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Aspergers and HFA Panic Attacks Disguised As Meltdowns

Your child is majorly upset over something - but is it a meltdown, shutdown, tantrum, or full-blown panic attack?

As a parent of a child with Aspergers or High-Functioning Autism (HFA), you know that your child is capable of having a meltdown occasionally. We’ll describe a meltdown as “an over-reaction to environmental stimuli designed to give Aspergers/HFA children a sense of control when they feel that their world is out-of-control.” 

Let’s also make the distinction between a meltdown and a temper tantrum. We’ll describe tantrums as “normal acting-out behaviors designed to help children assert their independence as they learn they are separate beings from their parents.”



Having defined meltdowns and tantrums, parents need to know that there are times when their “acting-out” Aspergers and HFA children are having neither a meltdown nor a tantrum; rather, they are in the throes of a legitimate panic attack. Let’s describe panic attacks as “periods of intense fear and apprehension that are of sudden onset and of variable duration of hours to days.” Panic attacks usually begin abruptly, may reach a peak within 10 minutes, but may continue for much longer if the child had the attack triggered by a situation from which he or she is not able to escape. 

In panic attacks that are triggered by a situation from which the Aspergers/HFA child desires to escape, he or she may make frantic efforts to escape, which are often violent – especially if parents attempt to contain the child. Often, the child suffering from panic attacks will experience significant “anticipatory anxiety” in situations where attacks have previously occurred (e.g., a child having a panic attack after the neighbor’s dog jumps up on him, resulting in the child fearing ALL dogs in ALL situations after the initial incident).

==> TEACHING SOCIAL SKILLS AND EMOTION MANAGEMENT

Experiencing a panic attack is one of the most intensely frightening, upsetting and uncomfortable experiences in a child’s life and may take days to initially recover from (unlike meltdowns, which usually only last a few minutes to a few hours). Repeated panic attacks are considered a symptom of panic disorder. 

Children with Aspergers and HFA are prone to anxiety, which in extreme situations can lead to panic attacks. Panic attacks are a terrifying experience where the body reacts as if it is in immense danger, in a situation where most children would not be afraid. A small number of Aspergers and HFA children will go on to develop panic disorder, whereby panic attacks are intense and occur frequently. If left untreated, panic disorder can be a debilitating condition, severely restricting the quality of life for the youngster.

In between attacks, the affected child often feels intense anxiety, worrying when and where the next one will strike. Panic attacks are accompanied by the unpleasant physical symptoms of anxiety (e.g., heart palpitations, hyperventilation, muscle pain, dizziness, sweating) along with the fear that the attack will lead to death or a total loss of control.

Aspergers and HFA children suffering from panic attacks need to be taught that the physical symptoms they experience with an attack are just extreme versions of normal bodily responses to danger. For example:
  • Pupils dilate for more acute vision, and this can cause difficulty with bright lights or vision distortion.
  • Blood is diverted away from non-essential areas including the stomach, brain and hands, resulting in digestive problems, dizziness and tingling or numbness in the hands.
  • Adrenaline being released into the blood stream causes the heart to beat faster and the breathing rate to increase in order to supply major muscles with more oxygen.
  • Sometimes it may appear that the walls are folding in, or in extreme cases, inanimate objects may appear to move.

During an attack, the affected child can become convinced that the symptoms are caused by a major health problem (e.g., heart attack, brain tumor) or that he or she is going crazy. This fear causes more adrenaline to be released. Thus, a worsening cycle can be generated.

Panic attacks can be accompanied by other conditions (e.g., depression), or they can give rise to the development of phobias. If, for example, the Aspergers/HFA child has a panic attack during his first day of school, and then associates panic attacks with “the classroom,” he or she may refuse to go to school. Some of these children’s lives become very restricted, and they avoid normal, everyday activities. Some may even refuse to leave the house unless they are accompanied by a parent (i.e., agoraphobia).




Treatment—

There are a number of treatments for panic attacks, with research showing cognitive behavioral therapy to be the best practice. Some parents may choose to combine a number of treatment options for their child, for example:

1. Relaxation techniques/meditation: These can be useful to reduce acute anxiety or to help the child cope during a panic attack. There are numerous books, CDs and DVDs which can help the child learn these techniques. 

2. Medication: Some of the anti-anxiety drugs are very potent and some produce severe side effects in some kids. While medication can give short term relief to the symptoms, it is important that other strategies are used as well, including counseling and learning more about the condition.

