Managing Meltdowns Some students with autism, overwhelmed with frustration and anxiety, refuse to cooperate. In a recent online conference, autism expert Jed Baker provided tips to help SLPs manage emotions, defuse student crises and set up prevention plans. Overheard
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Overheard  |   July 01, 2014
Managing Meltdowns
Author Notes
  • Jed Baker, PhD, is director of the Social Skills Training Project, an organization serving people with autism and social communication problems. He serves on the professional advisory boards of several autism organizations. jandbbaker@aol.com
    Jed Baker, PhD, is director of the Social Skills Training Project, an organization serving people with autism and social communication problems. He serves on the professional advisory boards of several autism organizations. jandbbaker@aol.com×
Article Information
Special Populations / Autism Spectrum / School-Based Settings / Overheard
Overheard   |   July 01, 2014
Managing Meltdowns
The ASHA Leader, July 2014, Vol. 19, online only. doi:10.1044/leader.OV.19072014.np
The ASHA Leader, July 2014, Vol. 19, online only. doi:10.1044/leader.OV.19072014.np
Susan Cassell: Is there a way to tell if a meltdown is anxiety-based or noncompliant behavior? If the meltdown is anxiety—for example, a child who has anxiety about new social situation—should there be a loss of privileges?
Jed Baker: [There is] no 100-percent way to tell. Much noncompliant behavior is anxiety-based. Even instances that are not often have a good reason, as work may be too difficult. I am not a fan of taking away privileges for someone who has repeat problems. I would rather try to prevent the problem ... Don’t want to add fire to fire.
KheanAi Alethea Chew: What are some thinking strategies that you employ as a clinician in order to become nonreactive—acting not in fear or in anger—in a situation, especially when the situation is already very volatile?
Baker: That the situation is not about my competence. That I do not have to solve it now. It may take time. That perhaps the real solution will come later upon my own reflection about the incident.
Barbara Germany: As students get older, they are in more and more inclusion classes—especially in a private school setting. How do you handle discipline for outbursts—such as those you described that sound disrespectful—while you also handle the real need? There is often a “need” for discipline because of the setting, but … ?
Baker: Rick Lavoie tells us, “Fair does not mean equal. Fair means you get what you need.” We have rules and discipline for everyone as a starting point. When it does not work for a child with a repeat problem, we do things differently. We explain to the peers that it is okay to treat people differently based on what they need in the moment.
Julia Clouse: We have a constant issue with students that are in an inclusion setting and whole-class consequences. Even if fair is not equal, would you recommend a student with autism not serve the whole-class consequence—such as losing five minutes of recess—if they were part of the problem behavior, such as excessive talking? Teachers, parents and support staff cannot seem to come to a consensus about what is most appropriate.
Baker: Take your cue from the child’s behavior. If he can tolerate the whole-class consequence, then fine. However, if it causes repeat escalations in his behavior, we can excuse him from it and have a different plan for him.
Dana Weise-Brown: Any suggestions on how to help foster hope and optimism with parents?
Baker: Tell them about the research I described by Mark Durand: that hope predicted better outcome. Give them the long-term picture and provide them with respite so they can refuel and come back to their kids with renewed energy. Pick a small behavior to start with to show how change can really happen.
Linda Liss-Bronstein: Your presentation covered so much and yet so many basic principles. The examples you gave for the 80/20 principle [helping children to succeed by having them do the 80 percent of things they find easy, followed by the 20 percent they find more difficult] were very practical. Can you give such an example for children at kindergarten age as well? I agree that many times right after a break the teacher returns to the same situation that frustrated the child in the first place.
Baker: Many kindergarteners find circle time very difficult. Consider starting with a timed and smaller amount of time at circle time with visual supports indicating what tasks are to be performed before getting a break. Returning from a break can be easier if it is clear that the child is only returning for a small amount of time. If they think they must return for a long period, you are likely to get more resistance.
Beatrice Fargnoli: I really appreciate the insight you presented in your talk. It is difficult to recognize one’s feelings and “keep your cool” when a person is having behavioral challenges. Regarding functional assessments, what are the basic elements to consider to have a good idea as to the function of a behavior? How long do you collect information?
