Dr. Joshua Feder is a child and family psychiatrist in California. He is the former Chief of Child and Family Psychiatry at National Naval Medical Center and a father of a son with Austiam Spectrum Disorder. In today’s post, Dr. Feder discusses his approach to transitions for people with ASD.
It can happen on any given day. I walk into my waiting room to invite a family into my office. A child or teen with ASD is intently focused on playing a hand-held electronic game. The parent kindly tells him to turn off the game and come into the office. The child resists, perhaps with a tantrum, perhaps throwing the game. The parent may be assertive and wrest the game, or maybe stern words are enough to get results. The child (or teen) is off to a sour start to our interaction, which naturally might focus on non-compliance at home.
Many people with ASDs have difficulty making transitions from one part of the day to the next. Often there are tantrums or even self injurious behaviors. We ask ourselves things like: “Why can ‘t he just turn off the game and come to dinner?” Is he being willful, that is, purposely non-compliant? Why? If not, what is the problem? Is this all about the ‘need for sameness’ that we hear a lot about?
Having an ASD is a set up for becoming willful. The world is a difficult place, and often enough resistance to transitions is accidentally rewarded with retreat on the part of those around him who do not want to upset him. All people with challenges, not just ASDs, may learn to control the emotional tone of the moment, gaining a sense of mastery in a difficult world, even though it is distorted and not as adaptive as he need to function in the world. This process may be almost addicting in the sense that the person becomes ever-more fixed on getting his way.
This dynamic offers a path to helping make transitions smoother. The key might be to accept the person’s resistance as an effort to do the best he can, even if it isn’t so adaptive in the larger world of family, school, etc. If we can not take is personally, and if we can honestly empathize with the person about how hard it is, we have a chance of joining the person, giving a bit of space to find a compromise solution, and perhaps effecting a smoother transition.
For instance, when we wait out a child for a bit, making clear that we see he needs a minute or two to get to a place to pause, we often see pretty good compliance. Not always, mind you, but we can often enough bargain a bit about it. I like to do this using less verbal and, more natural vocal/ gestural communication, so that we are engaging in interactions that support reading others’ cues.
This is a brief overview, but to understand it better, the next time someone interrupts you while you are doing something you like, e.g., watching TV, note the difference between when the other person intrudes during the show vs. how you feel when the person cues you that they need to talk and yet waits for the commercial. You might feel a bit of what the person with ASD feels with such requests, irritated when interrupted, but ok when you are approached in a manner that shows the person interrupting was thinking about your point of view too.