Autism Spectrum Disorder (ASD) And Transition Challenges
Background
The Early Intervention Programme for Infants and Children (EIPIC) center that I am currently working in serves children with a range of disabilities. For the past two years, I have been working with children who have Autism Spectrum Disorder (ASD), ranging from low support needs to high support needs. One behavior I observe or hear from caregivers is the difficulties these children face during transition from one activity to another or transiting to an unfamiliar environment. Even though some of them may have found coping strategies along way, some still struggle in adapting unfamiliar routines or activities. Early in 2018, there was a 4-year-old child, Anna, diagnosed with ASD who was enrolled in my class. For the first two weeks, Anna displayed high levels of attachment to her grandmother, constantly checking that her grandmother was within her reach. Whenever her grandmother tried to move away, Anna will not hesitate to jump onto her lap crying and refusing to participate in any activity. As weeks passed, Anna showed progression in terms allowing her grandmother from within her reach to within her sight.
However, I noticed that the behavior of constantly requesting for her grandmother, crying and refusal to participate returned during some of these transitions: change of teachers, locations and activities. Her behavior has caused disruption to the class and inevitably affected her learning. Despite giving her time to adjust, it seemed that Anna constantly faced difficulties in transiting to activities that are not part of her routine. In this context, routine activities are activities conducted in the classroom by her 2 teachers. As her teacher, I have concerns for her learning and independence during transitions. Knowing that children with ASD responds better with visuals, I wondered: “How does the use of visuals help Anna increase her independence during transition to non-routine activities?”
Literature Review
Autism is a “neurodevelopmental disorder and is characterized by severe and pervasive impairments in reciprocal socialization, qualitative impairment in communication and repetitive or unusual behavior” (Levy, Mandell & Schultz, 2009). According to the Diagnostic and statistical manual of mental disorder (2013), one of the defining features of Autism Spectrum Disorder (ASD) is the restricted, repetitive patterns of behaviour, interests, or activities they display. It also specifically mentions a difficulty in transitions as an example criterion. Having a rigid adherence to routines or resistance to change can be highly disruptive to an individual’s ability to transit from one task to another and their progression between steps within a task. These difficulties in transition can signify challenges in caring, impede learning and contribute to significant distress in children with ASD (Sevin, Rieske & Matson, 2015).
When a child is distress during transition, the tendency to engage in problem behaviour such as aggression, in appropriate vocalizations and dropping to the floor increases and causes difficulties for the child and those in the immediate environment (e. g. teacher, peers, caregivers) (Lequia, Wilkerson, Kim & Lyons, 2015). In some instances, some children are excluded in educational settings due to their high frequency and intensity of problem behaviour during transitions (Strain, Wilson & Dunlap, 2011). A study conducted by Matson, Gonzales and Rivet (2008) reported that 94% of the ASD population display some challenging behaviours, of which, more than half exhibit externalizing behaviours and 83% exhibit internalising behaviours. It was later suggested that their behaviour was attributed to their preference for highly predictable and consistent routine. Importance of independence during transition. As mentioned, a large percentage of children with autism face difficulties in transition. Transiting between daily activities may seem simple for most typical developing children, but for children with ASD, it can cause them high levels of anxiety, leading to problems behaviors (Mechling & Savidge, 2011). Problems in this area has contributed to the limitations of these individual’s independent functioning throughout the day as supervision and prompts are needed in supporting them from one activity to the next (Palmen, Didden & Verhoeven, 2012). Many of these individuals may learn to depend on their caregivers or teachers to initiate an activity. As these continues, children facing difficulties in transitions may fail to respond to the natural cues to perform the following task, and instead rely on the external cues given by their caregivers (Koyama & Wang, 2011). As these children grow older, most of them may face problems with education or life transitions, such as transition from home to pre-school or from school services to adulthood (Palmen, Didden & Verhoeven, 2012).
Challenges faced by Caregivers / Teachers
On average, people spend a significant amount of time in some type of transition, and is no different for children who have difficulties with transitions. Going through these transitions may be tough and stressful for these children, however, the caregivers and teachers supervising these children would face a degree of difficulty in managing their behavior and still proceeding with the necessary transitions. Such difficulties can limit the amount of teaching provided to these students, as well as their peers, as the instructional time was used to respond to the challenging behavior (Lequia, Wilkerson, Kim & Lyons, 2015). Besides transiting between daily activities or in school, transition during a family outing can cause great distress for both the child with ASD and caregivers. In an interview conducted by Ryan (2010), with 46 parents of children with ASD, many parents felt that public spaces brought them unpredictability in terms of their child’s behavior and the response they get from the public. Despite the amount of preparation prior to an outing (by explaining where they were going, what they were going to do ect. ), parents could not predict how their children will respond to an unfamiliar environment. In some cases, when children display inappropriate behaviors, these parents that receives stares and unpleasant comments, leaving them disheartened.
For these families, the difficulties in transition has caused some of them to reduce or overcome the embarrassments and disruptions in order to achieve a “normal life” (Bridgens, 2009). Use of visuals during transitions Children with ASD have been known to respond to visual images more effectively compared audio stimulation, relying on visual imagery as their main learning tool (Arwood & Kaulitz, 2007). Visual aid can come in different forms, one of which is a visual activity schedule. Visual activity schedules are photographs, pictures, symbols, or drawings that provide information about a sequence of activities or events (Zimmerman, Ledford & Barton, 2017). A study done by Pierce, Spriggs Gast and Luscre (2013), found that the use of visual activity schedules increased the independence during transitions between activities and locations. When the visuals were faded off, these individuals also showed an increased independence during transitions and on task behavior compared to their baseline level. They later attributed it to the skills acquired during the period where visual activity schedules were implemented. In another study by Koyama and Wang (2011), also found similar outcome of the use of visual activity schedules. The use of visual had significantly reduced the amount of verbal and physical prompts given by the supervising adult. In some cases, children who learnt to use the activity schedule, could perform tasks and transitions independently in the absence of a supervising adult. Anna’s difficultly in transiting to non-routine activities is something common among those diagnosed with ASD.
These literatures have shown a high percentage of children with ASD struggling with transition between daily activities, resulting in several problem behaviors, including violence. These challenges have affected their learning in various ways and caused them to increase their dependency on their caregivers in initiating many tasks and transitions. Besides the impact it causes on these individuals, people in their immediate environment have faced challenges in responding to their behaviors. Families have changed their lifestyle to be bounded in the comfort of their own houses and caregivers dedicating their waking hours to supervise these individuals. However, the usage of visuals activity schedules has been successful in increasing independence and lowering anxiety during transitions for these children with ASD. Recognizing that independence during transition is crucial for the individual, it further urges the need to look into employing visual strategies to ease Anna’s transitions.
