Welcome to the February edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Neuhaus, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Neuhaus will do her best to answer them each month. Send your questions to theautismblog@seattlechildrens.org.

Question: My child recently started school and our daily routines have changed. He is having a very hard time adjusting and has a meltdown almost every time we move from one thing to the next- whether it’s time to clean up for dinner or time to put on his pajamas to get ready for bed. What can I do to help my child transition throughout the day?

Answer: Starting school is definitely one of the bigger transitions in a child’s life, and it can be hard for both children and their parents to navigate this change. Whether or not a child has autism, big changes can increase their level of fatigue, make it harder for them to keep their emotions under control, and make tasks that used to be easy suddenly seem more difficult. Most of the transitions you’re describing take place toward the end of the day, which could mean that he’s used up his energy and flexibility just coping with the new daily schedule. The good news is that things may get easier again as he settles into the new routine, but there are definitely things you can do to ease the situation now. Some of the big picture strategies that might help include making sure he has enough sleep every day so he’s well-rested, building calm play time into the day’s schedule so he has a chance to decompress, and following a consistent and predictable routine each day so he knows what to expect and can learn the new routine more easily.
Thinking more specifically about easing transitions within the day, we often think of supporting children during transitions using strategies like giving warnings/notice for upcoming changes (e.g., “In 3 minutes, we’re going to put away the cars.”), sequencing activities so that non-preferred activities come before preferred activities (e.g., brushing teeth comes before reading bedtime books), and using visual supports. We’ve recently welcomed two new speech-language pathologists to our team at the Autism Center – Helen Strausz, M.A., CCC-SLP, and Elaine Nguyen, M.S., CCC-SLP. They’ve offered a few additional thoughts about the value of visual supports during transitions:
Transitions can be difficult if your child feels anxious, uncertain, or is faced with an unexpected event. Visuals can eliminate or decrease some of those fears. Some visuals can include picture schedules, written schedules (if your child is reading), social stories, visual timers, or an app on a tablet such as Choice Works. Including these strategies will help lessen some of the uncertainties and support your child in anticipating events in their day. Here are a few resources about routines and visuals:

Question: How can I ask my child’s teacher for help with setting up a visual schedule at home?

Answer: As we saw in the question above, visual schedules can be a really helpful tool for easing transitions and helping children move through their daily activities. From your question, it sounds like your child’s teacher and school team might already be using visual schedules at school. It’s a great idea to use similar strategies at home if you can – not only are visual schedules useful tools in general, but your child is already familiar with them. To build on that familiarity, you might ask their teacher to see what visual schedules and other visual supports they use in the classroom – parent/teacher conferences and IEP meetings at the school could be natural opportunities to do this. If you’re in contact with the teacher by email or other methods, you could ask for a digital photo of your child’s visual schedule so that you can make a similar one for home. If you can, you might also check in with other folks on your child’s team – speech/language therapists, occupational therapists, resource room teachers, aides – to see if they’ve developed visual schedules for their work with your child that they could share with you, or if they have suggestions for what might be most helpful as you set them up at home. Finally, check out the resources we listed above for tips on putting together a schedule. Best of luck!