ABA for Breath Holding & Cyanotic Spells

Breath-holding spells — where a child turns blue or pale and loses consciousness briefly during a cry — are one of the most frightening things a parent can witness. The good news: they are almost always involuntary and medically benign. ABA can’t stop the spell itself, but it can reduce the behavioral triggers that lead to the crying episodes that precede them.

Understanding breath-holding spells

Breath-holding spells (also called cyanotic spells) are involuntary physiological events that happen at the peak of a cry — a child inhales deeply, then goes rigid or limp, turns blue or pale, and may briefly lose consciousness. They are not voluntary breath-holding and they are not seizures, though they can look terrifying. Any child who has breath-holding spells should be evaluated by a pediatrician or pediatric neurologist to rule out cardiac or neurological causes — this is a medical question first. In children with autism, these spells are often triggered by frustration, pain, or overwhelm that escalates into intense crying. The behavioral role of ABA is to address those triggers — not the spell itself, which is beyond behavioral intervention.

How ABA helps reduce the behavioral triggers

Because breath-holding spells are triggered by intense emotional arousal — usually a frustrated or panicked cry that spirals — ABA focuses on reducing the frequency and intensity of the triggering episodes. This includes teaching communication skills so your child can express frustration or pain without escalating, using preventive strategies to identify and reduce high-frustration situations, and building emotional regulation skills so your child can de-escalate before reaching the cry that triggers the spell. Caregiver coaching is central: the way you respond to early signs of distress can significantly influence whether a cry escalates. Related: emotional regulation and communication skills.

Frequently asked questions

This page is general educational information, not medical advice. Every child is different — a BCBA can assess your child’s specific needs. Autumn ABA serves families in all 21 NJ counties; see where we provide ABA therapy.

← Back to all resources