3. Diet and exercise: Physical fitness and a good balanced diet are essential for emotional well being. Many young people find that doing something physical helps reduced the “keyed up” feelings often associated with anxiety. For some children, high caffeine drinks and chocolate can act as a trigger to panic attacks, probably because caffeine can cause bodily changes (e.g.,  increase in heart rate), which can be misinterpreted as the start of a panic attack. The fear this causes can then trigger a real panic attack.

==> TEACHING SOCIAL SKILLS AND EMOTION MANAGEMENT

4. Complementary therapies: Some parents report that the use of herbs, vitamins, and homeopathy have been effective with their child when either used alone or in conjunction with other treatments.

5. Cognitive behavioral therapy: CBT is very effective for treating panic attacks. It teaches affected children how to identify their anxiety and how to change anxiety-generating thoughts. The underlying belief with CBT is this: It is not so much “events” that are a cause of anxiety, but what the child “thinks” about the events.

6. Parental instruction: Teach your child to avoid fighting the panic. When experiencing a panic attack, affected children need to remember the following: It does not matter if they feel frightened, unreal or unsteady, because these feelings are just an exaggeration of normal bodily reactions. The feelings are unpleasant and frightening, but not dangerous. Teach your child to face the symptoms and not run from them. Tell your child to not add to his or her panic with scary thoughts about what is happening or where it might lead. Instruct your child to allow time to pass, and for the fear to fade away. He or she can use one or all of the following positive statements:
  • “I can be anxious and still deal with the situation.”
  • “I’ll just let my body do its thing. This will pass.” 
  • “This anxiety won’t hurt me, even if it doesn't feel good”.
  • “This feeling isn't comfortable or pleasant, but I can accept it.”

Symptoms of panic attacks include the following:
  • chest pain or discomfort
  • chills or hot flushes
  • depersonalization (i.e., being detached from oneself)
  • derealization (i.e., feelings of unreality)
  • fear of dying
  • fear of losing control or going crazy
  • feeling dizzy, unsteady, lightheaded, or faint
  • feeling of choking
  • nausea or abdominal distress
  • palpitations, pounding heart, or accelerated heart rate
  • paresthesias (i.e., numbness or tingling sensations)
  • sensations of shortness of breath or smothering
  • sweating
  • trembling or shaking

Many children being treated for panic attacks begin to experience “limited symptom attacks” (i.e., fewer than four bodily symptoms listed above being experienced). It is not unusual for the affected child to experience only one or two symptoms at a time (e.g., vibrations in the legs, shortness of breath, an intense wave of heat traveling up the body).

Some symptoms are sufficiently different from any normal sensation such that they clearly indicate panic disorder. Panic disorder does not require four or more symptoms listed above to all be present at the same time.

Pure “causeless” panic and the racing heart beat that panic causes are quite sufficient to indicate a panic attack. But, with proper treatment and parental-coaching/encouragement, affected children can go on to live very normal lives.

The "Smart Parenting" of Children on the Autism Spectrum

"For those parents of both neurotypical kids and children on the autism spectrum, do you basically parent the same - or is there a big difference in your approach with the autistic child?"

There are basically two types of parents who are raising Aspergers and High-Functioning Autistic (HFA) children: (1) those who use "traditional" parenting techniques with ALL their children - including the one with Aspergers, and (2) those who have learned that you simply can NOT parent Aspergers children and "typical" children in the same way.

Why? Because the mind of a child on the autism spectrum is wired differently than that of a "typical" child. 

Think of it like this: Let's say you have 3 children. Two of them only speak English, and one only speaks German. You, as a parent,  have learned to speak both languages. So, which language will you use when you are trying to get your point across to the German-speaking child? German, of course! But too many parents are speaking a foreign language to their Aspergers or HFA child, and then they wonder why the kid "doesn't get it." 



It's not that your child "doesn't hear" you; rather, he or she "doesn't understand" you. When you, as a parent, try to teach your child how to behave, you must know how he or she thinks and what language he or she understands. Don't speak "neurotypical" to a child on the spectrum.

