The Stages of Rages or The Meltdown Sequence
The stages of rages or the stages a child with bipolar disorder goes through in a meltdown (The Meltdown Sequence) are Triggers, Escalation, Rage, and Post Rage.
• Triggers: Transitional changes, Sensory Overload, Being told “No”, Too much stuff, Too much information, Being Tired or fatigued, over extended, and Hunger. STOP and Be Aware of Mood Changes: Anger, Confusion, a confused or dazed look, Whiny/crying for no apparent reason, changing facial expressions from happy to sad or angry, body language changes, and this is the time to REDIRECT. Intervention at this stage can be very successful, but it needs to be noted that the child could be experiencing neurochemical changes that can cause the fight/flight/freeze reactions and that a meltdown is possible.
• Escalation: Mild escalations show slow anger outburst, name calling, startled responses(verbal/physical), quick rapid verbalization, voice getting louder, pitch increasing, arms-hands-body tensing. Rapid escalations showing a mental-physical-behavioral mood change, body tensing/throwing, quick temper, hostility, anger words (i.e. Hate, you never…, leave me alone…), profanity, voice escalation, red face, clammy body, making fists, and either backing away or moving into your personal space (proximity changes). These are the beginning of Panic Behaviors, Anxiety Behaviors, and Hostility Behaviors. Intervention at this stage is possible, but understand that the fight/flight/freeze response is probably underway and it is important to be calm, relaxed, and non-confrontational. Speak in a slow, quiet voice and be firm and simple with directives, or what you are asking them to do. If it is possible – walk away.
• Rage/Meltdown: In progress – allow the child space to go through the physical manifestations of the meltdown. Do NOT try to restrain, bully, yell, scream, or make them understand. Allow them to go through the cycle of fight/flight/freeze reactions.
• Post Rage or After the Meltdown: the child will be tired, passive, exhausted, spent, calm, sorry, apologetic, headache, may be remorseful or not, ready to do something positive, may not even be aware of behaviors, may not be willing to talk about triggers. They may even fall asleep for a while. Intervention is to allow them to put the behaviors behind them. Discussing consequences of behavior will not work at this point, It is time for consoling, releasing anxiety and pain and letting them know you are there for them. Help them understand what happened – (ie you just had a meltdown and when you are ready we can talk about what set you off…)
Rage or meltdown behaviors are NOT cognitive for the most part, and are not done through conscious thought on the part of the child with bipolar disorder. Behavioral expectations at this point need to be very basic (by parent, professional, therapist, teacher, etc.) as you cannot expect complex communication and understanding with a child going through a neurochemical event that is causing the manic depressive shift.
Keep the child calm, reduce distractions and stimulus while allowing the child to come down from the rage. Do NOT speak loudly, with anger, negativism, sarcasm, or a taunting tone. Stay back – DO NOT RESTRAIN! Your child may or may not remember what just happened – they may not even know they just had a meltdown!
Note: These four stages of rages are technically referred to (you may see this someplace, like in your child’s psychological evaluation) as: Dysphoric affect, provocation, explosion and exhaustion.
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