Families For Life | Changing Routines: Children and Teenagers with Autism Spectrum Disorder

Changes in familiar activities, places or people can make us all feel anxious. Children and teenagers with autism spectrum disorder (ASD) can find these things particularly stressful. You can help by planning and preparing your child for changes to everyday routines and activities.

Changing routines and your child with autism spectrum disorder

Children and teenagers with autism spectrum disorder (ASD) often like routines and rituals and don’t like change. This means your child with ASD might need help to manage changes to her daily routine.

Common changes or new situations might include:

• leaving the house

• having visitors at your house

• going somewhere new, like the dentist

• switching between toys, activities or tasks

• doing things in a different order – for example, having a bath at an unusual time

• eating new foods

• cancelling activities – for example, not going to the park because of bad weather.

Explanations and instructions can be hard for children with ASD to follow, so just telling your child about a change might not always work. But using visual strategies to help your child understand can be useful.

Planning for expected changes in routine

Planning ahead for transitions and changes to your daily routine can help them work better. If possible, try to let your child know what’s going to happen ahead of time.

It’s easiest to plan for changes that you know about in advance, like going to a party or going to an appointment with the doctor or dentist. It’s the same with transitions that happen regularly, like leaving the house.

The strategies below can help your child cope successfully with new activities.

Social Stories™

Social Stories™ are a good way to let your child know what’s going to happen in terms he can understand.

For example, you can make a Social Story™ about going to the doctor. You could use pictures, words or both to describe leaving the house, arriving at the doctor’s, having blood pressure taken and so on. Ending the story on a positive note is always a nice touch – for example, ‘When the appointment is finished, I get to play at the park’.

By letting your child know what to expect, you cut down on surprises and reassure your child that it’ll be a positive experience.

Timetables

Timetables are a simple way to let your child know what to expect, and when. You could use pictures, words or both. For example, try using pictures of clocks to explain what time your child can expect a certain activity to happen.

Some children can get very upset if you tell them a birthday party will end at 3 p.m. and it doesn’t, or if they’re told the doctor’s appointment is at 10 a.m. but they don’t get seen until closer to 11 am.

If your 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 example, if you want your child to have a bath earlier than normal, your timetable could show a picture of a bath before a picture of your child having dinner.

Extra time

Spending some extra time making the change can help your child feel less anxious. For example, to help your child cope with someone coming to visit you at home, you might spend some time with your child getting ready for the visit. You could talk about what will happen during the visit or your child could help you prepare. You could also show your child some pictures of what will happen.

Visits to new places

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. This way your child can get more familiar with the environment, without being overwhelmed by lots of noise and people. If you can’t do that, try looking for images of the place on the internet.

Timers

If your child finds it hard to switch from a favourite activity, a timer might help. Set the time and let your child know the activity will be over when the timer rings. This strategy could also help with leaving the house. For example, ‘When the timer rings, it’s time to go’. You can get a smartphone timer app or use a stopwatch or kitchen timer. 

Small changes

It can help to introduce small changes and work your way up over time.

For example, if your child insists on eating breakfast first and then getting dressed, but you want her to get dressed before breakfast, you could start by just putting her socks on and letting her eat breakfast. Once she’s comfortable with that, you could try putting on her socks and pants before breakfast, and so on.

Praise and reward your child when he’s able to be flexible and cope with these changes.

Slow and steady

If your child finds it hard to switch between activities, try slowly adding new activities, one at a time.

For example, if you want your child to learn to stop what she’s doing and move to a new activity when you ask, you could start by making the new activity one you know she’ll enjoy. When she has done the activity, praise her and give her a reward, like a high five, a sticker or extra time on the computer.

Keep doing this until your child is comfortable moving to the new activity when you ask him to. Then you could try making the switch more difficult, like moving to an activity he hasn’t done before. Keep practising until your child can move to a new activity when you ask, even if it’s new or something he doesn’t like.

Other people

Sometimes you might find it helpful to include other people, like your child’s teacher or the doctor, in your plan for change. You could talk to them about your child’s needs. They might also have useful tips to help you plan a successful transition.

Behaviour skills

There are no specific interventions for managing change, but behaviour strategies can help. They include Applied Behaviour Analysis (ABA), Discrete Trial Training (DTT), Positive Behaviour Support (PBS) and Pivotal Response Treatment (PRT).

Managing unexpected changes in routine

Sometimes changes are unexpected and you don’t have time to plan ahead. Coping with a sudden change can be something you and your child prepare for before any change happens.

If your child understands a warning system for unexpected changes when she’s calm, she’ll be better able to apply that knowledge if she gets upset during the actual change.

Adding a ? to your child’s schedule

One way to do this is to build some ‘space’ for change into your child’s visual supports.

For example, if you use a visual schedule of activities for your child, you can leave gaps between each picture to allow another picture to be put in later. You could use a ‘question mark’ to represent a ‘mystery’ or uncertainty. If your child has a written schedule, leave one blank line between each task.

By using a step-by-step approach, your child can learn how the ‘?’ works. He can gradually learn to deal with pleasant change, and then less pleasant change.

For example: 

• Go on an outing, placing a ‘?’ on the schedule. Make sure something fun for your child happens when it’s time to do the ‘?’ on the schedule. Praise your child for coping. Your child can learn that something unexpected can be a pleasant thing.

• Go on an outing without the ‘?’ on the schedule. At some point slip the ‘?’ into a gap on the schedule. Immediately bring out the fun surprise and praise your child for coping.

• Go on an outing without the ‘?’ on the schedule. At some point make an unplanned diversion – for example, a sibling wants to look at the pet shop, and it’s not on the schedule. Add in the ‘?’, reward your child for coping, then quickly get back to the schedule.

• Go on an outing without the ‘?’ on the schedule. Make an unplanned diversion that your child usually doesn’t enjoy – for example, visiting one extra shop. Show this by placing the ‘?’ in an appropriate gap in the schedule. When completed, reward your child for coping, and then return to the usual events.

Once your child is familiar with the ‘?’, you can use it anytime there’s an unexpected change to show there’ll be a diversion from the schedule and then a return.

You could put this technique together with a Social Story™ to explain to your child that sometimes things don’t go exactly as it says in the schedule. You could include the things that your child can do when something doesn’t go according to plan – for example, ‘When things change I can take five deep breaths or name all the Pokemon in alphabetical order in my head until I feel calm’.

Rewarding flexibility

Another simple way to help older children cope with change is to make a big deal of the concept of ‘flexibility’.

Praise or reward your child whenever she copes with a change or an unexpected event, like not getting her desired table number at a restaurant. Tell her how wonderful it is that she’s ‘flexible’ and get her to associate this skill with getting something she likes, like attention.

Video: Building everyday routines and handling change

In this video, parents of children with autism spectrum disorder (ASD) share their experience with getting their children to adapt to day-to-day family life through proper planning and structure.