I find myself talking about transitions to the parents I see perhaps more than anything else. A parent will say, for example, “When I call her to come to dinner and finally say, ‘Kate, I need you to come here right now!’ I will either get a nasty response or none at all. If she does respond it will take 10 minutes and more nagging before she comes! Why does it have to be that way?!” the beleaguered mother will ask. These parents are good parents of good children. Most of the children whose parents consult me have major or minor neurodevelopmental problems, ranging from autism to ADHD or the kind of organizational problem commonly called “executive function disorder”. All of these problems involve difficulty making transitions. The good mother who is explaining that her daughter does not come when she calls is looking at the top of an iceberg. She sees a little mound of snow or ice. It is a simple, reasonable request. Why can’t her daughter make a “normal” response? However, beneath the water is a huge iceberg of patterned behavior and the meanings associated with it that has been built up over the child’s life.

Let’s analyze the mother’s “simple request” to “come now”. First of all, she is requiring that the child take in the auditory command. This is harder for some children who have ADHD or who have what is called “auditory processing problems” than for others. The mother might not know that Kate has auditory processing problems or if she did hear that from a tester, she may not have entirely understood what it meant. Or even if she did understand what it meant when the tester was explaining it to her, it is hard to keep in mind during the course of family life.

Second, the mother’s command requires Kate to shift her attention from whatever she was doing at the moment to what her mother is telling her. That shift in attention can be much more difficult that you would think. It involves taking apart the current organizational state of the child – her attention, narrative (the story of what she is doing), and her motor activity. It requires Kate to change her postural position and her physiological state of excitement or of comfort, and prepare for something else. Usually, these shifts in our state of being take place out of awareness. We have an intention to change, and it all happens – we stop reading, get up, and walk to the kitchen to start cooking dinner. We don’t realize that all these small changes of everyday life take energy. Other transitions – sleep to wake, home to school, bedroom to bathroom, bedroom to kitchen table, pajamas to school clothes or even worse, snow pants, also take energy. For some children it requires more energy than for others.

In addition to all those shifts, there is the relational and symbolic meaning associated with the transition. For Kate’s mother it may mean, “Oh, dear. I shouldn’t have taken so long reading that paper. I need to get dinner started!” That may be slightly annoying, but no big deal. For Kate, her mother’s calling her may have a very different meaning. That may be something like, “She is bothering me again, just when I got comfortable watching t.v. I had a really hard day at school and Susie was mean to me, and Mom just can’t give me a break. Why is she always making me do things and not Freddie (little brother)!” I am not suggesting that these coherent sentences appeared in Kate’s mind, but that her mother’s reasonable request may feel entirely unreasonable to her, and this meaning comes together with all the other transitional demands – that she shift her attention, her body, get stirred up inside instead of comfortable, etc.

There are two general antidotes for the stress of transitions. One is routine and the other is what I call “herd mentality”. Herd mentality is more available to teachers than to parents of children in small nuclear families. I first noticed it at the orphanage in El Salvador when the little children – most of whom had suffered early neglect and abuse and therefor could be expected from a neurodevelopmental point of view to have difficulty with transitions – all seemed to manage transitions relatively well. I came to think that it was because they all did the transitions together. When it is time to come to dinner and all the other kids start heading in the direction of the dining hall, the stragglers seemed to notice the general movement and catch up, as if noticing that they didn’t want to be left alone. There is another factor – those children didn’t have the hypnotizing effect of video games or other screens to interfere with the process of the transition.

In addition to the herd mentality, there is the importance of routine. What I tell parents is that routine is their best friend. That is because a routine has momentum. The teacher of the children in the preK classroom in the photo above is using routine, herd mentality, and the rhythm of dance, to facilitate a transition. Once you have established a routine the child does not have to move into that state of limbo, an extended disorganized state, with all the stress that entails. (Remember that stress can be expressed as irritability or aggression!) Instead, although the child may not want to interrupt what she is doing to come to the table, it is easier for her to do it. Kate’s mother’s command does not “come out of the blue”. Dinner is at the same time every night, more or less. Kate’s mother has given her a warning five minutes ago, just as she always does. She may even have gone into the family room to join Kate temporarily in her present state (“That looks like a good program! How about if we record it so that you can finish it later!”) and then used her own body to generate a rhythm in the direction of the kitchen. She may also have initiated a conversation about something that interests Kate – “Remember that girl, Karen, who moved out of the school? I just heard that she was moving back!” All these things help establish a routine. Once the routine is established, it makes everything easier.