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Transitions

Children on the Autism Spectrum don’t do well with transitions. Transitioning is just a nicer way of saying, your child can’t switch gears very well. Moving from one activity to another or from place to place can be difficult. These children usually thrive in a routine environment. Waking up at the same time, eating the same thing for breakfast, lunch, and dinner and generally doing the same thing day in and day out is a dream come true for them. You on the other hand, may go a little crazy with that extreme insistence on routine. It’s one thing for a child to wake up at the same time everyday but it’s a whole ‘nother story when your child can’t handle it if you turn left out of the grocery store parking lot instead of right. This insistence on routine can be part of a coping strategy when having to deal with communication issues, sensory dysfunction, anxiety, or a combination of all three. When children are very young, routines are important even for the typically developing child, but it’s paramount when dealing with a child on the spectrum. But, since most of us don’t live in a bubble and we have to go to the store, the bank, go to doctor’s appointments, and pretty much live a normal life—somewhere along the line your little one is going to have to experience these things. 
 
I remember not wanting to go anywhere because my son was probably going to lose control at some point, sometimes right off the bat. First of all, you’ve got to get him or her to stop what they’re doing and that ain’t easy. Most of the time, young children are involved in doing something they like such as playing, coloring, watching a video, or maybe even flipping the light switch on and off a thousand times a minute. And when these kids are involved in something, they are totally involved. When you have something to do or somewhere to go, they’ve got to stop, switch gears, and move to the next activity or place. Meltdowns are going to happen when he or she has to stop playing to go sit in the car or do what you want to do, especially if there’s no warning of what’s to come. 
 
Typically developing children will also pitch a fit when they’ve got to stop playing and get in the car for a bunch of errands. The difference is that the typically developing child will eventually settle down and think or do something else at some point (listen to the radio, play with their toys in the car, whatever). The child on the spectrum can have a meltdown that lasts hours because they can’t transition. Often, by the time that they are just beginning to adjust to the new place or activity it’s already time to move on to the next. He or she is always just a few steps behind everybody else. Then everything just spirals out of control from that point on.
 
This could be due to sensory issues such as having to adjust to new sounds, smells, environments, people, and so on. By the time they are (if at all) able to adjust you’ve already left the bank and now expect to just run in and out of the post office. Another reason a child has problems with transitions can be a lack of communication skills. If they don’t understand what you are saying to them (poor receptive skills) then no matter how many times you say it, it’s just not getting through. So you can give all the verbal cues, prompts, or warnings you want about what’s going to happen but this little one is still flipping out. Many of these children are very visual and I know from experience that using real photos (not symbols in this case) can be really beneficial. This is one of those times, you’re gonna need to get out that digital camera and start snapping pictures of everywhere you go and the sequences involved (putting my coats/shoes on, getting in the car, getting out of the car, etc…).
 
One way to help prepare for making good transitions is to provide some real photos either laminated with a label to hand to the child, Velcro to the door when they wake up so they know the schedule for the day, in combination with some type of social story, or all of the above. Using a Velcro photo schedule is easy to do and inexpensive. You can buy thick display-like poster board for about $1.00 and print digital photos for about .19 cents a print. Even if you don’t have a therapist who can help you laminate the photos, most craft stores sell laminating sheets that don’t require any special equipment.
 
For children with a hypersensitive auditory system you could also provide a way for them to ‘hear’ the places you need to go to or activities you need to do by listening to recorded audio clips of specific sounds. For a low-tech approach, a simple tape recorder can be used to record the sounds, play them back and allow you child to play a guess that sound game with photos (of all the places you’ll be going). By adding the environmental sounds that a child is going to encounter you allow them to be somewhat ‘desensitized’ without having to actually be there. It gives children time to practice seeing the places they are going to, hearing sounds that may occur, and allows them to understand what is going to happen next. 
 
