The rage and recovery stages

Following on from the previous post, the next two stages in the rage cycle include the rage stage, then the recovery stage (Myles & Southwick, 2005).


The Rage Stage

It is at this stage that you will see uncontrolled, explosive behaviour. It could be physical, such as hitting, kicking and self-injurious behaviour. It could be verbal, with screaming and yelling of abuse. It could also be withdrawal, where the child withdraws from contact and any interaction.

This is not the moment for trying to teach new skills or redirect the child.

What should you do?

Myles and Southwick (2005) suggest a range of things including:

1. Protect: The child, property and others around the child. This could include finding non-harmful ways for the child to release adrenaline such as those suggested in the previous post.
2. Plan: Have an "exit" strategy, one that allows the child to escape from the pressures of the situation without feeling humiliated or disempowered. Use this routinely, preferably having discussed it previously in a teachable moment. This should be your crisis management plan.
   
3. Prompt: With as few words as possible, and very circumspectly, prompt the child towards there safe space (as discussed in the previous post).
   
4. Prevent a power struggle: Don't argue or respond or try to negotiate. At this stage in the rage cycle the more you say, the more the behaviour is likely to escalate. In my experience, a simple and calmly repeated phrase can help diffuse a child's anger. This could be a simple prompt towards the child's safe space.
   
5. Timer: Having a timer that provides the child with a visual prompt as to when they should stop can help them find an end to the rage stage.
   

As Myles and Southwick (2005) state, it is important (and difficult!) to remember not to take the child's behaviour personally.


The Recovery Stage

As with all stages in the rage cycle, every child will act differently at the recovery stage. Some will be so exhausted that they will fall asleep. Others will use withdrawal into fantasy or denial to remove themselves from the incident. Others will be apologetic.

What should you do?

At this stage it is likely that both adult and child are feeling fragile and emotionally drained. It is important that the recovery stage is just that - used for recovery. This stage is also not the time to discuss the incident. Don't place any demands on yourself or the child until you are absolutely sure that the recovery stage is over.

You could:

1. Rest, and allow the child to sleep.
2. Redirect the child into their special area of interest.
3. Use relaxation techniques - for example: deep breathing, stretching, blowing bubbles.
4. Give the child space if they need it.
5. Use familiar structure and routine to help settle the child.

Once you have both recovered, then you will have teachable moments where you can plan, discuss and use tools like social stories to address the reason why the meltdown happened in the first place.



References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

Read more...

The Rumbling Stage

When dealing with meltdowns, or rage, it is important to recognise when it is possible to negotiate, re-direct or deflect the child's emotion... and when it is time to "ride it out", letting the emotion take its course. If we can catch a child/youth before the emotion takes over their reasoning or thinking power, we are more likely to prevent or minimise the meltdown (Myles and Southwick, 2005).


The Rage Cycle

According to Myles and Southwick (2005) the rage cycle includes three main stages - the rumbling stage, the rage stage, and the recovery stage. They suggest that before and after these stages teachable moments occur. Once the rage cycle starts, the opportunity for the child to learn is gone.

At this stage it is about management and, where possible, prevention of escalation.


The Rumbling Stage

Parents have often expressed to me the fact that they can tell when a meltdown is coming on. The signs could be categorised into four different categories:

• Physical signs, including fidgeting, tapping, restlessness, muscle tenseness, grimacing
• Verbal signs, like name calling, threats, grunting, increasing or decreasing volume
  
• Behavioural signs, like refusals, crying

What can we do in this stage?

Myles and Southwick (2005) identify a range of strategies that could be used in this stage. Some ideas include:

1. Provide a safe, cool down space: Help the child feel safe by moving to a space that is familiar and away from the triggers of their meltdown.
2. Provide a physical outlet: Give the child a way to get rid of the excess adrenaline that is flowing as a result of their emotion. This can be anything from squeezing a stress ball, to bouncing on a trampoline, to tearing up paper.
3. Remain calm and quiet: Don't try to reason with them, remain calm and close-by. Walk with them if necessary. For some children, touch can also be helpful.
4. Redirect: Using a child's interest it may be possible to redirect their attention and emotion. You might need to help the child re-evaluate their goals.
   
5. Use routine: Help the child get back to familiar and safe sequences of events.

But the most important thing to remember at this stage is that, as adults, it is important that we remain calm and flexible, adapting to the needs of the child as the child will not be able to be flexible once they have entered the rage cycle.


References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

Read more...

Why are they melting down?

Meltdowns are a physical, adrenaline-led response to a range of different emotions and triggers (Lipsky, 2009). These can be anything from anxiety, anger, frustration to sensory overload. An important step in dealing with meltdowns is to understand the reason why they are occurring (Myles & Southwick, 2005).


Functional Behaviour Assessment

Part of Applied Behaviour Analysis is identifying the function of behaviour. In a previous post, four key functions of behaviour were highlighted - to avoid something, get something, sensory-based responses and pain attenuation.

Functional behaviour assessments are about recording observations and analysing them to identify why repeated difficult behaviour happens. You can find out more about this in this post or by reading this document from www.usu.edu.


An online tool

http://www2.monacoassociates.com/masontheweb/index.aspx

Parents, teachers and therapists can try this easy-to-complete online tool that can give a quick indication for the possible function of a child's behaviour. You fill out a series of questions online, then you get a table which indicates which of the key functions of behaviour are most likely to be behind your child's behaviour. Below is a sample of what you will see.

Printable Resources

If you prefer a more complex, thorough process (especially if you are a teacher) you might want to download the following forms from polyxo.com:

Behaviour Observation Forms
Functional Behaviour Assessment Forms



References:

Lipsky, D. and Richards, W. (2009). Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. Jessica Kingsley Publishers.

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

Read more...

Ask Amanda: Managing Meltdowns

At the Autism and Aspergers Support Group Inc Hawkesbury meet in July I was asked by a parent about how to manage meltdowns. There is not simple way to answer this question, though other parents did provide some suggestions. Some things that work for other parents and their children include:

• Staying calm
• Get down to your child's level and sit with them
• Speak reassuringly, assuring them they are not "in trouble"
• Hug them tightly or wrap them tightly in a blanket (for some children with Sensory Integration issues this can be comforting)

Since that time I have been reading some information on the topic. One book that I have found particularly useful is Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. It is written by Lipsky, who has been diagnosed with high functioning autism herself, and Richards.


SCARED stands for...

Safe - find an environment, or follow the child to an environment where they feel safe.

Calm - stay calm, speak calmly, talk in literal language.

Affirmation - show that you know what they are afraid of by putting it in words.

Routine - work with repetitive, routine behaviours that they may be using to help calm themselves (so long as it does not involve self-harm).

Empathy - show you are there to support and help.

Develop an intervention strategy - make a step-by-step, concrete plan for what to do if a meltdown happens again.


This month...

This month I plan to explore these six elements of responding to meltdowns in more depth.


Reference:

Lipsky, D. and Richards, W. (2009). Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. Jessica Kingsley Publishers.

Read more...