One of the main diagnostic criteria for autism spectrum disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is that the individual with autism shows restricted, repetitive patterns of behavior, interests, or activities. So, as a result, one of the earliest signs of autism can be a love of ritual, consistency, predictability, and routine. Some routines can be harmless, but others can cause serious inconvenience.
One of the symptoms that support the diagnosis of autism is that they adhere strictly to their routines and are not completely flexible in this regard. It is an insistence that can be observed in many different ways, has many different types and extends to extreme details. Everything you can think of can set an example for this situation. Meals and the order they were eaten, or even the tone of words used in a fairy tale
This insistence on routine and sameness can only be categorized as obsessive and compulsive. Any slightest deviation from any of these features can cause incredible anxiety in an individual with autism and result in tantrums. Adherence to routine is an obsession with individuals with autism, and any change in this pattern is the root cause of anxiety.
It should be kept in mind that it is important to understand that routines can be a mixed bag when it comes to the pros and cons of the rituals. Because of the fact that the same routine might help in some ways and hinder in others. A routine can be particularly helpful at the start of something, for example when they go to a new place, doing it in a predictable way can make it less scary, however, start to interfere as time goes on.
As a general rule, it is good to accommodate routines and rituals up to a point even though there is no hard and fast answer. Nevertheless, caregivers should keep gently pushing in order to incorporate new things so that their children with autism start learning to cope with any challenges.
For an individual with autism, the world can feel like an unpredictable place and since those with autism tend to be anxious, unpredictable equals frightening. As a natural solution, people around them try to make things as predictable as possible or try to control the environment in order to make sure that no new situations come along that make everything frightening again.
Having routines can be an advantage for individuals with autism. As we all know, daily life is too challenging for them and any difficulty can easily lead to depression, anxiety, or uncertainty. These routines they have make it easier for them to deal with such problems. Individuals with autism use dependence on routines, maintaining the same, or obsessive repetitive behaviors as a way to relax themselves.
Nevertheless, resistance to changing routines can also create problems when those changes are unavoidable. For example, moving between classrooms when going up in grade levels at school, moving from one city to another, or when a new sibling is born.
“There is a family who wants to share their child with autism day-to-day routine. They do not have bath time mornings because they often do those at nights during the summertime. So, she starts by getting breakfast with cereal. She makes every step by herself under the parents’ watch. It does not help that her summer routine is a little jacked up because that family is in the process of moving. So, that makes things a little bit challenging for both the child and family. Messing up her routine leads to confusion and anxiety, frustrations, some new behaviors and things like that. But still, she is doing pretty well, all things considered.
Every little thing affects her, even not having out a dining room table because they got rid of that before the move. Just every adjustment to her typical surroundings, her normal environment. After finishing the breakfast, again she cleans up under parents’ watch. Then, she listens to some music. She likes hip-hop and rap. The mother gets her ready but parents have to switch off like one person get ready and get the child ready. One of their summer routines is eating donuts every morning.
Getting out the house is pretty crucial to summertime. Because she gets cabin fever very quickly and if they are in the house for more than two days in a row where she does not really leave, just going to the store, then also fun activities lie going to the pool, going to the beach and then just outings with other people. She does not want to hang out with mom and dad all the time, even she has autism, still, she is a teenager. So, sometimes she wants to hang out with her friends.
If she does not have any therapy or respite at the day, still it is part of her summer routine. Some days of the week she has therapy. ABA therapist comes to the house and they work on primarily life skills, so that is kind of helpful for the family for going out and doing outings and things like that. Because they can implement the things that they learn from the therapist during their outings and such. And then the rest of a bit. She gets break from the rest of the family, as caregivers, they get to have a little bit of a break from the caregiver position.
Also, it can be implemented some form of sensory activity into her day during the summertime into her schedule. That way, it is almost like a build-up for her. Her sensory needs, kind of a build-up throughout the day and she has a better day when she can get that out and get that sensory input that her body requires. In addition, one of her routines is painting. She likes to paint. Nanny helps her with a painting by making stuff like sensory-friendly and occupational therapy style painting. Other than a couple of meals and the bedtime comes. The bedtime is kind of as she gets tired. That’s pretty much it. That’s pretty much her day in a nutshell.“
There is no denying that the need for routine can get inconvenient when it applies to a lot of things. Common areas where fear of the unknown kicks in include new food or drinks, leaving or entering the house, meeting new people, going to new places, arranging the familiar environment, doing ordinary routines in a particular way and transitioning.
New food or drinks: It is one of the big issues and, if it is extreme enough, it can cause worries about malnutrition.
Leaving or entering the house: Sometimes caregivers may have to perform a lot of rituals in order to get the child with autism to cooperate, which is not easy if there is a hurry.
Meeting new people: Visitors who come to the house or a new person in a familiar place, for example, a supply teacher, can cause a lot of anxiety in those with autism.
Going to new places: Some of these places, for example, hospital appointments, cannot be avoided.
Arranging the familiar environment: If the child with autism has decided that, for example there should be mirror on the wall, the kitchen door should be open always or milk should be top of the fridge, even a small change can be a big deal for them.
Doing ordinary routines in a particular way: Some activities may not seem important for us whether the child with autism flushes too loo before or after the activity or task, however, it can seem very important or even vital for them.
Transitioning: This is the technical term for switching between toys, games activities, task or even places. When individuals with autism have settled down to one thing, it can be surprisingly difficult changing to another one.
Routines can creep up on you because the child with autism can start applying them to anything. Caregivers might not even realize that a ritual has developed until they cross it. For instance, you happen to buy the same toothpaste a few times in a row, and think nothing of it until you pick up a new brand on special offer and find your son or daughter with autism will not touch it. Within reasonable limits, routines are not a problem, but if it pasts a certain point they start to make life unmanageable.
Although reinforcing routines may seem irrational, it can be used as a method to demolish individuals with autism to be firmly attached to their behavior. Having routine may strengthen the sense of well-being and stability for individuals with autism. When these feelings become fulfilled, it becomes easier for them to deal with other changes in their routines.
A moderate amount of routine and rituals can be good for individuals with an autism spectrum disorder. Anxiety could be painful, and a bit of regularity can help in order to keep that in check, not to mention speeding things up when it is time to get ready for school.
However, if they start to get so dependent on the routine that they panic if it looks like it is going to be disrupted, then at that point it is stopped preventing anxiety and started causing it that no one can control every possible variable at all times, and routines do sometimes get disrupted. The child with autism cannot make it through the day when that happens, then the routines are starting to do more harm than good.
In these cases, even though it is very difficult, caregivers may need to start trying to change the routine before it gains a complete stranglehold. They may be dealing with something a little less obvious, though, or they might need to explain the situation to a teacher, social care worker or therapist. In those cases, there are some questions that can help caregivers in order to clarify the issue. For example:
- Is the routine actually harming those with autism or anyone else?
- Is it helping those with autism in order to manage their anxieties, or is it making them more anxious?
- Does it make things easier or harder for them to handle?
- Is it affecting their ability to learn?
- Is it affecting their social life?
- Is it affecting their family’s ability to carry out day-to-day activities, or to go on holidays or trips?
Some of these questions will have very clear answers, while others may need more thought. Families always involve compromise, but if the compromise is in no one has interests, it may be time to address the routine rather than accepting it.
Routines, Rituals, and Obsessions
Routines: They are often quite important to children with an autism spectrum disorder. They might like to do some activities in their daily routine in the same way, every time. They may want to eat, take a shower, leave the house, and go to bed always at the same time. Every child on the spectrum can have a different routine. It doesn’t have to be that all of them share the same behaviors, the same activities, and the same patterns. One can happy with one path and the same one makes the other one stressed.
Rituals: Some children on the spectrum have rituals. Those rituals give them comfort and make them relax in a way. Sometimes they can use it as a self-shooting behavior. For instance, keeping the favorite toy in a specific place such as under the parent’s bed, drinking from only one particular cup, eating on the same plate always, and so on.
Obsessions: All people in the world more or less have favorites and we tend to do those or use those what they are. But for individuals with autism, these are often more intense and more focused.
Some of them on the spectrum move one interest to another in a very short time period such as 2 weeks. They can be obsessed with it for only 2 weeks. Then, they can change it to another. On the other hand, some of them may have discovered something in their childhood and continue these obsessions throughout their lives.
Why Routines Are Important for Individuals with Autism?