You could also use your computer do this—especially if it is a regular routine that could be played in some type of photo story format. I would suggest a program like Photo Story 3 for Windows or other similar programs. They are often quite easy to use and to create visual stories. Other ideas include using a talking photo album and these are actually quite affordable from such vendors as Ablenet (www.ablenetinc.com). You could use some type of PDA (handheld device—like the Palm Handheld at www.palm.com) that allows you to download digital photos and MP3 sound files. Finally, if your child has a communication device (such as a Dynavox at www.dynavoxsys.com) these too can help ease transitions by using photos and sound files. There are plenty of ways to create social stories that your child finds interesting even if the normal ‘story’ format isn’t one of them. 
 
You will find several types of photos in our e-store that can help you do this. Check out the PECS and Dynavox link to find out more about downloading photos from this site. We do have sets of special events like parades and fairs, to help visually prepare young children. In the very near future, this site will be able to provide audio and video clips for you to download into different devices to use just for these purposes. Check back at our e-store frequently to see what’s new.
 
Bath Time
This can be a bit rough at times for young children with sensory problems. For one, it’s water and your whole body feels different in the water—if it’s deep enough you’ll feel buoyant. Another hard part about bath time is the temperature of the water. What you perceive to be warm or lukewarm water can feel like boiling water to some kids (remember the hypersensitive tactile system?). Other kids want that water as hot as it can get. My son always felt like it was too hot and would actually come out of the tub (in practically cold water) and his skin would be beet red. I remember once forgetting to drain the tub and the water sat and continued to get colder and as I was cleaning the bathroom, he jumped back in the tub in freezing cold water and enjoyed it. 
 
Another problem with bath time is washing a child’s hair and having to tip their head back to rinse with water. Tipping the head back, when he or she may also be gravitationally insecure, can really freak a kid out. After just one bad bath experience, this kind of child isn’t going to want to get back in the tub anytime soon. But we all have to get clean at least once in awhile so finding a way to communicate to your child about bath time is important. Again, making pictures of the process, including the sounds of the water running and splashing, and also getting temperatures just right, can make bath time a little bit more bearable. Providing choices about what toys a child can take into the tub, maybe allowing the tub crayons or something special he or she just gets to do during bath time can also help. Singing always helped our son, so we sang every song we could think of and made up a few as well!
 
Haircuts
Let me just say this—holy cow. This has been an issue since the day my son was born. He was born with a full head of hair, so by the time our son was 6 months old, we had lots and lots of comments about our pretty (not so little) girl. Well, dad had just about had enough of that when he pretty much demanded he get a haircut. The first few were done with a pair of safety scissors and since our child could crawl, it was done as he moved around. I don’t recommend this! As he got older we realized that we had to find other ways to cut his hair. I tried doing it while he was in the highchair, asleep, in the tub; you name it—none of it worked. By the time he was about 18 months, my husband and I thought he might like one the children’s salons where you get to watch a video in this cool chair while a professional cuts your hair. Oh, how naïve we were.
 
First, we get there and a giant indoor playground greets as you walk in the door. Instantly, he’s all over that thing. But since he had lots of motor planning problems at the time, getting on and around it was difficult and somewhat frustrating for him (the meltdown meter just went up). I got there early so he could adjust to being there before the haircut. Unfortunately, the child before us cancelled so the hairdresser called us back as soon as we checked in. Not a good way to transition a child like mine. So I pick him up kicking and screaming and try to get him into the ‘cute’ little chair in the shape of an airplane. Then, she turns on the clippers, and this is when Ewan just completely and totally lost it. By the time it was over, I think I lost more hair than he did during the entire process. Before we were able to leave, Ewan had hid himself under the playground and was rocking back and forth trying to calm himself. The next day we realized just how stressful this was for him as he started his first foray into self-injury by scratching his chest and stomach. 
 
So from that point on, I have cut his hair at home. At first I started with scissors, and later I was brave enough to try using clippers. I’m not a hairdresser by any means and usually I find it pretty hard to get it just right. It doesn’t help that Ewan has had a hard time sitting still in the past. The first few times I used the clippers, his dad bravely volunteered to let me cut his hair first and show Ewan that it really was OK. Thankfully, I didn’t whack my husband’s ear off or anything and Ewan has been able to sit through them a little bit better each time. Dad always has to go first. 
 
