Q: My 10-year-old granddaughter has been diagnosed with autism spectrum disorder. She has many medical problems, as well. My granddaughter does extremely well in a regular private school, where she is the model student and excels academically in music and art. She has won many awards. She is not socially popular, but she's included by the other children. This school has zero tolerance for bullying. She has a few friends.

Our concern is that my granddaughter has huge temper meltdowns. At school, she has complete control, but at home, she is dangerous to herself and her siblings. She goes to extremes in no time at all. She will hurl objects at people, scream dangerous threats and threaten suicide. Many therapists are in place for her siblings and for her.

She has these outbursts in public with her mother, hurling herself to the floor and kicking and screaming in places such as the grocery. She hasn't had a meltdown in public with her dad, but she does have meltdowns at home with him. Timeouts do not work. She kicks holes in walls. Locks have had to be placed on windows.

She is a lovely, bright, charming child when she does not go into a meltdown. Medications we've tried so far have not helped her.

She will be entering public school to get an individualized educational plan. The idea of her in a chaotic school is scary. She has tics and is a target for bullies. She is partially blind and wears a shoe lift and therapeutic sneakers. A host of other obvious disabilities will make her a sitting duck. She is excited about the prospect of new friends. We are terrified that her low self-image will be brought down even more by her having to go to public school. She will return to her private school if the public school does not work out.

She tests above the 95th percentile academically. Her thirst for learning is huge. She has had a small job working in her dad's store this summer and has done very well. You would never know about these meltdowns if you saw how she works with the public. She is polite, meticulous and charming and seems sensitive to others.

Any suggestions would be appreciated. This could be the loss of a very bright young life if we cannot figure out how to save her. Thank you!

A: Your granddaughter's behaviors are so serious and problematic it would be impossible for me to give a solution by letter. I can tell you that her parents seem to be using resources well and should continue to search out other possibilities. There are a few techniques that I can suggest to add to your already large bag of tricks, but all should be discussed with her present therapists before attempts to use them.

Because your granddaughter is absolutely capable of holding things together in school, you know that she is embarrassed for other important people to see her behavior. She is old enough for capable therapists to teach her anger management tools for self-control. She will need to choose a quiet timeout space for herself and an activity that calms her while in timeout. As she learns to use her tools, her parents can video any tantrums when she fails to use her management tools. They can share the videos with her and her therapists. This technique, which assists the child to view her own behavior, sometimes causes sufficient awareness and embarrassment to motivate her to manage her own anger. Behavioral rewards can be added to encourage her positively for each good day at home.

In addition, parents should note any behavior or food triggers that may occur on days when she can't control her behavior to see whether they can identify a pattern. Sibling issues also need to be carefully observed because they may be an important part of her problem. A regular exercise routine can also reduce anxiety. It would be important for all adults to monitor talks about her issues within her hearing (referential speaking) so that she doesn't feel helpless to control her anger.

Dr. Sylvia B. Rimm is the director of the Family Achievement Clinic in Cleveland, a clinical professor of psychiatry and pediatrics at the Case Western Reserve University School of Medicine, and the author of many books on parenting. More information on raising kids is available at www.sylviarimm.com. Please send questions to: Sylvia B. Rimm on Raising Kids, P.O. Box 32, Watertown, WI 53094 or srimm@sylviarimm.com. To read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.