A lone parent stands in the grocery store, her child kicking, screaming, biting, shouting, and turning into someone she barely recognizes. “All this over candy?” she thinks. “Is this because of his special needs?” she wonders. Other parents and bystanders appear to be staring in judgement as she gazes in horror and debates what to do.
Have you been there? A grey area exists between sensory issues and behavior, but just because a child has sensory needs does not mean every explosion of emotion is sensory related. Understanding the difference between a meltdown, which is sensory related, and a tantrum, which is behavior-based, is crucial to choosing an appropriate and productive course of action in a situation like this one.
Tantrum
A tantrum is behavior-based, usually driven by a goal, and is performed in front of an audience.
Usually driven by a goal: Often, a tantrum arises when a child may want something, such as an item, when a child wishes to avoid a task or when an expected task or schedule has changed.
Performed in front of an audience: During a tantrum, children are able to interact, express thoughts, and will even seek out the attention of others.
If the child gets what he wants, the tantrum will stop and the child will learn that the tantrum is an effective way to achieve a goal.
Meltdown
A meltdown is a result of overstimulation, usually triggered by a buildup of undesired sensory stimuli, has no goal, and is not attention seeking.
Buildup of undesired stimuli: Children with sensory processing disorders do not take in information from their senses as efficiently as typical children. When a large amount of sensory information is coming in at one time, a child with sensory issues may not be able to process all of the information quick enough to produce an appropriate output or to self-calm as efficiently as typical children. Imagine being at work and receiving a large amount of customers, reports, and phone calls all at one time to the point of it becoming overwhelming, then on top of all of these new demands your partner comes in and asks you why you did not do the laundry last night. Your partner may wonder why you are ‘losing it’ over a little thing like the laundry. The process is similar during a meltdown.
Has no goal: During a meltdown there is no concrete goal. The child is not seeking his own way, avoiding a task, or trying to communicate. A meltdown is a complete loss of control which usually requires external assistance to stop. Children can sometimes be taught how to self-regulate during a meltdown or learn strategies prior to a meltdown to avoid having one.
Not attention seeking: Children during a meltdown are not able to communicate effectively, or seek anyone’s attention. Children who have learned strategies for self-regulation may seek deep pressure or a similar strategy, but they would not be focused on other wants or needs (i.e. they would not care about candy, getting their way, schedules, hushing you, etc.).
What to do?
There are different approaches for each type of outburst (tantrum and meltdown). The following depicts different strategies for each:
Meltdown:
- Practice calming strategies when child is calm (i.e., “when I’m upset I can” strategies)
- Utilize heavy proprioception (i.e. put the child in a lycra swing, under pillows, give giant hugs when child is not aggressive, roll therapy ball over child, deep pressure)
- Utilize heavy work and repetitive motions (i.e. stack books, color a paper all the same color, take a heavy backpack up and down the stairs, etc.)
- Reduce stimuli (i.e. turn lights off, remove clutter, etc.)
- Have child drink a sip of water IF water is not contraindicated (when children sip water they cannot cry or scream)
Tantrum:
- Do NOT give the child their way or what they want. Giving in is the easy route and you will regret it later when they think they know how to control you.
- Do NOT let the child out of the task if they are throwing a tantrum to avoid the task. You and the child may need to take a break, but once the child is calm have him go right back to the task.
- Be firm about boundaries ESPECIALLY those which involve safety (i.e. stay on sidewalk, etc)
- Say what you want them to do not what you don’t want (i.e., pick up the mess vs. don’t make a mess, hands in your lap vs. no hitting, stay on the sidewalk vs. don’t run)
- Don’t be afraid to use your position of authority as a parent. Use your mom/dad voice if needed, especially to set boundaries. Do not argue. If you argue the child will think they can negotiate with you. A tantrum is not the time to negotiate. Pick the boundaries then stick with the demand.
- Get on their level physically, within eye contact. If they are on the floor, you may need to kneel to look them in the eye.
- Have a consequence for the behavior.
Consequences
Consequences should be given when the parent is calm, or at least can appear calm. Consequences are not a way to get back at the child for his behavior, but a way to teach the child what he should have done. Consequences often vary based on parenting style, culture, and preference. The type of consequence and amount also needs to vary based on the child’s cognitive level since this is supposed to be a teachable moment. These are the steps to an authoritative consequence, which tends to be more effective and structured:
- Let the child know what they have done
- Let the child know what they SHOULD have done. THIS IS THE MOST IMPORTANT STEP.
- Tell the child what the consequence will be.
- Do NOT negotiate consequence
- Follow through.
- Have the child RETELL you what he SHOULD have done and apologize as needed
- Give hugs and an “I love you.” This is an important step because the child needs to know that you expect certain behaviors because you love them and want the best for them.
Examples of Productive Consequences:
- Have him practice the correct way to engage in the task he tried to avoid with a tantrum, or the correct way to handle a certain situation. For example, if the tantrum was about not getting candy at the store, set up a pretend store or go in the kitchen then have him practice acting appropriately in the store. If the tantrum was about the child not wanting to clean the floor, have the child practice cleaning the floor with an appropriate attitude. Repeat the practice several times.
- Have him do age/strength appropriate heavy work such as raking leaves, stacking books, pushups, pushing a full travel suitcase, etc., a certain number of times. Heavy work is a sensory strategy, but repetitive motion is calming, and also provides a concrete and productive consequence for the behavior.
- Give the child a time out, in a corner or in a designated spot, but NOT in the child’s room or a place of comfort. Depending on his age you can have him stand on one leg or raise arms if needed for a certain time limit.
- Restrict his access to a desired item or task for a certain amount of time.
Handling a tantrum is NOT EASY. It’s incredibly challenging, no two children are like, and it requires a LOT of consistency and dedication on the part of the parents. If tantrums are handled consistently and the child learns that following parents’ boundaries will give more rewards than tantrums, the tantrums should reduce. Note that if the child has been throwing tantrums for a long time, it may take months to make progress. Get help if needed from people you trust and do not give up.
Carolyn Miller, MSOT, OTR/L
