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Taming Transitions: Helping Children with ASD Cope with Transitioning Among Activities

Updated: Jul 4, 2021

Jennifer Keluskar, Ph.D.



Many parents can relate to scenarios in which their children have trouble transitioning or leaving one activity or task to start another. The thought of leaving a preferred activity can be distressing to some kids, even when they are being asked to transition to something else they enjoy.


In my clinical experience, I have seen that kids with Autism Spectrum Disorder (ASD) often show particular difficulty transitioning among activities, and that this difficulty is one of the most common triggers of undesirable behaviors like outbursts, tantrums, and refusals.


In reality, the challenge of transitioning is not unique to ASD. We all struggle with this to some extent, especially with all our electronic distractions. Children with ASD tend to feel more intense distress in response to having to change to a different task, location, or activity. We can help kids transition more smoothly by giving them additional skills and resources to cope.


As we dive into specific skills for helping children better tolerate transitions, we need to also understand what makes transitions difficult in the first place.


Executive Function Problems


One way to understand trouble with transitioning is from the perspective of a set of skills known as "executive functions," or the mental processes that serve to help us initiate, plan, and organize activities and tasks, as well as manage and regulate emotions and behaviors (Gioia et al., 2015).


Take the common childhood activity of coloring, which requires the following steps:


1. Deciding that they want to color (as opposed to doing other activities).

2. Finding or asking for materials they will need (e.g. crayons and paper).

3. Deciding what they want to draw or color and which color(s) they want to use.

4. Remembering how to draw what they want to draw or how they want to color.

5. Noticing their progress and using it to take the next step--for example, thinking “I drew a picture of myself. Maybe I will draw a picture of Mommy and Daddy next.” Or “The bird is blue, maybe I will make the fish yellow.”

6. Thinking about what they will have to accomplish to consider the task as being finished—for example, planning how much more they would need to color to say “done.”


When we start thinking about executive functions involved in apparently straightforward activities, we realize that even the simplest activities can be broken down into several mini directives. Just like the executive of a company coordinates the various roles their employees perform to make sure the company runs smoothly, our executive functions make sure we are able to coordinate the many steps involved in everyday human behavior.

To address executive functioning difficulties contributing to trouble with transitions, make the end of the activity concrete and routine.


For example, you could create a visual schedule depicting what is going to happen immediately before and after the activity. This might start off with a simple sketch that allows the child to check off pictured activities. If this is a strategy that seems to work, you could set up Velcro pad with figures to symbolize an end to the current activity and moving on to the next.


Be prepared for the child to resist the schedule at first. Remember, using the schedule is another example of asking the child to do things in a different way than was done before, which is what the child struggles with in the first place. I have seen children with ASD who resist schedules at first but with time, and sometimes a few minor tweaks in how it is presented, end up embracing them.


Another one of my favorite strategies is to use a visual timer to prepare the individual. I use an app on my phone that shows a picture being gradually revealed as time passes, and the color of the timer changes to red when time is running low. I recommend reminding the child when time is running low.


Motivational Problems


Think about the last time you stalled on a task, such as resisting the urge to keep reading your Twitter feed when you knew you had to get out of bed and start your day. Well, it turns out that this difficulty is pretty much the same problem children face when asked to stop using the iPad to do homework.


If you think about what motivated you to get out of bed, you’ll realize it might have been hunger, reminding you it was time for breakfast, or stiffness, reminding you it was time for your morning workout. Children on the autism spectrum, however, often have difficulty recognizing these motivational cues.

For example, if a child is playing a video game and they are asked to brush their teeth, it might become a difficult transition because most kids prefer playing video games over brushing their teeth. In a case like that, children often do not recognize that it is an OK time to stop a game—after all, the game is designed to keep the player playing. You might need to point out that the game results at that point can be saved and returned to later. Perhaps you and the child can finish one sequence together and remember where you were so you can get back to it later. One could also use a “place holder” such as taking notes for their children to help them remember where they left off in a game.


If you think in terms of motivation you’ll tend to arrange for an enjoyable transitional activity to follow. For example, you could help a child transition from television to dinner by having them pick out dessert in advance. When you do that, make sure the child actually transitions (turns off and moves away from the television) first. Having an enjoyable activity follow the demand will help motivate the child to cooperate.



Problems Regulating Emotions


ASD researchers have long been interested in the concept of emotion regulation. Carla Mazefsky of the University of Pittsburgh created a measure of emotion regulation difficulties that has been used for children with ASD and extended to various other populations (e.g. Mazefsky, Yu, & Pilkonis, 2020). One factor that is assessed by this measure is called Reactivity. Reactivity refers to how intensely we respond to events. Take the uncomfortable scenario of an insect flying close to your face. Person A might gasp a little, but Person B might scream loudly enough for others in the area to freeze and look concerned. Both Person A and B were bothered by the insect, but Person B showed greater reactivity to the event.