Baker: In my efforts to do a functional behavior assessment, I try to focus on the antecedents and triggers, as then my intervention will be more proactive in preventing problems. So I do not limit myself to discussion of only four functions of behavior, but consider seven broad categories or triggers. In taking a history from staff or parents and observing the child, I always consider these triggers. As soon as I have some reliable/repeat triggers, I begin to intervene. During intervention I continue to monitor triggers and functions of behavior so I can revise the intervention as we go.
Claire Waldron: What is your best advice for helping everybody in a family—not just mom and dad, grandma, sister, etc.—respond to meltdowns?
Baker: Responding to a meltdown: Redirect to a better way for the child to get his needs met. If logic is gone, simplify the problem or demand and consider the use of distraction to get their mind off the difficulty temporarily and calm down. Distractions for me include special interests, novel activities/items, different sensory input.
Susan Tonkin: In your presentation you talked about “I hope you make a mistake” when talking about self-esteem. Would you please expand on this intervention. In your book, “No More Meltdowns,” is there a section on self-esteem?
Baker: Yes there is a section in my book on self-esteem issues and perfectionism in particular. For perfectionists—not for everyone—I ask them to make mistakes as a sign they are trying things that are hard or new. I give them points for handling mistakes, not for getting things done right the first time—which may only be an indication of doing things that are already well learned. To grow, we must make mistakes and get help.
Diane Clemmons: How do you recommend approaching regular education teachers who have students with autism spectrum disorder in their regular classroom who believe in trying to control those students’ behaviors with what is just shy of yelling and punishment? I know they often feel overwhelmed, and from their perspective it appears to work.
Baker: I validate their approach as a good first step to do with the 80 percent of kids who respond to rules and consequences. I then ask if that is working for the kid with a repeat problem in their class. If not, I suggest we try something more preventive for that child and the other, roughly 20 percent, who have repeat problems. I model what to do, rather than just tell them as they may not know or are resistant to a new approach. The proof is in the pudding—if my strategy works, they are sold for the next 20 kids like that.
Kelsey Shannon: Do you have any experience or advice for working with students who have auditory processing disorders? I find that for some of my students their meltdowns stem from miscommunications, or not understanding what is being asked of them.
Baker: Many kids with auditory processing issues benefit from an FM system or having the instructor miked. I also teach them to “check it out first” before responding to a perceived insult/criticism to help clear up future misunderstandings. Visual supports can also clear up demands and instructions.
Biji Philip: I was just curious about some of the strategies you employ in complete meltdown situations—your kids clinging onto your legs at the grocery store and whining, and for the hypothetical child that hits the wall and breaks it.
Baker: Grocery store: I have lured my kids out of the store with music or a video on my iPhone, then returned later without them to shop. I have tried to prevent problems with clear rules ahead of time of what and when snacks will be purchased, and given them jobs to find certain things in the store by a certain time. Hitting the wall—sometimes just waited it out or tried to reduce workload to one or two items before taking a break. So no escaping all work, but simplify it then take a break.
Nataliya Falevich: I have a child on my caseload who I struggle with on a regular basis. He is very easily distracted, and hard to engage even in activities that he usually enjoys. He hits, kicks, screams, curses—you name it. It’s always a struggle for me to work with him. With cases like this, what would be the best approach in terms of handling his outbursts?
Baker: Hard to say without knowing more. My goal is to try to understand in each instance what he actually wants and give him a better way to communicate it. If he is less verbal, when he hits/etc. I would say “I want . . . “ and point to visual icons of “help,” “break,” “favored item,” “quiet place.” See if he can learn a different way to communicate what he wants. And then give him what he wants if he communicates without aggression.
Kathryn Mease: Could you please give recommendations on how to improve compliance and motivation of older students—later high school, young adults—with autism?
Baker: For higher functioning students, it must start with discussion of their talents, strengths, to give hope of an optimistic future/career, and then from that place discuss working on a particular challenge. Discuss more strengths than challenges and explain that they never have to be great at their challenges, just get good enough so that it does not stand in their way of reaching their goals given their great strengths. See the chapter on this in my book, “Preparing for Life.”
Jessica Magrin: What do you do when the triggers of a student’s behavior are happening in an environment that is out of our control—for example, the home?
Baker: I assume you mean the behavior problem is at school but the trigger is at home? Certainly try to work with the family to alter the triggers at home. If that’s not possible, do a check-in each morning to determine the student’s mood when they arrive to school. If they are upset, try to offer activities that will foster a more positive mood before starting the work demands. See the chapter on relaxation folders in my book, “No More Meltdowns.”
