Transitions. You have probably heard of them in some shape or form. In this short article we will discuss the following:
- Definition of transitions;
- Why transitions are difficult;
- Strategies and techniques to assist with transitions
Transitions, or Transitioning is a term used within autism spectrum disorders (ASD) to describe the process of adjusting to new people, places and/or routines and also includes the process of switching from one activity to another.Â It is important to emphasise that even predictable transitions can be distressing for some children. For instance, if the child has a tendency to perseverate on certain activities they may find it distressing to move on.
2. Why are transitions difficult?
Imagine that right before you drive home from work this evening, you are told that all of the road rules have changed: Red no longer means stop, green no longer means go. All the signs and regulations that you usually rely on to navigate your way home are no longer valid. Consider how you would feel about your impending drive, how would you react during the drive home, what behaviours would you display?
Transitions can be difficult for everyone because we all rely on routine and past knowledge to navigate our environment and feel secure. Children with ASD in particular rely on routine as it helps them to understand social situations, participate and function in activities and the environment, and feel safe. Therefore, sudden or unpredictable change can cause confusion and anxiety which is often expressed through challenging behaviours such as tantrums.
Transitioning from one activity to another can also be difficult, even when it is part of a known routine. Think of a great book you have read. Did you get it hard to put it down even when you knew it was time? Similarly, when a child with ASD is engrossed in an activity they may experience difficulty in switching their attention.
3. Evidence based strategies and techniques:
A number of strategies and techniques have been designed to provide support during periods of transition. The aims of these interventions are to help the child to make sense of their environment, predict upcoming events, comprehend expectations on them, and anticipate change. In turn, this facilitates effective communication and social development, reducing challenging behaviours. (Dettmer et al, 2000). The techniques can be used before a transition occurs, during a transition, and/or after a transition, and can be presented verbally, auditory, or visually.
Verbal and Auditory Techniques:
This is a straight forward technique that involves giving an auditory warning in advance that a transition is going to happen. For example, five minutes before the end of an art activity, the child is told that it is almost time to eat. In a study by Tustin (1995) it was found that giving an auditory cue in advance of an activity ending reduced transition time and stereotypical behaviours.
This technique is effective because it recognises that individuals with ASD may not comprehend subtle cues leading up to a transition such as, other pupils packing away their books or taking out their lunch boxes. A criticism of this technique is that it relies on auditory comprehension which is an area of weakness for many children with ASD.
Other auditory cues may assist in more successful transitions include, using a bell or timer to signal a transition, playing music when it is time to stop an activity and clean up, or singing. Hume (2008).
Research has shown that an easy-hard sequence seems to decrease resistance to following through with difficult tasks, establishing “behavioral momentum” (Banda & Kunda, 2006).
In practice, this approach involves asking the child to participate in favoured/easy activities immediately prior to or alongside requests for to participate in less favoured activities. Recent research into this technique involved the child being presented with a series of favoured/easy requests (e.g., “Give me a thumbs-up,” “Say your name”) prior to requesting a transition/a less favoured request.
The current research on this technique suggest it increases compliance in children with ASD and reduces transition times. However, it is important to note that the research also shows that it is essential to use random sequences of favoured and non-favoured requests as predictability reduced effectiveness.
Research in ASD has continually demonstrated a strength in visual learning. According to Hume (2008), when individuals with ASD are given the opportunity to learn with visual supports they complete more tasks independently, learn more rapidly, have decreased levels of frustration and anxiety, and adjust more readily to changes in their environment.
Examples of visual support strategies used in transitions include visual schedules, social stories and video priming.
Visual schedules are useful with children with ASD as it provides them with an accessible means of comprehending their routine which allows for predictability. When using a visual schedule it is important that the child has access to it throughout the day and can see which activities are next. In this way, visual schedules are often used as a sort of countdown tool. Numerous studies have consistently found that the use of visual schedules can assist in decreasing transition time, increasing independence, and eliminating challenging behaviours during transitions. (Dettmer et al., 2000).
Video priming was recently investigated with by Schreibman et al., (2000). Participants in the study demonstrated challenging behaviour when transitioning between places on a day out in the town. The families videotaped various walking routes throughout the town such as the butcher, chemist and post office.Â The children watched the videos over several days and disruptive behaviour significantly decreased.
Similar to social stories, video priming is particularly effective where the child has difficulty with a transition due to lack of predictability. However, social stories may replace video priming where the event is less accessible to video, such as novel and/or exclusive outings. Recent research by (Ivey, et al 2004) supports the use of Social Stories in preparing for transitions to novel events.
Other considerations in the use of social stories verses video priming include how well the child responds to printed information. As with all of the above interventions, it is extremely important that the childsâ€™ comprehension is assessed to ensure it is pitched at the correct level. The story should briefly describe the upcoming transition and the activities that will occur. The story may include photographs or illustrations to assist the student in comprehending the information.
When creating a plan for a transition it is important to consider secondary factors that may influence the transitioning. For example, preference of activities, the strengths and abilities of the individual, and the attention an individual receives during the transition process which may be reinforcing the difficult behaviour.
Transitions for people with ASD should be carefully planned and may include starting school, switching between activities and settings throughout the day, and transitioning to adult life. (Hume, 2008). As change is an unavoidable and essential part of life, the goal is not to avoid transitions but to help the individual cope and adapt.
If you have any further questions or comments on transitions in ASD please do not hesitate to contact me: .
Dettmer, S., Simpson, R., Myles, B., & Ganz, J. (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15, 163-169.
Hume, K. (2008). Transitioning between activities: Online training module. In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI.
Ivey M.L., Heflin L.J., Alberto P.A. (2004). The use of social stories to promote independent behaviors in novel events for children with PDD-NOS. Focus on Autism and Other Developmental Disabilities. 19(3), pp.164-176.
Schreibman L. 2000. Intensive behavioral/psychoeducational treatments for autism: research needs and future directions. J Autism Dev Disord. 30(5):373-378.
Tustin, F. (1995). Autism and childhood psychosis. London: Hogarth Press.
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