Helping Resistant Children with Transitions

"My child with autism (high functioning) still has trouble with transitions. Social stories don’t work that well for him. To get him to stop doing what he’s doing to get ready for bed (as just one example) is like pulling teeth. Help!"

Here’s a 7-step plan for giving your youngster with Aspergers or High Functioning Autism (HFA) plenty of warning and helping him make transitions more calmly:

1. 10-minute warning: Tell your youngster, "You’ve got 10 more minutes" (parent’s secret: unless your youngster is watching the clock or is a stickler for accuracy in this area, you can give this warning well before you actually only do have 10 more minutes). Let’s assume that your youngster is ignoring you at this point (e.g., he may be thinking he has plenty of time yet).

2. 5-minute warning: About halfway into the 10-minute warning, say, "You’ve got 5 more minutes" (get at least an acknowledgment that your youngster has received the message at this point). As HFA children often do, let’s assume that your youngster is still ‘dilly dallying’ around (i.e., taking his sweet time).

3. Warnings by the minute: Just as some snooze alarms get louder each time you hit the button, make your warnings more frequent at this point (e.g., give a 4-minute warning …3-minute …2-minute (parent’s secret: the countdown doesn't have to actually correspond to factual time; you can say, for example, that he only has 2-minutes left, but he may actually have 2 ½). In any event, let your youngster know that it's time to get organized for a change.

4. Warnings by the second: At this point, your youngster should be at least reluctantly moving toward change. Count down in 10-second increments at this point (e.g., you’ve got 50 seconds …40 …30 …and so on).

5. An extra 10-count: If your youngster is still goofing off, tell him he has a count of 10 to get with it. Then count up from 1 to 10. And move on.

6. This technique should work with those kids on the autism spectrum who have difficulty with motor planning and change. However, you will want to calibrate the amount of time used to your particular youngster's needs. The countdown described above is merely an example, and one that can be tailored according to the situation – and your child’s temperament.

7. A stopwatch or a timer can sometimes also be effective countdown tools. When choosing a timer, opt for one that will be most appropriate for your youngster, and make sure that it is something that he will easily understand. While a digital timer may be an appropriate choice for older kids, this may not be well suited for younger ones. For younger kids who still do not have a concept of time, the hourglass timer usually works best – not only because it is more interesting, but also because it is easier to understand. Since younger kids may not know how long 3 minutes is, the hourglass timer gives them a visual of how long 3 minutes actually is.

Before you use the timer, let your youngster know what the timer is for. Let him know that the timer keeps track of when he needs to switch activities (e.g., “When the timer goes off, it is time for you to stop playing your video game and get ready for bed.”). Explain it simply and use words that will make him understand.

When using the timer, it is also important that you provide warning signals (e.g., ringing of a soft bell, gentle snapping of the fingers, etc.) when the time is almost over. This way, your youngster will be ready when the time runs out and will not feel surprised or rushed. The important thing is to be consistent and to always use the same warning signals. This way, it will become part of the routine.

Tips to help you be successful with the “transitioning” method outlined above:

1. Be consistent. Use the same warning time and words every time. This makes it easier for your youngster to understand and adjust to the transitions. By knowing what the expectations are, he will transition easier.

2. Do as much as possible beforehand. Pick out clothes the night before, make sure his shoes are readily available, etc.

3. Evaluate situations that are difficult. If there is a particular situation that causes major problems during transitions, evaluate the circumstances surrounding the situations. For example, it could be that your child doesn't want to do the next activity due to sensory issues or other problems. It could be that the schedule needs adjustment, or that other accommodations need to be in place.

4. Make sure all of the “extra activities” are taken care of beforehand. It is easier to get out the door when the boy or girl can’t pause when it opens and exclaim, “I have to go to the bathroom!” Take care of those needs before you walk out the door. Do the same with food and drink. Better yet, bring a water bottle and a snack (one less excuse for your youngster to dawdle).

5. Make your youngster part of the team. Enlist his help in order to get out the door on time. Have a checklist and allow him to check off what gets done, or have him help load important items into the car if you are leaving.

6. Negotiate transitions when possible. For example, if he’s playing video games and you want him to stop so he can get some homework done, you can say, “Do you want to continue playing your game for another 30 minutes and then do your homework – or do you want to stop for now, do some homework, and then go back to your game for 60 minutes? So, 30 minutes now – or 60 minutes later …what’s your preference?”

7. Never underestimate the power of a good social story. If you’ve tried social stories, but they didn’t work, it may have just been a poorly applied story. Social stories are a wonderful tool for working with Aspergers and HFA children. The value of seeing his name in print with clear expectations will be golden for your youngster. A social story is a simple story naming the youngster along with the story of what you want him to accomplish.

8. Respect your youngster’s need for a warning. When an HFA child is engaged in an activity, it is very difficult for him to move on to the next activity. Teaching him how to transition takes patience and time on your part. By giving a warning, the youngster will have an easier time accepting transitions.

9. Teach your child to tell time. The sooner you do it, the easier it becomes for your son or daughter to understand the passage of time and how it works.

