|
Clear guidance on structure and flexibility is needed
|
|
Variation in professional advice on structure: Structuring routines predominated advice from professionals but varied across families and was not always useful.
|
Courses/professional advice is useful in managing challenging behaviours
|
19
|
52.78
|
1
|
|
Advised to create a structure or use visuals
|
17
|
47.22
|
1
|
|
No advice on routines received
|
10
|
27.78
|
0.82
|
|
Advised to vary structures
|
4
|
11.11
|
1
|
|
Intervention should include caregiver training and support caregivers to solve problems around implementation
|
|
Caregivers’ experiences affect how they engage with the child: The history of the relationship between the child and their caregivers influences how caregivers manage the environment.
|
Siblings and peers used to encourage child's engagement
|
8
|
22.22
|
1
|
|
Parents treat child like a typically developing child
|
7
|
19.44
|
1
|
|
Improved parental management of changes with experience reduces the likelihood of resistance to change
|
5
|
13.89
|
1
|
|
Caregivers differ in preparedness for supporting children’s flexibility: Parents’ background and experience impacts on their willingness and ability to promote flexibility.
|
Parents are willing to vary structures
|
22
|
61.11
|
1
|
|
Parent background and education contribute to understanding
|
12
|
33.33
|
1
|
|
Parents have learned strategies to deal with resistance to change outside targeted training/professional advice/educational background
|
8
|
22.22
|
1
|
|
Parents are hesitant to intentionally vary routines
|
7
|
19.44
|
1
|
|
Parental self-efficacy influences ability to introduce flexibility
|
5
|
13.89
|
1
|
|
Psycho-education for caregivers is important: Integrated support for caregivers, including education would facilitate implementation of the approach.
|
Caregiver supported problem solving should accompany the approach
|
22
|
61.11
|
1
|
|
Parents’ understanding of cognitive processes underlying child's difficulties helps parents support their child more effectively
|
8
|
22.22
|
1
|
|
Parents incorrectly mistake transitions and task-completion as resistance to change
|
7
|
19.44
|
1
|
|
Psycho-education would help parents understand children's difficulties
|
4
|
11.11
|
1
|
|
Easy to follow reminders /prompts to implement the approach are suggested
|
4
|
11.11
|
1
|
|
Guidance in evaluating progress and triggers is suggested
|
1
|
2.78
|
1
|
|
Intervention should support visual planning in way that is appealing to children and can be modified by caregivers to suit the family
|
|
A new approach to visuals is needed: A novel way of using visuals is needed to facilitate long term implementation and utility.
|
(Traditional) visuals lose impact over time
|
20
|
55.56
|
1
|
|
Visuals are important to support children using a new approach
|
16
|
44.45
|
1
|
|
Visuals increase rigidity
|
5
|
13.89
|
1
|
|
Visuals have practical disadvantages
|
4
|
11.11
|
1
|
|
Families differ in preferences for structure: Structure to routines is sometimes necessary but the level of preferred structure in routines varies across caregiving families and across children.
|
Family structure enhances naturally occurring variability
|
17
|
47.22
|
1
|
|
Structure is originally driven by child's needs
|
16
|
44.44
|
1
|
|
Structure is necessary to meet practicalities of family life
|
13
|
36.11
|
1
|
|
Parents don't like rigid structure
|
10
|
27.78
|
1
|
|
Parent has a personal preference for structure
|
8
|
22.22
|
1
|
|
Child implements self-imposed routine
|
3
|
8.33
|
1
|
|
Flexibility should be imposed in a structured way where possibilities are planned in advance by caregivers and are communicated clearly to the child
|
|
Individuals differ in changes that are problematic: Specific types of changes precipitate challenges, which vary across individuals but can be in expectations, order and/or people.
|
Child's expectations not being met is upsetting
|
19
|
52.78
|
1
|
|
Parents are aware of the underlying causes of resistance to change
|
11
|
30.56
|
1
|
|
Changes to fixated rules of order and duration of task/routines are problematic
|
8
|
22.22
|
1
|
|
Being in the presence of unexpected people is upsetting
|
7
|
19.44
|
1
|
|
Communication is linked to resistance to change: Communication between child and others can influence resistance to change and how this develops over time.
