Assessing Transitions During School or Workday and Across the Life Span

Abstract

A major challenge for persons with autism spectrum disorder is the breaking of rituals and changing from one topic or activity to another. As a result, considerable literature has developed in regard to transition challenges. This chapter will provide a definition of the problem, the types of activities most commonly effected, and description of how the transition issues should be assessed. The transition assessment cycle including how the transition issues are identified, interventions that are used to target transition behaviors, and how progress should be assessed will be covered.

Appendices

Scenario 1: Transition Assessment Cycle for 5th Grade Student with ASD, Carlos

Step 1: Identify Transition Issues—Gather and Analyze Data

Interviews

Interviews were conducted with Carlos, his parents, and his special education teacher. Carlos’s teacher indicates that he has difficulty transitioning from one activity to another, especially if the transitions are from preferred to non-preferred activities. He does have difficulty with transitions within activities, but the behaviors between are currently the biggest concern as he often refuses to transition and will sometimes fall to the floor. His parents report that this is only a problem at home if he is asked to transition to something unexpected such as instead of playing Fortnite after school, he is taken to the park. Carlos said that he likes Fortnite, watching YouTube videos, and drawing. His favorite subjects in school are art and science. He struggles the most with math content.

The team decided that they would target the transitions between activities at school to begin, since Carlos’s behaviors are a bigger concern during that time.

Direct Observation Data

Direct observation data were gathered by watching transitions over 3 school days. Both Carlos and his peers were observed to gather information related to what typical peers behavior was in comparison to Carlos. Based on the data below, Carlos tends to prefer smaller group activities and activities that occur outside the classroom (i.e., lunch, recess, specials).

Transitions during the school day	Typical peer performance	Carlos’s performance
Transition from bus into the building. Walk to the classroom. Unpack backpack and hang in cubby.	Independent	Carlos was met at the bus and an adult walked him to class; he did not engage in inappropriate behaviors.
Transition to desk to complete morning work.	Independent	Independent
Transition to morning meeting.	Independent, with a verbal reminder for some	Carlos continued working on his morning work; the teacher had to physically guide him to calendar.
Transition to language arts large group.	Independent	Required three verbal prompts and a threat of timeout.
Transition to language arts small group.	Independent, with a verbal reminder for some	Independent
Transition to math large group.	Independent	Carlos refused and eventually fell to the floor; he remained on the floor during math large group.
Transition to math small group.	Independent, with a verbal reminder for some	Independent
Transition to Lunch.	Independent	Independent
Transition to Recess.	Independent	Independent
Transition to Specials (Art, Music, PE).	Independent	Independent
Transition to Social Studies.	Independent	Required three verbal prompts and adult proximity.
Transition to Science.	Independent, with a verbal reminder for some	Independent
Pack up.	Independent, with a verbal reminder for some	Independent
Transition to Bus.	Independent	An adult walked Carlos to his bus; he did not engage in inappropriate behaviors.

Step 2: Create an Action Plan—Set Goals and Identify Instructional Strategies

The action plan created below was done in the form of an ecological inventory. In a typical ecological inventory, each sub-environment would be broken apart and specific skills to be completed in that sub-environment would be targeted. For Carlos, it is the transitions between the sub-environments that are challenging, so the sub-environments are listed and considered in regard to the transitions between each. Based on the information contained in the ecological inventory, the team decided that they would implement a daily visual schedule for Carlos and they would also manipulate the task order. The visual schedule had Fortnite characters on it as his special interest and included a static picture of each activity during the school day. The task order was manipulated by moving recess between language arts and math. Math small group occurred after recess as it is more preferred than math large group. They also manipulated the task order by moving science directly after specials as it is Carlos’s favorite subject. The teacher was familiar with using visual schedules, so she did not need additional training.

Ecological Inventory

Environment: Elementary School

Transitions to sub-environments	Carlos’s performance/level of prompt	Discrepancy analysis	Goals	Potential instructional strategies
Bus to class	With adult supervision	Carlos was met at the bus and an adult walked him to class; he did not engage in inappropriate behaviors	Walk to class independently	Fade adult support; adult meet him at bus with visual schedule and fade out
Morning work	Independent
Morning meeting	Physical	Carlos continued working on his morning work; the teacher had to physically guide him to calendar	Transition to morning meeting independently	Visual timer Visual schedule
Language Arts large group	Verbal	Required three verbal prompts and a threat of timeout	Transition to large group language arts independently	Visual schedule
Language Arts small group	Independent
Math large group	Refusal	Carlos refused and eventually fell to the floor; he remained on the floor during math large group	Transition to large group math independently	Visual schedule Manipulate task order
Math small group	Independent
Lunch	Independent
Recess	Independent
Specials	Independent
Social Studies	Verbal + Adult proximity	Required three verbal prompts and adult proximity	Transition to social studies independently	Visual schedule Transition object Manipulate task order
Science	Independent
Pack up	Independent
Class to bus	With adult supervision	An adult walked Carlos to his bus; he did not engage in inappropriate behaviors	Walk to bus independently	Fade adult support

