'Act Out' or 'Meltdown: Is There a Difference?

Revised: 27 April 2017

I am always concerned by attempts to identify behaviors that are somehow 'unique' to persons identified with either autism or other specific developmental/behavioral diagnoses. Many risks to such a practice exist most notably ranging from still more stereotyping of ASD, assuming a common ASD neurology, denying individual temperament and personality for the 'diagnosis' and, above all, ignoring the remarkable heterogeneity of persons identified with ASD.

https://www.linkedin.com/pulse/does-autism-cause-behavior-risk-stereotyping-lou-sandler-phd-bcba-d?trk=prof-post

https://www.linkedin.com/pulse/asd-magical-mystery-tour-lou-sandler-phd-bcba-d

In this way, I advise great caution when broadly equating what have come to be called 'Meltdowns' - a term which is neither helpful nor behavioral analytic in nature - to persons with autism as if a kind of medical (or) neurological 'symptom' or otherwise inviolable characteristic in the same way that wheezing is to asthma, chest pain connects to cardiac problems or seizures are a part of epilepsy.

Specific developmental diagnostic profiles are fundamentally identified due to a consistent cluster of characteristics (behavioral observations) which can increase the probability of specific behavioral, social, functional, expressive, cognitive and/or adaptive characteristics. This is, of course, what allows for a 'diagnostic' category in the first place.

Persons with autism have higher probabilities of sensory overstimulation and/or perseveration/stereotypy...but not always and not always the same way.

Persons with Down Syndrome may require more cognitive support...but not always and not always the same way.

Persons with Angelman's Syndrome may have an intensive drive to eat...but not aways and not always the same way.

Persons with a Conduct Disorder (socioemotional) profile may engage in significant cognitive/social misattributions....but not always and not always the same way.

In reality, persons with Down Syndrome can sometimes evidence rather intense stereotypical behaviors and persons with Conduct Disordered profiles may have expressive deficits that are very similar to persons who are more advanced learners along the autism spectrum to include responding to very similarly structured interventions/instruction.

As a relevant aside...I've never liked 'low' and 'high functioning' labels and tend to use an 'early' to 'advanced learner' identification.

https://www.academia.edu/5686314/Is_Autism_a_Public_Health_Crisis....July_23_09.

And everybody else...all the rest of us...can easily and also demonstrate any of these human behaviors depending on a huge range of circumstances, environment, function/adaptation and interactions since everything identified is, after all, human behavior rather than characteristics unique to a particular developmental/behavioral diagnosis.

We smoke and chew our nails (stereotypies); know every stat of our sports stars or favorite actors and keep trying to share this information with friends and family whether or not they are interested (perseveration).

We have explicit cognitive strengths and deficits (areas where we can offer support to others or need support ourselves); have trouble with excessive snacking and weight gain (self control) or may deliberately misrepresent (misattribute) the actions of others in an attempt to not accept responsibility for something we did but know we shouldn't have...

The reality is that there is not a single behavior seen by a person considered to be on the autism spectrum which does not occur, at some time and for a range of reasons, in every other human being.

In other words, each experience is different and 'Meltdowns' cannot be referenced as an across the board, unavoidable and singularly identifiable clinical event just because an individual is identified as having autism.

While issues related to overload or overstimulation can be higher probability in persons on the autism spectrum...sometimes...and can trigger sharply escalated behavior...also, sometimes...these events remain representative of functional behavioral relationships (escape; negative reinforcement paradigms...or..."get me the hell outta here or I'll keep carrying on!"); instructional needs (improved self regulation; self monitoring or enhanced coping skills to include being able to say 'get me out of here' rather than continuing the (functional; contextually relevant) escalated behavior.

With regards to overstimulation/overload; I've long believed that these are a very real and often overlooked predictor for escalated and disruptive behavior both, in persons with autism and other developmental behavioral diagnoses in particular.

Overstimulation/overload is an extremely underexamined establishing operation with regard to such specific escalation/disruption (based on higher probability overall environmental conditions...and I know I'm using EO a bit differently than from the more traditional perspective).

So, instead of the far too ubiquitously used and non-descriptive 'Meltdown,' I actively use, and recommend the use of Act Out as a much better representation of what's happening in that the person is 'Acting Out' function, need and environmental relationships by way of more escalated behavior.

When an individual is trying to communicate, for instance, their preference to avoid/escape a high stress environment and then successfully do so based on the Act Out (not 'meltdown') episode, that success becomes reinforcing thereby increasing the chance the same (and not unavoidable) Act Out will predictably recur.

As always, teaching appropriate alternative behaviors aligned with the function of the related behavior remains key.

While such Act Out (rather than 'meltdown') behavior can and does actively happen - in some - persons with autism, the reality is that Act Out also occurs across different human temperaments and personalities. It is human behavior.

One reason Act Out events can occur more frequently in individuals with autism is directly connected to the occurrence of more significant communication deficits which are often - but, again, not always - present. This point also means that other individuals with other developmental and related diagnoses which share the occurrence of communication deficits also become higher probability candidates for Act Out episodes.

For more elaborated information on this; check out the 'Communication Hypothesis' constructed by Ted Carr and a few others, look up the 'Natural Language Paradigm' designed by Robert Koegel in the late 1970s (the precursor for Pivotal Response Training) or work done to identify 'Coercive Cycles' by Gerald Patterson. And even though Gerald Patterson did not do much work with persons with autism, his writing, research and clinical applications very definitely apply.

There is a sometimes argument for the identification of 'Meltdowns' in persons with autism based on observations that such behavior can also occur when alone. But a reality is that this kind of behavioral event can happen under alone conditions for those with AND without autism; those with or without developmental concerns.

Individuals stressed for a huge number of reasons ranging from employment and money to family issues, loss of a loved one or chronic pain can become intermittently overloaded/unable to cope and Act Out without any need for an audience. And Act Out events which occur under such alone conditions continue to have derived or covert functional/environmental relationships; can be part of a kind of negative reinforcement paradigm as the individual struggles to 'relieve' personal stressors.

And there definitely are times where individuals with autism have simply had enough; are overstimulated and need to recoup and reorganize. But that also occasionally happens to me, too.

Anybody else...?

A little space to include - sometimes - verbalized empathy can be all that is needed under such (correctly) assessed circumstances.

At the same time, that a child who becomes oppositional during a demand activity is not always trying to escape/avoid, overload or overstimulation, and the presumed 'meltdown' cannot be assumed because a person has autism and he/she happens to be in a very active environment. Individualized assessment and knowledge of the person remains the priority.

Kids and adults with autism, of course, also have good old fashioned 'I do want...,' 'I don't want....,' 'I want to watch TV rather than go visiting,' 'I hate shopping' and 'leave me alone' Act Out episodes (or, tantrums!) just like everybody else and most every other child.

Recognizing that children with autism (and other developmental/behavioral diagnoses) are and, always, children first each with their own temperament and personality is too often forgotten for the medicalization of 'autism' and other developmental/behavioral diagnosis. And the misperceived 'Meltdown' is, I believe, part this highly problematic and misrepresented medicalization of autism.

The key remains knowing the person first; knowing and understanding primary environments and relevant others so we can best assess what is going on in order to respond in the most effective/efficient AND respectful/responsive manner to each individual one at a time.

#Meltdown #appliedbehavioranalysis #Functionalbehaviorassesment #severebehavior #autism