Tag Archives: Meltdowns

#Depression: What It Feels Like to Me

I have had experience with low moods since I was a child. Nonetheless, until a few months ago, I was never diagnosed with depression. During the last round of diagnostic revisions, my psychologst decided to diagnose me with depressive disorder NOS along with dependent personality disorder and borderline personality disorder traits. I am not sure I agree and my psychologist admitted at first that it was more her needing to give me a diagnosis on axis I to warrant me staying in the institution than my actually needing treatment for this.

Today, Aspiecat described what depression is like for her. I could relate to some of these experiences, but nto others. I am going to describe what it’s like to be depressed for me.

Let me first say that low moods are my default. I am pretty sure that dysthymia, ie. chronic but mild depression, is a more useful diagnosis for me than depressive disorder NOS. Apparently though my psychologist doesn’t feel I meet the criteria for that. Really not remembering a prolonged time when I did not feel low makes me wonder whether I’m truly depressed or just pessimistic. I know that depression and optimism do not mutually exclude one another, but I tend to gravitate more towards the negative than the positive.

Then there is the state, as opposed to the trait, of being depressed. Like Aspiecat, I experience two forms of depression: the first in which I feel numb and inert and the second in which I mostly feel despair, sadness and often anger. The former tends to last longer and be harder to overcome. During this state, I sleep more than usual, eat irregularly but usually more than normal, am slower than usual and generally unmotivated. I don’t usually experience the extremest of dark thoughts in this state. Rather, I worry and feel a bit anxious. I may experience suicidal ideation during this state, though it’s rarer than when I’m in my state of despair. I am also less likely to act destructively, unless you count binge eating. When I do experience suicidal ideation in this state, it’s more of a logical, thought-based kind focused on self-hate rather than an active wish to die. I just can’t be arsed to care about life.

In the state of what Aspiecat refers to as meltdown, I, like her, experience all kinds of negative emotions. I think I may be somewhat alexithymic (unable to read my own emotions) too. I often express my emotions as anger when I’m in this state anyway, even though I think I experience many other emotions. I am more likely to experience suicidal thoughts and to engage in destructive behaviors in this state. I am usually agitated rather than slow.

Unlike Aspiecat, I prefer the state of despair to the state of numbness and inertia. There are several reasons for this, one of which may just be the fact that I’m currently numb and not liking it. Any emotion seems better than this state of inertia now. I however also feel that my despair is more actionable, because it tends to be more situational.

Other people also tend to understand my state of meltdown more than my state of inertia. They see me lying in bed all day as a choice, whereas when I’m in meltdown, they see my despair. They may not accept my agitation in this state, but at least they notice that I’m not doing well. My medication also tends to help with this state more than with numbness. I do take an antidepressant in addition to an antipsychotic, but I’m not so sure it helps with my low moods. The antipsychotic and maybe the antidepressant too do take the edge off of my agitation.

Unfortunately though, people see my state of despair as more needing treatment than my state of numbness. This may be because I don’t tend to respond well to psychotherapy and medication-wise, there is simply more to be done against agitation. I take a high dose of an antipsychotic on a daily basis. I also have a low-potency neuroleptic, an anti-anxiety benzodiazepine and a sleeping pill (also a benzo) as PRN medications. All of these can be seen as depressants. Like I said, I do take an antidepressant too, though in a low dose. I am not so sure it works, but then again it isn’t a great medication for the kind of atypical depression I experience. By this I mean that it isn’t shown to be too effective with depression that is characterized by inertia, eating and sleeping too much and general anhedonia (numbness). This kind of depression is particularly hard to treat.

Because other people are more bothered by my meltdowns than by my state of anhedonia, I also feel they tend to want me to be numb rather than agitated. I mean, of course they don’t actively want me to be numb, but they see it as less of a problem, because it causes little disruption to others. I go along with this and have never asked for more help, medication-wise or otherwise, with my inertia-based depression. I am not so sure that I should.

