By Lisa deFaria, LCSW, BCD, Faculty, ICDL (Interdisciplinary Council on Developmental and Learning Disorders)
Susan’s note: Lisa originally posted an earlier version of this on the Yahoo Floortime board. I thought it was so timely and helpful that I asked if she would be willing to let me share it with you all, and, lucky for us, she did.
As our children move forward developmentally, "typical" phases that were previously delayed may emerge. One example is the (so-called) "terrible twos." Many kids on the autism spectrum never had the "terrible twos," a time when children become more engaged in their world, with new-found communication, mobility and intentions ("I want”/”Me do it...")
So when parents start reporting to me that their child is tantruming and oppositional and won't do what they say, I say "great!” The child has moved beyond the earlier, more disconnected, passive or self-absorbed phase and demonstrated that he is "cooking." It's when a child doesn't move to this phase that I am concerned.
Of course, with these changes, the child is, perhaps for the first time, bumping into "NO."
Now we have a new set of challenges--not bad, just different. As your child moves forward into this phase, he is also much more aware of the complexities of his environment, the expectations of others, the world moving too fast, too loud, too bright around him. Though he now understands far more language, he may be slow to process it, and many adults forget that the child can't take in a wall of words.
Motor planning, still often immature, becomes frustrating for your child, for how exactly is little Johnny going to get from here to there? A profound desire to be "in control" kicks in, as though saying, "Wait a minute! Slow down!!!" So many kids in this situation need to put their brakes on and try to hold onto control, particularly during transitions (into the car, into bed, out the door, TV off...).
Sensory issues may also be involved. "No" for our children is a bit of a different experience than it is for a typically developing child. With awareness and engagement with their environment, often more sensory issues emerge during this phase. This can create a very challenging pattern of behaviors--look at how many transitions occur in any given day!
A child at this phase needs a lot of transactional support to help ease his movement through the day. You have to experiment with what will work.
1. I often suggest to parents to reduce the number of transitions your child has during this period. If it's preschool and therapy, great. If it's preschool, therapy, trip to the mall, then the dentist--not.
2. Try verbal reminders, but keep the words simple. ("Johnny, in 10 minutes, get in car and go to store." "In five minutes," etc.). Get down in his line of vision when you are doing the countdown and hold up your fingers.
3. Help sequence for him. "First _____, then _____." ("Johnny, first shoes, then car.")
4. Give simple choices. "Would you like to hold my hand as we walk to the car, or walk by yourself?" (With the end goal being the same thing).
5. Slow down. Make more time for transitions. I know we are all in a rush, but slow down. He may not be able to process as fast and he’ll notice the tension in you, which is further upsetting.
6. Give your child something "heavy" to carry during a transition, like mommy's purse, or a backpack with some books in it.
7. Using a visual timer can be helpful to indicate how much more time is left before a transition.
8. A visual schedule of pictures or icons that take a child step by step, sequencing him through a routine is often recommended. A PECS system is one kind. But I also like the idea of visual strips that actually break down the steps involved in each major transition in a day. One for bedtime routine, morning routine, getting in the car and buckling up, going to preschool....
At preschool, consider a visual strip that has the routine broken down, possibly pasted to his cubby. (For the older school-age child the strip should be taped to his desk.) The parent reviews the sequence of steps in each strip before executing them. Point and say, "First _____" to the first picture, "then _____." If he starts to wander or resist, show him the visual again, reduce your language, keep your affect calm. Wait him out. Repeat again.
At first this will be new to your child and he may not get it. But soon he will seek it out, as it is a very reassuring support.
Creating these visual strips takes a bit of work. The first thing you have to determine is whether your child can interpret "symbols" (such as icons), or does he do better with photos of the actual item/activity? Icons are typically better suited to a child who is “symbolic thinking”; after all, they represent or stand-in for “something.” (If your child is playing with baby dolls, or pretending to cook, or answer the phone, they’re starting to be symbolic.) Icons are available through Boardmaker software (expensive, but your speech therapist probably has it), or free online at the Internet Picture Dictionary.
If your child isn't quite symbolic yet, then take your digital camera and go to work. Take a picture of your child performing each step. Take a picture of the school, church, park, store that are typical outings. Take a picture of the therapist, the teacher or others in his life. Print them on your computer in manageable 1.5" squares. Either edit them into a strip, print and laminate as a whole, or cut into individual pictures, laminate and velcro the back (PECS-style).
If your child already "understands" words, why use pictures? Because visual processing is faster. A child can look and see what to do much faster than he may be able to hear, process and respond to a request. This is particularly true when the child is escalating. Auditory input is pretty much useless: a picture of a "quiet corner" in your home and/or at school with comfy blankets or pillows says more: take a break.
For more information on “Transactional Supports,” you might want to look into the SCERTS” (Social Communication Emotional Regulation Transactional Supports) Model, by Barry Prizant, Emily Rubin, and others.
Lisa deFaria is a Licensed Clinical Social Worker, Psychotherapist, Child Development Specialist and Board Certified Diplomat in Clinical Social Work. She offers a child and family centered approach for supporting the growth, development and learning of young children with special needs, as well as those with emerging emotional, behavioral and learning challenges. Lisa has a private practice in Scotts Valley and Pacific Grove, CA. For more information, or to contact Lisa directly, please visit www.lisadefaria.com.