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THE WAY I SEE IT -- by Temple Grandin, PhD

The first step when non-verbal teenagers and adults with autism break down is to determine what is causing an outburst or a meltdown. When the cause is accurately identified, it will be much easier to prevent further meltdowns in the future.


The next step is to determine if the challenging behavior has either a biological or purely behavioral cause. The three biological causes could be 1) a hidden painful medical problem;

2) sensory overload; or 3) psychometer seizures. The three main behavioral causes are 1) frustration, because the individual cannot communicate needs; 2) to get attention; 3) to escape from a task. The first step is to rule out a biological cause.


BIOLOGICAL CAUSES


Hidden Painful Medical Problems:

This is the first thing that must be ruled out in a non-verbal person. Some doctors make the mistake of assuming that the behavior problem is due to autism and fail to diagnose a painful issue.


Acid reflux and upset stomach are one of the most common problems. Several research studies have shown that autistic people are more likely to have gastrointestinal issues. Some of the other painful conditions that must be ruled out are constipation, yeast infections, urinary

tract infections, toothaches, and earaches.


Parents, teachers, and caregivers need to be aware that a painful condition may be present if the person’s behavior suddenly worsens. Painful medical issues need to be promptly treated.


Sensory Overload

If meltdowns occur in noisy places, such as a crowded restaurant, train station or sporting event, it may be sensory overload from noise. In this situation, the autistic person may have to be removed to a quieter place. Sometimes an autistic individual can learn to tolerate additional noise if they are given control. They can be taught to give a signal, such as raising their hand when they want to leave. Sometimes sensory issues can be reduced with a low dose of risperidone. It is approved by the FDA for “irritability associated with autism.” Use the lowest effective dose.


Psycho Motor Epilepsy

This is a form of epilepsy that does not cause a typical grand mal seizure. A rage attack might occur “out of the blue,” and there is no obvious trigger for it. The outburst will suddenly turn on like a “light switch” with no warning behaviors. The treatment would be medications used

for treating epilepsy.


BEHAVIORAL CAUSES


Frustration Due to Lack of Communication

I can remember when I was a child, in which my ‘not being able to talk’ was really frustrating. The non-verbal person MUST be provided with a method to ask for basic needs. It could be a picture board, sign language, or an electronic+* device. A person needs to be able to tell others if they are close to sensory overload, thirsty, hungry, tired, cold or

need to use the restroom.


Escape from a Task

Some individuals learn that they can get out of performing a task by screaming or hitting. The first step is to look at the task from the viewpoint of the non-verbal person. Teaching numbers or colors may be meaningless to them, and they become frustrated and have meltdowns. The individual needs to be taught how numbers relate in the real world. For example, one dollar buys a piece of candy, and five dollars buys a meal at McDonald’s.


A really perceptive teacher described a case where a non-verbal individual started throwing silverware when they were being taught to set the table. The mistake that was being made was that the person was being trained to set and unset the table multiple times. Nobody does this in real life. A better way to teach is to set the table before each meal. Non-verbal people

know the difference between real and useful work and stupid busy work.


Get What They Want

Some individuals will scream, because they know that their teachers or parents will give in and let them have the video game. One young adult never screamed when his dad drove by his favorite restaurant, because he knew that dad would not stop if he screamed. When he was in the car with mom, he screamed when he saw the restaurant, because he knew his mother would stop.


Parents, teachers, and caregivers will be more successful in preventing meltdowns and other challenging behaviors if they accurately determine the motivation behind it. 


Temple is an internationally-respected specialist in designing livestock handling systems. She is also the most famous person with autism in the world today. She is the subject of the Emmy Award-winning HBO biopic Temple Grandin. She frequently writes and speaks on the subject of autism, sharing her personal experiences.

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