A College Memory

Last week or the week before, one of the prompts from Mama’s Losin’ It was to write about a college memory. Since just yesterday I shared on my Dutch website about studying with a mental illness, I thought i’d write about it here too. It’s been 8 1/2 years since I dropped out of university, of course. For this post, I’d like to share about my first day of university.

My first day of university was September 3, 2007. I took a ParaTransit taxi to the building where I’d have my first class. As I approached what turned out to be a large lecture hall, I was immediately overwhelmed by the huge number of students. Until that day, my idea of a large group of students was my psychology class at college, where about 35 students were in the room. I had expected the same number of students in my university classes, because only about fifteen to twenty students enroll in the linguistics program each year. Turned out the class was a combined linguitics, business communications and language and cultural studies class and there were over 200 students in attendance. I had the most spectacular meltdown right there and ran off. I don’t remember much of what happened next. I think I called my home support worker, because the team manager, who also acted as my support worker, came to pick me up. She drove me to the office of the organization I received care from. This was the first time I was in such major crisis that the team manager decided to call mental health services. She later told me I was “not crazy enough” to be admitted.

I must say here that a meltdown whilst in a lecture hall is of course not in itself a reason for a mental admission. In this sense, the mental health agency was right that I was “not crazy enough”. Maybe if they’d knwon that I had meltdown after meltdown almost on a daiy basis, they could’ve offered some help. Now back in the day my only options were an admission or no help. Today, most mental health crisis services offer more varied help.

The professor for my first class – the only class I even attempted to go to that first day – was by the way one of the most supportive people in the university. He offered to have me listen to the lectures in a room attached to the lecture hall that is often used for recording lectures. I was able to attend his classes up to the moment I landed in my final psychiatric crisis in late October. His class was also the only one I took an exam for – three days before my hospitalization. This professor was the first to notice I wasn’t at university anymore and I don’t think it was solely because he was the professor for my Mondaya morning class. The director of studies E-mailed me the Monday after midterm that said professor had been missing me in his class, so had I quit my sutdies? I didn’t read this E-mail till I was home on a visit the next month.

I don’t have the greatest experiences with accommodations for me as a mentally ill, multiply-disabled student at university. I remember being told a number of times that I had a bad attitude and “we’re not a therapy center”. Though this is true, I badly did want to continue my studies for as long as I could. This one professor was, without even talking much to me, one of a few people who kept me going. He instilled a continuing interest in language composition and univesal grammar in me.

How Far I’ve Come on My Mental Health Journey #Write31Days

31 Days of Mental Health

Welcome to day 4 in the #Write31Days challenge. Sorry for being a bit late to publish my post. Today, I’m sharing a personal post, describing how far I’ve come on my journey of learning to cope with mental illness.

I sought mental health help for the first time in early 2007. I was severely behaviorally disturbed at the time, having aggressive meltdowns several times a week. Though I didn’t physially attack other people, I was quite verbally aggressive and threw objects a lot. This behavior lessened with some counseling from a community psychiatric nurse and eventually medication, but it didn’t completely disappear.

When I was admitted to the psychiatric unit on NOvember 3, 2007, I was seriously suicidal. I had spiraled down into a crisis while living independently. I at the time showed classic borderline behavior, making suicidal threats when I was seriously distressed. I no longer threw objects as much as I’d done before, but I was still verbally aggressive.

After about three months on the locked unit, my disturbed behavior became less severe, but I still had many milder meltdowns. I’d also display rigid behavior. For example, I had a crisis prevention plan and i’d tell the nurses when they weren’t following it. Now the staff at that unit were quite authoritarian, so I was threatened with seclusion for telling staff they weren’t following the rules. I don’t see this as disturbed behavior on my part now, but I do see how, in the insane place of a psychiatric hospital, it was.

My meltdowns and outbursts didn’t lessen in frequency till I went back on medication in early 2010. It also helped that I’d transferred to the less restrictive resocialization unit. I eventually was quite stable there on a moderate dose of an antipsychotic and a low dose of an antidepressant. I still had my moments where I’d act out, but they were manageable.

