve the problem

Conclusion to Part 3Conclusion to Part 3

But if these interventions don’t work…

Respond to crisis• Isolate the individual for safety

• Use protective strategies• Wait, quietly, for the storm to blow over• Assist the individual with calming/coping

strategies

Conclusion to Part 3Conclusion to Part 3When it is long over…

Team process

Regular reinforcement for replacement behaviors

Social Stories

Teach calming strategies

Did you want to share this information with others?

Consider buying the DVD…

Go to www.rebeccaklaw.com.

http://www.rebeccaklaw.com/

thoughtful response to agitation, escalation and meltdowns rebecca klaw, ms, med

Documents

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med slide

punishment slide

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