HJAR Mar/Apr 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 23 regular intervals, visual schedules, visual timers, transition cards, and providing pre- ferred comfort items during a transition. Supporting the child’s communication can help reduce frustration that leads to mal- adaptive behaviors. Use of social stories and visual schedules can help with their understanding of situations and with know- ing what to expect or what’s coming next. Working with speech-language pathologists to find ways to assist the child with self- expression is also important. There may be a need to offer alternative forms of commu- nication, such as picture cards or electronic communication devices. When prevention is not enough and emo- tions and behavior are escalated, the next step is to intervene. Intervention requires several thoughtful first steps for the person intervening. First and foremost, we should remember to put the behavior into perspec- tive. Separate the behavior from the child, remembering that most behavior is to com- municate something, and that misbehaviors do not make a “bad”child. Next, maintaining a calm demeanor is essential when address- ing the behavior. Do you need to walk away, or is there someone else who can help or give you a break? Responding to the child with escalated emotion will only exacer- bate the situation. After checking your own emotions, check the environment. What needs to be removed? Are there other chil- dren or people around? Is there something that can hurt them or others? Once safety is addressed, it is time to implement inter- vention strategies. For example, the child might be moved to a quiet area to sit, offered a distraction with another activity, or offered preferred sensory items. Weighted vests, and intensity. Finding these patterns is key to finding the behavior’s function and the best way to address it. Meltdowns and tantrums are often terms that are utilized interchangeably. For clinical purposes, a meltdown is not typically out- come driven but is characterized by a loss of emotional control. It is generally unpredict- able, not redirectable, and is often caused by overstimulation. 6,7 Thus, attempts to reason with the person, calm them, or discipline the behavior are usually unsuccessful. It is important to reframe meltdowns, so they are not seen as “bad” behavior. In contrast, a tantrum is more purposeful, controlled, and most likely redirectable. Although both are challenging, undesirable, and can be difficult to distinguish sometimes, know- ing the difference can direct us on how to better respond. The ideal goal is to be proactive and not reactive when it comes to managing behav- ior, intervening early at the first signs of escalation. Many professionals will refer to the first signs of escalation as the “rumble stage.” 6 Some examples of this may be self- stimming behaviors (e.g., pacing, rocking, hand flapping) or the start of some minor self-directed aggression. This is the best time to take action. Prevention strategies can include distractions, removing trig- gers, and providing sensory helpers (e.g., weighted vests, headphones, fidgets, etc.). Common triggers for tantrums, melt- downs, and aggression toward self or oth- ers include difficulties with transitions and communication. The more preparation that can be provided for a transition, the better. Supports include providing warnings or reminders of the upcoming transition at Maladaptive behavior is one of the most common and distressing challenges that leads families to seek out a diagnosis of autism spectrum disorder (ASD). Some of the most frequently reported challenging behaviors include tantrums and meltdowns, aggression toward others, and self-injurious behavior. 1 Researchers withAutism Speaks, Autism Treatment Network estimate that more than half of children with autismmay be physically aggressive toward others. 2 Additionally, studies have shown that these behaviors can be enduring, with approxi- mately 44% of children with autism who exhibited self-injurious behaviors maintain- ing these same behaviors ten years later. 3 The first step in appropriately address- ing maladaptive behavior is to determine the underlying cause. For individuals with autism and communication impairment, maladaptive behaviors almost always serve a function, communicating a desire or need. The function that behavior serves may be related to biological (i.e., physical pain or sickness), social (i.e., obtaining attention or avoiding something), or environmental (e.g., sensory challenges) factors, or a combina- tion of these. 2 Challenging behaviors fre- quently communicate a desire to obtain or avoid something. Determining the specific function and triggers for the behavior helps to direct treatment. The best way to identify a behavior’s function is to find patterns with the behavior. This is often done through an assessment called a functional behavioral analysis (FBA). 4,5 An FBA gathers informa- tion about what happens before (anteced- ents to) and after (consequences of) the behavior, when and where it happens, and in whose presence, as well as its frequency Managing Meltdowns, Tantrums, and Aggression in Autism: A Guide for Caregivers and Providers By Chayla Slaton, PhD, and Elizabeth Pulliam, PsyD Evidence-Based Services for Children with Autism