I’ve had to cut his hair in sections over a period of several days because he could only handle a minute or two—so you can imagine how great his hair looked during that time. We’ve had to have an entertainer (his sister) blow bubbles for him, act silly, play music, or anything that was helped him tolerate the experience. We’ve let him hold the clippers, hear the clippers, and we made several social stories in his communication device about haircuts. I’ve also tended to rub his head (as much as he’ll tolerate) quite a lot in the days before his haircut to help desensitize his head. He now sits in a booster chair that allows me to strap him in for his haircuts. We’re not home free yet when it comes to haircuts but it does tend to get better over time. Talking to your child beforehand, labeling equipment, explaining what’s happening during the process, and allowing your child to experiment (in a safe way) with the clippers or using safety scissors to cut a doll’s hair may help. 
 
Bedtime
Ohhh, if this is out of whack, everybody is out whack. My son was the sleepless wonder for the first 9 months of his life so if you are up at 2am reading this because your child is still awake—I feel for you. Not getting enough sleep can affect your health and your outlook on life. At some point, you will crack. The typical human body needs sleep and WILL shut down on it’s own eventually. So it’s important for you to have some kind of alternative that allows you to get enough sleep. That can mean sleeping in the same room as your child, using a gate system for the child’s room, or whatever that you and your child can handle that allows for a safe exit in case of emergencies. First and foremost if your child continues to NOT sleep on a day-to-day basis, seek some medical advice. There are sleep studies that can be done (which by the way, aren’t a barrel of fun), there are ways to check for seizures, ear tubes for recurrent ear infections might help, and from what I understand there are medications available. My son had the sleep study done (all normal), has had EEG’s to check for seizures, and did have tubes placed in both ears. The tubes really did help but he had to have them due some nasty ear infections that just would NOT go away. 
 
Here’s the list of what we tried from the time we brought the sleepless wonder home from the hospital. First, we tried letting him sleep with us or right next to the bed in a type of co-sleeping situation. Nope, that didn’t work. We moved his crib to the corner of the room. Nope. We tried using a background noise machine. Nope. We tried using a dehumidifier with a fan to block out noise. That helped some. We moved him to his own room. Helped me a lot but he was still awake. He stayed in his crib (surely by the grace of God) until he was almost 3 so I didn’t have to worry too much about him roaming the house or anywhere else. Exercise, and I mean a lot of exercise, has helped. This includes a trampoline, running, whatever might exhaust this kind of kid a little before bed might help too.
 
When he was very young, he would be awake until midnight or later and then be back awake by 5am ready to go. I, on the other hand, could have starred in a remake of the Night of the Living Dead. At one point, he did start going to bed at the same time every night, but he got into the very, very bad habit of wanting to watch a video before bed. One turned into two, two turned into an obsession. Finally, we had to completely nix all TV for him way before bedtime. Now that we have stuck with the same strict routine, dinner, play, bath, story time, and then bedtime, life is a little easier. 
 
By an enormous stroke of luck, one of his grandma’s had made a nice fleece blanket for him for Christmas one year. This is one of those ‘got to have’ items that has helped him with transitions, stress, and bedtime. He now, I swear to you, sleeps with about 8 or 9 fleece blankets on his tiny little bed, every single night. He is Linus (remember Snoopy) times 8. Using a weighted blanket (under the advice of a professional OT) might also be an option for some children. I’ve also tried, with some success, lavender scented bath soaps, laundry soaps and dryer sheets for his pillowcase. My advice is to keep trying either new strategies or find one that you are comfortable with and stick like glue to it. 
 
Routines like transitioning, bath time, and bedtime can be dealt with by using photos, explaining what’s going on, labeling everything, creating some social stories, and lots of practice can help. As time goes by, all of these problems may become less of an issue by using the appropriate strategy for your child and sticking with it.

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I agree to that. Children with autism don't do well with transistion. buy soundcloud plays. But with routines, they are good at it.