This changed when I transferred to my current long-term unit in 2013. I transferred in the summer, so there were often fewer staff available. I also couldn’t cope with the fact that my part of the unit was often left to our own resources when the staff were catering to the needs of the presumably less independent people on the other floor. I started eloping regularly, something I’d previously done sometimes but not nearly as often as I did now. At one point, it eventually led to the staff considering having me transferred to the locked unit. That fortunately never happened. Instead, my antipsychotic was increased to eventually the highest dose. I have been relatively stable for about nine months now.

What helped me along this way was a building of mutual trust and cooperation. An example was that the staff would often offer to allow me into the comfort room when distressed. At the resocialization unit, when I’d have severe meltdowns, I’d be transferred to the locked unit and made to sit in their comfort room. Their comfort room was really a reconstructed seclusion area and there was little comfort to be found. Consequently, I saw the comfort room as punishment, but on my current unit, it isn’t. We have a really good comfort room which is truly calming. I learned to realize that the offer to have me sit in there was an offer for help, not punishment.

Eight years into my mental institutionalization, I still cannot say I have fully overcome my destructive ways. They have significantly lessened, but I still have my moments. That probably won’t be over with for a long while.

Borderline Personality Disorder Awareness: BPD Explained

May is mental health month in the United States. It is also borderline personality disorder awareness mnth. BPD is my current diagnosis. I have written a few posts on this condition already, but most required some previous knowledge of BPD or mental illness in general. In honor of mental health month and BPD awareness month, I am going to write about my experiences with mental illness in this post and will share facts along the way.

I have always struggled with rapidly shifting emotions and mood swings. If it had been popular at the time and my parents had sought help for me, I might’ve been diagnosed with a childhood-onset mood disorder. I do not have bipolar disorder or major depression now, but these conditions are thought to affect children differently. In the current edition of the psychiatrist’s manual, the DSM-5, there is a diagnosis for children with severe mood swings, dysphoric (sad or angry) moods and extreme temper tantrums. This disorder is called disruptive mood dysregulation disorder. It is thought not to be lifelong, as it can only be diagnosed in children under age eleven.

I remember as a child of about nine already experiencing suicidal thoughts and making suicidal threats, particularly during meltdowns or tantrums. This is not necessairly a sign that the child is going to attemtp suicide – I never did -, but this is also not just “attention-seeking”. It is, in fact, a sign that a child is in serious distress.

Making repeated suicidal threats or attempting suicide is one of the core symptoms of borderline personality disorder. It is commonly thought that most people with BPD only threaten suicide and “aren’t serious about it”. In fact, however, about ten percent of people with this diagnosis die of suicide.

As a teen, I started self-injuring. Self-injury is also a core feature of BPD. This may have many functions other than “attention-seeking”. Of course, some people with BPD do not know how to ask for attention and instead use self-harm as a way to get it. Even then, attention is a human need and withholding it altogether will not usually solve the problem. Other functions of self-injury may include to express pain, to numb out feelings or conversely to feel something when one is feeling empty or numb.

Chronic feelings of emptiness are another symptom of BPD. Generally, a person with BPD is somewhat depressed or numb. This feeling of numbness is also common with major depression, post-traumatic stress disorder and dissociative disorders, all of which commonly co-occur with BPD.

Dissociation is the feeling of being disconnected from oneself, one’s thoughts or feelings or one’s surroudnings. Symptoms of dissociation, particularly depersonalization (feeling “unreal”), are common in many mental illnesses. The most well-known specific dissociative disorder is dissociative identity disorder, also known as multiple personality disorder. My former therapist, who diagnosed me with BPD, believed that BPD and DID/MPD are on the same spectrum.

Paranoia is also common in people with BPD. However, as opposed to people with schizophrenia or related disorders, people with borderline personality disorder experience paranoia only briefly when under stress. For example, when I am overwhelmed with eotions, I tend to mistrust people and situations, while I am not usually paranoid.

Lastly, people with BPD have difficulties in relationships. Firstly, they often have an intense fear of abandonment and go to great lengths to prevent people from leaving them. Some may push people away (“I abandon you before you can abandon me”). Others, like me, are excessively clingy. People with BPD may also alternate between idolizing and devaluing the people who are important to them.

