Transitions: How to Decrease Anxiety and Increase Compliance

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In our daily lives we transition constantly from places and activities. Thanks to schedules and daily routines, we have a map of what our day generally entails. Now imagine you are asked to start a project, but all information regarding expectations and deadlines is being withheld until after the project has already begun. That scenario would almost certainly leave you feeling frustrated and anxious. Knowing what is expected and when it is needed gives us a sense of accountability, responsibility and contentment.

Those feelings of frustration and anxiety when expectations and schedules are unclear may last longer and be more intense for individuals with an Autism Spectrum Disorder (ASD). They may exhibit their frustration in the form of tantrum-like behaviors, which may include screaming, hitting, biting, scratching, throwing themselves on the floor and/or other self-injurious behaviors.

Managing this type of anxiety involves two key components. While we want children to follow routines and schedules, we also want them to be flexible enough to handle situations that are unscheduled and to cope with unanticipated events. To effectively manage anxiety, we focus on utilizing schedules to increase compliance and how to handle unexpected events that arise.

A schedule is usually used so the child can refer to it and have a visual reminder of what is occurring throughout their day. We can use different types of schedules:

  • Picture schedules allow the child to visually see the type of activity coming up (i.e. numbers for math, a swing for the park, etc.)

  • A child who can read may benefit from smaller to no pictures and many to all words on their schedule. We also like to fade pictures as the child makes more associations with the activity using words rather than pictures.

There are many other types of schedules that can be used depending on the child’s age, needs and preferences.

Along with schedules, we utilize timers and verbal cues as additional signals that the current activity is close to ending and that a transition is coming. Typically, when we give reminders of what is expected or what is coming up, we see a smoother and quicker transition than when those cues are not presented. Something as simple as “2 minutes left until lunch time” can make all the difference.

This brings us to the unexpected situations. Sometimes a store is closed, there is no glue left for arts and crafts, or bad weather interrupts an outdoor play date. Unforeseen circumstances like these can lead to tantrum-like or self-injurious behaviors. For these situations, we suggest using breathing and calming techniques as well as social stories to help bring awareness to the situation.  These techniques are not taught during an “episode” but should be introduced preemptively during more relaxed moments. Explaining that certain items aren’t available or that something can’t happen is easier and often better received outside of the situation since the child is not in a heightened state of anxiety or frustration. These strategies can also help in situations where you can anticipate a difficult situation like loud noises or crowds.

These are just some of the many ways to alleviate anxiety and frustration when dealing with transitions and unexpected changes. The Behavior Technicians and BCBAs that work with your child can make schedules and social stories tailored to your child’s specific needs to promote independence.                 

Stephanie Riccardi, M.S., BCBA, LBA
Associate Clinical Director, New York
October 8, 2019