This blog is the first in a four-part support series for parents by Marci Lebowitz, occupational therapist and autism specialist. Find out more about how Marci supports autism parents and professionals at www.marcilebowitz.com.

What Causes Meltdowns May Be Different Than You Think

For many parents, the very thought of taking your autistic child to the mall can stir up anxiety and brings up memories of previous experiences. This can come from the concern about how others may react if you child has a meltdown and also evoke feelings of helplessness and shared pain for your child. As a result, you may limit your treks out into the world because it is easier to stay out of the public view and in a calmer environment like home. Though meltdowns can easily happen at your home, somehow they feel more manageable in the safest environment. The reality is that there are times when you have to go with your child to the mall and you are willing that this time it will go well.

Things can be okay and then wham, too much stimulus coming in so fast. Too many lights, sounds, smells, emotions, touch, hot and stuffy air. Simply too much of everything bombards them. Because their heightened nervous and sensory system are constantly “switched on”, they seem to be constantly receiving too much input from the environment or some subtle, internal reaction. Each stimulus builds on the last and can create a feeling of overwhelming suffocation. This is also known as sensory overload.

Although it may not be clear what specifically is causing the overload, you know the signs when your child is beginning to escalate. You watch their reactions heighten and their anxiety rev up. They may begin to yell, cry, or screech. Then it comes on fast, the meltdown occurs. Full-blown with maybe hitting, biting, kicking, and screaming. Their focus is gone and the outburst takes over. Your baby, your child, your love.

What can cause these extreme reactions?

There is a link between poor breathing and heightened anxiety. What will register as extreme anxiety for an autistic, may feel like simple fear to us. Their fight and flight mechanism is running all the time. When caught in a constant feedback loop of fight or flight, these children have an extremely difficult time making accurate value judgements of situations. They experience stimuli and circumstances as threatening, intrusive or painful. Because of their exquisite sensitivity, they often feel that many people and situations are unpredictable and frightening. Fight, flight or freeze becomes their primary option.

If you observe a child when they are in complete sensory overload or during a meltdown you may notice they are holding their breath. They do not exhale and are only able to take tiny shallow inhalations, so over time there is more and more stale air in their body and less space to breathe in fresh air. They simply cannot breathe fully which I believe contributes to their panic and escalation of challenging behaviors. Some believe that the child may feel like they are suffocating which must be very terrifying for them.

Think about when you are anxious… Do you notice your breath may become short, ragged or you may even hold your breath? This is amplified for people with autism.

When a threatening situation ends, our bodies and breath should calm. For the children because of their constant state of fight or flight, they may calm down a bit and take a deep breath at the end of a threatening situation, but it is usually from their chest, not from their diaphragm. If you watch them closely, they are calmer, but they never seem to fully calm down. A telltale sign is that they put all their effort into inhaling, not exhaling. In efficient breathing, the effort is on the exhalation in which the muscles relax and the inhalation is gentle and without effort.

In my decade of work as an occupational therapist with children with severe autism and aggression, I have consistently noticed that these children breathe only from their upper chest, rarely do they breathe deeply from the diaphragm. It is easier for us to see that they have poor core strength. This is actually an indicator that the diaphragm is weak and does not work effectively.

Do you know the signs of upper chest breathing?

- Pressured speech or vocalizations
- Shrill voice
- Difficulties listening to others
- Not present
- Difficulties with focus, processing and memory
- Absent, glazed look
- Muscle tightness
- Anxiety
- Difficulties taking a breath
- Difficulties pausing when talking
- A clenched jaw
- Poor posture: Hunched or high guard
- Inability to sit up straight

Does this remind you of your child?

Other causes of sensory overload

There also may be severe, underlying or undetected medical conditions causing sensory overload including conditions like toothaches, stomachaches, seizures, earaches and headaches. Medications or medication changes can also cause heightened reactions. For many, particularly those that are non-verbal it is extremely difficult for them to communicate to us what they are experiencing.

Many but not all manifestations of underlying medical conditions also are present with compromised breathing.

Effective respiration and diaphragmatic control is essential for:

- Strengthening the immune system, brain and gut
- Reducing inflammation
- Speech
- Posture
- A good nights sleep
- Motor control
- Emotional regulation
- Ability to self-soothe
- Processing, thinking, concentration and focus
- Effective colon motility
- Lymphatic drainage
- Neural development

Gentle tips to promote breathing

I encourage you to examine your child’s diaphragm to see if you can detect movement. You’ll see the belly go in and out while they are breathing. Also, look at the chest. If the rising and falling occurs only at the chest and not at the belly, this indicates that they are only upper-chest breathing. Look for where they exert their maximum effort. Is it on the inhalation or the exhalation?

One simple thing you can do to begin to help open your child’s diaphragm is to gently place your (warm) hand on their belly with the intention to help them relax. It is easier to do this when they are laying down. I would recommend only doing this when they are in a calm. Please do not attempt this when they are upset or melting down as this may not relax or calm them. You don’t have to tell them to breathe, your gentle hand on their belly should help them to relax and their breathing may slow. Simply hold your hand on their belly for two to three minutes and breathe yourself! Bedtime or couch time is a really good time to try this.

We’ve been taught to focus on the inhale. However, research shows that the part of the breath cycle that is most important for relaxation is the exhale. Usually we tell people to inhale if they are upset to calm. If they do not have good diaphragmatic control, a strong inhalation can make them feel more anxious as the chest can become tighter. By getting them to exhale first, it creates more space for fresh air to be inhaled.

You want to gently exhale the stale air out of the lungs. Try taking a very small, gentle inhale through your nose and blow out the air through your mouth. See if this helps to relax your body. You can do this with “low functioning” children by having them use a straw to breathe. It is really difficult to take a hard inhale through a straw and much easier to exhale.

I’d love for you to share your thoughts with me. Leave me a comment and let me know about your child’s breathing. Do they have any movement in their diaphragm or is it all in their upper chest?

Marci has been an occupational therapist for 28 years and an autism specialist for over a decade. During her expansive career, she has worked in schools, private outpatient practices, hospitals, a prison medical facility, and skilled nursing facilities.

Known as “the Mary Poppins of Autism,” Marci has developed effective behavioral management systems, sensory calming strategies, and alternatives to physical restraints and seclusion.

Marci is a dynamic speaker and loves educating autism parents, extended families, and professionals about the underlying causes of challenging behaviors; distinguishing between tantrums, sensory overload, and meltdowns; and how to have fun with children with severe autism! Find out more about how Marci supports autism parents and professionals at www.marcilebowitz.com.