No two people with BPD or any other mental illness are alike. For a diagnosis of borderline personality disorder, you only need to meet five out of nine criteria. I meet between six and eight depending on how you look at it.

Borderline personality disorder bears similarities to post-traumatic stress disorder, dissociatve disorders and mood disorders, particularly bipolar. However, the difference between bipolar and borderline personality disorder is that people with bipolar disorder experience long-lasting mood episodes, whereas people with BPD have rapidly-shifting moods. BPD cannot be diagnosed in children, although of course they can have mood swings. They may then be diagnosed with disruptive mood dysregulation disorder. Psychiatrists are beginning to diagnose BPD in adolescents starting at arund age fifteen. This is good, because, the earlier someone gets treated, the more likely they are to reach recovery.

#HighFunctioningMeans I Can Hold It Together Until Finally I Can’t

I had been doing quite well mental health-wise for a few weeks. I was in fact doing so well that I was beginning to doubt anything is wrong with me. Maybe I don’t have autism and borderline personality disorder after all.

Then on Thursday, I started feeling a bit cranky. I thought I was coming down with the flu again, as many people seem to get it a second time around. The self-doubts also became worse. Maybe I am too “high-functioning” to be in an institution, like so many parents of “low-functioning” autistic children used to say when I still had stronger opinions on autism than I do now. Maybe I fake the whole of my mental illness and developmental disability.

Then on Friday night all came crashing down. I had this huge autistic, borderline meltdown. I ran off the ward with just socks on my feet not realizing it was too cold and rainy for not wearing shoes. I was actually very confused. When a few people came by, I called out for help, but they went on chatting and, I thought, filming me. I have never been truly psychotic, but psychotic-like symptoms are common with both some forms of autism and borderline personality disorder.

Long story short, after melting down more on the ward once the staff found me, I spent the night in seclusion. I don’t advocate forced seclusion on anyone who isn’t physically harming anyone, and I wasn’t at the time, but I was confused enough that I could physically harm myself. I went into seclusion voluntarily.

About a week ago, some autistic bloggers launched a hashtag on Twitter: #HighFunctioningMeans. They meant to raise awareness of what it is like to be (seen as) high-functioning but still be autistic. I would like to contribute to this hashtag with this post.

I don’t have meltdowns everyday. Not anymore since going on a high dose of an antipsychotic. Before I went on medication, a day without meltdowns was indeed a rarity. Though I don’t become physically aggressive towards other people anymore, I have broken a huge amount of objects and become self-injurious. I in fact have done all the things parents of “low-functioning” autistics say their child does while in a meltdown, including as a teen becoming physically aggressive towards people. Now that I’m an adult, I still hand-bite, head-bang, throw objects, run into the streets, etc.

I am not proud of these behaviors. I wouldn’t medicate myself with heavy duty medications if I were. I do advocate finding better treatments for autistic irritability. The reason I write this, however, is to demonstrate that those who appear to be “high-functioning” on the Internet, or even those who appear “high-functioning” when you first meet them, can be severely disturbed when eventually they can’t hold it together anymore.

Asking for Help

Asking for help. It’s one of those things many people have difficulty with. I am no exception. There are many reasons for this. Like, I’m somewhat anxious in social situations. In fact, on an online but seemingly pretty formal questionnaire (the Liebowitz Social Anxiety Scale), I score as having very severe social anxiety. It surprised me a little, given that I have only mild difficulty stirring up a conversation with basically anyone. Then again, most of the situations asked about were situations in which you had to do more than stir up smalltalk, such as asking for help.

I have always had trouble asking for help. Unfortunately, due to my disabilities, I often need help and I can’t avoid communicating somehow that I need it in the end. Ironicaly, this often led to me coming across as very demanding, because I would eventually get frustrated trying to do things on my own and “ask” for help in an aggressive way.