10. Use rewards. When a kid on the spectrum is engaged in an activity, sometimes it is difficult to get him to transition to a new activity. In order to help him, offer some incentive to change activities (e.g., a preferred food or item, a desired activity later in the day, etc.).

A plan for blatant resistance: “This Tantrum Is Not Solving Your Problem”

If your child flat-out refuses to make the transition from the current activity to the next one – or worse yet – throws a temper tantrum, help him understand that “resistance” and “throwing a tantrum” will not help him get what he wants. For example, let’s say he’s watching television …then you come along and want him to get ready for dinner. Your first request for this transition is met with stiff confrontation (e.g., yelling and throwing the remote). You can say, “If your problem is that you want to watch TV, then yelling and throwing the remote is not solving that problem …it’s just prolonging the problem! If you want to solve that problem, then come and eat a few bites, then you watch TV some more.”

==> Preventing Meltdowns and Tantrums in Kids on the Autism Spectrum

 COMMENTS:

•    Anonymous said... for the ideas

•    Anonymous said... Hi my son is 15 and he still has no concept of time I'm finding him very hard work ATM he never wants to do anything he can be snappy towards me has anyone any ideas please or suggestions many thanx x

•    Anonymous said... I have those magnet ones, my iphone app I got works great too. We use them for night time routines usually now. I used to have one in each area of my home.

•    Anonymous said... I've learned that my son needs a "5 minute warning" before a transition (even if it's not a true five minutes). If I spring something on him, he wigs out.

•    Anonymous said... jp always needed a warning 10 min then 5 min and then i had to say time for dinner and lead the way. sometimes we sang a tidy up song before bed and we still have an identical bedtime routine. i find routine and consistency the best for him

•    Anonymous said... Just make sure the timer is a pleasing noise!! My son is now scared of timers because the load noise bothers him! The timer we used had a ringing noise and it actually caused more problem than the transition!

•    Anonymous said... My son is 5-1/2 and we use an hourglass timer. And also a picture to do list. Pictures of the activities in order is something he has really been able to follow and with the timer for each activity it really helps him feel like he can be prepared for what's next.

•    Anonymous said... Thanks for sharing the link to that timer - it is really cool! I usually do a verbal time warning. I used to do 10 minutes then 5 minutes and so on. We can now do a 5 minute warning, then a 2 minute and 1 minute warning before any kind of change - getting off the computer, time to leave, etc...

•    Anonymous said... The tricks depend on the age and what kinda kid. My son does better with "finish the chapter" than time as I think he's a bit OCD and really compulsive about finishing and saving (like in Minecraft--Roblox has been hugely frustrating for the lack of saving "all that work"). For recurring transitions, predictable "transition helpers" work for us. Like (pls don't blast me for the food thing) when we leave McD's after eating and playing, my kids get their dessert (a cookie) in the car. On the computer, we have been using Family Safety in Win8 to regulate time spent. I especially love that I can really customize the curfew settings by adding in 1/2 hr curfews for meals in addition to the whole time limit for the day. Most kids get really wrapped up and forget to eat. Good luck!

•    Anonymous said... There are great visual timer apps for the iPad and smart phones. They have worked well for my 4 -year-old daughter. She also has trouble with transitions.

•    Anonymous said... there are some cool timers used in autistic classrooms that work on the principal of a traffic light, green, yellow, red,this gives the child a warning,, and a visual indicater

•    Anonymous said... This is my son exactly!! Especially at dinner time. But not only is it a challenge to get him to the table, it's also a nightmare to get him to stay there. Or to do anything I ask of him really.

•    Anonymous said... We don't uses timers but I am thinking would be good to show some patience. Any meal time I have our 5 yr old help I incorporated his schooling time with cooking time. Now he is not a big eater so we are working on it. The more we do meal cooking really new stuff he will try a lil bit. That is a huge step.

•    Anonymous said... We set the oven timer and remind him every few minutes of how long he has until whatever it is we want him to do eg, pack his school bag, turn off the Wii, brush his teeth, come to the dinner table. It always works. We can never just spring something onto him...he is very literal and visual.

•    Anonymous said... we use a hand held cooking timer ($6 @ walmart) but try it out before buying because the bell/ringer can be too loud! We let our 5yr old son set it himself so he feels some control over what's going on. before beginning any activity, we let him know how much time is allowed for that event (10 min.) & when it's over, we will move on to the next activity (name it - bath time, dinner, etc.). he likes knowing what the upcoming activity is, but not more than that. At the 5 min. mark, I countdown each minute until the bell rings, he loves it! At 2 min. mark, I explain that he has 2 minutes left, but that the next activity (eating) will be great because (we're having his favorite dish). It helps make the transition smoother when he's down to the last minute. My son really likes a schedule, a time-table of events/activities, but has to be fore-warned when changing from each activity.

•    Anonymous said... Welcome to my life. I find that touching him and speaking directly works well. Calling from downstairs I do not reccommend unless you want to call atleast 10 times. When he is playing lego he is lost in his own world.

