What is an autistic meltdown?

Autistic meltdowns, often confused with tantrums, is a reaction to intense feelings of being overwhelmed, distressed, or dysregulated. Tantrums are different because they are goal-oriented and typically stem from the frustration of not getting what a person wants in that moment.  A meltdown is never a contrived or pre-meditated act, nor does it have a goal. They can be a common occurrence for autistic people of all ages, not just children.

The intense response of a meltdown causes an autistic person to temporarily lose all control of their behavior. When they reach the point of sensory, emotional, and information overload, or too much unpredictability, a variety of external behaviors can be triggered that are similar to a tantrum or a complete shutdown and withdrawal may happen. In autistic adults, a meltdown may look like crying, yelling, lashing out, suicidal ideation, self-harm, inability to talk, lack of ability to think, or rage. Experiencing burnout is sometimes the precursor to a meltdown in adults.

During a meltdown, some autistic individuals report feeling out of control with their entire body and experience blurry vision, muscles getting hot, cheeks getting warm, and bunched up shoulders. They may have a diminished ability to think and sometimes difficulty finding words or remembering basic things. Intense stimming can occur such as rocking, muscle tensing, vocal stims, or joint cracking. Some people run away, zone out or disassociate.

What are some specific triggers for a meltdown?

The Reframing Autism website lists the following specific triggers for a meltdown:

• Sensory triggers
• Stress
• Unmet needs that the person is unable to communicate
• A disruptive work, school or home environment
• Inconsistency or change in routine
• Lack of sleep
• Life changes such as marriage, births, moving house, changing jobs etc.
• Co-occurring mental health conditions such as anxiety and depression
• Hormone changes
• Chronic pain, illness or other disability
• Reactions to new medications
• Lack of control over an element of life

The Low Arousal Approach, Arousal States, and Meltdowns

The Low Arousal Approach talks about the trigger phase as the second stage of an increase in low arousal states. Common cues that may indicate an escalation in a state of arousal are:

• Changes to the face – expression, coloring, pallor or ruddiness
• Changes to breathing rate
• Apparent increase in energy levels, leading to movements not usually seen in the individual when they are calmer
• Increase in body tension – hands, arms, shoulders, face look ‘tense’  –  (My autistic daughter twirls her hair.)
• Changes in communication – rate, volume and rhythm of speech or vocalizations  – (My autistic son  become echolalic.)

Internal or external events may ‘trigger’ an increase in arousal. When we understand the key triggers for a person who is likely to become distressed, this means that they can be removed or at least minimized.

Autistic meltdowns can last from ten minutes to an hour or longer, but often last at least 20-30 minutes past the removal of the initial trigger for that person (potentially longer if the trigger is not removed or resolved). In the context of the Low Arousal Approach, this is the escalation phase when there is an atypically sharp increase in the state of arousal due to an increase in stress, frustration and/or excitement. Marked changes in a person’s cues are a result of not being able to cope with the mounting triggering factors and may initiate the ‘fight, flight or fright’ response. If de-escalation doesn’t happen in this phase, the person then moves to the crisis phase.

The crisis phase is usually where the greater risks lie for physical and emotional safety. When a distressed person enters the crisis phase they have the least ability to use whatever self-awareness and control skills they might have. Both their physical and emotional impulses become expressed more explosively. Mindful and reciprocal communication with others becomes increasingly difficult. These are the hallmarks of a meltdown.

How long is the recovery time from a meltdown?

Once a crisis ends, recovery begins. During this time period, an individual will remain highly sensitive to their triggers in this phase. Post crisis triggers often initiate new episodes of distressed behavior. The longer a distressed individual is caught in cycles of crisis, the longer the recovery phase is likely to last. For my adult autistic daughter, average recovery time from a meltdown is about 6 hours.

During the recovery period, think about:

• Giving time and space to regain emotional regulation
• Providing a calm or familiar activity, such as reading a book or touching a sensory object
• Playing their favorite music or movie to give them something pleasant to focus on
• Ensuring not to use shaming, punishing or judgmental language or tone about the meltdown – encourage them to discuss their feeling with you when they’re ready, without pushing them
• Trying to determine if there were new triggers or a combination of triggers
• Asking them how you can best support them next time

(List from Reframing Autism, Australia)

Many won’t be able to recall the details of what happened during the meltdown. This memory lapse can be upsetting and may contribute to subsequent anxiety.

What can I do to help an autistic person during a meltdown or help prevent one?

The most important thing is to be there for support and help the person to feel safe. Remain calm and don’t add fuel to the fire. Try to:

• Give personal space. 
• Reduce eye contact. Just give intermittent eye contact.
• Avoid touching a person. Skin sensitivity increases with escalation of arousal. Our attempt to offer soothing or reassuring physical contact could be interpreted very differently by the distressed or angry individual that we are trying to calm. It is probably best to avoid initiating physical contact in the higher states of arousal.
• Reduce noise levels. Turn off the music or TV and reduce background noise.
• Remove others. Don’t try and move the person having the meltdown as this can escalate arousal levels. Get other people out of the way.

When a person is building towards a meltdown, try and distract or redirect them. You can do this by:

• Offering something tangible. Are there any foods, drinks, favorite toys or objects of interest that the individual might be more interested in than the current problem? If offering these, make sure they are available, ‘follow through’ and give them to the person.
  
• Offering something non-tangible. The same principles for tangibles could be applied to favored topics of conversation, interests and activities. My daughter loves to talk about cats; my son enjoys talking about transportation, British period dramas, and horses.
• Think of something funny or surprising. It’s very difficult to stay angry if you’re laughing! If we can do something that makes the person laugh, or that shocks them (in a good way), this might be enough to break the escalation of their arousal. Sing, dance, or tell your favorite (clean) joke! The YouTube Kitty Kat Dance does it for my daughter every time!

What things are calming for a person experiencing a meltdown?

Some things you can try to calm a person experiencing a meltdown are:

• a drink of water
• calming sensory tools like a vibrating cushion, noise cancelling headphones, a weighted blanket
• favorite music
• turn the lights off
• a cool compress on the forehead
• a quiet place to retreat to

Finding strategies that work will be trial and error. There will be good days and bad days. Some days, these ideas will work and other days not. If a meltdown does occur, do not reason, argue, reprimand, or talk. Keep the person safe and allow time for processing. Offer reassurance and let the individual know that things are alright between you and them. Helping an autistic person prevent (where possible) and navigate meltdowns starts with you showing that you’re a safe, trustworthy and caring person. Keeping a trusting and open relationship is the foundation for providing solid support for well being.

References

All About Autistic Meltdowns: A Guide For Allies. Reframing Autism

Penot, J. (July 20, 2023) What Is an Autistic Meltdown? Psychology Today