Step 3: Implement Plan—Teach and Monitor Progress

After baseline data were collected, and the teacher confirmed the information gathered in the initial direct observation, the visual schedule and task order manipulation were implemented. The teacher taught Carlos how to use his visual schedule by presenting it to him at the beginning of the day. She made the announcement “check your schedule” to the class prior to each new activity. There was a large group schedule on the board that matched Carlos’s individual schedule. She used graduated guidance to help Carlos find the next activity on his schedule, remove the picture, and transition to that area of the classroom or school. She chose to use graduated guidance since she could naturally fade her support as he learned how to navigate the visual schedule independently. She did not have to teach him about the task order manipulation because it was captured his visual schedule. She continued collecting data on Carlos’s behavior.

After 3 weeks, Carlos had started to transition more independently and with less refusals. The team met and decided the visual schedules and task order manipulation was working. Carlos was still having adult assistance walking him between the bus and classroom in the mornings and afternoons. He was also still having trouble with the transition to the morning meeting if his morning work was incomplete. The team decided to continue the use of the visual schedule and to add a visual timer to the morning work segment of the day. The team also decided to allow Carlos to transition between the bus and classroom with more independence.

Repeat

The team agreed to meet every 4 weeks to re-evaluate Carlos’s transition behaviors. As he makes progress, new transitions and environments will be targeted. His visual schedule will be altered based on independence and special interests.

Scenario 2: Transition Assessment Cycle for Adult with ASD, Emma

Step 1: Identify Transition Issues—Gather and Analyze Data

Interviews

Interviews were conducted with Emma, her mom, and her employer. Emma works at a veterinary clinic completing a variety of tasks. At work, Emma is a hard worker who shows up on time for her shifts. The areas of concern reported by her boss were that she requires constant supervision to complete tasks, even those that she has completed before. She seems to need a prompt to know what to do next as well as how to complete many parts of her job responsibilities. She also struggles with coming back from break. Her boss often has to go find her in the breakroom to remind her that it is time to go back to work. Emma reports that she really likes her job. Her mom is concerned because she has been fired from two previous jobs for similar issues. She wants Emma to have a job so that she can earn money to spend on things she likes. She reported that transitions at home were really not an issue, but she did say that she is always with her, reminding her of what needs to be done and often reminding her how to complete some of her routine daily living tasks (e.g., washing and drying laundry, making simple meals). Her mother reported that she was not concerned about her transition behavior in community settings other than work because she can always be with her. Emma did suggest she would like to begin to do things like shop at the mall or go see a movie alone or with friends.

The team decided to target transitions at work first since it appears to be negatively impacting Emma’s life more than her transitions in other settings.

Direct Observation Data

Direct observation data were gathered by watching transitions between and within job responsibilities for three shifts during the week. After consulting with her boss, some additional notes were made to ensure an accurate picture of Emma’s performance was reflected. The list below captures typical responsibilities, not necessarily in the order she needs to complete them. It was noted by Emma’s boss that other adults were able to complete an entire shift’s work with very little to no support since their tasks are the same or similar each day. Based on the data below, Emma seems independent with the job responsibilities that are routine and never change (e.g., clocking in, checking in with office manager) or those that have a visual support (e.g., feeding animals based on the cards attached to their kennels). Emma struggles to complete tasks that have been verbally told to her (e.g., walking certain dogs) or those with multiple steps (e.g., cleaning kennels or exam rooms). She struggles with within activity transitions more than between activity transitions, although she does often have to be reminded of what to do “next.”

