Many children with Down Syndrome and/or Autism struggle with transitions from one activity to another or from one environment to another. In Adventure Boy’s case, we saw a huge struggle with changing environments. For many months, leaving home to go anywhere was very difficult. He engaged in several different behaviors to prevent leaving, including what I’ve heard affectionately referred to as the “flop and drop,” verbal refusals, crying, screaming, kicking, and hitting. For a period of time at the end of his first grade year, I ended up carrying him from our house to the car and then from the car to the school. I started to dread leaving home.
I can’t say enough about how his team at school helped us problem solve this issue as a family. Here are some of the interventions we have tried that helped immensely:
1) Using clear, concise language and first/next instructions: Adventure Boy struggles with receptive language, so using as few words as possible is a must. First/next language has been a lifesaver. To use this technique, pair something you want the child to do with something he is motivated by. For example, “First put on your coat, then play outside.” This method works best when the second item is highly reinforcing to the child.
2) Visual Cues: Adventure Boy benefits from pictures to help him understand expectations. We have done this in two ways. The first was an app available on iPhone called First Then Visual Schedule. The second was a little laminated card labeled first and next with interchangeable pictures. Both have their benefits, but we found that Adventure Boy responded best to the physical First/Next card.
3) Visual Schedules: Adventure Boy shows some anxiety about what will happen the next day, which goes right along with transition difficulties. To help with this, his para helped me make a weekly calendar with picture cards. He now reviews it the day before at bed time. Since he loves his para so much, knowing he will get to see her on a certain day helps make getting ready for bed and the transition out the door the next morning much easier.
4) Transition Music: Adventure Boy loves music. After a brainstorming session with other paras, his helper suggested trying walking into school (and to other environments) to his favorite song. It worked like a charm! There are still tough days, but at this point, when Adventure Boy hears the song, he will usually stand right up and walk.
5) Objects: Because Adventure Boy loves objects that dangle, like strings of beads or pompoms, these objects are sometimes offered for him to carry while he walks into school or when transitioning to other environments. As he has gotten better at transitions over the last several months, we have faded the use of objects.
6) Consider the environment the child is entering: Once upon a time, Adventure Boy went to his classroom to hang up his coat, and then headed straight to the cafeteria for breakfast. The cafetera is a large, open space with a lot of people. It can also become quite noisy, although breakfast is better than lunch. Since this sort of environment is overwhelming for him, the team decided to try having him eat breakfast in the resource room with his teacher. He showed very good improvement with this change.
7) Visual Timers: We have discontinued visual timers for the school transition, but still use them for other transitions occasionally. My favorite visual timer for use with Adventure Boy is Best Timer, an app available on iPhone and iPad.
8)Routine, routine, routine: We work hard to have a very structured morning routine at home and school. Since Adventure Boy knows through many repetitions what will happen next, it has gotten much easier for him to leave home for school. Other environments, especially unfamiliar ones can still be a struggle, but he continues to improve and grow everyday!
As evidenced above, problem solving around a child’s struggle with transition, or any behavior for that matter, is rarely a quick fix with one step. It’s a result of observation, data keeping, team collaboration and trial and error for each child. The effort is well worth it in the end. After practice and repetition, Adventure Boy consistently walks or dances into school with no drama at all and a big smile on his face!
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