By Dr. Brandon Printup, Clinical Director at Bobby Dodd Institute
Ten years ago, I worked with a 13-year-old teenager diagnosed with attention deficit hyperactivity disorder (ADHD). On paper, my client presented with classic ADHD symptoms and was put on medications, which, at that time, were more stimulant-driven. As I progressed in working with him, I noticed some red flags indicating that he might be experiencing a trauma response, not ADHD. We spoke with his psychiatrist to obtain permission to take him off his medications and try to work with him from a behavioral standpoint. We began working through the trauma lens, focusing on safety (more on safety covered below). With the support of his parents, we started managing some high-energy behaviors and lapses in focus and concentration. What we discovered was that, in fact, the issue wasn’t ADHD but a trauma response. He was exhibiting a fight response characterized by hyperarousal.
More and more often, I see people dealing with classical trauma responses, and we often rush to diagnose conditions like ADHD. We need to approach these situations from a different perspective, ensuring that individuals feel emotionally safe and supported as they confront their challenges.
In my practice, I am privileged to meet with many individuals. Each of them comes to me with their own story, struggles, hopes, and wants. While I always approach each person individually, through my work with diverse disabilities and mental health conditions, I have found that there are some universal strategies that can help with meltdowns. If done right, these techniques can be extremely helpful for autism, ADHD, anxiety, and depression.
Before we dig deeper, let’s first cover some important concepts.
Let’s do an exercise. Look at the picture below while listening to the beat of the song “Happy” by Pharrell Williams. Imagine yourself sitting at the beach. The sun is kissing your skin. You are holding a refreshing drink in your hand. The sound of the ocean is so relaxing. Doesn’t this feel fantastic?
Now, let’s change the perspective. You are sitting at the same beach with your feet on the soft, wet sand. You feel the waves. But out of nowhere, the people around you start screaming and running in multiple directions. The tune changes drastically, and instead of “Happy,” now you hear the theme song from “Jaws.” There are sharks in the ocean approaching quickly, and they are right in front of you. What happens now? Your heart rate begins elevating. You are overpowered by crippling anxiety. What would you do in this situation?
Our brains are programmed to react differently in different situations. In our example, the first situation was soothing. The second was severely traumatizing.
This brings us to our first concept.
Fight, Flight, Freeze Response
During stress overload, like the not-so-happy shark adventure, our brain usually defaults to the primal responses: fight, flight, or freeze. When our safety is endangered, this triggers a natural response to stress. If we go back to our shark massacre example, the natural fight, flight and freeze defense mechanisms can help us escape the threat. In most situations, when the stressor goes away, our body returns to its normal state. When we find ourselves away from the danger, we begin to calm down.
Short-term stress is proven to have many benefits, such as enhanced mental and physical performance, better recovery, improved immunity, and increased resistance to infection. On the other hand, long-term stress can negatively affect our physical and mental health and compromise our immune system. In the example with my client, he was in a constant fight state as a response to trauma, resulting in hyperarousal.
In fight mode, an individual is more aggressive, hyperactive, irritable, and angry. They may have trouble concentrating and become easily agitated. Physical symptoms may include increased heart rate, high blood pressure, and tight muscles.
In flight mode, an individual is more withdrawn and avoidant. They may also isolate themselves and become easily bored. A person’s heart rate may increase in preparation to escape a triggering situation. A person who is in flight mode may feel trapped. Fidgeting or being unable to stay still is also common.
In freeze mode, an individual shuts down and zones out, often daydreaming. You may find them whining more and needing to be more compliant. They may have trouble speaking or become non-verbal. They may not be able to take action or respond to a situation.
Sometimes, trauma responses can be mistaken for other diagnoses, so it’s important to treat the behavior and trauma instead of just using medications. This means we need to make people feel safe to help their brains relax and calm down.
Practical steps include recognizing what triggers flashbacks and making sure we interact in ways that make the person feel safe and cared for.
Before I reveal my de-escalation techniques, let’s first review a very important concept — behavior.
What is Behavior?
Simply put, behavior is a response, whether emotional or non-emotional, to an event. It is the way our body processes the things that are happening to us and around us. The renowned philosopher and psychiatrist Alfred Adler, who focuses on individual psychology, says that every behavior has a purpose. He believed that we all have one basic goal — to belong and feel important. When we don’t belong, and we don’t feel secure, we tend to act out through aggression and negative behaviors.
Escalation in behavior is a pattern that can worsen over time; it can manifest in behaviors such as increased vocalization of emotions, social withdrawal, property destruction, severe tantrums, etc.
Stress Response Triggers
Lack of Safety
When we interact, we must make sure that the person in front of us feel safe in any situation. This is a crucial first step in the communication process. Safety is emotional, physical, mental, spiritual, and social well-being. In essence, the person needs to feel like they won’t be hurt or endangered in any way.
In order to understand safety, it is essential that we understand the individual’s diagnosis and his or her functioning level. Different psychological conditions, such as anxiety, post-traumatic stress disorder (PTSD), and neurodivergence, influence how individuals perceive and respond to safety. For example, you cannot treat a person with autism the same way you would treat someone with depression. The feeling of safety is a case-by-case basis for each condition.
When people get upset, frustrated, or angry, they don’t feel safe because they don’t know what to do, what to expect, how to communicate, how to talk, or how to navigate through certain situations, which may cause concerns and can trigger responses.
In my opinion, many things that we usually refer to as post-traumatic stress are simply trauma responses, like complex trauma or acute trauma. There is ongoing research to help us understand these better so we can offer improved and more specific trauma responses.