I am somewhat better now at asking for help before the situation escalates, but this is also because I have some momnets when I can ask for staff help in my daily routine. I don’t mean that I can’t ask for help at other moments, but it’s harder to do in unexpected situations.

Anxiety is one factor in preventing me from asking for help. I fear I’ll be a burden, but end up being a burden in the end because I can’t handle many situations on my own.

Another factor, however, is that I often get so overwhelmed with situations that I can’t pin down what I need help with. For example, when I have a computer problem, I often feel like the whole stupid device is crashing when in fact it might just be a particular eBook won’t load (this was a recent actual situation). In this situation, I ended up melting down because I thought my computer was crashing and I didn’t know what else to do than work on the computer and well now I probably needed to buy a new computer anyway, and… you get the idea. The question about what you’d do if your computer crashed, is the only one I end up answering “incorrectly” (ie. like a neurotypical) on the NT screening test on Autistics.org. Then again, I doubt having a massive meltdown is particularly characteristic of neurotypicality. I answer that I ask a family member, but usually, I don’t.

The worst about asking for help is that you have to be really clear about what you need help with and how the other person can help you. This is hard enough when I’m mentally well, but when I am in a bad mental state, this is not possible for me. Fortunately, some good mental health professionals recognize this. When I am in a psychiatric crisis, I usually can’t say what I need, because I have no clue. In this situation, even though I ultimately have the right to refuse intervention because I’m an informal patient, I need peoople to propose what might be best for me. Unfortunately, some people just look at my diagnosis, borderline personality disorder (and forget the autism), and say I am an adult so need to take responsibility for my own life (even though adults with other diagnoses get much more directive care). I may not like being told what is best for me, but sometimes, making this choice is exactly what I need help with.

Mama’s Losin’ It

We Don’t Stop Playing Because We Grow Old

This week’s spin cycle theme is “grow”. Ginny Marie over at Lemon Drop Pie asks: “Are your kids growing like weeds? Are the weeds growing in your garden? Does your garden have vegetables growing? Or are the veggies in your fridge started to grow mold?” Since I don’t have kids, a garden or a fridge, I need to invent another topic to post about. After reading Ginny Marie’s contribution, I thought of something. I want to write about growing up, too, but I struggle. As a kid, I always feared growing up, because it’d mean I needed to stop playing.

For a long time, from around age twelve on, I thought playing meant you were childish and being childish meant you were bad. When I was eleven, the school psychologist wanted me to become a residential student at the school for the blind. My mother explained to me that I was troubled because I had too many toys. I till this day don’t see the connection. Sure, I had quite the toy collection, but so did other kids. Sure, I had trouble making friends, and my interests were not the same as those of my age peers. I doubt they were all into books, which my mother said I had to be into in order to fit in. Books or music. While my age peers in the neighborhood were into music, I didn’t fit in once I listened to the music they were into and had Backstreet Boys posters covering my walls. Not that this period lasted long, because I’d quickly had enough.

Besides, I wasn’t troubled because I had few friends. That wasn’t the reason the school psychologist wanted to institutionalize me. The reason was my meltdowns and tantrums, and I have no clue what they had to do with toys. Sure, I had a tantrum when my Barbie doll’s leg broke off, but I had and still have similar outbursts when my computer crashes. Maybe that means computers aren’t the right interest either.

However, I internalized the idea that to play is to be childish and to be childish is bad. I remember when I was thirteen I kept track of my behavior problems, like tantrums, and soon added any sort of childlike behavior, including playing with Barbie dolls. I was going to regular education in a month, and it had become very clear to me that regular kids my age don’t play with Barbie dolls.

Once at regular school, I listened to the right music and read the right books. It didn’t change my outcast status. It didn’t lessen my meltdowns. It didn’t make me not fear growing up. It did make me grow old. We don’t stop playing because we grow old, after all, but we grow old because we stop playing, according to George Bernard Shaw.

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The Realities of an Asperger’s Diagnosis

A few weeks ago, I read an article in a women’s magazine about autism. It started out by explaining that autism is a spectrum and then went on to say that Asperger’s Syndrome is the mildest form of autism. Someone sent in a response saying that Asperger’s can be severely disabling too and, because it is often misunderstood, may be more severe in some ways than classic autism.