Transitions at work	Skills	Emma’s performance
Clock in on time.	1. Navigate to name on computer 2. Choose “clock in” 3. Confirm “clock in”	Independent
Check in with office manager for job responsibilities for the day.	1. Walk to front desk 2. Wait until the office manager is available (e.g., not with a customer, on the phone) 3. Request the work to be done for the day’s shift	Independent
Emma’s typical jobs:
Clean dog kennels that are empty.	1. Remove bowls or other things from kennel 2. Scoop feces and any debris using the feces scoop 3. Discard appropriately 4. Rinse the entire kennel with water 5. Apply disinfecting solution 6. Scrub the kennel with the scrub brush 7. Rinse the entire kennel with water 8. Squeegee the entire kennel 9. Clean the bowls with disinfectant 10. Rinse the bowls with water 11. Put the bowls back into the kennel	Needs verbal prompts to know where to discard feces/debris; needs verbal prompts to know how much water to rinse the kennel with; needs verbal prompts to know how long to scrub
Feed the dogs being boarded based on cards on kennels.	1. Clean out food bowl 2. Locate the feeding card on the kennel 3. Follow the directions on the feeding card, feeding the correct type and amount of food 4. Make sure they have fresh water	Independent
Walk the dogs the office manager told her to walk.	1. Choose one of the dogs that needs to be walked 2. Get a leash 3. Get the dog from their kennel 4. Walk the dog for the time required 5. Return the dog to their kennel 6. Repeat until all dogs on list have been walked	Independent, often has to ask the office manager for a reminder of who she is supposed to walk and sometimes needs a reminder of how long she has been walking each dog
Bathe the dogs the office manager told her to bathe.	1. Choose one of the dogs that needs to be bathed 2. Get the dog from their kennel 3. Take to bathing station 4. Wet the dog with water 5. Shampoo the dog 6. Rinse the dog with water 7. Dry the dog off with towels 8. Return the dog to their kennel	Independent, often has to ask the office manager for a reminder of who she is supposed to bathe; this activity can take longer than needed for each dog, depending on the day
Fill prescription orders.	1. Locate prescriptions that need to be filled 2. Fill one at a time into individual bags 3. Put into basket on office manager’s desk	Independent
Clean exam rooms.	1. Throw away any trash left in exam room 2. Spray disinfectant on the exam table, scale, chairs, and sink area 3. Let it sit for 10 min 4. Wipe exam table, scale, chairs, and sink area with a damp rag 5. Sweep floor 6. If things are left on the floor after sweeping, mop the floor 7. Use disinfectant wipe to wipe light switches and door handles	Needs verbal prompts to remember each step
Take a break.	1. When it is time, take a break in the breakroom or outside 2. When the break time is over, resume working on your tasks	Takes her break when told; has to be reminded when break is over
Clock out.	1. Navigate to name on computer 2. Choose “clock out” 3. Confirm “clock out”	Independent

Step 2: Create an Action Plan—Set Goals and Identify Instructional Strategies

The action plan created below was done in the form of an ecological inventory. In this example, the environment is the veterinary clinic where Emma is employed. The sub-environments are the various tasks she is required to do as part of her job responsibilities within the sub-environments at the veterinary clinic. Since transitions within activities are a concern in addition to the between activity transitions, the sub-environments and skills within each were assessed and part of the plan of action. Based on the information contained in the ecological inventory, the team decided they would place visual supports in various areas of the veterinary clinic (e.g., the exam rooms, near the dog kennels) where multi-step jobs were assigned. In addition, a video activity schedule with an embedded timer would be used to help Emma navigate the transition between and within activities while at work. Many applications that are used to build video activity schedules also include internal timers, so the activities that need to be timed (e.g., walking the dogs, letting disinfectant sit for 10 min) can have the timer embedded. The employer and mother have not had experience using video activity schedules so they both needed to be trained.

Ecological Inventory

Environment: Veterinary Clinic

Sub-environments	Carlos’s performance/level of prompt	Discrepancy analysis	Goals	Potential instructional strategies
Clock in on time.	Independent
Check in with office manager for job responsibilities for the day.	Independent
Clean dog kennels that are empty.	Verbal	Needs verbal prompts to know where to discard feces/debris; needs verbal prompts to know how much water to rinse the kennel with; needs verbal prompts to know how long to scrub	Clean dog kennels independently	Visual supports Video activity schedule Timer
Feed the dogs being boarded based on cards on kennels.	Independent
Walk the dogs the office manager told her to walk.	Independent	Often has to ask the office manager for a reminder of who she is supposed to walk and sometimes needs a reminder of how long she has been walking each dog	Walk dogs on her list without having to ask	Visual supports Timer
Bathe the dogs the office manager told her to bathe.	Independent	Often has to ask the office manager for a reminder of who she is supposed to bathe; this activity can take longer than needed for each dog, depending on the day	Bathe dogs on her list without having to ask	Visual supports Timer
Fill prescription orders.	Independent
Clean exam rooms.	Verbal	Needs verbal prompts to remember each step	Clean exam rooms independently	Visual supports Video activity schedule
Take a break.	Verbal	Takes her break when told; has to be reminded when break is over	End break and return to work on time	Timer
Clock out.	Independent

Step 3: Implement Plan—Teach and Monitor Progress

After baseline data were collected, the visual supports were hung up around the veterinary clinic and Emma was taught how to navigate the video activity schedule loaded onto her phone. The navigation was taught using the activities she was already independent in completing to show her how to navigate and complete the various activities using the visual schedule and embedded video models. Once she learned how to navigate the video schedule, her entire schedule was uploaded. One additional level of support that was implemented was the office manager texted her a list of dogs to walk and bathe each shift. That way, if she forgot during her shift, she could just refer back to her text messages.

After five shifts, Emma had fully mastered navigating the activity schedule. One week later, she was using the video activity schedule to independently complete all tasks required during her shifts at work. She was also adhering to the times set with the timer. It was agreed that if her independence continued, she would be able to pick up additional shifts at work and perhaps be given even more job responsibilities similar to others her same age (e.g., holding pets during exams, assisting in getting materials ready for surgery).

Repeat

The team agreed to meet in 2 more weeks to ensure the video activity schedule and extra visual supports were still working. As she makes progress, the intention is to create video activity schedules for the home environment to lessen the need for prompting from mom. Eventually, the team would like to see these support increase Emma’s independence in the community.