Expert: Dr. Sharon A. Mitchell - 10/31/2008

Question
My six year old grandson who is autistic does not transition from one thing to another with out difficulty.  If it is something that he does not want to do, he will flop on the floor or wherever and just bulk.  For example:  If he doesn't want to get dressed he will flop down and resist all attempts at putting his clothes on, you can't pick him up or get him to cooperate at all.  He does this other times also--like in a store or even on the street.  If it is not what he wants to do.  I have a normal 2 year old granddaughter and his behavior is very similar to her terrible two behavior.


Answer
You're exactly right in your observation that some of his behaviors resemble that of your 2 year old granddaughter.

There are some neurological reasons for that and they're related to the limbic system, a collection of structures in the brain. The limbic system is often thought of as the seat of our emotions and is responsible for our fight, flight or freeze reactions.

Emotions are at the fore in two years olds, like your granddaughter. Kids this age can go from giggling to crying. They react to the world emotionally and excessively. But as we mature, our brains develop more neuronal connections that allow input from the world to be filtered through our cerebral cortex so that we can pause and reflect, put things into perspective, relate what's happening right now to past experiences and the strategies that worked for us last time.

Unfortunately for kids with autism, their brains do not develop these neural connections at the same rate or to the same extent as do other kids their age. This means that they continue to operate out of their fight, flight or freeze reactions far longer.

Kids with autism have a great deal of difficulty making sense out of their world. When you're in a confusing, uncomfortable or scary place, you cling to what you know. That's a big part of the reason why kids with autism can become so rigid, wanting things done in exactly the same way. Then they can predict what will happen next, what's expected of them and they know that they'll be safe.

Think what it would be like if you were to tour fourteen European countries on a ten day trip. You'd be whirling around in strange cultures, trying to operate in strange languages. You might be excited but you're be exhausted. In that situation, how would you feel about your schedule or itinerary? My guess is that you're cling to it. And you'd want to stay near your tour guide. You'd want to know what's coming next, where you'll eat, where you'll lay your head, etc.

Well, that's how life can feel for a child with autism.

Your grandson may just become comfortable doing something then the adults in his life insist that he change activities or put on his coat and go somewhere. YOU may certainly know where he's going next, what will happen to him there and what will be expected of him. But chances are, HE doesn't know any of that. All he'll know is that you're pulling him out of his comfort zone. And even if this is a transition that he's done over and over again, he may not be making that connection since this is difficult for kids with autism.

Now, I'm not in any way implying that you should not expect him to change activities or go with you when asked. That's life and he needs to learn to do that. But it helps if you can understand what it's like from his perspective.

Back to our European vacation. I'd bet that during that hectic trip you would guard two things - your wallet and your itinerary. You can help your grandson by supplying him with a tool that's similar to that vacationer's itinerary. I'm talking about a schedule and preferably a visual schedule.

When I see kids with autism spectrum disorders who are having behavior difficulties, I've found that adding visuals is the single, most effective tool to help.

You may have found that when he's upset, talking to him does not do much good and may even make things worse. That's because people with autism have weaknesses in auditory processing. While their hearing may be just fine, auditory processing involves not just listening but making sense of the words, then figuring out how to act on them. Auditory processing is a harder task in noisy or confusing situations or when under emotional duress.

When it's time for a transition, rather than telling your grandson, try showing him with a picture what it is you want him to do. The picture need not be elaborate or detailed. I've found that kids are trusting - do a stick figure sketch, tell the child what it represents and chances are he'll believe you. Showing rather than telling helps get the information across. Most kids with autism have stronger visual than auditory skills.

But backing up a bit further, I'd suggest starting your grandson's day by going over a visual schedule of how you think his day will look. First you'll have breakfast, then get dressed, then go to the park, then have lunch, etc. But rather than just talking about it, show him. Tape the day's schedule to the fridge door so he can refer to it whenever he wants.

There's a website I really like at http://www.do2learn.com/ Here you'll learn more about how to make visual schedules and just why they're so helpful. And, best of all, there are free pictures, grids to use to make your schedules and lots of helpful hints. Parts of the site are free and some require a subscription but the free parts will give you lots of information to get you going.

I'd go even further with visuals. On his bedroom wall you could tape the order in which you'd like him to put on his clothes. You could also label (with words or pictures) things in his bedroom that will help him organize and tidy his room. In the bathroom, have a picture list of what he should do there, like brush his teeth, wash his face, etc. Beside the back door have a list of what he needs to put in his back pack before leaving for school. Another set of visuals can remind him of the chores he needs to do. A picture of a place setting will show him how to set the table.

For some kids, actual photos work better than line drawings but you'll need to experiment to see which work best for your family. As he gets older, you may wish to switch to the written words rather than the pictures but for now, I'd suggest sticking to pictures.

There are a few other factors that may be influencing your grandson's behavior. Young children do not have a good sense of time. This is especially so with kids with autism. Plus, often children with autism have the ability to hyperfocus, concentrating intently on what is interesting them.

So for your grandson, he may have been intently playing with Lego for half an hour but he may have no idea how much time has past; he's just having a good time. Then you go and interrupt him to say he has to leave now. He's not going to be a happy camper about leaving his favorite toy. Unfortunately, sometimes he just has to go when he's told to.

Rather than interrupting him to say he needs to leave right now, try giving him a ten minute or five minute warning. Show him the picture of what it is he's to do next. Some kids respond well to visual timers. You could set a visual timer for ten minutes. That length of time will show up red on the clock then the amount of red showing will decrease as the ten goes by.

Here are a couple sources where you can purchase visual timers:

http://www.autismstuff.com/teaching/timers.htm

http://addwarehouse.com/shop-bin/sc/productsearch.cgi?storeid=*10dac219ff07d6a02...

The first site above also has a wealth of information on the how and why of using visuals.

Another tool for you to try (along with, not instead of visuals) is social stories. A social story lets a child know what's going to happen and what's expected of him. The sites below have some ready-made social stories and give you directions on how to make your own:

http://www.polyxo.com/socialstories/

http://www.adders.org/socialstories.htm

http://www.thegraycenter.org/

If you're interested in books on visuals or on social stories, here's a few I like:

Visual Strategies for Improving Communication : Practical Supports for School & Home (http://tinyurl.com/6q2n9r)

Making Visual Supports Work in the Home and Community: Strategies for Individuals with Autism and Asperger Syndrome(http://tinyurl.com/5m3mtc)

The New Social Story Book : Illustrated Edition (http://tinyurl.com/6ee8jw)

The Social Skills Picture Book Teaching Play, Emotion, and Communication to Children with Autism (http://tinyurl.com/5dyvlm)

Despite all these autism factors that may be influencing your grandson's behavior, there is another point to consider. He's a kid. Any child can be contrary at times and much prefer to do just what he wants to do, autism or no autism.

While it's sometimes difficult to weed out the "won't" from the "can't, if you use visuals, give the child ample warning that a transition is about to occur, practice the transition and are sure that he know what he is to do, then perhaps the current tantrum is more of a "kid" thing than a result of having autism and you can treat the situation behaviorally. I'd predict that this will happen less and less though once you've incorporated the use of visuals and schedules into his daily routine.

Best of luck,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca