Flexible scheduling to prevent the development of disabling resistance to change

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Several neurodevelopmental disorders, including autism spectrum disorder, fragile X and Prader-Willi syndrome are associated with strong difficulties in dealing with changes to routines or expectations ("resistance to change" henceforth). Such resistance to change represents a highly disabling aspect of these disorders because it commonly precipitates behaviour problems that have a major negative impact on the lives of individuals with the disorders and their families.Evidence from experimental studies shows that this resistance to change is associated with limitations in cognitive flexibility (task switching), which is the ability to think about situations differently depending on changing demands. Furthermore, work on the typical development of cognitive flexibility suggests that - from both theoretical and empirical perspectives - this may be facilitated by exposure to environments with specific characteristics, namely those comprising flexiblility. Finally, our own work with individuals with PWS suggests that exposure to more rigid routines can be detrimental to an individual's subsequent ability to deal with changes, perhaps particularly when this exposure occurs during early school years.Taken together, this evidence suggests that an intervention strategy which increases flexibility in the environments that children are exposed to during early school years (when cognitive flexibility is developing rapidly), may be effective in preventing the development of disability linked to resistance to change. The present project aims to develop such an intervention strategy capitalising on current best practice, which advocates use of visual schedules to structure environments (to avoid changes that may precipitate contemporary behaviour problems). Thus, the inherent limitations of best practice implied by the evidence outlined above, will also be addressed.Critically, the present project aims to develop the intervention strategy and an associated implementation monitoring tool, collaboratively with stakeholders to maximise acceptability. Furthermore, the feasibility of implementing the intervention and monitoring; the capacity of the intervention to increase flexibility in children's routines; and the feasibility of the measures needed to evaluate the intervention in future pilot work will be assessed.The present work represents an essential step in the creation of a new intervention strategy that can prevent the development of disability linked to resistance to change, which is relevant for individuals with several neurodevelopmental disorders. Importantly, resistance to change is associated with particularly high negative impact (most disabling) for many families but is not well addressed in existing prevention approaches. Thus, the present strategy would be the first to systematically target prevention of resistance to change.The work will enable a future pilot randomised controlled study. The future planned pilot study will evaluate how far exposure to increased flexibility in routines during early childhood - mediated by the presently developed flexible visual scheduling caregiver led intervention - can prevent the development of disability linked to resistance to change, via increases in cognitive flexibility. Since in the present project, the intervention will be developed collaboratively to maximise acceptability; if the outcome of the pilot study suggests its efficacy, this can be immediately followed by a large evaluation, designed to enable the intervention to be used to decrease disability on a wide scale.