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The New Diagnostic Criteria for Autism

The publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will have a huge impact on Autism Spectrum Disorders (ASDs). Aspergers and PDD-NOS will disappear, new criteria will be used to diagnose ASD, and new categories have been developed which are likely to absorb many individuals now diagnosed with ASD.

Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).

D. Symptoms together limit and impair everyday functioning.

The DSM is a manual that organizes behaviors and symptoms into diagnostic groups for the purposes of clinical diagnosis and recommended treatment. Over time, the DSM has changed significantly. The concept of an "Autism spectrum" is relatively recent, and major changes to criteria for Autism diagnoses will change what we presently think of as the "spectrum." Most significant for individuals in the autism community will be the removal of two existing Autism spectrum diagnoses from the manual: PDD-NOS and Aspergers.

Treatments will probably not vary much as a result of the DSM change. Also, there should not be a shake-up in terms of services and therapies. People and their needs aren't changing, just the way we capture their diagnoses.



The new criteria attempt to better describe and identify what Autism is, including what social communication is (separate from general learning disabilities). The DSM will also incorporate a dimensional aspect to ASD, indicating how much support an person needs in his/her community to focus on what the person should be doing at their age and developmental levels. This acknowledges that there is a range of causes in ASD, with a different range of functions.

An individual with present symptoms of Aspergers will fall in the diagnosis of Autism Spectrum Disorder, and there will probably be additional “specifiers” (e.g., without intellectual disability, with fluent speech, etc.), which may better describe the diagnostic picture for such an individual than is currently done with the term Aspergers alone.

Preventing Meltdowns: Diversion Tactics for Parents

When it comes to parenting a child with an Autism Spectrum Disorder (ASD), there are a few scenarios that are fertile ground for meltdowns. Some examples include (but are definitely not limited to):

• all afternoon shopping trips
• an endless car ride
• long wait at the doctor's office
• slow service at a restaurant
• too many homework problems

These are moments where a meltdown is coming on fast, but can still be diverted. These are the times when moms and dads need “diversion tactics” (i.e., a supply of items and ideas that can fill a moment or turn a head).

While diversion tactics come in handy with any youngster, it's particularly imperative for kids with an Autism Spectrum Disorder who are often significantly less able to amuse themselves, negotiate transitions, or avoid meltdowns. A parent needs to be quick, versatile, creative, and resourceful to keep things running smoothly. Planning ahead can help.



Here's how to make sure you always have plenty of tricks in your bag:

1. Your diversion tactics should do one of these (and preferably more than one): Soothe, Entertain, and Distract. They must be deployable at a moment's notice, especially in stressful situations. The space of time between the need for soothing, entertainment and distraction, and the onset of complete disaster can be brutally short.

2. Some of the tactics in your “diversion kit” will be actual items (i.e., things you keep in your purse or pockets for emergencies). It doesn't hurt to have some on hand at all times (that's why most of these are small) and then to load up with extras when you know you might need them. Some possibilities (depending on the age of your ASD child) include:

• Animal crackers
• Coins
• Crayons/coloring book
• Deck of cards
• Dice
• Doll
• Fidget toys
• Finger puppets
• Flash cards
• Hard candy
• iPad
• iPhone
• iPod
• Keys
• Little notepad and pen
• Magnetic travel game
• Photos
• Pretzels
• Puzzle book
• Raisins
• Small storybook
• Stickers
• Toy cars

3. Some of the tactics in your “diversion kit” will be ideas that you can implement without any need for props. You may have to go through a few before you find one your ASD youngster will run with, so keep a list if you can't keep them all in your head. Some possibilities include:

• 20 Questions
• A is for ..., B is for ...
• Blowing a raspberry on his or her arm
• Clapping games
• Getting a drink from a water fountain
• Hide something in fist -- guess which hand?
• I Spy
• Let youngster choose what to do next
• Looking out window
• Math facts
• Play with youngster's hair
• Pushing hard against each other's hands
• Rock-paper-scissors
• Saying something silly
• Taking a walk
• Tell me three things you did today
• Tickling
• What color am I looking at?
• Whispering secrets
• Word games where each person adds an item, alphabetically, and the next person must remember the whole string of words

Putting together a good list of diversion tactics is one thing, maintaining it is another. As your ASD youngster gets older, changes interests, gets bored with some things and taken by others, you'll want to keep changing and replenishing the tactics in your "diversion kit." Remember, the objects don't have to be big, they don't have to be fancy, and they only have to be able to run your youngster past a bit of boredom, anxiety, or a little rough behavioral spot. But they do have to soothe, entertain, and distract.

Note: If you only have a couple diversion tactics, they can fade with overuse. The more tactics you've got in your “bag of tricks,” the better.

==> Preventing Meltdowns and Tantrums in Kids on the Autism Spectrum

Raising Kids on the Spectrum: Dealing with Parental Stress

Of course, not all moms and dads of children with ASD level 1, or high functioning autism (HFA), are under stress, but many are. As one mother states, “You learn to live with a significant amount of stress and you throw yourself into your everyday job as a parent when you have a youngster with an Autism Spectrum Disorder. If you work outside the home, you work even harder - and you don't think much about taking care of yourself.”

 

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