Facilitating the child’s ability to accept change:

Change is a necessary part of any day and any routines. The ability to have a life that flows is the ability to accept change on multiple levels: within routines and apart from routines. The child needs to be able to accept a change in a component of a routine: e.g. not being able to sit on a specific chair because it is wet/. not being able to wear a short sleeve shirt because it is cold in the house/ not being able to feed the dog because his brother wants a turn. In addition, the child needs to be able to accept a change in the sequence of the day’s events, e.g. not being able to swim because it is thundering and lightening/ not going to get ice cream after going to the store because his stomach is upset/ not going to the park because he has a birthday party. When the child has a tantrum about a change, the negative reaction is strong and supports the creation of a strong negative episodic memory. As a result, when confronted with change, the child will have a rush of strong negative feelings that results in a tantrum as he tries to protect his sense of competency embedded in the fixed routine. Our job is to introduce change in a way that is non confrontational and to support the creation of positive episodic memories about his ability to accept change. One way to do so, is through the use of patterned activities. When a child is in a patterned activity, part of his job is to adjust to small changes. For example, when he is given a spoon to place in a drawer, as he demonstrates competence small changes are added. The spoon is held up high, so now the child has to reach up to get it. The adult steps back, so now the child has to stand up and walk to the adult to get the spoon. That is, the child is maintaining his competence despite changes. Hence, by practicing patterned activities, the child practices remaining competent in the face of change. Schedules could also be used to support changes across routines. For example, if the child expects to go for ice cream after going to the store, before leaving for the store, the adult could show the schedule of events indicating that the child will go to the birthday party instead of getting ice cream. The adult could even preview a video about a birthday party and show the child that he will be getting ice cream at the birthday party. When the child goes to the party, the adult should take pictures of him eating ice cream and having fun. Later, the adult could support the child’s ability to retain a positive memory around a change in a routine by showing the child the picture of him having fun at the party. Pictures of positive moments, when the child can accept change, should be kept in an album or in a file on the phone or computer, to be reviewed to help the child to retain positive memories about cognitive flexibility.