WHAT IS A TRANSITION ROUTINE?
Transitions range from major transitions (e.g., the transition from high school to college or work; the transition from being single to being married) to small transitions (e.g., the transition from lunch to classroom work). Major transitions are stressful for everybody. Small transitions can be stressful for students with disability, particularly for those with impulse-control problems, organizational impairment, or other sources of inflexibility common after TBI.
Activity-to-activity transitions include ending an activity, moving from one activity to another, and beginning the new activity. Thus transition routines include the words, activities, and rituals that teachers use to bring one activity to an end, transition to the new activity, and then begin the new activity.
Transition times offer teachers and parents many excellent teaching opportunities. They can use the ending of an activity to review the activity that is ending and possibly to review the day up to that point. This review helps to consolidate memories in the student’s head and also creates a habit of reviewing work that has been completed. The review also helps to prepare for the transition. Teachers and parents can use the starting routine to plan the next activity and reflect on how difficult it might be and what might be needed to get the job done well. [See Tutorial on Self-Regulation Routines]
WHY ARE TRANSITION ROUTINES IMPORTANT FOR MANY STUDENTS AFTER TBI?
For anybody, transitions can be stressful and thus a source of behavioral disruption and cognitive disorganization. Adults without disability find major life transitions stressful and disorienting (e.g., leaving home, getting married, changing jobs). Therefore, they typically provide support for one another and create helpful rituals and other comforting routines in order to successfully negotiate difficult transitions.
Students with brain injury often have damage to the frontal lobes, resulting in both cognitive and behavioral inflexibility. Therefore even simple transitions may be difficult and stressful, such as moving from one scheduled activity to another or accepting an interruption within a familiar routine. Thus supportive transition routines are critical from the perspective of reducing stress (and the negative behaviors associated with stress) and facilitating orientation and self-regulation.
WHAT ARE THE MAIN FEATURES OF TRANSITION ROUTINES THAT ARE IMPORTANT FOR MANY STUDENTS WITH TBI?
Well planned transition routines serve three important purposes:
1. Reduce stress and behavioral disruption: Effective transition routines make transitions less stressful and therefore prevent disruptive behavior that may occur during difficult transitions.
2. Facilitate acquisition of organizing schemes: Transition times offer adults the opportunity to teach students a variety of organizing schemes, such as the daily schedule, the activities involved in clean up, the activities involved in activity preparation, and many more. [See Tutorial on Organization]
3. Facilitate acquisition of self-regulation/executive function routines: Transition times also offer adults an opportunity to create habits of goal setting, planning, organizing, reviewing, self-evaluating, strategic thinking, and other elements of self-regulation. [See Tutorial on Self-Regulation/Executive Function Routines]
In summary, transition routines not only facilitate transitions for the student. They also offer adults an opportunity to teach children how to think in an organized way, how to plan (organized thinking projected into the future), how to remember (organized thinking directed into the past), how to talk in an organized way, and how to organize their behavior to achieve their goals in a way that is consistent with the interests of others.
It is useful to think about transition routines as having three parts: What is done to bring an activity to an end; what is done to make the change, and what is done to move effectively into the next activity. When it is known in advance that students will face stressful transitions (e.g., leaving preferred activities and resuming non-preferred activities), it may be wise to discuss and practice the transition routines in advance until they are well understood and easy.
Well-designed routines for ending an activity can include some of the following options, depending on the student’s level of concreteness and other abilities:
- Alert the student in advance of the ending time, to help prepare him.
- Complete the activity in a natural and logical way, assuming that the activity is organized so that it has a logical completion (and it should have a logical completion). Completing the activity within the time frame allotted may require that the teacher or parent help with the completion.
- Engage the student in a review of the just-completed activity: The goal, the plan, the execution, possible problems that emerged and how they were solved, the outcome, what worked and what didn’t work. Possibly use objects or pictures to support this review. Throughout this review, use language (mediation) that will ideally be internalized by the student to shape his thought processes.
- Clean up; put things away.
- Remove the picture or symbol for that completed activity from the TO DO side of a planning board and place it in a completed category.
THE CHANGE ITSELF
Well-designed routines for the change itself can include some of the following options, depending on the student’s level of concreteness and other abilities:
- Physically move from one place to another, even if technically not necessary. (Physical movement is an indicator of activity change for a concrete thinker.)
- Give the student an object that is a symbol of change in activity (e.g., a ticket or key).
- Somehow say goodbye to people in the previous activity or to the activity itself. That is, make the change very explicit and complete.
Well-designed routines for beginning a new activity can include some of the following options, depending on the student’s level of concreteness and other abilities:
- Highlight the new activity on the planning board.
- Give a general orientation to the new activity possibly reminding the student of what was accomplished last time.
- Set a goal and make a plan for the new activity. Physically represent this plan somehow (e.g., a clear sequence of photos or symbols or words). Use mediating language that will ideally become the student’s thought process over time. [See Tutorial on Self-Regulation, Executive Function Routines]
- Collaboratively create a prediction about how well the student or the group will do.
- Collaboratively make a judgment about how much help will be needed and what kind of help.
- Involve the student in assembling all of the needed items.
ROUTINES TO CHANGE ROUTINES
Students who are concrete thinkers, disorganized to some degree, and dependent on concrete routines usually have great difficulty when their routines are violated or need to be changed. Because these students are dependent on routines, they need routines to deal with changes in routines. This may sound paradoxical, but it is very important for these students.
Well-designed routines for changing routines can include some of the following options, depending on the student’s level of concreteness and other abilities:
- Discuss the change or new routine well in advance of the change.
- Practice the new routine.
- When the change is implemented, use behavioral momentum-building activities to help put the student in the best frame of mind for the change. [See Tutorials on Behavior Management: Prevention Strategies; Positive Behavioral Momentum]
- Graphically represent the new routine (e.g., a sequence of photographs or drawings) if the student is a concrete thinker who benefits from visual sequences to guide his thinking and behavior.
Written by Mark Ylvisaker, Ph.D. with the assistance of Mary Hibbard, Ph.D. and Timothy Feeney, Ph.D.