Managing Behavioural Crisis: What is it and how to handle it?

A behavioural crisis is a severe/or prolonged outburst of behaviour during which the child may appear upset, angry or aggressive. During this the child may prove to be a danger to self or others. It is therefore important to recognise signs of the outburst, prepare and prevent the triggers. It is also important to work on a long term plan for  supporting the behaviour.

This article is based on inputs from consultant Neuro-developmental Pediatrician, Dr Ajay Sharma. He has offered expert advice and guidance in consolidating this information. It will also help you in understanding the difference between a tantrum and a meltdown and in learning the ways to support the behaviour crisis in children

You might also want to read this blog written by a parent of a special needs child on identifying and managing behavioural crises.

What is a Behavioural Crisis?

Autism Spectrum Disorders (ASD) or autism is a neuro developmental  condition often characterised by a delay in communication and limited social interaction. Children with autism therefore find it difficult to regulate their emotions often leading to behavioural concerns. Sensory sensitivities, additionally make it difficult for children to regulate themselves in overwhelming situations.

A behavioural crisis refers to prolonged episodes of severe behavior that is often difficult to manage. During this the child may be upset and aggressive, placing themselves or others at immediate risk. It is therefore extremely important to identify the underlying factors that may cause these behavioural outbursts. It will be helpful to prepare and prevent the triggers and work on a long term plan for managing the behaviour.

What can be done?

• The root causes of the behavioral outburst:

It is important to identify what triggers the child and results in a behavioural outburst. Be mindful that each child is different and therefore each child’s reaction to a situation or their coping mechanism will be vastly different. 

Among incidents leading to a behavioural crisis, two commonly occurring events are tantrums and meltdowns. They may look similar but are entirely different. In order to help support children during a behavioural crisis, it is extremely important to understand the differences between a meltdown and a tantrum.

Tantrums

• Often when a child with autism is unable to get what they want, or in order to gain attention, they may often exhibit behaviours that can be characterised as a tantrum. 
• Such tantrums can also be observed in neurotypical children, but in children with autism, there might be other underlying factors that result in such behaviours.
• A tantrum might result when a child wants something.
• It also might be an expression of an unmet need of the child. It may manifest as a result of the frustration, when the child is denied what they want.
• A tantrum can also be a way to get the attention of people around.
• They are often for short durations, and may stop once the child gets what they want.

Meltdown

• Meltdowns may often look like tantrums but are vastly different.  Unlike tantrums, meltdowns are not aimed at receiving anything. 
• They are often a response to overwhelming emotions or stress or due to a sensory overload.
• They last for long periods of time, as the child does not understand how to cope, and may last even when the stressor is removed.

• Recognising Signs:

It is often difficult to differentiate between a tantrum and a meltdown. In such situations, it may help parents if they look for apparent signs by asking themselves the following questions.

• Was the child denied something that they wanted?
• Were they trying to get the adult’s attention?
• Was the child asked to do something that they were not willing to?

If the answer to these questions is a yes, then in all probability the child is having a tantrum, where the child is angry or upset as a result of things not going their way.

However, this is not the case in a meltdown, where parents or caregivers should think about the following questions.

• Is the child having a stressful day, or was there stress in situations preceding the meltdown?
• Have there been any sudden changes in the usual routine of the child?
• Is there a sensory overload on the child, resulting in the meltdown?

If yes, then the child’s response is to a situation arising from overwhelming sensory differences or stress. There is little that the child can do to cope in such situations and often need strong support to support them.

• Preparing and Preventing:

Once parents identify if the child is having a tantrum or a meltdown, they often look for the best possible way to address and deal with their child’s behavioural outbursts. 

• Stay Calm:

Before addressing the child’s outburst, parents should try to remain calm and not panic. Address the child using a calm but firm voice.

• Identify Early Signs:

• • It is important to identify any events that might have happened resulting in the child having a tantrum or a meltdown. 
  • If the parent anticipates any situation that may be likely to be upset, distracting the child to other activities might be helpful. 
  • If there is a sensory trigger that might overwhelm the child, removing the stressor wherever possible might be helpful too. 
  • Offer the suitable sensory stimulus to help the child feel better, in case of a meltdown.

• Acknowledge the changes:

Ensure the child that you as a parent understand their emotional state using a calm voice to reassure the child.

• Support and Management:

It is essential to manage the child’s outbursts appropriately to ensure the wellbeing of the child. Different approaches can be used to manage a tantrum or a meltdown.

What to do during a tantrum?