I have an Asperger’s diagnosis. I also have a high IQ. I can attest to the common misconcetpions surrounding an Asperger’s diagnosis. For one thing, the ability to speak does not necessarily mean that someone can communicate effectively. Even if speech on the surface makes sense, that doesn’t mean the Aspie’s words come out of their mouth as they were intended. However, because we have normal to above-normal intelligence, we’re assumed to “know better” and our miscommunicatin is understood to be willful misbehavior.

Speaking of behavior, it is a common misconception that Aspies don’t have as severe or as frequent aggressive or self-harming outbursts as those with classic or “low-functioning” autism do. H.L. Doherty, a father of a child with classic autism and an intellectual disability, often makes this mistake. He does so again when he talks about shards of severe autism reality. In this post, Doherty describes the consequencces of his son’s self-injurious meltdowns, and accuses autistic advocates of ignoring this reality. He connotes that those with “high-functioning” autism, ie those who can disagree with Doherty on the Internet, do not have these experiences. I, for one, do.

When I still lived in independence training, I had meltdowns almost everyday. An experience like the one Doherty describes is quite familiar to me and occurred regularly until I went on medication in 2010. My last episode of severe self-injury was two months ago, and it was so scary that I went into seclusion for a night.

Now I for one agree with Doherty on some controversies. I disagree on others. My agreeing or disagreeing and how eloquently I can put this into writing, does not change anything about my functioning level in any other area than written communication about a specific topic. I am too ashamed to write about some of my Aspie realities. The details of my severe self-care difficulties, for example. I know that Doherty and his supporters would not believe me anyway. After all, I’m so intelligent. Yes, I am. Relative intelligence is required for an Asperger’s diagnosis. That does not cause any of my difficulties to go away.

Was My Hospitalization Inevitable?

I was reminded yesterday about the situation surrounding my psychiatric hospitalization in 2007. I had been put on antipsychotic medication three months prior and had quit taking it again three weeks before I ended in crisis and was hospitalized. Yesterday, when talking to my therapist about this situation, she suggested more or less that being hospitalized could’ve been avoided if I just continued taking my meds.

Really, I consider my crisis inevitable. When I was still taking my medication, I was very irritable; just not irritable enough for the crisis team to intervene and hospitalize me. “But other people don’t like to be hospitalized,” my therapist said, as if by quitting my medication I’d somehow manipulated the crisis team into an unnecessary admission. The thing is, I’d been on the edge of a crisis ever since I moved into independent living. Maybe quitting my medication was the final straw, but is it all that strange that you want help when you’re struggling with meltdown after meltdown after meltdown?

I saw this reasoning all along when I still lived independently. I remember my care coordinator once saying that it was better for me to bang my head against the walls of my apartment, than to go outside and scream. Well, what the bleep? Isn’t a person’s safety more important than the person being a pain in the butt? Besides, it isn’t like I made a conscious choice either way.

For clarity’s sake: hospitalizations aren’t fun. The psychiatrist who admitted me, didn’t do so to please me. In fact, I didn’t ask to be hospitalized, as I didn’t know what I needed really. Hospitalizations happen as a last resort. Long-term institutionalizations are certainly not a choice either. And just so you know, the fact that I’m an informal patient doesn’t change that.

Why did I have a full-blown meltdown yesterday after my therapist asked me to name the pros and cons of asking for help less? Why did I feel offended when she suggested that, with medication, I could’ve been kept at home? Why do I struggle with all this “least restrictive environment” bullcrap that I hear everywhere? I’d like to consider my hospitalization avoidable, and maybe it was if I’d just continued taking those pills. But as I said, I was completely on the edge for all those three months. Apparently, however, intervention is only inevitable if you’re literally (nearly) dead, and if you aren’t, quality of life doesn’t matter. Especially not if you’re also a pain in the neck.

mumturnedmom

Handling Tantrums and Meltdowns in Children with Autistic Spectrum Disorders

Many children with autsitic spectrumd isorders, including pathological demand avoidance syndrome, have meltdowns. They can have different causes. A child may act out because they’re impulsive and find it hard to delay gratification. This is different from being spoiled, although the difference may be subtle. I still act out when I ask for help and am not told when I can get it. If someone is clear when they can offer me what I need (I don’t act out for not getting something I merely want, for clarity’s sake), I usually don’t have a meltdown.

