Supporting Transitions

Background

TU, a 6 year old girl was referred to Middletown as she experienced difficulty with demands or directions.  TU exclusively pursues her own interests, which include  outside play, repetitive movement and sensory seeking behaviour and becomes stressed when requested to engage in other tasks.

Triggers

TU presents with elements of spontaneous verbal communication coupled with learnt phrases and at times, immediate and delayed echolalia. TU is currently using pictures/TOBIS (True object based Icons) in her schedule and work systems both at home and in school.

As a result of adult direction, TU will verbally protest by screaming and /or will hit out at the adult who is directly engaging the transition. Transitions seem to be difficult for TU, especially transitions from favoured activities (such as outside play and water play) to less favoured activities, which often result in negative behaviours.

TU will self regulate using a range of self stimulatory and repetitive behaviours following transitions from school/outside. Sometimes these behaviours can also upset TU resulting in further instances of stress responses.

Strategies

A range of sensory, behaviour and communication assessments were completed with TU, her parents and school staff. Observations were carried out at home and school. Analysis was combined with the assessment results from the specialist occupational therapist, specialist speech and language therapist and behaviour intervention specialist. 

It was evident from results that TU displays a range of sensory seeking behaviours to include vestibular and proprioceptive (deep pressure) input. This sensory input  is essential to allow TU to function in a calm and alert state. A number of strategies were introduced with the aim of reducing stress responses and resistance to direction and to maintain a calm alert state.

TU had difficulty understanding what is expected of her which leads to increased anxiety and a possible stress response. She also found transitions difficult and often did not understand what would happen next.

Objective One: Support transitions. Strategies included:

  • Introducing the use of visuals (TOBIS) to help her understand what is happening now and next and to reduce anxiety
  • TU will benefit from using a ‘first/then’ visual system, to aid transition and to inform her specifically of when an activity is coming to an end and what is expected of her for the next activity
  • Adults should schedule preferred activities, such as sensory activities, after short non-preferred activities
  • The use of a transition card or object could be used to encourage independence.  This is used for the purpose of transition following activities and also as part of her work system following structured work sessions
  • Using a countdown strip helps prepare TU for a change either for an activity or location. Link here for practice resource for tips on using these strategies.
  • Engage TU in appropriate and regular access to sensory stimuli to promote a calm and alert state

Objective Two: Provide regular and structured access to sensory supports.  Strategies included:

  • Planned sensory circuits using clear visual/physical boundaries and start/middle/end of the session
  • The use of the bear hug for the application of deep pressure prior to and or/during transitions/ outside play/outings.
  • Movement breaks as scheduled and as a needed
  • The use of fiddle toys and resistance equipment to regulate sensory seeking behaviour

Link here for sensory resource

Objective Three: Reduce screen time. Strategies included:

Step 1: Using a consistent visual schedule to provide predictability

Step 2: The schedule included a variety of activities

Step 3: Screen time was limited to times when social activities were not possible eg. while mum made dinner

Step 4: Place preferred activities after less preferred activities; screen time can become more of a reward for completion of less preferred activities, such as cleaning up toys

Step 5: Use a timer to indicate duration of screen time; a timer can be used to indicate when screen time will end so TU knows what to expect

Step 6: Replace screen time before bed with calming activity; screen time at bedtime can interfere with sleep, so remove screens at least 30 minutes before bedtime; replace screen time with a calming activity like reading a book or telling stories