Autism and Dealing with Change

The adjustment to the start of a new year is a reminder that change is constantly occurring. Change, especially unexpected change, can be extremely stressful for children with Autism Spectrum Disorder (ASD). Children with ASD often prefer to have a sense of structure and to know what to expect during the day and what activity they will be doing and when. Consistency and predictability help children feel reassured that they know what will happen next. When change occurs, children with ASD may respond in a variety of ways, including exhibiting withdrawal, repetitive behaviors, tantrums, or even aggression. It is important to remember that these behaviors are typically the result of extreme anxiety and/or inability to communicate their emotions/desires. Below are some tips for managing change and transitions in your child’s life.

As much as possible, try to predict and prepare for upcoming changes:

1. Provide your child with daily visual schedules and timers so that they can see clearly what is happening and when. These visual supports can help a child to understand the order of daily events, the steps involved in daily living skills, and the daily schedule at school, including any changes in routine that may occur. Parents can download a free toolkit about visual supports on Autism Speaks.
2. Picture cards can be a great strategy to help a child manage daily change. These picture cards can show images of daily events or tasks that may need to be completed. They can be placed on a Velcro strip and moved around according to the day’s schedule. You can then put the card in a “completed” box when the activity is over.
3. In order to encourage flexibility, parents may want to include a new daily activity in their visual or picture schedule that is a positive event. That way, your child can learn that change can bring fun and exciting things as well!
4. If your child is able to use a calendar, mark important upcoming events or use a count-down calendar to the event. Show pictures (such as a new place or new people) and discuss the change to help your child understand what will be happening.
5. If possible, practice going to the new location or activities that relate to the event. For instance, if you are planning a road trip, practice driving for longer distances and make sure your child has some favorite activities/toys for the ride. If your child will be attending a new school, if possible, visit the new school and set up meetings with new teachers.
6. Making videos can also be helpful. For example, go to the location with a video camera and walk through the steps that will be required while taping and provide a simple narration one to four minutes long about the process and requirements. For example, if planning a field trip to the zoo, visit the zoo and while videotaping, explain aspects of what will happen there, such as riding the train, using new restrooms, and eating at the snack bar. After making the video, show it to your child several times to help prepare for the event. Research has shown that when using videos in this manner, with children with ASD, disruptive behavior decreased greatly as the routines were made more predictable.
7. Social stories can also be a great resource in preparing for change or an anxiety-provoking event (such as going to the doctor’s office). These are short stories, often with pictures, that describe different situations and activities so that children with ASD know what to expect (such as will the child need to sit and lean back in the dental chair? Will there be a prize?).

Of course, life is unpredictable, and new, unforeseen events may occur (such as school being cancelled or making a last minute trip to the grocery store). Here are some tips on how to handle these situations:

1. If using picture cards, use a “?” or “surprise” icon card when an unexpected event happens. Remember to use these cards for fun surprises as well so that your child does not always associate the card with a negative surprise. Although the change may still be anxiety-provoking, consistent use of picture or icon cards will help your child adjust to change.
2. Allow extra time to adjust to the change if possible. If you know your child will be upset by the change, attempt to prepare for the change as much as possible. Use visual cues when you can and try to be in a calm, quiet environment. For example, if you are out at the mall, return to your car so there are not as many distractions or noises.
3. If there is an unexpected change such as a detour in the road, try to distract the child with a song, story, or toy. Point out something in the new situation that they like. For instance, if they like construction machinery, point out the big machines being used to fix the road.
4. Try to re-direct your child to a calming activity or encourage the use of coping skills such as deep breathing or self-talk phrases (for example, “I’ve been through change before, and I can do it again.”). Praise your child or use other rewards for coping with change.
5. Attempt to be a calm presence and talk in a soothing voice. Validate your child’s experience. For example, you might say, “I know this is a change in the schedule, and you don’t like that.” Try to re-direct back to other activities on the schedule. For example, you could say, “After this we will go back home and have your play time.”

Although change can be anxiety-provoking for children on the autism spectrum, visual supports, a calm environment, extra time to adjust, and parent support can go a long way in helping children adjust to unexpected change. All these factors will help prepare your child to be more flexible and tolerant of change.