mander

This is a question that hundreds of people asked after my latest Twitter thread about Sia’s movie, where the autistic character is restrained in prone position while having a meltdown.

That post explains why & how prone restraint is dangerous and traumatic. But a lot of people were wondering what should be done to help an autistic person during a meltdown. What are the alternatives to restraint? What would I recommend, as someone who’s had countless severe meltdowns myself?

I generally advise against trying to assist with a meltdown unless you know the person. If they’re totally by themselves, then it’s a judgement call. But more often than not, the person will already have someone with them who can help. Additionally, having a stranger approach during a meltdown has a high chance of making the situation even more stressful for the autistic person. So only approach the person in this circumstance if you think it’s absolutely necessary and would definitely help. For example, if the person was lost and needed assistance getting back to a familiar location.

Okay, so, what do you do if assisting the person is the right role for you to take?

The first step when assisting with any meltdown, is to minimize sensory input and ensure physical safety. Meltdowns are the result of overstimulation, so it’s important to try and reduce the amount of external factors that could be causing overwhelm. It’s also important to ensure that the person is not in immediate danger. Often, solving for those two things will involve changing location.

This is complicated, and if a meltdown is already underway it might be impossible to change locations safely. Even if you do change locations, the meltdown has already started so it’s not just going to stop immediately. So, here are some suggestions for direct support to the person. All of this depends on the environment, the tools available, and your relationship to the person having the meltdown. Use your critical thinking skills to consider different types of responses in different scenarios.

If the person can’t speak: assess what communication methods they can use, and what kind of communication is necessary. If you need to collaborate with the person to find solutions (particularly if you’re in a public place), using an AAC app, a picture-based communication system, pen and paper, or sign language will probably be your best bet. If the person can’t access those things but is still able to nod & shake their head, make sure that any questions you ask are yes or no questions. If you ask something like “Do you want to stay or leave?” they won’t be able to respond. Instead say, “Do you want to stay?” and then if that answer isn’t clear, “Do you want to leave?”

If the person is in a loud or chaotic environment: try to remove them as soon as possible. If they stay in that situation, the meltdown will probably get worse. Sometimes it can be hard for autistic people to move on our own when we’re in a meltdown. We tend to get stuck. So having someone lead us elsewhere can be extremely helpful in a circumstance where we’re too overwhelmed to move ourselves or even know where to go.

If the person has comfort items: try to make sure they have access to them. Blankets, pillows, stuffed animals, water bottles, chewies, stim toys, etc. can all help comfort an autistic person who’s having a meltdown. Some of us have favorite items that we carry with us everywhere. Make sure we have those with us (assuming the items aren’t lost; and if they are lost, help us find them).

If the person is injuring themselves or others: the first step is to try and find replacements for those actions, that meet the same sensory need. If someone is biting themselves, try to find something else for them to bite into. Many autistic people have chewies and other stim toys that can help us in this type of situation. If we don’t have one with us, sometimes other kinds of strong sensory input can work as well. Something that has worked for me in the past, to keep me from biting or hitting myself, is to put something frozen on my lips or in my mouth. The cold is strong and provides a very similar sense of relief.

Many autistic people, myself included, find it beneficial to be hugged tightly and to have our hands or arms squeezed by someone else. But this really depends on the person and their sensory profile, as well as your relationship to the person. Some autistic people hate being touched during meltdowns. So you have to be aware of the individual and their specific needs.

The ONLY circumstance in which a person should be restrained, is if they are at imminent risk of causing injury to themselves or others. Noncompliance, angry speech, etc. are NOT a valid reason to restrain someone. And the typical kinds of restraint used on autistic people are actually quite dangerous. Prone restraint, for example, can be deadly. The only kind of restraint I’ve had used on me that was physically comfortable and felt safe, was when my mom sat behind me and put her legs over mine (leaving some space so that I could still bend my knees a little bit), and hugged me from behind so that my upper arms were against my sides but my hands & wrists weren’t being held and could still move.

I’ve been restrained in a basket hold and in prone position, and both of those positions were extremely painful and traumatic to me. There are probably forms of restraint similar to the one I described that would work but are not harmful and that don’t run the risk of injuring the person. The key I think is to have the person sitting upright, and to restrict the movement of their limbs without putting any pressure on their torso or running the risk of bending/stretching their limbs too far. And again, only do this if it’s absolutely necessary and all other options have been exhausted.

If the person is stimming, making loud noises, sobbing, screaming, and so on: Do not restrain the person, try to stop them from stimming, or try to stop them from making noise. As long as they’re physically safe, this needs to be allowed because it’s the only way for the energy of the meltdown to be released. If they’re screaming and it hurts your ears, put in earplugs to meet your own sensory needs. The truth is that there’s almost always nothing you can do to stop this aspect of a meltdown. All you can do is provide sensory tools, move the person to a safer and quieter location, and wait for it to pass.

Now, here are some reminders about meltdowns:

They are neurological events that are beyond the person’s control

Becoming angry at a person who’s having a meltdown will not help

Meltdowns are caused by a buildup of overwhelming stimuli, not just one tiny thing

They can be triggered more easily if the person is hungry or has low blood sugar (so if a person is getting cranky or seems like they might enter a meltdown, try to get them to eat something)

Every autistic person is different, which means that all of our meltdowns look different and all of us need different things when we’re being helped

You should talk to your autistic friends or relatives about how to help them during a meltdown when they’re in a calm and regulated state. If you can’t talk to the person, you can ask their caregivers what things tend to help the most

Meltdowns often require a period of recovery and after-care. Make sure that the person is safe and comfortable as they recover

While there are lots of things you can do to mitigate the chances of a meltdown happening, sometimes they just can’t be prevented. That’s okay, and it’s something you can prepare for

Communication is key when caring for someone who’s having a meltdown. Let them know what you’re doing and why, ask simple questions when needed, and listen when they communicate with you

What works during one meltdown might not work during the next one. Try to be flexible and ready to adapt as needed, because every situation is different

It’s okay if you don’t get everything right. Situations like these are stressful and hard for everyone involved, so don’t worry about doing things perfectly. All that matters is that you’re trying your best

This is all I have to say for now, but there’s a lot that I’m forgetting about or just haven’t included because it would make the post too long.

If you have any questions about autism that you want answered quickly and you’re willing to pay me a small amount (starting at $3) via Venmo or PayPal, you can email your questions to me at [email protected] and I’ll get back to you with a detailed answer (and payment information) as soon as possible. This is something I’m starting as I expand the consulting side of my advocacy work. Thank you for your support!

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