Communication: Help the child communicate their needs by using any form of communication such as gestures, pictures or speech. Encourage and praise for using communication skills instead of having a tantrum.

Ignore behaviours: Unless the child is at a danger of harming themself or others around them, it is best to ignore any behaviours directed at gaining attention. This will help the child understand boundaries and what’s acceptable in situations.

Offer Alternatives: Offer an alternative that the child can engage in that moment, such as an alternative activity or an alternate form of communication when the child is too upset.

Do not reinforce: Offering rewards or other things of attraction may often lead to a child believing that this display of behaviour is the only thing to get things. Therefore do not reinforce uncontrolled behavioural outbursts.

What to do during a meltdown?

Stay Calm: Utmost care should be taken while handling a meltdown. Speak in a calm and soothing voice that is reassuring to the child.

Reduce and Remove: Identify and remove any stressors that might be causing the meltdown. Any sensory triggers likely to cause an overload such as loud sounds, bright lights should also be reduced. This will help in the child feel calm and settled.

Use Calming Methods: Use methods that you know can calm the child down.These can be breathing exercises, the child’s favourite activities such as singing etc. 

Offer Space: Unless it appears that the child may be in any form of immediate danger, it may be wise to give the child some space to decompress without any added pressure.

Choosing a method suited to the child and offering alternatives can go a long way in addressing a behavioural crisis. 

What NOT to do during a crisis

It is important to understand that as caregivers, it’s our duty to make sure that the child does not feel threatened or overwhelmed but feels safe and calm by our responses. It is therefore, important that parents:

1. Do not argue with the child
2. Do not criticise the child
3. Do not try to teach the desired or appropriate behaviour during the crisis

Long Term Planning and Management

Behavioral crisis, whether a tantrum or a meltdown can have a huge impact on not only the child, but the emotional and social well being of the family as well. It is therefore important to work towards preventing such outbursts in children by adapting coping mechanisms that can offer children a safer alternative to emotional outbursts.

• After the crisis, when the child has calmed down
• Talk to the child about the incident in a calming and reassuring tone. 
• Talk about what is unacceptable like breaking things or hitting people. 
• It is also important to reflect on the incident and try to identify if there were any triggers that might have caused the event. 
• Work on removing such stressors to prevent outbursts in future.
• Create a sensory friendly environment based on the child’s needs. Removing sensory triggers from the child’s day to day activities, wherever possible will largely help the child cope without being overwhelmed. 

Establish and Follow a routine

• Children do well when they have routines. This gives them structure and predictability. 
• Having visual schedules in place helps guide the child through different activities during the day. Visual schedules can also help the child transition from one activity to the next, reducing chances of anxiety and fear.
• Working on the child’s communication will also go a long way in managing behavioural outbursts. Teach the child to use different means of communication to convey their needs. 
• These can be through signing, visual aids like Picture Exchange Communication System (PECS) or by using their words. 
• The child should understand that communication will be more effective than displaying behaviours such as screaming or throwing things.
• This can be done by reinforcing positive behaviours like asking, sharing or giving.
• Also, find and practice other activities that can be used as replacement of demands. 
• These activities should be based on the child’s preferences like a sensory toy, or an activity the child enjoys such as listening to music or a tool that reduces sensory overload such as noise-cancelling earphones.
• Be aware of possible triggers that can lead to the child being overwhelmed and work on reducing them as far as possible. 
• For example, go to places at times when they are not too crowded, try to give the child frequent breaks to help calm them down.

Practicing these methods to prevent and manage overwhelming situations will gradually help the child cope with unfavourable situations and help prevent or minimise events leading to a behavioural crisis.

Acknowledgement: Special thanks to Consultant Neuro-developmental Pediatrician, Dr Ajay Sharma who has offered expert advice and guidance in consolidating this information.

Additionally, do listen to Dyslexia Therapist and Counsellor, Afshaan Jabeen, discussing the main causes for behaviour challenges in children with developmental disabilities. Another interesting and helpful conversation with Pediatric Neurologist, Dr Ram Kairam, on the use of medications to manage mood swings and anger, can be accessed here. 

If you have questions about Autism, Down Syndrome, ADHD, or other intellectual disabilities, or have concerns about developmental delays in a child, the Nayi Disha team is here to help. For any questions or queries, please contact our FREE Helpline at 844-844-8996. You can call or send us a message on WhatsApp. Our counsellors speak different languages including English, Hindi, Malayalam, Gujarati, Marathi, Telugu, and Bengali.

DISCLAIMER: Please note that this guide on managing behavioural crisis is for information purposes only. Please consult a qualified health practitioner for safe management.