Develop Common Ground Autism Remediation

Learning to Handle Change

What has been will be again,

what has been done will be done again;

there is nothing new under the sun.

Ecclesiastes 1:9

A two-month-old girl is lying next to her mother on the bed, learning an infant game that is played throughout the world. Her mother covers her baby’s face with a washcloth and says, “Where’s Susanna?” Susanna is still and quiet. “Where’s Susanna?” Mom says again, her voice filling with excitement.  Susanna’s legs begin to kick in anticipation. “There she is!” Mom cries as she uncovers Susanna’s wide eyes.

Mom throws the cloth over Susanna’s face again. This time, she waits a bit longer before repeating “Where’s Susanna,” and waits longer still, building the suspense, before she reveals Susanna’s smiling face. Although they may not be aware, parents never play this game the same way twice. They change the pace, the pitch of their voices, the words, the objects used to cover the eyes; all in endless variation. Why?

The baby is learning that many things about the game can change and it is still the same game. It is the same, but different. Neuro-typical children perceive the minute changes their parents make to the game, and learn to delight in them. The pleasure that is produced by unexpected changes to their known games becomes addictive and children seek this pleasure again and again. Parents and children spend thousands of hours engaged in these intense interactions in the first two years.

As the child grows into a toddler and begins to learn a task such as taking a bath, they are already expert in discovering which parts of the task are essential and which can be varied. Neuro-typical toddlers delight in exploring the many variations on bathing, dressing, and playing that are available to them.

When neuro-typical children begin to converse, they are already attuned to the countless combinations of vocal pitch, tempo, and volume which they learned in the playful interchanges of their infancy. Their expertise at pattern recognition allows them to quickly pick up the emotional and linguistic patterns within these variations.

Children with autism spectrum disorders (ASD) have difficulty with the concept of “same but different.” Their aversion to changes in routine is due in part to this lack of ability to put the change in context. They are unable to perceive underlying patterns that give them a sense of continuity.  This can lead to a great deal of anxiety about anything new. These children can sometimes feel such a terror of change that they seek to control everything and everyone in their environment. Hence, a child with ASD may not tolerate driving a different route to school or visiting a new restaurant.

One reason that children with ASD have difficulty handling change is that they do not experience as much training in dynamic interaction in their infancy. Through no fault of their parents, children with ASD have difficulty holding up their side of the intense back-and-forth of baby talk and infant games. ASD can be caused by a number of different neurological and sensory problems that interfere with this early infant/parent communication. Try as they might, parents of children with significant neuro-developmental deficits often don't get enough feedback from their child to create long and sensitively coordinated interactions.

In RDI® (Relationship Development Intervention), parents are taught to turn everyday activities into a second chance at learning to handle the processes of change that characterize all human experience. Parents establish a simple pattern of interaction, such as cleaning the table together. Once the child feels comfortable, the parent begins to add just noticeable variations to the activity, one at a time. Many different activities are undertaken with this theme of balancing familiarity with variety. RDI® consultants guide parents as they help their children develop a genuine understanding of “same but different.” Through this careful guidance, children with ASD learn to handle change with confidence.

Published in National Autism Association of Central Texas newsletter, Oct. 2011

Kari Ramachandran, OT, RDI ® Certified Consultant, Austin, TX 512-363-6857