5. Meltdowns: what to do when it all boils over

In this episode, we take a deeper look at one of the most misunderstood behaviours in autistic patients: the meltdown. We explain what a meltdown actually is—an intense neurological and emotional response to overwhelming stress—and how it differs from a tantrum or deliberate behaviour.

We explore the common triggers that can lead to meltdowns in the emergency department, such as sensory overload, unexpected touch, changes in routine, or feeling misunderstood. Through real examples, we show how these experiences can push a patient beyond their capacity to cope, resulting in what appears to be explosive, erratic, or aggressive behaviour.

We offer clear, compassionate strategies for responding to meltdowns safely and effectively—emphasising the importance of staying calm, reducing sensory input, giving space, and avoiding power struggles. We also discuss what not to do, including common clinician responses that can unintentionally escalate the situation.

Finally, we reflect on what meltdowns can teach us—not just about our patients, but about ourselves, our systems, and how we can create more human-centred, trauma-informed care environments.

This is an essential episode for any clinician who has ever felt unprepared, overwhelmed, or unsure during an escalating situation. Because when we understand meltdowns, we s