When helping these special needs children to learn new behaviors (e.g., positive social skills, taking “no” for an answer, doing chores, completing homework, etc.), parents can use a combination of parenting strategies that work well with nearly any child, but that seem to work especially well with the child on the spectrum, including:
  1. being a positive role model
  2. consistently following through with positive and negative consequences
  3. continuous reinforcement
  4. developing and clarifying clear expectations
  5. modeling
  6. praising the youngster for his or her behavior
  7. prompting
  8. rehearsing appropriate behavior
  9. role playing corrective behaviors
  10. staying calm in the midst of meltdowns when your youngster gets upset

 ==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's


Let’s take a deeper look at some of these strategies:

1. "Target Behavior of the Day" is a technique used to help Aspergers and HFA children think about good behavior on a daily basis. Parents can introduce this exercise by asking the child to make a list of specific behaviors that are desirable (e.g., listening when parents talk, waiting your turn, speaking with an inside voice, cleaning up the bedroom, not picking on the younger sister, etc.). These behaviors are then written on large strips of poster-board and displayed everyday on the "Target Behavior of the Day" bulletin board. During the day, the mother or father records a mark on a tally card each time the child displays the desirable behavior. If the child modeled such behavior throughout the day, the parent praises (e.g., “You did a great job of being responsible today”) and rewards (e.g., “As a reward, you can have an extra 15 minutes of computer time tomorrow evening”) the child at day’s end.

2. “Do what I say and not what I do” is a common phrase that is often repeated; however, it only confuses kids on the autism spectrum. These young people will not do what the parent says, rather they will do what the mother or father has modeled. Kids model the behaviors that the parent has presented to them time and time again. Looking at the messages you send your youngster is easily seen by analyzing your own behaviors. Your main goal is to always set a positive example that your child can model.

3. Before parents concentrate their efforts on disciplining their youngster for misconduct, they must have a strategy, or game plan, for teaching their youngster how he or she is expected to behave. Moms and dads must model the appropriate behavior for their child if they want him or her to be successful in behavior modification.

4. Continuous reinforcement is an “operant conditioning” principle in which the child is reinforced every single time he or she meets parental expectations. For example, you, as a parent, might offer an extra 15 minutes of computer time every time your child completes his or her homework before dinner. However, one of the biggest dangers when using this type of reinforcement is “saturation.” For example, the child basically gets full – you keep offering that extra 15 minutes of computer time if homework is completed, but it’s no longer a motivating force for the child. In other words, NOT doing homework before dinner has more value for the child than extra time on the computer. Thus, the idea that “giving reinforcement in the same way all the time” is the best way to teach/learn is NOT necessarily true. Instead, you will want to periodically offer other reinforcers that have equal value (e.g., the child can have his or her favorite food item for dinner if homework is completed on time).

5. Developing clear expectations of what both parents want is crucial. Depending on the background, or what is deemed as right and wrong, parents, within reason, should plan and communicate their expectation to each other. Creating a list of expectations (e.g., social, academic, religious, family oriented, personal appearance and hygiene, etc.) for different settings and activities will help moms and dads to be very specific and concrete in teaching their youngster. Some expectations are certainly more demanding than others; however, moms and dads must take into consideration the youngster’s age, ability, developmental status, and resources that are available to the family. Have you, as a parent, taught the expectation to your child? Can your child clearly understand the expectations given? Can your child model and perform what you have expected? Answers to these three questions will determine whether or not your expectations are realistic.



6. Negative consequences are defined as “adding a negative consequence to prevent or decrease a certain behavior that is problematic, or taking away something that the youngster holds dear.” Doing extra chores and/or taking away a privilege are examples of negative consequences. Aspergers and HFA kids will soon realize that the behaviors that are causing these consequences are to be avoided.

7. Positive consequences are used to increase or encourage desirable behaviors. Catching your youngster doing good acts and following directions are great examples of when to apply a positive consequence. Positive consequences can range from short-term rewards (e.g., candy, extra play time, etc.) to long-term rewards (e.g., trips and gifts). Parents should use positive consequences that will work for their youngster, and use consequences that don’t cost money.

8. Providing constructive feedback to the child is important. Many parents have devised an approach for helping their “special needs” son or daughter to demonstrate positive behaviors, For example, every Saturday, one mother writes a brief progress report on the child, describing his behavior (both good and bad), effort (or lack of effort), chore and homework completion (or lack of completion), and the total number of parental requests that were accepted (or rejected). Then the mother meets with the child to discuss the comments in the progress report. During this meeting, mother and son work together to problem solve and suggest alternatives where needed.

