Dr. Bharti Gurnani

Parents dread having to deal with meltdowns. However, parents of children with ADHD may face more meltdowns than other parents.

Children with ADHD are more prone to meltdowns for a number of reasons. Often their brain circuitry for emotional regulation is dysfunctional in which it takes less to trigger an anger episode that lasts for a longer periods of time than other children. This is the result of faulty wiring. Working with them on relaxation techniques like taking deep breaths or counting to ten at the first sign of being upset can help. It is important for them to practice these when they are calm.

These kids often aren’t fully tuned in to what is going on around them and miss important information that causes them to misinterpret a situation and then react to what they think is going on rather than what really happened. If you are having a discussion with your child, pause frequently to make sure they are getting your point. Ask questions to make sure they understand and encourage them to ask you questions as well.

Some ADHD kids lack the ability to be flexible causing them to go into meltdown mode when there is a change in routine or an expected event does not happen. For instance a boy may be having a great time “rough housing” with his dad but does not want to stop when dad feels it has gone on long enough. This can become ugly and lead to fewer such play situations. Agreeing to use a timer and stop when the timer says to stop rather than dad might help avoid this.

Here are some tips for coping with a meltdown:

1. Don’t Loose Your Cool

Take a few deep breaths. This triggers the relaxation response and will lower your own anxiety/anger level and make it possible for you to think clearly and model appropriate behavior for your child. Remember the preflight instruction, “When the mask comes down, please cover your own nose and mouth first before you assist your child.”

2. Don’t React – Respond

If you and your child have already agreed on how meltdowns will be handled with a behavior plan, make sure the plan is being followed. As an example, you might have agreed on an incentive program where your child can earn rewards for following the behavior plan. Incentives might be earning points every time he/she is able to calm down before having a meltdown. Points earned can be cashed in at the end of the day for a desired activity such as television time or a special treat.

If you do not have a plan in place then you can respond by saying “WE have a problem here. Let’s see how we can solve the problem TOGETHER.” Find out what the child’s concern is. See if there is a way to address it. It is not giving in if you modify a situation in a way that is more accepting to the child while still meeting your needs as well. Good leaders listen to the people they are leading and incorporate the feedback they receive.

3. Don’t Dictate – Discuss

Ask, “What is making you upset?” Listen carefully and respond empathetically such as “I see you (want or don’t want), what’s up?”  Find out what the child is concerned about. For instance if the problem is not wanting to go to bed, you might say, “I understand you do not want to go to bed right now even though 9:00 is your usual bedtime. What is bothering you about this?” Perhaps the child says, “I need to finish my video game so I can get to the next level.” You then can say, “So here is the problem we have. I want you to go to bed because it is your bedtime and you need your sleep to feel good and do well at school and baseball tomorrow and you want to stay up later to finish your game. I am not saying you don’t have to go to be now but do you have any ideas on how we can solve this?”

For discussion let’s say it is only for a few minutes and you decide for tonight to let him finish the game to avoid an hour or more of meltdown versus a few more minutes. You might say, “Ok for tonight you can finish the game. Tomorrow we can talk about this and come up with a solution so that from now on you will be able to finish what you are doing and go to bed on time.”

It is ok for us to listen to our children’s perspective on difficult situations. If this is an isolated incidence then, problem solving could avoid a major meltdown. However, we need to follow up the next day with a detailed discussion on how this can be avoided in the future.

If this is an ongoing problem, then simply stick to the program/plan you have already set in place. If you have been working on anger management techniques such a taking deep breaths, then remind the child to practice it.

4. Don’t Demand – Encourage

If you have a prearranged plan to follow or you have come to an agreement for this crisis situation then you can say, “I know you are upset right now but I also know you can do a good job of calming down now,” or “You know what our agreement is and I bet you will do your part now just like the great job you did yesterday. I love how you are getting better at this each time.”

5. Don’t Give Up – Stay Committed

• Raising a child with any type of special need, be it developmental, psychological or medical, requires a tremendous amount of patience and strength to endure and continue to handle tough situations when they come up. Make sure you have a good support system. Be sure to have a break from time to time to do something fun and relaxing. Also, try to view the whole situation from the 30,000 foot level to see the progress you have made so far and that meltdowns now and then can just be little bumps in the road to helping your child learn to cope with the day to day events they encounter.
• If you have truly committed to following a behavioral approach under the guidance of a mental health provider and are not seeing progress, please don’t hesitate to discuss this with your child’s physician. A referral to a psychologist for a comprehensive evaluation may uncover other conditions that may need to be addressed. Sometimes ADHD may be misdiagnosed or a child can have more than one disorder which needs to be addressed.
• When talking to a professional, you should be able to tell them when and where these episodes happen and what took place just before the meltdown; these are valuable clues that a well trained clinician can use to modify your approach or discover an underlying skill deficit that can be improved or addressed.
• Sometimes, when behavioral approaches have been in place for some time and have been tweaked all they can, medication may need to be considered. Parents should be cautious about having their child placed on medication prematurely, but when symptoms are severe and interfering with a child’s ability to function in several environments then medication should be considered and can be extremely helpful.