Anxiety Attack vs Meltdown

For awhile now, Lizze and I have been saying that Emmett has anxiety or panic attacks. When I had mentioned this to the developmental neurologist, she said he was simply throwing a fit.

As far as I’m concerned, a meltdown and an anxiety attack are to vastly different animals.

Emmett can have a meltdown when he doesn’t get his way.

I get that.

However, when we are trying to get him dressed and he completely loses it, its different than a fit. He seems panicked and afraid. When we mentioned that to the developmental  neurologist,  she again said it was a fit and to push him through it.

I bring this up because, after therapy today, Emmett had two panic attack-like episodes.

Lizze was with him when it happened but she said he was hyperventilating and seemed scared, rather than angry.

This actually happened with me the other day. I was getting him out of the car and the ground outside was wet. When he realized the ground was wet he went into a panic. He doesn’t like walking on anything that could make his shoes wet or dirty….

Now, the developmental neurologist says to make him walk on the ground anyway. This will help to desensitize him.

I get the point of doing that, however I don’t feel right pushing him when he’s literally terrified. I know the difference between a disciplinary issue and some that causes my child to completely panic.

We work with him in overcoming those fears but we won’t traumatize along the way. Most of it is sensory related and something that will be a work in progress.

Do you think that we are doing the right thing? Should we force hon to do something that will cause him to get so upset that he vomits?

In of the mind frame that baby steps, no matter how small, still constitutes forward progress. Forcing something on him like that seems counterproductive….yes?

Thoughts? Experience?

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@Kibblet

OT should be a better judge of this, as a psychologist would be. (Especially one that specializes in behavior.) A neurologist, as smart as they may be, simply don't specialize in this sort of thing, and I've been told that by them more than once. There are ways to desensitize kids, and ways to make baby steps, and ways to figure out why they're balking. Even discussing recent problems with my son, his psychiatrist said we should see a psychologist more regularly to help sort out what is a medical problem and what is a behavior problem. When we first started having problems, we saw a psychologist who specialized in "challenging behaviors" who observed him at school and at the clinic in Iowa City, and he actually helped us learn how we were making things worse! Things we all already knew, but were so wrapped up in, we were missing. A lot of "OH MAN, YEAH, HE'S RIGHT" insights. But he was the expert in that, which is why he picked it up. (Him, and his entourage of grad students, of course.) And OT has really helped my sons with SO MANY THINGS and we didn't have to force them to do ANYTHING. In fact, one kid graduated OT completely. By the way, have you seen the How Your Engine Runs program? IT helps teach kids the skills they need to regulate behavior, using sensory input if they are "too high" "too low" or "just right". Sensory exercises are in their "tool belt" (short ones to help little things before they get huge) and "tool box" (more intensive ones done regularly, like a car tune up, or done when a huge meltdown or other similar problem is occuring.). They use it at therapy here, AND in the schools. It's pretty awesome.

Ashley Farmer

I really think this therapist is wrong!! When it comes to the spectrum and sensory related issues, I feel like each kid is unique in how you have to approach it. In my son's case, for example, he won't eat a lot of foods because of the way they look to him. Most of the time, we can't even get him to try them. We started playing a game with him to get him to take a bite of the food. Sometimes he puts it to his mouth and then won't eat it, but sometimes he'll take a bite and decide he likes it. It took a silly game to get that to work. We tried pushing him to eat these types of foods before and it did nothing but scare him and end in all of us upset and/or angry. I won't do that again. Now I give him a lot of latitude in what he eats, but he usually always tries at least one bite of something that we are eating and that's all I expect of him.

Yesterday, he had a complete breakdown because I didn't want to put his dirty socks back on him for him to go to bed. He's insistent about wearing his socks to bed. After he started hitting himself in the face and got really upset about it, I realized it was really that important to him (maybe it's textural for him?) and put them back on. In the grand scheme of things, what does it matter if he wore dirty socks to bed? Really?

And I think maybe that's the same case for your son. Working with him to progress over time is absolutely a fine thing to do. And I would never recommend we push our kids to the point of vomiting. What purpose does it serve? I think that would just make him MORE frightened of the event/item that he was scared of the first place.

My recent post Autism – A Mom’s Perspective

@FCMichigan

The Crash Course in Meltdown Management does a great job in breaking down the differences between the different types of meltdowns. Check it out at http://blog.friendshipcircle.org/2011/12/06/a-cra

Julia

I feel like an idiot, I totally forgot how visually sensitive Emmett is, which could explain why he doesn't want dirt on his shoes..it changes the way they look.

Kaitlin

It isn't a good idea to completely give in and avoid these things because that is how they get worse, whether it is anxiety or fit related doesn't make a difference. I have OCD and my daughter has autism. I understand because of my OCD that giving into irrational anxieties only makes them worse. But facing these fears must be done in a careful manner. It isn't good to force and it isn't good to completely ignore. They need to be slowly addressed. I would start small. No matter what, the situation is going to be uncomfortable and you will likely see tears, but this isn't the same as throwing him into the lion's pit. Maybe start by showing him you don't care when your shoes get dirty. Then maybe move on to putting a tiny drop of dirt on his shoe and show him nothing bad happens. You get the idea. Keep trying. It needs to be addressed or else it will only get worse. When it comes to getting dressed I would talk to and OT if possible.
My recent post The Rubberneckers

