Anticipate Problems
It is always important to anticipate problems. That means, for example, anticipating stressful events, the effect of a high conflict relationship, and transitions.
Stressful events may include a visit home from the orphanage, a birthday or other special occasion, a test at school. High conflict relationships can cause stress at home with a caregiver or sibling, or at school with a teacher or a classmate. Any observer on the playground during free play at school will witness many problematic exchanges; sometimes these exchanges are repeated in the same relationship day after day, and those patterns can be anticipated.
Transitions are difficult for all children, indeed, for people of all ages. Children with developmental problems – and as I have said, that includes all children with significant histories of neglect and maltreatment – have even greater difficulty with transitions than others. This is because ideal developmental outcome is evidenced by the smooth integration of experience and function at different levels and in different domains in a continuous flow. In this case, a transition – which necessitates the taking apart of the organization that was functioning in the previous state and creating a new organization to deal with the new one – is manageable. For example, when a “healthy” person wakes from sleep, the complex physiological, emotional, and motoric transitions that are required to move from bed to upright and to preparing for the day are no big deal. If, however, the person suffers from a mood disorder or has a fever or has a developmental problem related to autism or trauma or cerebral palsy, for example, this transition can seem or even be actually impossible. The same is true for the transition from home to school or to work or even from one classroom activity to another or one work situation to another. One must never underestimate transitions, because transitions are challenges to organizational capacities, and these capacities are the first to be affected when development follows a problematic pathway.
Prepare for Transitions
Preparing for transitions can be done in many different ways according to the needs and capacities of the individual child. It is often helpful to make a schedule of predictable events and display it in some central place in the child’s bedroom or in the home. Some children respond better to visual cues. For example, a teacher in the preschool where I work has created a beautiful laminated strip of photographs of classroom events (children engaged in these activities) in the order in which they occur to use as a visual reminder for a child with a developmental problem. This child also has a laminated strip with the steps in hand washing (turning on the tap, taking soap from the dispenser, rubbing hands together, rinsing hands, drying hands with paper towels, throwing towels in the trash). This has proved to be extremely helpful and has turned an often oppositional struggle into a calmer series of redirections to keep on task.
It is also helpful to give friendly warnings to prepare for transitions. Although this seems routine, caregivers often forget. If the caregiver anticipates the need for the warnings, they can be given without the annoyance generated by noncompliance. First, the caregiver can give a 5 minute warning, then a 2 minute warning, and finally a 1 minute warning, for example. If a schedule similar to this is given routinely, a ritual is established. The child knows what to expect, and the caregiver is not stressed to think of how to respond.