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From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively by Deborah Lipsky

Introduction 11 1 Seeing the World Through Our Eyes 15 Is autism part of an evolutionary process? 17 The importance of scripts 19 Heightened senses impact our ability to navigate social settings 20 Growing up undiagnosed with autism 24 "Scripting": the golden rule in autism 26 Going off script 27 Hating spontaneity 32 Dealing with going off script 33 2 Anxiety: Friend or Foe? 37 Neurological makeup similar to certain animal species 37 Difficulty making eye contact 38 Reason 1: sensory integration 39 Reason 2: peripheral versus central vision 41 Exercises to improve central vision 45 Reason 3: a non aggressive gesture 45 Light touch interpreted as aversive 46 The fight or flight response 47 A prehistoric carry over 48 Triggering a fight or flight response 49 1 The onset of the "freeze" response 49 2 The release of adrenaline 51 3 Loss of cognitive awareness 52 4 The danger of injury 53 The "freeze" response 54 My personal experience with the freeze response 56 3 How Anxiety Impacts Our Cognitive Abilities 59 The stress of navigating through the simple task of shopping 60 Societal inconsistencies 66 A world of absolutes: a major reason for anxiety 68 What are we "feeling"? 70 Problem solving from the autistic viewpoint 74 The fear of unpredictability 74 Stimming 76 Stimming defuses rising anxiety levels 76 Stimming done solely out of habit 79 The child who keeps badgering you with questions they already know the answer to 80 Should we use medication to help reduce anxiety levels in individuals with autism? 81 4 Rituals and Routines: A Natural Defense for Anxiety 85 The need for predictability 87 Although every individual is different, routines are universal 89 What is the function of a ritual? 89 How a ritual differs from a routine 89 Common sense, OCD, or a ritual? 90 Unexplainable rituals 93 Minor changes that could create anxiety leading to new rituals at home or school 93 Interrupting routines 94 Non functional routines established unintentionally 95 Avoiding the use of immediate tangible rewards 96 Modify a routine gradually 97 Replacing a non functional routine 98 Handling interruptions in routines 100 Unforeseen interruptions in a routine 100 The influence of stress on routines and rituals 102 A personal example of how a non functional routine was calming 103 Never interfere with a ritual or routine 105 5 What is a Meltdown? 107 Not all individuals will experience meltdowns 107 Meltdowns are not tantrums 108 What is a meltdown? 109 How I developed my interest in creating meltdown interventions 109 What causes a meltdown? 112 Going off script: a leading cause of meltdowns and catastrophic reactions 113 Not receiving comprehendible answers: another major source of meltdowns 114 Two types of meltdown/catastrophic reaction: cognitive and sensory meltdowns 115 Cognitive meltdowns 115 Cognitive overload and meltdowns 116 Too much choice causing a meltdown 117 Bolting or running away during a meltdown 119 Witnessing self injurious behavior during a meltdown 120 Can self injurious behaviors occur in the Asperger's population? 121 The physiological response of the body during a meltdown 121 Common warning signs and behaviors indicating increasing anxiety, leading to a meltdown 123 The "freeze" response heralds an impending meltdown 124 Immediately after the highly excitable part of the meltdown phase 126 Summary: phases of a cognitive meltdown 127 Sensory meltdowns 128 How a sensory meltdown differs from a cognitive one 130 Accepting sensory limits 130 Summary: sensory meltdowns 131 Cognitive and sensory meltdowns 132 Shut down responses: the other extreme of a meltdown phase 132 The aftermath of a meltdown: intense feelings of remorse, embarrassment, and shame 133 6 How Does a Tantrum Differ from a Meltdown? 135 The golden rule in meltdowns and tantrums 136 Tantrums are a choice 140 Distinguishing a meltdown from a tantrum: a checklist 140 Controlling established tantrums 142 How to handle a tantrum 143 A word of caution 145 Aggressive or self injurious behavior during a tantrum 146 Intervening successfully 148 How to test for a tantrum in the verbal individual 149 How to test for a tantrum in the non verbal individual 150 Utilizing special interests and/or objects to test for a tantrum 151 Look for the tell tale signs of anxiety 152 Non social tendencies 152 Instant gratification as a potential source of tantrums 154 Using a token system as an effective alternative 155 Today's society as a saboteur of behavioral interventions 156 Societal distractions as a sign of the times 157 A ray of hope 159 7 Meltdown Triggers 161 Novel situations: the number one meltdown trigger 161 Airports: my personal nemesis 162 Back up scripts or contingency plans: the main strategy for novel situations 164 "In the unlikely event of…" 165 A case in point 165 Multiple back up or contingency plans are beneficial 166 Communicating back up plans to the severely autistic or non verbal population 167 Back up plans for the verbal and high functioning population 168 Sensory issues compounding the stress of a novel situation: a classic example 169 Strategies to prevent a meltdown in this complicated novel situation 171 You can't prepare for all novel situations 172 Transitions: another major contributor to meltdown 172 Transitioning from class to class 173 Transitioning to a different subject 174 Substitute teachers as a transition issue 176 Other transitions that can cause a meltdown 177 Moving from one home to another 178 Transitions revolving around parental status 179 Guidelines for parental status transitions 180 First time visits to the dentist or doctor 181 Other triggers for meltdowns 182 Trying to participate in a group conversation 183 Time limits as a source for catastrophic reactions 184 Being rushed or hurried to do anything 185 Meltdown and catastrophic reaction triggers 186 Hormonal influences and meltdowns 188 8 Communication Triggers that Cause Meltdowns 191 Miscommunications are just as prevalent in the non verbal population 191 Autistic communication differences 192 1 A large factual knowledge base 192 Dealing with fears by acquiring facts 193 A teen obsessed with the macabre: a communication misinterpretation 195 Factual exchanges are mentally stimulating 198 2 Autistic individuals are more comfortable with "question and answer" communication 199 Communication as a main source of cognitive overload 200 Requests that imply ability and not a command 201 Literal phrases involving a timeframe meant to be interpreted as non specific 202 The overuse of binding words that aren't taken seriously 203 A broken promise 206 Vague time references that may elicit an extreme anxiety response 208 Vague undefined open ended questions 209 Adding a yes or no, as well as adding a time reference, clarifies your question 211 Why does the word "No" cause a meltdown? 212 9 Meltdown Interventions 215 Three main goals of intervention for meltdowns/catastrophic reactions 216 1 Safety of all involved is paramount 216 Self injurious behaviors and safety 218 2 Reducing the stimulation level 220 How you should communicate to a person in a meltdown 221 3 Addressing the problem at hand 222 When there are no alternative solutions 223 Autistic emergency tool kits for reducing the anxiety associated with impending meltdowns 224 Early recognition of signs of anxiety is the best strategy for preventing meltdowns 227 Physical movement as a calming tool for the verbal and non verbal individual 228 Avoiding a meltdown in the first place 229 Sensory triggers at crowded gatherings that are best avoided by not going there 229 A final suggestion: learning to accept meltdowns as just part of who you are 231 Getting the wind knocked out of my sail 232

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