Routines in ASD
It is often said that people on the autistic spectrum like routines. There might be some misunderstanding however, because a ‘routine’ is not limited to simply being the way a person structures their day. Indeed, some people with ASD have no structure to their day at all, yet will still have their routines. This article summarises four different ways a ‘routine’ may look in people with ASD.
1. When things are done
This is primarily about time. Some people with ASD are strongly aware of - and dependent on - the time. Things may need to begin and end at exactly the times planned, stated or specified. Some examples might be:
- If an appointment with the GP was scheduled for 10.10am, the patient needs to be seen at 10.10am (no delays)
- If the train is due to arrive at the station at 8.20am, it needs to arrive at 8.20am (no delays)
- If school ends at 3.20pm, then the class must be dismissed at 3.20pm (no keeping the class back)
- If somebody has scheduled a telephone meeting at 11am, they need to call at 11am (11am is what has been expected, not 11.05)
- If the chemist has an open time of 9.00am, it should open at 9.00am (9am is correct, not 9.03/4/5)
- If a lecture at university is said to be between 1 and 3pm, then it needs to fill that duration (no starting late, or finishing early/late)
- Dinner time is always at X time, shower time is at X time, etc. …
If a person is continually preoccupied by time, it can have consequences such as being unable to focus on the task in hand – in case it does not finish on time, for example. It would help if the person in control of the task provided reassurance in advance that the task is going to end on time.
Another potential consequence is the person having to walk out/away from the situation if the task has not kept to time. Imagine if this happened whilst waiting at the GP – the person would end up missing their appointment and therefore miss out o much needed potential help and support. A reasonable adjustment for ASD would be that the GP is always able to see that particular individual on time. If this isn’t an option, it would be helpful if the receptionist could inform the patient of any delays and how long they can expect to be waiting for their appointment.
2. How things are done
This is more about the method. There may need to be a certain sequence or order to how something is done, for example eating a meal or getting ready for bed. Some examples might be:
The right sock is always taken off before the left sock, then the trousers, then the T-shirt
One item of food is always eaten before the other (e.g. peas have to be eaten before chicken nuggets)
A particular plate and particular cutlery must be used, otherwise the person won’t eat at all
Certain routes must be followed to and from certain places (e.g. walking home from school going via the two roads Y and X, not the single road Z)
Methods can become almost ritualistic in nature, with attention placed on even the smallest details. If they are not able to do these routines, they can feel very stressed. Loved ones need to be understanding on how important these routines are, but also support the person in learning to cope when these routines are disrupted.
3. The order in which things are done
Although this overlaps with the two previous points, I thought it deserved a brief mention. What I mean by order is that a person with ASD may need things to be done in a particular sequence. These things could be as ‘small’ as the order in which they eat food items at a meal (as mentioned before, peas have to be eaten before chicken nuggets, for example), or as ‘big’ as the order of their daily tasks, e.g. going to the gym and then walking the dog, not the other way round.
4. The desire for sameness
There will be some overlap with the previous point, how things are done, i.e. because things are always done in the same way, but I think the desire for sameness deserved a mention of its own. What I meant by the desire for sameness is more about rigid preferences and a dislike for change and flexibility. Some examples might be:
- Wearing the same clothes/buying multiple copies of exactly the same items of clothing
- Eating the same items of food every day
- Doing the same things every day
- Travelling the same way to a particular place, e.g. taking the train and then walking, not taking the bus and then walking, or not taking the train/bus the entire way
- Sitting in the same chair in the classroom
As you can see, there is a lot more to a routine than simply knowing what you are going to be doing on any given day – and just because somebody lacks a daily schedule, they can still have routines of sorts. Not everyone on the spectrum will be a ‘timekeeper' (like I am!) - in fact, many don't care much about time at all. A routine can be a lot more than timekeeping and schedules.
Routines, no matter how trivial or frustrating they seem to the outsider, can be a great source of pleasure and comfort for people on the spectrum. Routines are often significant in helping them cope with everyday life. Routines create order, structure and predictability and help to manage anxiety.
I would advise that, unless causing harm or limiting an individual’s involvement in other activities, routines should usually be encouraged. Speaking for myself, my routine is my most important coping mechanism and has allowed me to live a much more relaxed life, and, as a consequence, I am more willing and more engaged in the outside world!
Founder, Curly Hair Project www.thegirlwiththecurlyhair.co.uk
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