Transitions & autism - Autism services: Assessment, Therapy and Training

Reasons why transitions are so hard for autistic young people & what helps:

What is a Transition?

A transition is a change from one state, situation, place, etc., to another. Transitions often involve uncertainty, e.g., not knowing exactly what will happen.

What makes transitions hard for autistic young people?

A thinking style that likes certainty, e.g., timetabled events, familiar places, predictable routines, plans. Certainty is difficult for many people, not just autistic people and it is often a trigger for anxiety across neurotypes, but the degree and extent varies.

Unexpected transitions can be very difficult, and they increase uncertainty. For example, reading inside when this is interrupted by someone asking you to come outside to see something in the garden.

An analytical mind and an eye for detail is a strength in lots of situations, e.g., engineering, fashion design, art, writing books, but it can make it harder to generalise information from one situation to another unless they are exactly the same, and no matter how similar two situations might be, they are unlikely to be completely identical. This can make it hard for some autistic young people to make predictions about what situations are going to be like based on similar experiences they have had.

Some autistic young people find it hard to leave things unfinished, e.g., curriculum work, programmes they are watching, games they are playing, things that they are drawing or making. It feels uncomfortable to leave things incomplete, and this can make it even harder to transition from one activity to another.

The change from one situation to another can be VERY big, which makes it harder to move from one to the other. For example, from quiet to noisy, from dark to light, from cold to hot.

Transitions take a lot of effort and energy to manage, e.g., they often involve regulating emotions, particularly anxiety, motivating yourself to transition, shifting your attention from one activity to another.

What appears to be one transition can involve several transitions, e.g., transitions involved in waking up: change from eyes closed to eyes open, change from seeing nothing to seeing everything, change from dark to light, change from silence to sounds. Many transitions are more complex than might be obvious.

Examples of less obvious transitions.

The mornings are a very good example of a lot of transitions, which can make getting up extremely difficult. For example, waking up, as described above, but transitions continue – change from lying down to standing up, moving from bedroom to bathroom, changing from pyjamas to clothes. Other factors can make getting up even harder. For example:

Sensory differences, such as sensitivity to light, to the feel of certain fabrics, to smells and noises.

Executive function skills, such as difficulty prioritising and planning what you have to do, this can feel overwhelming, and well-meaning prompts from parents to hurry up can increase pressure.

Getting up is a common experience for most of us, but this does not mean that it is the same experience for us all, what is straightforward to some of us, won’t be for others, but it can be hard to imagine this.

What can we do to make transitions more manageable?

Think about what is involved in your child’s routine and the number of transitions they experience in their daily life. Watch them in these situations and notice how they cope, which transitions are easier than others, times when transitions are easier – gather information on transitions they experience and how they respond.

If your child is old enough, talk to them about situations that they find hard. This is their experiences and the best person to tell you about them is your child. You could introduce the topic by saying something like, “I noticed that the mornings are really hard sometimes, what do you think?” “I wondered if you and I can think about how we can make the mornings a bit easier as I think they are quite hard, what do you think?”

Think of possible solutions together with your child, and if they are not successful, think about how to tweak them and try again – support is a process of trial and error, experimenting to find what works, and it is always more effective if you work together with your child as a team.

Research shows that visual support is very effective – but every child / young person is different, and you have to find the right visual support for them, their input is vital. For example, some young people might want to have a checklist of what they have to do in the morning to make it more concrete and predictable, some might want pictures or photos of their routine rather than words. Some people might only want visual support for certain parts of the routine, some might want visual prompts to reduce anxiety, e.g., positive affirmations, “Getting up is hard but you can do it, dude! And it’s your favourite breakfast – pancakes!” Knowing that something enjoyable is going to happen can increase motivation and reduce anxiety as they can focus on the pleasant experience that is going to happen, e.g., a lesson they really like first thing at school, they can hold the dog lead on the way to school when the dog comes with them. Base your suggestions on what you have observed and find out what your child thinks will help – work as a team to find possible solutions and to tweak these if they are not quite right.

Show empathy, compassion, and kindness, this means a lot to everyone. For example, “I can see this is so hard, I am so sorry.”

Share your experiences to normalise finding transitions hard, your child is not the only person who finds them difficult, and it is very reassuring to hear this.

Help your child to manage uncertainty more and to sit with the unpleasant feeling in their body. For example, talk about situations you and they have had that involved uncertainty, what that felt like, what you noticed inside your body (they might not be able to tell you this, be careful not to push them to describe it if they cannot), what you were thinking and what you did. Ask them about situations where they did not know what was going to happen, and find out how they felt, if they noticed any feelings inside their body, what they were thinking and what they did. You could:

Make a sensory box with different sensory toys in it that might help them manage feelings, e.g., toys to squeeze, different surfaces to feel, a vibrating cushion, massage toys. Experiment with these to see what helps your child.

Introduce the concept of a Plan A and a Plan B to help manage some uncertainty, e.g., “Plan A, if it’s sunny tomorrow, we will go to the park after school, Plan B, if it’s raining, we will go to a café and have a hot chocolate.”