9. Role playing with your youngster is great method to teach proper behavior without resorting to the use of punishments or consequences. Each and every time you practice doing the right thing in a situation with your youngster, you increase the chances for his or her success and decrease the likelihood that he or she will engage in that problem behavior in the future. Here is a simple four-step role playing format:
  • narrate the situation that occurred for your youngster
  • swap roles with your youngster
  • begin the role play
  • give critiques by giving feedback on the performance, using praises when needed

Role playing can help an Aspergers or HFA youngster to think in advance and rehearse adaptive responses to potentially frustrating situations, thus developing a more thoughtful and flexible response to the everyday problems that he or she faces.

10. Staying calm is an important part before applying any positive or negative consequences to your youngster’s behavior. Kids with autism can be sarcastic, defiant, rebellious, and even violent. Moms and dads have to prepare themselves for times like these and learn to keep their cool. There are times when these special needs kids will make their mother or father so furious that the parent gets caught up in the moment, and as a result, is not able to think clearly. Parents must be aware of what is going on around them. They need to know their limits to which the youngster pushes, and redirect situations back in focus to respond properly.

11. Verbal prompting has been found to help these children better understand the “house rules.” For example, one mother  helps ease transitions (generally a very difficult time for many children with Aspergers and High-Functioning Autism) by telling the child when there are "3 minutes to go before ______." Even younger kids who might not comprehend time can benefit from the cue, which alerts them of the approaching change.

12. Praise, praise, and then praise some more. Here is the “how and when” of praising an Aspergers or HFA youngster:
  • Always give a rationale of why you approve of your child's positive behavior. It is always good for the youngster to know why that specific positive behavior benefits him/her or others, since this helps the child to understand the relationship between certain behaviors and the outcomes. Sometimes you can add-in a reward, which reinforces the behavior that you have approved of, described, and given a rationale of why you approve of it.
  • Describe the positive behavior that you want the child to continue. This lets him or her know what behaviors to keep doing in the future. 
  • Praise your youngster when he or she makes positive “attempts” at new skills or tries new tasks.
  • Praise your child at tasks he or she is already doing well at, but that you may have taken for granted.
  • Praise your child when he or she makes improvements on current skills or tasks. 
  • Try action praises like giving a hug, a kiss, a high five, nodding in agreement, or the clapping of hands. 
  • Try vocal praises like “wow”, “keep it up”, “amazing”, “super”, or “that’s a great job.”

 ==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's


Here are some parenting tips that are very specific to children with Aspergers and High-Functioning Autism:

1. “Typical" children and those with Asperger’s Syndrome may have very different ways of communicating their feeling about life events, including: managing emotions, learning from life events, incorporating rituals and traditions for managing life events, dealing with dying and death, and coping with illness, injury or recuperation. Just because children may process and communicate their feelings differently, though, doesn't mean it's right or wrong. It is best to be honest and literal to help “special needs” children to manage major life events. Provide information and allow them time to process it.

2. A child with AS may have difficulty understanding clich├ęs or expressions and interpret a phrase literally. By speaking directly and factually, like saying "It's easy" as compared to "It's a piece of cake", the child is more likely to understand the line.

3. Aspergers and HFA children have difficulty with transitions. So, don’t surprise them – let them know your plans.

4. Being met with an individual in a dark uniform can be intimidating to a child on the spectrum, particularly when he or she has been a crime victim or is injured. Police and emergency responders may become frustrated, not knowing that the child they're talking to has an autism spectrum disorder. Responders need to communicate in a way that will create understanding and make the situation less stressful.

5. Body language, facial expressions, gestures, and turning away from someone may be cues that are missed by an AS child. When this happens, it is another opportunity for parents to be direct and factual, realizing that their body language or social cues may not be picked up by their child.


6. Children with Asperger Syndrome can manage situations by being aware of what they're feeling and thinking and expressing their thoughts to important adults in their life. Being aware of when they need help - and asking for it - is a good skill to have.

7. Children with AS take in information from their five senses as do “typical” children. The difference is that AS kids are not able to process it as quickly and can become overwhelmed by the amount of information that they are receiving. As a result, they may withdraw as a coping mechanism.