On the other hand, as a child, even up to early adolescence, I used to have tantrums when my sister got candy or a gift and I didn’t. This is not normal for a neurotypical adolescent, but that doesn’t make it not a tantrum. An autistic child beyond the typical age for temper tantrums may not be able to take the other person’s perspective, so they may feel they’re being mistreated. This can be explained in a social story, but if a child still tantrums when they’re simply not getting their way, treating it as a regular temper tantrum is best.

Some children or adults act out because they’re frustrated and don’t knwo how to solve a problem. This is something inbetween a temper tantrum and a meltdown. I often used to be frustrated if my computer was having problems, but I would not use strategieis that would solve the problem, either socially acceptable (asking for help) or not (screaming for help). In one case when I was sixteen, I totaled my computer trying to make it work again, losing five months worth of important documents.

According to Adelle Jameson Tilton and Charlotte E. Thompson, authors of The Everything Parent’s Guide to Children with Autism, 2nd edition, a child can also have a meltdown because they’re denied something they want, but they lose total behavioral control and don’t “switch off” suddenly again if the wish is granted. Children in a meltdown do not take precautions to prevent themselves from being injured. They will not care if someone is watching or reacting, and the meltdown winds off gradually. I had meltdowns often when I was at the independence training home, throwing objects in my own apartment while no-one was there. I did need help cleaning up the mess, but usually I had calmed down and wasn’t asking for what I had originally wanted once the staff helped me clean up.

From my experience, I can tell that a meltdown can also occur when I am overloaded either cognitively, emotinally or sensorially. I remember a few weeks ago completely melting down even though I had gotten the attention I’d wanted already, because I couldn’t cope with overwhelming emotions and had failed at channeling my overload. When later asked why I had had this meltdown, I had no clue. This is in my experience a distinctive characteristic of a meltdown: meltdowns do not necessarily have an underlying reason.

Meltdowns can also happen after a small seizure, according to Jameson Tilton and Thompson. I read in my neuropsychology textbook that aggression during a seizure is very rare and usually stereotyped, but aggression after a seizure may be more common. If a child seems to be totally uninvolved in their environment for a few minutes before mtling down, this could be a sign of a silent seizure.

In children with pathological demand avoidance particularly, a meltdown may come on as a result of anxiety. Phil Christie and others in their book Understandign Pathological Demand Avoidance Syndrome in Children, make a rigid distinction between aggression with the purpose of avoiding demands and meltdowns out of anxiety, but in my experience this distinction isn’t always clear. After all, demand avoidance often stems from anxiety and/or overload. In situations where an autistic or PDA child is overloaded or panicking, it is important that adults reduce the demands placed on the child, use simple language and do not enforce social niceties such as eye contact.

It may help to evaluate your own behavior as the adult managing a child’s meltdown. You can ask yourself whether the demands you placed on the autistic or PDA child were reasonable, whether they were truly non-negotiable (so that you were willing to endure a meltdown for them), whether you reacted properly or may’ve overreacted, etc. Remember, a meltdown, unlike a temper tantrum, is not a power play, and as a parent, carer or teacher you shouldn’t make it about power.

If the person who had the meltdown is an older child or adult, and you have a trusting relationship with them, involve them too in the evaluation process. (Note: if you do not have a trusting relationship with them, this is something you’ll need to work on!) Evaluating should be done in a non-judgmental way, avoiding the blame game. For some children, social stories may be appropriate, while others can tell you what you need to do differently to help them prevent or minimize a meltdown. This is again not to say that you’re to blame for the meltdown, but many children and adults in a meltdown do need external support.