Challenging Behaviour.

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I get daily meltdowns which involve challenging behaviour. I have bruises on my body, and even cuts from where I've been throwing myself all over the place and slamming things / breaking things. I also get challenging behaviour in public, to the point that I need support workers to help me when I go out, to keep me safe. My migraines are made worse by head banging during meltdowns.

I don't want injuries, I don't want people staring at me and I don't ever want to be involved with the police again (not criminal offences, but I've been taken under the Mental Health Act / Mental Capacity Act by the police to hospital many times, all of which started off with challenging behaviour in public).

Can anyone suggest anything I can do to reduce challenging behaviour that is not pharmaceutical? I already take high dose Olanzapine (mainly for schizophrenia but also challenging behaviour) and I have mental health team and autism charity support.

I'm asking for your experiences of non-chemical methods. I've tried 7 different antipsychotics and admittedly the only one that reduced my challenging behavior was 20mg Haloperidol, but I had too many side-effects so had to come off it.

An autism service dog?

What is causing the melt downs? Is it certain situations or when is it happening? Luckily for me I had my last bad meltdown in high school. But my daughters meds were messed up and she is in high school and it happened to her the other day. With her, we can see her becoming paranoid when her meds aren't working and getting more worked up and thinking more and more wrongly the more you try to reason with her. Then she explodes thinking she has been wronged so badly when she hasn't been. We find that trying to talk her rational just gets her more worked up about what she thinks people are doing. But we know why she melts down, she wrongly thinks people have done something like talked about her behind her back, or are avoiding talking to her (partly true as they don't to make her worse.) We have to manage her meds and that's about all we can do to stop it from happening. She knows about calming herself or taking a timeout when she needs it, but when her meds are off and she is worked up she doesn't remember to try that. When her meds are better, and she isn't paranoid, she can remember what to do to help herself. For her working meds are just so needed, I can't really think of a way to help her stop melting down without that part working better. If nothing can be changed about the environment or your situation and grand efforts to recognize things are building to that and calming yourself are not working, I'm not sure what more can be done.

The only other thing I can think of, beyond reading about any sensory things you've likely explored like a weighted vest etc would be a lot of mindfulness meditation or exercise, like an hour a day of one (or both) because being able to have some escape from thinking and being overwhelmed seems like it would help.

I like the ideas of investigating possible sensory causes (and taking steps to ameliorate them with weighted vests, etc) and of an autism service dog, if you have not tried either one of those possibilities, yet. Do you also have noise-cancelling headphones or a fidget (such as a Tangle toy or some stones, or anything like that) that help you feel relaxed and calm? My Tangle toy helps me a lot when I'm nervous or feel the need to bite/pick at my fingernails.

I also agree that it couldn't hurt to take stock of the medications....The anti-depressants I've been taking have actually stopped working for about a month now and have been making me even worse. I know that anti-depressants aren't like your meds, but meds can still have that effect, if they're no longer working, or are not the ones you need.

I have tried four different antidepressants during my late teenage and adult life, and they have all resulted in me going manic. People with schizophrenia are more likely to experience mania when taking antidepressants. My psychiatrist and I agreed that antidepressants aren't an option now.

I am on Olanzapine (antipsychotic) at a high dose and Gabapentin at a lower dose, but Gabapentin for migraines not mental / psychological health.

Can you tell me more about autism service dogs? I'd have real trouble looking after the dog (washing him, picking up his poo etc) because of my OCD. I can't even breathe near a dog bin, let alone pick up his litter on the street, and washing him would be a real OCD trigger. And also my uni don't allow animals into lecture halls and especially not laboratories (my course has lab work). Although an autism service dog could work after uni and if I get past my OCD.

I want to buy a weighted vest but they're expensive from what I've found so far. I've considered getting one of those vests that people use to weight them down during workouts at the gym as they are cheaper.

I have rather severe sensory issues. I have coloured light bulbs in my house as regular ones give me pain. When I go out I wear dark glasses and listen to my favourite music at a low level on noise-cancelling headphones (the noise-cancelling is not so great without music playing). I am guaranteed varying severities of meltdowns at uni as that is a major sensory trigger but I have a full-time support worker there. Touch is guaranteed to induce challenging behaviour.

I don't know what else I can do about sensory triggers, I already dampen life input a lot.

I also have Clonazepam but I only use that when I'm in the worst state as it's a benzodiazepine and I don't want tolerance and dependence.

I will ask my OT about what else I can do when I see her. I'll probably write her a letter as usual to avoid speaking too much. People say I sound a bit stupid when I talk, but when I write / type, I am eloquent and comprehensive in my descriptions.

I'm fairly sure universities have to make exceptions for service animals, though I'm not sure that applies in the laboratory.

I second the mindfulness suggestion. It works at least as well as anti-depressants for a lot of conditions, seems like your best bet to me.

I have been using directed visualisation for meltdowns with some success. It doesn't eliminate them altogether but it reduces the symptoms a little.
The steps for mine are as follows:
1) Identify triggers
2) think of a visualisation that will reduce the triggers to a smaller size
3) write a short script and practice the words until they are memorised
4) keep a copy of the script with you (you can write it on a card) alternately, you can carry an object with you that triggers your memory of the script. You can also tell a support worker to remind you if you forget.
5) say the script when needed (in your head if you don't want to appear too crazy)

How mine works:
1) crowds, noise, movement trigger meltdowns
2) I will visualise the people as ants (reducing their size)
3,4,5) "they are ants, all ants. I see them from above. They are swarming around me but they are just ants. I tower over the ants. It's ant noise. Ant music. Adam and the Ants. I love the jukebox...."

