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THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND MELTDOWNS. ...for individuals with autism spectrum disorders. Rebecca Klaw, MS, MEd. Based on the work of Dr. Ross Greene (author of The Explosive Child ) and many others who contribute to what is known about autism and related disorders.

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THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND MELTDOWNS

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Thoughtful response to agitation escalation and meltdowns l.jpg

THOUGHTFUL RESPONSE TO AGITATION, ESCALATION AND MELTDOWNS

...for individuals with

autism spectrum disorders

Rebecca Klaw, MS, MEd


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


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Part 1:Understanding the inflexible-explosive individual

WHY?


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Common Characteristics of Meltdown-Prone Individuals

  • Difficulty managing and controlling the emotions associated with frustration

  • Difficulty thinking through ways to resolve or cope with frustration


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Common Characteristics of Meltdown-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


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Common Characteristics of Meltdown-Prone Individuals

  • 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


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    Common Characteristics of Meltdown-Prone Individuals

    • 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


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    Common Characteristics of Meltdown-Prone Individuals

    • 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


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    Does this sound like anyone you know?


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


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    Bad parenting – no!

    Bad teaching – no!

    Neurologically determined pathways – yes!


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    Pathways to inflexibility and explosiveness

    • ADHD

    • EXECUTIVE FUNCTION DEFICITS

    • LANGUAGE PROCESSING DIFFICULTIES

    • MOOD

    • DIFFICULT TEMPERAMENT

    • ANXIETY

    • SOCIAL SKILLS DEFICITS

    • SENSORY INTEGRATION DYSFUNCTION


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    CONCLUSION TO PART 1

    If you don’t understand the basic characteristics that can cause distress in a individual with autism, you might think they are being “bad” or “manipulative”, or “controlling”.


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    CONCLUSION TO PART 1

    You might also choose inappropriate techniques to manage these crises, thinking that if you just keep piling on consequences, you will win the battle.


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    CONCLUSION TO PART 1

    But when you understand the characteristics of the inflexible, explosive and autistic individual, and how these characteristics are determined by neurological difference, you realize that it is never a battle where someone wins and someone loses.


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    CONCLUSION TO PART 1

    Becoming so frustrated that you lose control of your body and of your rational mind is distressing – for the individual and for you.

    No one ever, ever wins.


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    Part 2:Understanding the stages of crisis, leading to meltdowns

    MELTDOWN

    Demand to shift gears

    ESCALATION

    AGITATION

    RECOVERY


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    AGITATION

    • 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


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    AGITATION

    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


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    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.


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    They found that children with autism, even those with normal or above normal IQs, have marked difficulty in disengaging attention.


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    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.

      


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    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.


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    Escalating agitation…

    Vapor 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.


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    Escalating agitation…

    When our students are frustrated and their 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.


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    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.


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    MELTDOWN

    Dr. Daniel Goleman, the author of Emotional Intelligence refers to the meltdown phase as “neural high jacking”.


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    MELTDOWN

    Irrational

    Incoherent

    Destructive

    Abusive

    Out of control

    =

    A DEBILITATED STATE


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    MELTDOWN

    What the individual does and says during

    the meltdown is “MENTAL DEBRIS”


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    MELTDOWN

    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


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    Part 3:Reacting to agitation, escalation and outburst

    A word about consequences…


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    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


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    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


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    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”


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    “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


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


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

    begins?

    What are the typical signs?


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    REFUSAL

    NO!


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    Interventions

    Proactive:

    • Access to communication

    • Access to choice


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    Interventions

    Proactive:

    • Predictability


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    Interventions

    Proactive:

    • Environmental adaptations


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    Interventions

    Proactive:

    • 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


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    Interventions

    Proactive:

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

    •  quality of life


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


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    Reacting at the Crossroads


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    Interventions

    Reacting at the crossroads:

    Prioritize your demands

    Level A demands

    Level B demands

    Level C demands


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    Level A Demands

    • Non-negotiable

    • Safety of self and others

    • Health

    • Basic life expectations


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    Level 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


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    Level 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


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    Level 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.


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    Interventions

    Reacting at the crossroads:

    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.


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    “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


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    Interventions

    Reacting at the crossroads:

    Give time and space.


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    Interventions

    Reacting at the crossroads:

    Offer visual instead of auditory information.


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    Interventions

    Reacting at the crossroads:

    Provide support in a calm, non-threatening manner.


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    Interventions

    Reacting at the crossroads:

    Offer to do the activity with the individual.


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    Interventions

    Reacting at the crossroads:

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


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    Interventions

    Reacting at the crossroads:

    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?


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    But sometimes, no matter how well you react at the crossroads, your students continue to escalate into a full-blown meltdown


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    Interventions

    Beyond the crossroads, reacting to crisis:

    Wait it out safely.


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    Interventions

    Beyond the crossroads, reacting to crisis:

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


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    Interventions

    Beyond the crossroads, reacting to crisis:

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


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    Interventions

    Beyond the crossroads, reacting to crisis:

    Stop talking unless your words have a soothing effect.

    Really.


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    Interventions

    Beyond the crossroads, reacting to crisis:

    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.


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    Interventions

    Beyond the crossroads, reacting to crisis:

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


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    Interventions

    Beyond the crossroads, reacting to crisis:

    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.


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    Interventions

    Beyond the crossroads, reacting to crisis:

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


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    Interventions

    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.


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    Interventions

    Recovery (the long-term response):

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


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    Interventions

    Recovery (the long-term response):

    Social stories


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    Interventions

    Recovery (the long-term response):

    Practicing calming/coping techniques


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    Kari Dunn Buron’s books


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

    Written byAdolph Moser

    Illustrated byDav Pilkey


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

    Written byAdolph Moser

    Illustrated byDavid Melton


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    Conclusion to Part 3

    What you always do…

    Respond to basic needs

    • Communication

    • Safety

    • Predictability

    • Sensory differences


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    Conclusion to Part 3

    But 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


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    Conclusion 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


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    Conclusion to Part 3

    When it is long over…

    Team process

    Regular reinforcement for replacement behaviors

    Social Stories

    Teach calming strategies


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    Did you want to share this information with others?Consider buying the DVD…Go to www.rebeccaklaw.com.


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