In general use the word ‘meltdown’ describes a state of internal collapse. We might think of a nuclear meltdown or perhaps a financial market going into meltdown – states of collapse that are a consequence of over-stimulation or overheating and a failure of monitoring and regulation systems to keep things under control. In everyday use, ‘meltdown’ is also employed to describe someone who has reached a point where they can no longer cope.
In autism, ADHD and so on, meltdowns refer to an intense ‘out of control’ state which may include shouting, crying, throwing or breaking things, attacking others or causing harm to themselves. As well as outwardly explosive meltdowns, some are more like an implosion. Visible signs may include withdrawing from communication, hiding, self-harming, curling up in a ball, rocking intensely and or making sounds to drown out the world around them.
Meltdowns can pose a serious risk and once a full-blown meltdown has started it is usually impossible for others to successfully intervene. The priority is therefore to make the situation as safe as possible for everyone.
What causes a meltdown?
A meltdown is caused by a feeling of being overwhelmed, acute anxiety and a sense of loss of control – it is most helpful to understand meltdowns as panic attacks, an external expression of an internal state, rather than as a ‘behaviour’ or choice or wilful defiance.
With PDA, meltdowns usually occur only after a hierarchy of avoidance approaches have already been in evidence but have not been noted or acted upon (please see what is demand avoidance for more details on this).
Meltdowns are panic attacks not tantrums
It’s essential to understand that meltdowns are not tantrums. Tantrums tend to be short-lived, they can usually be brought to a halt by interventions from others and often have clear triggers and purpose. Someone having a tantrum is normally aware of their audience and surroundings. Meltdowns are normally longer lasting, unstoppable until they have ‘run their course’ and usually arise after an accumulation of factors leading to overload. Someone in meltdown is not aware of others or their own safety.
Meltdown is not a behaviour it is a panic response.
First things to remember
Meltdowns are best understood as a panic attack. This is not a battle to be lost or won, but a crisis to manage.
You are a person’s emotional brakes. How you manage the meltdown makes a difference to outcomes.
Separate your relationship with the person from the behaviours.
Emergency rules apply: ‘Don’t hurt yourself, others or damage property’. Do remember that things broken in a meltdown may be replaced or mended, so prioritise safety.
Discipline is ineffective for meltdowns, the person is not in a state to learn anything.
Things you can do
Be aware of possible triggers and look for signs that anxiety is rising. Prevention is better than cure.
Keep calm and level at all times. Shouting or getting angry will not help either of you, be careful about your facial expressions and body language. Keep as neutral as possible, be non-confrontational.
Reduce stimuli that may add to the sense of overwhelm – for instance, turn down TV/radio volume, ask others to keep quiet and not intervene.
Keep communication to a minimum. Instructions should be short and simple; or offer simple reassurance.
Speak in terms of what you would like to happen rather than what you would like to stop, e.g. “you may feel calmer if you stand still” rather than “stop running around”.
Give emotional and physical space. Take a step backward from the situation, rather than forward into conflict.
Encourage access to a safer place, if possible. Some people may prefer to hide away in a den or under a table or cover themselves with a duvet or coat.
Don’t threaten sanctions or offer rewards during a meltdown, the person is beyond reason and unable to respond and such interventions are likely to increase anxiety rather than act as an incentive to cease the behaviour because it’s a case of ‘can’t’ rather than ‘won’t’.
Physical intervention should be a last resort and primarily be used to keep the person or others safe. It is usually better to remove others rather than try to move a person in meltdown, but it may be necessary to place yourself between the person in meltdown and others.
Be aware of environmental risks, for instance scissors, knives or objects that may be used as a weapon. Other hazards may include glass doors, moving vehicles or proximity to a road.
If someone runs away during a meltdown, provided there are no immediate safety concerns, following at a distance is more effective than chasing after them (because pursuit increases the ‘flight’ response).
When someone is beginning to calm, it may be helpful to offer verbal reassurances. Younger children may be calmed by a hug; asking them “would you like to hug me until you’re better?” gives them control, as well as a sense of safety and security.
After a meltdown
Recovery time will be required after a meltdown, ideally in a safe space.
A snack or a drink may help.
Provide reassurance. Let the person know that you understand they couldn’t help it and that you still care for them.
Some people may be very upset and may express remorse or be angry with themselves; others may not. Try to move on and start afresh.
Some people find it helpful to talk and this can provide insight into triggers and causes. However, this kind of debriefing can be too stressful for many and may precipitate another meltdown.