Routine is a good thing to have for human beings. There is recent research that even we could all benefit from having a routine and a regular rhythm in our lives. But routine is especially important for individuals with an autism spectrum disorder. There are some reasons why it is important to have.
Reality is very confusing to an individual with autism. Therefore, determining routines, planning times, using certain routes, creating certain methods and having rituals help them lead a sustainable life. These make their chaotic lives easier. Adhering to routines reduces their fears. In addition, routines can reduce anxiety in people with autism because it creates structure and predictability.
The exact cause of obsessive behavior or the need for routines and rituals is not known. The cause might not be the same for everyone. For young children with autism spectrum disorder who have limited play skills, special interests can be just something they enjoy. For many of them, obsessions, routines, and rituals can also be a response to stress and anxiety. Their communication difficulties can make it hard for them to understand what is happening around them, and this is stressful for them. But their obsessions and rituals let them feel more in control of their environment.
Also, children with autism spectrum disorders typically have sensory sensitivity. These sensibilities can lead them to have obsessions and rituals. For example, a child with autism can bite his hand as if he wounds it and enjoys this feeling. Because this behavior helps him calm down. And children with autism often have problems with planning, so having a strict routine can help relieve them.
Order Form Chaos: Many of those who have autism spectrum disorder live in a world of full chaos. These individuals have difficulties in making sense of everyday movements, sounds, and actions. What sounds like a symphony to us, to normally developed individuals may sound like white noise to the individual with autism. Routine creates order in their lives. These individuals gradually learn what to expect and when to expect it. So, routine creates a safe and secure environment in which life is predictable.
Routine Comes Naturally: From the rule of thumb, children on the spectrum naturally tend to like repetitive actions and stereotypic movements. Routine comes naturally to them. They are not a challenging task for them, on the contrary to daily life.
Stress Relief: Routine is known as relieving stress is almost all individuals. The individual with autism has a particularly stressful life as he or she tries to make sense of his or her surroundings. Adding routine will relieve the individual’s stress.
Routine Adds to the Learning Potential: In order to teach a child with autism something new, the stress level of the child must first be reduced. There is a great job for the caregivers in this regard. It is relatively easy for the child to learn something after the stress is reduced. Routine is a powerful learning tool in the autism spectrum environment.
If you have a child with autism, routines should be indispensable in your life and should be at the center of your life. When you see how well your child with autism who you think he / she does not have the ability to learn is good at performing routines and can learn them, you will understand that your child is in better condition than you think. Your child can learn, make progress, and be happy when he reaches his goals. The important thing is to know how to help him at these stages.
Methods That Can Help to Change Routines
Let’s say that you want to make a change in the routine. So, how do you introduce this change with minimum pain for all concerned? The best thing to do is to make things as clear as possible. Some of the child’s anxiety will be the inevitable result of changing something, but it can be exacerbated by confusion, and the confusion is something that you can keep to a minimum.
It is important for parents and caregivers to understand why a child with autism feels the way they do. They should talk to the child about it, and help brainstorm ways to make the situation feel less threatening.
For instance, using visual supports, going somewhere new, using social stories, preparing those with autism for changes with a timer, making back-up plans, and praise, reward and reinforce method can be helpful when you want to make a change in routines.
Using Visual Supports: Caregivers can use visual supports, such as picture schedules or light-up timers, in order to explain what is going to happen. For example pictures of new places, written lists, ‘now and next’ boards and calendars can be count as visual supports. All of them make it easy to literally ‘see’ what is going to happen. If you put the information where they can look at it and take it in their own time, which may be a lot more comfortable for them.
Reminders: Providing plenty of reminders about a change in routine will be helpful to minimize anxiety when change happens. For example, you can say that “Remember, next Monday we are going to visit your sister at college.”
Visiting New Places: If you are going somewhere new, let them have a look at everything around them in advance. Drive through the area, and if it is possible to let them come in for a visit during a quiet period. You might be able to arrange a visit to a new place, like a birthday party venue, ahead of time, perhaps during a quieter time of day. For instance, visit a new school after hours so there are not so many other children making things overwhelming.
That’s why individuals with autism will have at least some idea what the ‘unknown’ will be, and hopefully, they will start to accept that it will not be anything terrible. This way your child can get more familiar with the environment, without being overwhelmed by lots of noise and people. If you cannot do that, try looking for images of the place on the internet.