|
Child's management of unexpected change improved with age
|
15
|
41.67
|
1
|
|
Increased communication linked to reduced resistance to change
|
15
|
41.67
|
1
|
|
Child's management of unexpected change worsened with age
|
10
|
27.78
|
1
|
|
No change in child’s resistance to change with age
|
4
|
11.11
|
1
|
|
Child's increased ability to communicate is linked with increased resistance to change
|
2
|
5.56
|
1
|
|
Child's own awareness of the need to be flexible has increased with age
|
2
|
5.56
|
1
|
|
Increased demands or expectations of what child should be capable of doing with age affects behaviour
|
3
|
8.33
|
1
|
|
Intervention should incorporate game-like components, which give children perceived control over flexibility and support their choice making
|
|
A game-like approach would motivate flexibility: A game-like approach that incorporates reinforcement (delayed/ social) and perceived control (distancing this from primary caregivers) would motivate children’s flexibility.
|
Delayed reinforcement is motivating
|
15
|
41.67
|
1
|
|
Unexpected change more tolerable if child perceives that they have some control/input over how it changes
|
11
|
30.56
|
1
|
|
Change is tolerable if more enticing
|
11
|
30.56
|
1
|
|
Social praise is motivating
|
11
|
30.56
|
0.94
|
|
Game-like changes increase compliance
|
10
|
27.78
|
1
|
|
Change is more likely to be problematic when initiated by primary caregivers than non-primary caregivers
|
6
|
16.67
|
1
|
|
(Traditional) token economies/delayed reinforcement is not useful
|
6
|
16.67
|
1
|
|
Delayed reinforcement is contrived
|
2
|
5.56
|
1
|
|
Support for choice making is necessary: Knowledge of practical alternative choices and support in selecting a choice would promote flexibility.
|
Child struggles with choice making and processing alternatives
|
20
|
55.56
|
1
|
|
Presenting alternatives is beneficial for preparing child for potential variation
|
16
|
44.44
|
1
|
|
Familiarity makes tolerating change more manageable
|
9
|
25
|
1
|
|
Varied choices are required to prevent fixations
|
4
|
11.11
|
1
|
|
Choices are impractical due to pressure they put on parents
|
3
|
8.33
|
0.84
|
|
Choices (with no preferential bias by child) are the most naturally occurring and convenient way to introduce flexibility
|
3
|
8.33
|
1
|
|
Intervention should use technology to facilitate ease of access and adaptation to individual needs
|
|
Technology should support access: A technology-assisted tool that is transportable and can be used flexibly would be beneficial.
|
Technology as a convenient way of facilitating the approach
|
13
|
36.11
|
1
|
|
Approach should be transportable across people and settings
|
4
|
11.11
|
1
|
|
Individual adaptation is beneficial: An approach that allows a child to experience achievement on an ongoing basis would be motivating.
|
Approach should not be prescriptive, there should be an ability to adapt features when needed
|
10
|
27.78
|
1
|
|
The approach should be designed to set the child up for success and generate initial buy-in
|
6
|
16.67
|
1
|
|
Feelings of achievement are motivating
|
5
|
13.89
|
1
|
|
Behavioural approaches lose impact overtime
|
2
|
5.56
|
1
|
|
Intervention should support management of children’s anxiety around change
|
|
Children’s emotions impact intervention needs: Children’s anxiety around change limits flexibility – support for managing anxiety is important
|
Child needs a chance to process the change
|
13
|
36.11
|
0.95
|
|
Child masks difficulties throughout day
|
13
|
36.11
|
0.95
|
|
Change more tolerable if child feels safe
|
9
|
25
|
0.94
|
|
Caregivers reduce warning to avoid the build-up of anticipation anxiety
|
6
|
16.67
|
1
|
|
Child struggles to identify emotions
|
6
|
16.67
|
1
|
|
Techniques needed to reduce rumination and anxiety for child prior to change
|
2
|
5.56
|
1
|