I used this in a situation the other day when I basically became a human traffic island in a large crowd. By using this technique I was able to keep it together until I could escape. I still needed to do lots of hand flapping and pacing afterward but I didn't cry nearly as much and it didn't last as long as usual so I guess that's a plus. I've only just started this technique though, maybe it will improve with time.

You probably think I'm crazy. You would probably be right.

It sounds like you are taking this PRN??? Which is the way it can actually be dispensed (prescribed). How often do you take it? Do you take it once-a-month----or, like, 3-5 times a week? I'm asking because I was presribed this medication, and was told to take it "as needed"----but, I had TERRIBLE problems with it!! !! If I take it once-a-month, or every couple of months, or whatever----NO problem!! ! If I take it 3-5 times per week, MAJOR problem. I would have meltdowns, be extremely angry, feared EVERYTHING, practically, etc. I had to take it on a set schedule. If I didn't take it every day, at the same time, FORGET IT!! ! When I read that you were taking it, I was thinking that it could be the reason for all of your problems, right there----or, at least, some of them!! !

Autism is basically a profile of different types of dyspraxia (fine motor which is often specific like non verbal or disgraphia; ideomotor which is imitation and learning from demonstration, and/or conceptual which interferes with initiation and follow through) and/or sensory. Autism does not correlate with cognitive delays.

NTs believe we lack empathy. But any group lacks empathy with those it feels separated from. We end with polarizations such as male vs female, black vs white, muslim vs christian, etc. NTs frequently feel separated from the autistic way of thinking and do not understand us, but we are empathetic. However we may not relate to NT thinking styles.

If you're having melt downs it is either sensory (visual. auditory, tactile, olfactro-gustatory, proprioceptive, and/or vestibular) or frustration with apraxia or both. Few NTs will understand this so you must research and fix it yourself. Many of us here have come to understand ourselves and created our own accommodations.

What does your psych say about these emotional dysregulation problems?
Is there some non-drug therapy that you have tried or could try?
Based on your posts about this topic and the descriptions of triggers and meltdowns, I think the problem to focus on is emotional dysregulation rather than sensory overload.
Your emotional dysregulation seems severe, so it might not matter how much you dampen sensory stimuli, if there is no control over the response.

If I were you, I would consider getting an autism service dog and use other sensory tools such as a weighted vest, as others have suggested.

Some strategies that have helped me include:
# Medication: Lamotrigine and Clonazepam daily at set doses
# Sensory: Weighted blanket (on bed etc), noise-cancelling headphones, eye mask...
# Communication: Tell others when I am getting anxious (traffic light system - green = OK, orange = getting anxious, red = getting very angry)
# Retreat: Place to retreat to when I am overwhelmed - an area that has minimal sensory stimuli and where I can use calming techniques eg. My bedroom, lounge room if at someone else's house, etc
# Meditation: Meditation/Prayer each morning, Mindfulness techniques during the day
# Routine: Daily routine on my phone etc, including adequate times to eat, exercise, sleep
# Lifestyle: Improving nutrition, ensuring I get more sleep each night, daily exercise

Lamotrigine probably had the greatest impact in my overall ability to regulate my emotions. It also has helped reduce obsessive excitability. The weighted blanket is wonderful when I need to calm down because I can wrap myself up in it. Plus communication and a place to retreat to are necessary.

Thanks everyone.

btbnnyr - I usually get meltdowns in response to sensory overload, but I do get meltdowns in response to change of routine. I am not sure what your mean about emotional dysregulation? I do get frustration when I can't do something but 75% of my meltdowns are in noisy, crowded places or on public transport.

I take Clonazepam maximum twice a week. I get quite significant drowsiness from 0.5mg but 0.25mg isn't good enough for severe meltdowns. So I can only take it if I know I will be able to sleep later on that day.

Mindfulness and meditaton - I've started on that recently but the progress is slow. My support worker does slow breathing exercises when I'm stressed out and she's there with me. I also found a guided meditation video on YouTube. However with meditation I seem unable to stay still. While the voice is telling me to relax my muscles, I have an itch on my foot that I need to scratch, then my leg feels numb, then I get an itch somewhere else....basically I find it hard to stay still, and tics don't help either. I find it incredibly hard to "zone out".

The script is something I will try today as I'm seeing a friend.

Yesterday I attacked my friend during an overload meltdown. He had to pin me down to the ground. I asked him to apply deep pressure by hugging me really tight which helped me to stop screamig and lashing out.

This morning I had a huge meltdown set off by a mixture of triggers. I have bruises on my body from throwing myself at the walls and tearing at my skin.

Clonazepam seems to have halted it but I took it too late, as I lose insight into my meltdown when I have one, and my dad had to literally yell at me down the phone to take Clonazepam.

But now I am a bit calm but exhausted.

I'm probably going to sleep. Clonazepam knocks me out.

My dad is emailing my psychiatrist about going on a typical antipsychotic like Zuclopenthixol or Haloperidol on top of my Olanzpaine. Olanzapine helps with psychosis but Haloperidol or Zuclopenthixol has helped me with challenging behaviour before.

I look like I've been beaten up.

Advice?