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Living with Autism


July 24, 2015

21 Possible Reasons for Acute Behavioral Meltdowns in Autism

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                      Acute increases in baseline behaviors in autism are often linked to underlying, undetected and untreated medical issues:

         1.  Chronic constipation causing intermittent abdominal pain

         2.   Reflex esophagitis  (you will see increased behavioral outburts during or shortly after ingesting food or drink).

       3.  Glutamate storm in brain. Elevated levels of glutamate can rise quickly and trigger a behavioral meltdown. You must work quickly to reduce the glutamate. Sometimes, glutamate spikes when the autistic person hasn't eaten, and blood sugar drops, so make sure they get snacks throughout the day. Research shows glucagon is a potential antidote to elevated glutamate.

Lamictal (lamotrigine) can also decrease glutamate.

Natural ways to remedy a glutamate storm in brain: Take recommended dosages of Taurine, Magnesium, Zinc.

   4. Exaggerated cortisol response. In a severely-autistic person with dysfunctional HPA system, the behavioral meltdown is more likely to have prolonged duration of elevated cortisol and slower recovery. The best way to immediately handle exaggerated cortisol is to let the autistic person walk or run fast with assistance and protective supervision. That's not always easy, especially if you're near a street or in a small, confined area.

5. Sleep Disorder rooted in a deviated septum or vibration or collapse of soft palate during sleep. In this case an autistic patient may wake up self-abusing due to the untreated medical condition.

6. Oxidative Stress causing abnormal methione metabolism and elevated levels of homocysteine. Elevated homocysteine works against NMDA receptors in the brain, which causes an imbalance of neuronal excitatory and inhibitory synapes which then causes psychosis. Imagine how terrifying this would be to an autistic person who can't communicate this is happening to them? Starting an IV banana bag with magnesium and Thiamine has been shown to calm an autistic person during a severe, prolonged behavioral crisis. In order to start the IV banana bag, it may be necessary to temporarily sedate to calm patient to get IV bag started.

7. Headaches, Earaches or gastrointestinal pain

8. Hyperammonemia. High levels of ammonia caused by certain medications, such as Valporate (Depakote).

9. Dehyrdation causing swollen tongue, dizziness, confusion and heart palpitations. 

10.  Side Effects of Current Medications. All medications should be evaluated for potential side effects causing an acute behavioral crisis in autism, especially if the person is non-verbal and can't articulate what's going on.

11. Injuries from possible abuse from others, which triggers acute rises in self-abuse in autistic people, since it's their way of communicating they've been hurt.

12. Pain from from self-abuse, which triggers more self-abuse. This takes expert evaluation, investigation, specialized knowledge or video surveillance---the ability to discern and see what pain would be caused by self-abuse and what could be caused by abuse from others, since abusive caregivers would most likely blame acute self-abusive or aggressive outbursts on the autistic patient.

13. Dental issues causing pain or discomfort. Dental issues would most likely present as autistic person presenting with sudden acute agitation and outbursts while eating something sweet, cold or hot. Imagine what eating with a cavity feels like. It can be 100 fold to a person with autism.

14. Blisters on body causing discomfort, ingrown nails, rashes causing itching, cuts that sting. Hence, the importance of a full body assessment. 

15. Urinary Tract Infection. Can be ruled out or confirmed by doctor. 

16. Nerve pain. Hard to diagnose in autistic people who can't communicate. If suspected, ICE PACKS, masage and medications like Gabapentin,Tramadol or Effexor could help.

17. Muscle pain. Magnesium could help. IM Torodol may help if not contraindicated. Massage therapy very effective with proper staffing support to relieve discomfort and calm the autistic patient. Some severely autistic children, teens and adults with aberrant behaviors are hoppers, toe walkers, constantly jumping, tensing muscles throughout the day, causing muscle stress and strain. 

18. Lactic Acidosis, especially suspect if autistic person has epilepsy is prone to dehydration and is physically active.

19. Vitamin D deficiency, causing chronic pain. A simple blood test can rule out or confirm.

20. Iron Deficiency, causing headache, ringing in ear or increased agitation. Ask doctor to test for low iron.

21. Vitamin B 12 Deficiency, causing heart palpitation, tingling, gas, dizziness. Ask doctor to check B 12 levels.