8. Due to the break of routine with family vacations, many parents of Aspergers and HFA children may avoid taking vacations. Steps can be taken to help make for a successful family vacation. One is sharing information with the child, like pictures or internet web pages. There are organizations that will make accommodations, if requested, to better manage uncertainty, crowds, noise disruption. This includes theme parks who allow “special needs” children to skip long lines and airlines or airports that may allow for a dry-run prior to the trip. Also, prepare prior to the trip so that there is a plan for managing boredom.

9. Environments with the least amount of disruption will help AS students remain calm. Speak in a quiet, non-disruptive tone and utilize a physical space that has a low level of disruption.

10. Many children with an autism spectrum disorder are hypersensitive to changes in sight, touch, smell, taste and sound. The sensory stimulus can be very distracting and can result in pain or anxiety. There are other autistic children who are hyposensitive and may not feel extreme changes in temperature or pain. Each of these has implications for making an autism-friendly environment.

11. Providing the best outcomes for a child with AS may be difficult, complicated by each youngster's unique way of managing communication and interaction with others, associated disorders that make each youngster's situation unique, and emerging understandings of neuro-diversity. Teacher effectiveness can be optimized based on an awareness of the differences along the autism spectrum, acceptance that each youngster is unique, engagement of the youngster in social and educational activities, and employment of teaching methods that are found to be helpful with kids who have developmental disabilities. 

12. Since change of routine can be quite anxiety-producing for many AS children, a structured, predictable routine makes for calmer and happier transitions during the day.

13. Social stories have been a great method to communicate ways in which my Aspergers child can prepare herself for social interaction.

14. Talking about - or engaging in - activities that the AS child cares about is a great way to bond with him or her.

15. When you find out that your child may not be able to look you in the eyes, realize that he or she is not trying to be rude. It’s simply uncomfortable for some of these children to do.


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


COMMENTS:

Anonymous said... After years of trying and my mom telling me not to "give in"- it was such a relief and a reward to know it wasn't that I was doing it wrong. I didn't even know the rules!

Anonymous said... Amen to that! It just does not work. They dig in like a tick. Resistance is futile, you have to move to them rather than pull.

Anonymous said... Even parenting 2 aspergers kids is not the same for both, as the same straigies for the same behavior doesn't always work.

Anonymous said... Now, if only we can get the schools to understand this!

Anonymous said... So agree especially with schools my son in mainstream and having daily struggles teachers don't understand and don't want to it seems

Anonymous said... So true x

Anonymous said... This is so reassuring. I read it often and I KNOW I cannot parent them the same way but it feels good to see it in black and white sometimes! My kids are two entirely different entities and one can handle one thing and the other can't. Thankfully, my NT daughter seems to understand the difference! When I tell people my son is stubborn, they brush it off saying all kids are. They have NO IDEA. My daughter is stubborn. Thank goodness. We all should be to a point. My son takes it to a whole new level!

Anonymous said... too true.
 

Anonymous said... That picture is EXACTLY how I feel every day this year as I homeschool our daughter!! I thought the problems she was having in school were causing her extreme resistance and that schooling at home would help. Wrong. I feel absolutely, totally, completely hopeless and can not STAND it anymore!!!! I do try many of these things, but there are more that I can do. My husband and I will look at this article and come up with a game plan for the rest of our school year (we have to go through June because of all the time my daughter's impossible behavior has stolen from learning). If things don't change, I'm going to send her back to public school just so I can get a break - she is stubborn and impossible no matter where she is at. At least if I can share the burden, maybe we can all be a little calmer and more patient. I had to ask her 15 times, very calmly and patiently to read back her word so I could check the spelling(the verbal exchange is part of the learning and I find skipping it hinders her learning - even though she hates the verbal). She explained very well (and I praised her for it) that when she has to do something that she doesn't want to do, she has a little war or argument in her head and it hinders her ability to speak - she is distracted by the argument. I get that, but when I threaten to take away her DS, she is able to overcome the argument and answer. I have told her that her task is to figure out ways that she can overcome the argument quicker without there being a threat from me. I have tried to give her ideas and I have told her that if she overcomes the argument with only three requests and then compliance she will receive a reward that she chooses ahead of time. That strategy is completely not working! I just want to throw up my hands and let my husband raise her for the next few years. I am all emptied out (and I am NOT one to give up easily - where do you think dear daughter got some of her "stick-to-it-ive-ness?). Ugh!

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

My Aspergers Child - Syndicated Content