stress and meltdowns

Stress and meltdowns

Digby Tantam

Paper given to conference on ‘Stress and Autism’ organized by Research Autism, given in London on 13 May 2013

Relaxation Stress

Ulrich-Lai, Yvonne M., & Herman, James P. (2009). Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci, 10(6), 397-409

Engelmann, Mario, Landgraf, Rainer, & Wotjak, Carsten T. (2004). The hypothalamic–neurohypophysial system regulates the hypothalamic–pituitary–adrenal axis under stress: An old concept revisited. Frontiers in Neuroendocrinology, 25(3–4), 132-149.

Chronic anxiety = stress

Selye’s ‘general adaptive syndrome/ stress syndrome

Gordon, I, Carina, M., Feldman, F, & Leckman, J. (2011). Oxytocin and Social Motivation. Development and cognitive science, 1(4), 471-493.

Gordon, I, Carina, M., Feldman, F, & Leckman, J. (2011). Oxytocin and Social Motivation. Development and cognitive science, 1(4), 471-493.

TEND AND BEFRIEND VS FIGHT AND FLIGHT

Stress and ASD: social corollaries

• Reduced response to soothing because reduced oxytocin

• Reduced access to peers and social solutions

• Social interaction as a source of threat• Failure of social sanctions• Challenging behaviour and not assault, or

criminal damage, or threatening behaviour• Perceived lack of planned impact on others

Parents stressedEstes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G., & Munson, J. (2012). Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders. Brain & Development. doi: 10.1016/j.braindev.2012.10.004

• Mothers of 18-30 month old infants with autism, intellectual disability, or infants who are normally developing

• Mothers did not differ on anxiety or depression

• Parenting stress greater for mothers of children with autism

• Anxiety or depression and parenting stress correlated with child’s problematic behaviour

People with an ASD are stressed and this contributes to challenging behaviour

• Anxiety contributes to challenging behaviour (Pruijssers, van Meijel, Maaskant, Nijssen, & van Achterberg, 2013)

especially in children with ASD where poor sleep is also a factor (Rzepecka, McKenzie, McClure, & Murphy, 2011)

• People with ASD have chronic stress states (Kushki et al., 2013)

• Displacement (e.g. rituals) relieves stress (Mohiyeddini & Semple, 2013)

 Kushki, A., Drumm, E., Pla Mobarak, M., Tanel, N., Dupuis, A., Chau, T., et al. (2013). Investigating the autonomic nervous system response to anxiety in children with autism spectrum disorders. PLoS One, 8(4), e59730, Mohiyeddini, C., & Semple, S. (2013). Displacement behaviour regulates the experience of stress in men. Stress, 16(2), 163-171, Pruijssers, A. C., van Meijel, B., Maaskant, M., Nijssen, W., & van Achterberg, T. (2013). The relationship between challenging behaviour and anxiety in adults with intellectual disabilities: a literature review. J Intellect Disabil Res, Rzepecka, H., McKenzie, K., McClure, I., & Murphy, S. (2011). Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder. Res Dev Disabil, 32(6), 2758-2766.

Catastrophes and stress

• Life-threatening stressor• Integrity threatening stressor• Social integrity: shame• Control: outrage at broken rules or coercion• Inner integrity: catastrophic reaction/

meltdown

Catastrophic reaction in dementiaYeom, H.-A., & Watson, N. M. (2009). Patterns of Antecedents of Catastrophic Reactions in Nursing Home Residents With Dementia in the United States. Asian Nursing Research, 3(3), 99-110.

• Fight: extreme anger or hostility • Perhaps influenced

by modelling• Flight: extreme

sorrow or withdrawal

• Combination of fight and flight: agitation

Meltdowns in ASD are a kind of catastrophic reaction, supervening on chronic stress, with an expression that is shaped by modelling, with one trigger being cognitive overload

• Executive function• What have I forgotten?• There’s not enough time…

• Nonverbal interpretation task• Was that a joke?• What’s going on in this group?

• Language task• What does that mean?

Implications

• Track an increase in ‘stress’• Be aware of shame and humiliation as

contributory factors• Can sensory factors be a trigger—

perhaps especially olfaction• Reduce complex cognitive demands• Take fatigue into account