What is important to remember here is that individuals with ASD experience emotions more intensely and react more intensely to their emotions. It also may take longer for them to self-soothe after an emotional event. This means that what may be a minor aggravation for some could be perceived as intolerable by an individual with ASD.


To complicate matters further, some individuals are highly sensitive to emotional reactions they perceive in others (Zap et al., 2018). Therefore, one's distress about transitioning might be exacerbated by their picking up on another's distress, which relays a message that the transition is a big deal. This is, of course, the opposite of how we want our children to understand the situation.


Keeping emotion regulation in mind will help you to provide a controlled choice. Plan ahead to have extra time for the transition. At the end of an activity, ask the child "Do you want to shut off the TV now, or would you like an extra 5 minutes?" Inevitably, the child will request the latter choice, so make sure you are actually able to follow through with this. Remind the child (after making eye contact to ensure they are listening), "We are shutting off the TV in 5 minutes and that is OK."

Finally, remember your own emotion regulation. Children are highly sensitive to their parents' emotions. When helping your child navigate a transition, try to stay calm and composed, even if you need to walk out of the room for a breather momentarily.



Social Communication Problems


Problems with social communication are at the heart of ASD. In fact, such difficulties are required for an ASD diagnosis.


For example, while distress might be triggered by difficulties with transitioning away from a hobby that the individual is intensely interested in, individuals might also have more trouble effectively communicating their anxiety and frustration. They might have trouble using "self-talk," such as "It is OK to come back to this later," and they might not get the same motivational boost provided by social context as others.



Use Social Stories to Help Children Understand the Importance of Transitioning Calmly, to Teach Children how to Appropriately Communicate Frustration, and to Rehearse an Appropriate Response.


A Social Story (Gray, 2010) is a short and individualized narrative accompanied by pictures (ideally including photos of the child) that uses descriptive phrases to explain the social context. A Social Story can describe appropriate behaviors to show in response to being asked to transition, the reasons why it is OK and important to change activities, and reasons why they can be hopeful that they will get to engage in the activity again at a later time.


Children may not consider these factors at the moment the transition is being demanded of them. Reviewing a social story that addresses social context can help individuals with ASD more effectively manage transitions.


Transitions can be difficult for everyone. This is not surprising when we consider all of the skills involved in navigating them. Children with ASD often have particular trouble transitioning among activities, and as a result may show behaviors like yelling and refusing. We can approach these instances as opportunities to support children's social-emotional growth using the above tools and interventions.

References

Anger, M., Wantzen, P., LeVaillant, J.L., Malvey, J., Bon, L, Gunole, F., Moussaoui, E., Barthelemy, C., Bonnet-Brilhault, F., Eustache, F., Baleyte, J., & Guillery-Girard, B. (2019). Positive effect of visual cuing in episodic memory and episodic memory and episodic future thinking in adolescents with autism spectrum disorder. Frontiers in Psychology. doi: 10.3389/fpsyg.2019.01513

Gioia G, Isquith P, Guy S, Kenworthy L: BRIEF 2 Behavior Rating Inventory of Executive Function, Second Edition Professional Manual. Lutz, FL, PAR: 2015.

Gray, C: The New Social Story Book. Future Horizons. Canada: 2010.


Granader Y, Wallace G, Kenworthy L. Characterizing the factor structure of parent reported executive function in autism spectrum disorder: The impact of cognitive inflexibility. Journal of Autism and Developmental Disorders. 2014;44:3056-3062.


Gray, C. 2010. The New Social Story Book. New Horizons.

Low J, Goddard E, Melser J. Generativity and imagination in autism spectrum disorder: Evidence from individual differences in children’s impossible entity drawings. British Journal of Developmental Psychology. 2009; 27:425-444.

Mazefsky, C, Yu, L., & Pilkonis, P.A. (2020). EDI in a nationally representative sample. Journal of Clinical Child and Adolescent Psychiatry. https://doi.org/10.1080/15374416.2019.1703710

Rodgers J, Herrema R, Honey E, Freeston M. Towards a treatment of intolerance of uncertainty for autistic adults: A single case experimental study. Journal of Autism and Developmental Disorders. 2018;48:2832-2845.


Zap, V.M.Z., McLachlan, N.M., Scheffer, I.E., Wilson, S.J. (2018). Enhanced sensitivity to angry voices in people with features of the broader autism phenotype. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-018-3641-7.

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