Using Social Stories: It is a good way to inform the child with autism using terms that he can understand. Carers can tell the same story several times to help children with autism do things that are often difficult to do without help. There should be a creative rehearsal of what will happen. By letting the child know what to expect, caregivers cut surprises and ensure that the child will have a positive experience.
For example, caregivers can make a social story about going to the doctor. Pictures, words or both can be used. Getting ready before leaving, on the way, arriving doctor’s place, seeing the doctor, giving some examples, and so on can be described. Ending the story on a positive note is always a nice and important touch. For example, it can be ended with ‘When we are done at the doctor’s place, I get icecream’.
Preparing Them for Changes with a Timer: Using a cheap stopwatch or an app can give individuals with autism a nice clear countdown. If they know that, say, you are going to leave the place or you are going to put the toy down when the timer goes off, they will have some time to get used to the idea. Timers would be helpful while switching from one activity to another.
Having Timetables: Timetables are important to make everything clear in everyone’s life. In terms of children with autism, they are a simple way to let a child know what to expect, when it will happen are where it will happen. For example, try using pictures of clocks in order to explain what time the child can expect a certain activity to happen.
For example, some of them can get very upset if it is told that a birthday party will end at 3 p.m. and it does not, or if they are told the doctor’s appointment is at 10 a.m. but they do not get seen until closer to 11 a.m. If the child is like this, it can help to use events like morning tea, after lunch or after school as reference points rather than specific times. For instance, if caregivers want the child to have a bath earlier than normal, the timetable could show a picture of a bath before a picture of the child having dinner.
If there are no schedule or time tables in a child with autism’s daily life, things will be very hectic. They may have several doctors and therapist appointments a month. Sometimes there will be more than one appointment a day. Keeping a schedule can help both the child and family to make sure they do not miss any appointments. Having a schedule and routine just might make life easier for them in the long run.
Having Back-Up Plans: Sometimes things change unexpectedly, so if a plan falls, you should try not to leave too much unstructured time. You should always have a backup plan or always have a second idea in mind. When making these plans, consider ways to calm a frustrated child, such as breathing exercises or bringing a favorite comfort object.
Praise, Reward and Reinforce Method: If your child with autism follows a new routine or copes with an unexpected change, it may be normal for anyone, but this is a real success for them. You have to tell them like that and give a small concrete reward. One of the best ways to deal with something frightening is to know that you will be proud and get approval if you do so. This is valid both for individuals with autism and for individuals who have completed their development normally. In this way, you will not only deal with something bad, but also turn to something good. Make these kinds of situations worth your time and let them know that you are satisfied with them.
Sample Daily Routine Schedule for an Individual with Autism
Whether on the spectrum or normally developed, children are growing up by routines. All children learn best when they repeat over and over again. Especially, for children with autism, it is more obvious and more necessary. They love the fix patterns. Creating routines at home is very important to promote positive bonds between children and caregivers.
Depends on the parents’ behaviors, ideas, and approaches, having structured homes could be beneficial or families more adapt to the flexible lifestyle. As there are certain activities which are happening every day such as lunchtime, dinnertime, or bedtime, it would be good to create a schedule. So the rest of the day can be created around these activities and according to those fixed times.
Schedules, routines, and structure help make the world a little more predictable and manageable for the child with autism. It will be highly helpful for them. And let’s be honest, it can also help the family in the long run.
- 7 AM – Wake up, get dressed and ready for the day
- 8 AM – Having breakfast
- 9 AM – Therapy Appointment at home
- 11 AM – Free time/ Playtime
- 12 PM – Having lunch
- 1 PM – Outdoor Play activity
- 2 PM – Arts and Crafts
- 3 PM – Free Time
- 5 PM – Having dinner
- 6 PM – TV time
- 7 PM – Bath time
- 8 PM – Bed Time
Or even more basic one:
- Brush teeth.
- Wash face.
- Read one bedtime story.
- Turn off the light.
Caregivers can keep them posted for the child to see, and stick to the schedule the best they can. This allows the child to know what is going on during the day assuming that they are not in some sort of school setting. It could be included doctors or therapy appointments on the schedule. It has to be adjusted for school time, and any extracurricular activities. It can be also included homework time, and chores into the chart.