Sensory Overload
You are peacefully cooking your favorite recipe. It smells delicious. You are in your own small world, thinking about dinner and the taste that your palate enjoys so much. It is nice and warm, and maybe you are hearing your favorite show in the background. But suddenly and without warning… BAM! The fire alarm goes off. Your idyllic moment is interrupted by this annoying sound. While many people can easily forget and move on from this situation, for those living with conditions like ASD, PTSD, anxiety, and depression, this could be extremely stressful. Something that simple could trigger severe meltdowns that can be difficult to manage. Meltdowns are not tantrums. They can be very intense, and the person experiencing them has no control over their reaction.
Sensory overload arises from too much stimulation. Overstimulation occurs when the brain takes in more information than it can process. This leads to behaviors like shutting down, becoming aggressive, isolating, or yelling.
Triggers can include intense sounds, certain smells, or even the texture of clothing tags.
Strategies like reducing sensory stimuli, such as removing clothing tags or organizing spaces to minimize visual and tactile overload, are crucial for reducing triggers and managing responses. Complicated tasks may need to be simplified to help individuals process and manage their environment effectively.
Fear
Fear is defined as an unpleasant or often emotional feeling caused by an anticipation of an awareness of danger. Fear has many faces. Whether it is fear of a situation, fear of things, fear of a task, or even fear of the unknown. Fear is a major trigger.
When people get upset, frustrated, or angry, they don’t feel safe. This leads to fear because they don’t know what to do, what to expect, how to communicate, or how to navigate through certain situations. This uncertainty can cause concerns and trigger responses.
Fear is a survival response, so when fear sets in, individuals may attempt to escape or find safety from the situation causing it. It can lead to behaviors like escape, fatigue, or aggression.
When it comes to managing meltdowns, it is important to note that a scared person cannot grasp discussions, complex reasoning, problem-solving, or understanding stories. Fear causes an individual to lose control and operate from the part of their brain that acts without logically processing or reasoning the situation first.
Some strategies to reduce fear may include alerting the individual about upcoming events and talking about those events in advance. Make their day predictable. Give them choices and let them be accountable for the situation. These simple things allow them to be prepared for situations that may cause anxiety, stress, or fear. Do not make them feel like they cannot escape or control their actions. Keep communication simple.
Control
This is crucial. It helps people feel aware of their environment and gives them a sense of ownership over what’s happening around them. When dealing with someone who is aggressive, it’s important to create a safe space first. Then, encourage them to talk about their feelings and understand the boundaries for safety. These steps help them feel more in control and can lead to managing their emotions better.
Now that we have covered these important concepts let’s dive right into some universal practical de-escalation strategies.
Ten Strategies for Behavioral De-Escalation
Ongoing research in the psychology and psychiatric community has defined the following strategies to offer comfort in situations of distress. While every event and individual are different, these are universal principles that can help you create a safe and calm environment to prevent further escalation.
Recently, I met one of my clients at the parking lot. The moment I saw him, I knew something was bothering him. He was upset because he felt unheard. On top of that, he was hungry, which always makes the things seem worse. To help de-escalate the situation, I suggested we take a walk and then offered to get him some snacks and a drink. After this, things calmed down.
Throughout, I kept a respectful distance and ensured a non-threatening presence. He apologized, and we were able to start addressing needs and therapy.
It’s crucial to use non-threatening verbal and non-verbal cues and be mindful of facial expressions and emotions. Remember, crisis management isn’t about you; it’s about the individual, so staying calm and focused is key. Setting clear, realistic limits helps manage expectations effectively. Starting with the basics and gradually building up can also be helpful. It’s important to choose battles wisely, understanding which rules are negotiable and which are not. Sometimes, silence and giving time for reflection can be beneficial, allowing individuals to process and make decisions calmly. Avoiding power struggles is essential. Instead, seek cooperation and understanding by helping and addressing underlying feelings constructively.
So, here is a list of tactics that you can begin applying today. They are simple but effective and only require your patience and time. Let me know if they worked.
- Be empathetic and nonjudgmental. Avoid criticizing or making assumptions about the person’s feelings or actions.
- Be respectful. Respect personal space. Be aware of your posture. Allow space between the distressed person and you.
- Be mindful that what the person is going through is an essential event for them. Recognize that the event is serious for them, even if you do not perceive it that way. Validate their emotions and concerns.
- Use non-threatening nonverbal cues. A distressed person does not listen to your words as much as they notice your nonverbal cues, so be mindful of gestures, facial expressions, and tone of voice.
- Always remember to stay calm. Do not yell. This may escalate the situation even more. By yelling, you look more threatening, which may trigger fear and other unwanted emotions.
- Set limits. Communicate expectations clearly. It is recommended to build expectations. Start low and increase as you progress.
- Choose wisely what you insist upon. Decide what rules are negotiable and which are not.
- Allow silence for reflection. Some silence can give a person time to reflect on what is happening and how to proceed productively.
- Allow time for decisions. Due to being upset, a person may not be able to think clearly, so give them a few moments to think through anything you have said.
- Give them control.
Although helpful, if you notice that these strategies do not work for you, consider reaching out to a professional counselor. We created a resource to help you find a therapist who is a good fit for you.
Additionally, Bobby Dodd Institute offers a unique approach to behavioral and mental health services through a holistic lifespan technique. We specialize in working with adults and adolescents living with mental health, autism spectrum disorder, intellectual, and developmental disabilities. The program is open to all individuals aged 15 and up.
For immediate access to routine or crisis services, you can call the Georgia Crisis and Access Line (GCAL) at 1-800-715-4225 or send a text to 988.
