Crisis Support for Families

By Rebecca Mandal-Blasio, PhD, BCBA-D

It is Thursday morning and I just received the 4th frantic phone call from a family member of a child with autism. These are parents who are desperate to find crisis services for their child. These are not families who already have our ABA services, these are family members who did not have any services. Others were on waitlists to receive ABA, and sadly others’ ABA providers hav closed their doors during this time. As I talk to these family members, I refer them to agencies I hope can help, but the reality is crisis services for children with autism are often hard to find even when there is not a pandemic occurring.

So what can families do whose children are not use to the major disruption to their routines due to their school or learning center bing closed and added the social disruptions caused staying at home and social distancing? The limited explanation or understanding about why these changes have occurred can lead to stressful feelings that may manifest as irritability, tantrums, aggression or self-injury. Ultimately, family members understandably become fatigued and frustrated as they do the best they can in a hectic situation.

Here are a few tools/tips to best support and guide your family during this time and  to help prevent crisis from occurring.

1. Explain what is currently happening: Children need to know why there are closures or why they can not go outside. Keep it as simple as possible, but explain in concrete terms….in black and white. Having “gray explanations” and using abstract words or concepts will only make a confusing situation worse.

2. Social Stories: Often times ABA therapists and families utilize social stories to help explain stressful situations such as going to the dentist or getting a haircut. A social story could be a useful tool in explaining what, how and why they can not leave the house and go to the park they used to go to every day. Many autism websites will help provide tips on how to write these stories that could be reviewed each day. If your child is able to assist you with writing a social story, it is great opportunity for an afternoon activity too. Click here for example.

3. Try to keep a schedule: This may be hard to do given our schedules are not predictable each day, but making the child’s schedule as predictable as possible will help calm stressful feelings. This can be accomplished by using a visual or word schedule to make their routine predictable. As the child completes one activity have them put the picture in an envelope or cross the activity off of the paper. Helping set up a schedule for your child will also help put a routine in place for you as well. Ideally, this would as similar as possible to the schedule the child had before the restrictions of the COV-19 were in place (i.e., wake and bed times, bath times, eating times). Don’t put pressure upon yourself to create an elaborate schedule. A simple schedule will be just as effective. If changes need to happen in the schedule, review the changes with your child to prepare them that their routine won’t be as predictable on that particular day.

4. New Skills: New skills may need to be taught using task analysis. For example, hand washing more frequently, the new way to greet people with out shaking hands, using hand sanitizer, or keeping 10 feet away from others may be new skills that should be taught during this time. Breaking these activities into smaller steps and rewarding each step completed will lead to the child learning these new skills. Choosing their favorite song to wash their hands to or setting a timer to indicate when they can stop washing should be considered. Again, no pressure on creating these task analyses….there are many websites that are available for free to help parents create these during this event. Click here for example.

5. Everybody needs a break: Down time is a good thing for everyone. Watching a show on tv or tablet, reading a book, counting beads, or taking a nap is necessary for all of us during stressful times. Exercise or going for a walk outside are also good activities. Down time allows us to escape from the stress and recharge ourselves so that we can face the new activities of our lives.

6. Identifying triggers: You might be aware of the regular triggers that upset your child, however, new triggers during this time may be developing. Observing your child to see what triggers or antecedents proceed challenging behaviors will be vital in decreasing stressful times in your household. If you can identify these triggers, remove or minimize them around your child. But sometimes this is not possible which leads to #7.

7. Coping skills: Determining the activities or skills your child has to self-manage or calm themselves down will be a must in at this time. Counting to 10, deep breathing, touching a sensory item, or behavior relaxation are some ways children have been taught coping skills. If your child does not have coping skills, having a quiet place to calm down will be necessary. A dim room, maybe a circulating fan for a cool breeze, soft relaxing music, access to sensory calming items may be used to create the perfect calm place. The quiet place needs to be individualized for your child’s preferences and what he or she finds relaxing.

Where to Access Help in a Crisis

1. State agencies: Many states have agencies that specifically work with individuals with developmental disabilities. These agencies have psychologists who have experience in providing behavioral services. Often they have crisis teams that work in conjunction with mental health agencies that can help during dangerous or extremely stressful times. Local parent groups can often be great resources for this type of information, like this example from the Phoenix Autism Society website. 

2. Mental Health Clinics: If your child is currently being seen by a psychiatrist, the psychiatrist should be notified that a crisis is occurring. Emergency office visits or telehealth appointments can be set up to get medication guidance during this times.

3. If a child is an imminent risk to themselves or others, hospitalization may be unavoidable. Working with a psychiatrist will help you in locating in-patient mental health services. Child specific hospital emergency rooms may not have as many COV-19 emergencies that can assist if hospitalization is necessary.

Know that you don’t have to do it all alone.  Connect to family and friends when possible or with other parents on community pages on social  media.  With support and quality resources, you will get through this challenging time and back on track.