Janine Ell: I have a preschool child on my caseload who presents with selective mutism. He has recently started talking more—albeit with a very low voice volume—within our speech-language therapy sessions, and he talks to peers while playing on the playground. However, he will not talk within the classroom setting. I liked your ideas of discussing true versus false alarms and using a sort of hierarchy to encourage a target behavior. Would you recommend choosing a specific time of day—for example, after playground time which would provide aerobic exercise, as you discussed—to initially target and reward verbalizing within the classroom? Or is this something that the team should just jump into and formally reward with points or stickers all throughout the day?
Baker: My thought is to do it all day so whenever he verbalizes the points are in effect. You might also get permission to record his voice and play it in front of him and the teacher to “break the ice.” Stay positive with rewards, no power struggles and figure it can take six months to a year to see progress.
Sarah Ahmed: Any advice on how to reduce instances of self-hitting when the child is obviously self-stimulating from it and doesn’t have a normal threshold to pain? Should a clinician step in and actually hold hands down if in these cases a serious injury could occur? How do you ultimately work on reducing this type of behavior?
Baker: Like all behaviors, we want to know why it is happening. If it communicates desire to escape or get attention, or communicate that there is a pain, we want to teach alternatives ways to request that. Often I see later kids who had serious sinus, ear infections, dental pain, GERD, and other bothersome pains that were associated with self-injury. However, if it feels good and has a self-stimulatory quality, we do need to limit the self-injury with gentle redirection of hands down and see if we can provide an alternative feel-good behavior (compression in a gym mat, other repetitive sensory activities). Sometimes diet plays a role here, too, when someone is in pain from reactions to food sensitivities. Getting tested rather than simply eliminating many foods is preferable.
Lisa Kommatea-Steyer: Please explain a little bit more about the ABC model and how to apply it in the elementary school level.
Baker: This is really functional behavioral assessment. There are whole books on how to track the ABCs of behavior. In “No More Meltdowns,” I try to explain it in simple, plain English. We are tracking the before, during and after of behavior problems as they occur to look for patterns in what triggers them and what may reinforce them. We use this information to make intervention plans. I have an app called “No More Meltdowns” at the Apple store (bit.ly/meltdowns-app) that allows folks to keep track of these behaviors as they occur, and one can upload it to www.sysmtrned.com/nmm, which will analyze the triggers and consequences of a particular behavior, and then suggest what kind of prevention plan may work best based on the triggers to the problem.
Suzanne Heitin: How do you get the teachers to buy in to the 80/20?
Baker: Again, first validate their one-size-fits-all approach for the majority of students with whom that might work—the rule-consequence approach. Then ask if it is working for the kid with repeat problems. If not, then we can talk modifications including using the 80/20 rule.
Katherine Egan: Any tips on dealing with peers “copying” another’s meltdown? There’s frequently a domino effect following the first “true” meltdown.
Baker: Give points to the whole class when they are not disruptive. However, if one student is disruptive—that is, has meltdowns—and the others are able to ignore it, give the class points for ignoring it as well. Make sure to teach them ahead of time how to ignore others’ tantrums and why. Points can add up to more free-choice time.
Allison Smith: I loved your point about explicitly teaching students to “try when it’s hard.” I think this is a big component of frustration tolerance when they are learning new concepts or skills. Can you offer any pointers for doing this with low-verbal or nonverbal students with autism spectrum disorders?
Baker: Kids with less language can learn to watch an activity first without being told to do it or imitate. Just model activity for them or use video instruction. Then cue them to do a small first step of the task. Provide “help me” cards and “break” cards as well and teach them before there is frustration how to hand you the card and get help or a break.
Kelly Thomson: In a high school setting, have you found peer education to be beneficial to the student with ASD who has already been labeled as an outcast?
Baker: When someone is only isolated but not disliked, I try to create peer programs without talking about any student in particular. However, if a student is very much disliked, I try to get permission from him/her and the parents to talk about the student by name to others to try to change the attitude of students who have a negative image of the student. Descriptions of these lessons are in my book, “Preparing for Life,” for the high-school level.
Bridget Stokes: Have you ever worked with children who were nonverbal and used images to convey your strategies?
Baker: Yes. Use of schedules, icons and choice boards are all ways to give kids options and understanding about what is happening. Many of these methods are employed by the TEACH approach.
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July 2014
Volume 19, Issue 7