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Meeting Point: Latest From Lovaas
Facilitating Success with Transitions and Change
Many children with autism have difficulty with transitions and may be resistant to change. Abrupt changes or unfamiliar events can be particularly difficult. Even a minor deviation from the daily routine may pose a challenge. While few people really enjoy an unexpected turn of events, one goal of behavioral intervention is to help children learn to anticipate and accept transitions and changes more readily.
As a general rule, it's usually best to prepare the child for any changes that will occur in the future and anything that deviates from his or her typical routine. The following strategies have been used with a number of children and are designed to help make transitions and changes as positive as possible.
Strategies for Successful Transitions Between Activities:
Use a picture or written schedule:
Provide your child with a visual reference of a sequence of activities. This can also include representations of the total elapsed time until the final, preferred event. Pictures or a written list of the activities should be presented in order. The corresponding picture or word is then removed/crossed off once completed. You may also find it helpful to use a monthly calendar in addition to the daily schedule to indicate events that will occur in the weeks ahead.
Warnings:
Provide verbal warnings indicating the remaining time before the upcoming activity (e.g., "One more minute until it's time to do homework."). It is recommended that you vary the time at which the warning is delivered and whether or not the remaining time is specified (e.g., "In a couple of minutes it's time for dinner!"). These verbal warnings can be paired with pointing to a timer or clock to increase comprehension and independence.
Use a timer:
Using a timer can help make transitions smoother. You can use a kitchen timer, electronic sports timer, electronic light timer, or music alarm clock. In some cases, your son or daughter can help set the timer and turn it off to create a greater awareness to the time limit. Initially, you should remain nearby to provide verbal warnings of the remaining time and to follow through with the transition once the timer sounds. Your level of support can be faded once your child demonstrates success.
Deliver reinforcement!:
Deliver reinforcement when your son or daughter transitions between activities without disruptive behavior (e.g., "Thank you for listening the first time!"). Reinforcers may consist of granting more time with the preferred activity, engaging in a fun activity prior to the start of the next activity, or delivering a desired tangible (e.g., small edible, 'gold star,' or favorite toy) immediately upon the demonstration of appropriate transition.
Use a transition object:
This can help some children complete the current activity and prepare for the next activity. For example, give your son a book in preparation for the schedule change to reading; provide your daughter with a ball in preparation for the schedule change to playing soccer in the backyard. These related cues may help your child anticipate what event is coming next.
Choices:
Increase your child's involvement in decision making by providing opportunities for him to choose the order of activities and/or the activity to be completed following the transition. This allows your child to be an active participant in the process and provides him with a sense of self-control. Be careful to offer choices as an initial strategy only; be careful not to offer choices as a result of challenging behavior.
Preparing for Events and Unfamiliar Destinations:
Review, review, review!:
Prior to the transition, present pictures of the location and people your child might see. Discuss the upcoming events, if appropriate. A social story may be created to assist with this process. For example, in preparation for an out-of-town trip to Grandma's house, one parent presented her daughter with pictures of Grandma and other relatives, her house, the planned activities, and finally discussed the pictures with her child. Another family used this technique to help prepare their son for school. They took pictures of the classroom teacher, the classroom, school, and schoolmates in addition to reviewing the school schedule and classroom rules.
The picture books/sequence lists can also be reviewed after the transition to prepare the child for the next time a similar event occurs.
Schedule a short visit:
If possible, plan a short visit to the location to increase your child's familiarity with the new environment.
- In preparation for a birthday party at Chuck E. Cheese, one family took their daughter for a quick tour that included an introduction to Chuck E. Cheese himself. They showed her some of the games and took pictures. These pictures were then reviewed with their daughter and incorporated into a social story.
- If preparing a transition to a school, there are often open houses scheduled at the beginning of the year for the students to see the new class, meet the teacher, and get re-acquainted with friends and routine. Parents may also want to schedule a one-on-one meeting with the teacher to introduce their child and allow him/her to explore the classroom. This could also be a great opportunity to discuss the child's strengths, goals, and other helpful information (e.g., motivating objects/activities, food allergies, tips to help on-task behavior).
Ease into the routine:
A few weeks prior to a big transition, adjust schedules to synchronize with the new routine. This may entail adjusting sleeping schedules and using an alarm clock, providing more structured activities, and offering foods or snacks that may be present in the new location.
- For example, in preparation for school, start waking up and going to bed at the same times as during the regular school year, and begin preparing foods similar to what would be available in your child's lunch box.
Familiarize the unknown:
You may want to purchase or borrow any clothing and items related to the new event.
- For example, in preparation to a trip to the snow, let your son or daughter try on their boots and jacket around the neighborhood.
- In preparation for school, practice carrying and eating from a new use lunchbox during lunchtime and use a backpack when going into the community.
Special Considerations/Notes:
For some children with autism, using a schedule may cause them to demonstrate less, rather than more, flexibility with changes. It is important that once your child understands how to follow a picture or written schedule, begin teaching her to accept changes to the schedule. You may initially introduce this by offering choices within the schedule. Upon success, try changing the order of two equally-interesting activities in the schedule or change a minor component of a scheduled activity.
Noreen Laberinto
Lovaas Institute – San Diego
The names of all children in this newsletter have been changed in respect for family confidentiality.
On the Lighter Side...
...5 outrageous reinforcers sure to add fun in therapy
Hide Behind the Table! Turn the table on its side with the legs toward you. Hide until the child stands up to find you and then either roar or act scared.
Stayin' Alive! Break out your best John Travolta Disco imitation.
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