Julia

The biggest difference between an anxiety attack which is OCD related and one that is sensory based is that a person with defensiveness isn't reacting to a thought or perceived threat, their brain actually interprets the information as threatening and dangerous or painful. So when Emmett puts clothes on, he actually genuinely feels pain like when a typical person cuts themselves which is why it's so important not to push in these situations unless the defensiveness is being treated and you've changed the neurology first. The dirty shoes thing would appear to be more purely anxiety related because the dirt isn't physically touching him but he could see dirty shoes as only being a small step away from dirty feet and therefore panic inducing. Teasing out how much is sensory/anxiety and behaviour is always a bit of a challenge 🙂

jvb

My aspie son has had some successes with similar anxiety issues. I agree with you that some meltdowns are due to anxiety and these are different in many ways from the typical rage meltdown. My son has a super high anxiety level for many many things. I also agree with you that forcing him to do something that terrifies him would be counterproductive! What has worked for my child is 1. social stories about the thing that is bothering him..I read these several times a day to him but ESPECIALLY right before I know he will be exposed to something that makes him anxious. (of course,..I don't always know but sometimes I am lucky enough to know beforehand!) 2. exposing him to it in micro mini doses..like 2 seconds.For example, my son had huge anxiety over family members walking around outside without shoes on. So what I did was for about a month I would read different books to him that had one picture of someone walking barefoot. Then the next month the books would have more than 1 picture of that in it. Then when he would tolerate that, I would put one shoe and sock on and only a sock on the other foot and say I wanted to check the weather outside and would just open the door but not step outside. When he tolerated that then I would do it without the sock on. Then I would just tap my foot outside the door for a second but not actually go outside and so on and so forth. It was a very long process.but it worked. 3rd I had him repeat a catch phrase about it to me. We also did this several times a day. His was " Walking without shoes on is ok. Sand at the beach feels soft on my bare feet. " I chose that because he loves the beach and the sand so in my thought process I hoped it would trigger a pleasant memory that could help counteract the anxiety he was feeling when he saw/thought about/talked about bare feet. Like I said before..it was a long long process but now he is ok with it..well kinda..he will still chant the catch phrase if I go outside without shoes on and he still has some anxiety over it but he USED to scream wildly and bite / claw at me (drawing blood!) if I even opened the door to the outside and I did not have shoes on. If I even tried to joke that I was going to go outside with no shoes on he would usually bite me and go into a meltdown. Sooo being a little anxious over it is HUGE progress for us 🙂 Good luck with your little men. I hope the info I have shared might be helpful to you. I found your blog through twitter. Thanks for sharing glimpses into your life. I always find it comforting to know that I am not alone in going through this autism journey ! I especially like your posts about "no autism here" !

Jodi

Have you tried writing a social story for him about his anxieties. We use "different is ok" quiet often in my school
You can say sometimes my clothing makes me feel funny or Itchy or uncomfortable because it is not what I usually wear( not sure what he usually wears). But different is ok. The clothes may feel funny but it won't hurt me. When I
Go out I need to wear my pants. I like to go out. Etc (talk basically about positives of wearing items and lable different is ok. So when he is upset you can try saying different is ok. This may take time to go over many times but can help with transitions.

Also for walking on wet. I don't like walking on wet ground. I don't like getting wet feet but different is ok. I can try to walk on wet ground and stay away from puddles. If my feet get wet I can change my socks ( make sure you have dry socks.)
Again you may have to go over many times but we successfully use social stories often with childen I work with with many sensory clothing issues. What is your OTs view on this. Our OT at
School helps with sensory issues.

Also teach him a relaxation technique to do when he needs to calm from a panic attack. Keep it the same prompt him through it and hope eventually he does on own to calm.

I have worked with many children with autism over the years. So I'm new to reading blog. But feel I can offer suggestions based on what I have seen over the years

Personally I HATE wet socks too. I often keep dry socks around so I can change.
Good luck.

Silachan

Any doctor, neurologist or professional who says you need to just make him do it and 'desensitize' him does not deserve to treat those with sensory issues. This is not OCD, where gradual exposure will help ease the symptoms. Sensory issues, especially those that cause anxiety, do NOT need to be forced upon a person no matter how small. If Emmett is anxious about touching the wet ground because he doesn't like the feeling of wet socks or shoes, then continue and help him however you see fit- even if that means picking him up. It won't make him "spoiled", but it'll help reassure him that you're there to help him.

Have you tried to talk to his OT about it? She might be able to help out better since she directly knows his needs and what he avoids.

Julia

Gah!!! I hate doctors sometimes. There is absolutely no benefit in pushing a defensive child into an experience when they are in a heightened state of fear or anxiety. All you do is create a negative emotional 'tag' that stays with the experience even after you've cured the defensiveness itself. Exposure should only be attempted with the child's willing participation and in a situation where they have a certain degree of control. Yes there are things that kids just have to do but the anxious/panicked reactions are purely instinctual and reflexive. There is no rational thought involved and in the heat of the moment, they actually over ride the ability to think rationally.
So to summarise, you're doing the right thing 🙂

Toni Smith

We are faced with a very similar dillema. Our son Andrew has a severe anxiety about trains. He needs to cover his head with his favorite blanket in order to cross any railroad track – he has had meltdowns because of this. He gets anxiety about going anywhere away from the house because he needs to know exactly how many tracks we will cross to get there. Unfortuntely we live in an area where we are forced to cross tracks no matter which direction we go. Lots of people tell me the more he crosses them the more it will desensitize him. I say "yeah right". The more exposure he has the greater his anxiety. Some people ask what is it that causes him to feel this anxiety? I say "I don't know" and that's the truth. It is many things: the flashing lights, the dinging of the bells, the train itself, the feeling of the tracks as we pass over them.
So, we are in a similar boat and we just don't know what to do about it. We are praying he will eventually outgrow it but if he does, I will put down a bet that there will be something else he is affixiate his anxiety to.
Keep your chin up Rob 🙂

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