Treating Patients with Autism in a Dental Setting
Meltdowns vs. Tantrums

Recognize the difference between a meltdown and a tantrum. The public often verbally abuses families with autism because what others see as a “bratty” child that needs discipline may actually be the child desperately struggling with their environment.

Characteristics of a tantrum:

• When a child has a tantrum they will look around ever so often to see if their tantrum is getting any attention or reaction.
• A tantruming child typically avoids hurting themselves.
• A tantruming child will try to manipulate the situation to their benefit.
• Tantrums achieve a certain goal and once that goal is reached all returns to normal almost as quickly as it began.

Characteristics of a meltdown:

• In a meltdown, the child with autism does not look nor care if anyone is reacting to them.
• They will not consider their own safety and stand at risk of putting themselves in danger.
• Meltdowns seem to continue as if having their own power and will taper off slowly.
• No one feels in control during a meltdown.
• The meltdown might occur from a desire not being met or even inability to adapt to a change in the environment; however, once a certain point is reached in the meltdown, nothing will be able to satisfy the child until the situation is over. For a simple example, the child wants a cookie (which was not permitted), a meltdown occurs and in an attempt to “make it stop” the parent offers the cookie. If this were a tantrum, giving the cookie would normally end the tantrum. However, during a meltdown, the child has lost complete control and awareness and continues engaging in the meltdown behavior (indicating that the cookie being offered is no longer relevant).

There are potentially many triggers in the dental environment for meltdowns. Before treating your patients with autism, it is the clinician’s responsibility to find out if the patient has meltdowns, what triggers them and what signs the patient will give (if any) that a meltdown is about to occur (see Appendix A for a worksheet to be completed prior to treatment).

While a meltdown can be frustrating for the dental provider as it interrupts treatment, potentially scares other patients or causes the clinician to run late, take time to consider the feelings of the other party. The parent/caregiver will feel a great deal of strife and grief and maybe even embarrassment. They will need compassion, patience and support. If you feel helpless for the hour this individual is on your schedule, imagine the energy it requires to live with a disabled child every single day. Imagine the energy expended and the amount of stress and emotion the patient has felt during this meltdown. They truly feel their environment is out of their control and may not have any other way to communicate their fear and frustration. As we focus on the challenges of working with individuals with autism, imagine the frustration of having autism.