How Routines can Reduce Anxiety and Improve Development.

Tried and tested successful parenting methods may not work well with autistic children.  This is because autistic children experience the world differently and as such often learn and respond differently.  The best way we can support an autistic child is to adapt our parenting methods to their learning and development needs.

Providing routines and predictability enables many autistic children to learn better and have fewer behavioural problems.  Keep in mind everyone is different and this won’t be right for all children, however the majority will thrive with routines.

Autism Routines & Changes

A common early sign a child may be autistic can be obsessive or ritualistic behaviour.  Many young autistic children will line up their toys rather than play with them as others would.

Life is very confusing for most autistic children, a constant change of people, environments, noises etc. can be very overwhelming. Routines and rituals help to provide order in a constantly changing environment. A routine needs to be something done regularly in the same order so it provides repetition and predictability.

Some on the autistic spectrum may struggle with the ability to predict behaviour, have problems with social imagination and understanding behaviours.  This is why it can be hard for an autistic child to know what is expected of them.  Using a regular routine allows them to predict the behaviour required as it is familiar and a repeat of something they have done before.

Change

Anything new can be particularly challenging.  The need for sameness and security within a routine can cause significant anxiety when things are different or new.  This is why change is often a trigger for challenging behaviour or meltdowns. Keeping everything the same can reduce anxiety surrounding constant change.

Routines can become almost ritualistic having to be precisely followed. In some cases this is fine but often rituals can be problematic.  A child who will only eat off a particular plate or use one toilet will at some point not have that option.  Sameness provides comfort and security so taking it away will also be challenging. 

Providing sameness whilst introducing changes can be a tricky balancing act for parents and carers.  Learning to read a child’s trigger signals will help you to realise when they can be pushed a little and when they need to be allowed to follow their rituals.

Transition

Transitions (moving from one thing to another) can be difficult especially when a child is content in their environment / activity.  My youngest always struggles to finish playing outside or give up the iPad. Transitions can be small like asking a child to sit rather than stand or huge like moving home.  One easy change is to ensure a child is pre-warned about an upcoming transition. Where possible always give time to complete their current activity. 

Big changes like starting school, flying abroad or Christmas may need long build ups of preparation because they will be so different.  However using the right support and preparation methods means a new experience can already be familiar by the time you come to it.

Unexpected change is often the most difficult to manage and having back up plans or methods to distract will be helpful.

The more we analyse challenging behaviour the more we will understand what is likely to be a trigger.  Once we know what those triggers are we can put in place strategies to support them. It took me a while, but tracking behaviour helped me to realise my son was impacted by seasonal change.

Young children will have all sorts of rituals, they may expect you to drive the same way to the supermarket each time, always park in the same spot.  Food can be an area where sameness is required with dislikes for change.  This can be based on sensory needs or simply a need for familiarity.

Daily Routines

We have all sorts of daily routines:

• getting dressed
• going to the toilet
• going to bed
• brushing teeth
• washing hands

Alongside our daily routines we have other regular routines such as making a sandwich, going shopping or getting a haircut.

Favourite books and nursery rhymes are routines as they are the same each time.  My 4 year old is very quick to point out if I get a word wrong! Action songs, regular games (rolling a ball or building a tower) will quickly become a routine.  If the routine changes each time it can trigger anxiety and then behaviour issues.

A child can expect to follow a pattern from the first time they learn something and it can sometimes take a long time to change that pattern.  The first time I played with stickers with my eldest I put one on his forehead.  For the next year every-time we had stickers the first thing he would do was put one on his forehead!

Step by step

To support predictability we need to look at every step of a routine.  Break each part down so you know all the steps that need to be mastered. Here is an example of each step needed to wash your hands.

1. Go to the sink
2. Turn on the water
3. Wet hands
4. Put hand under soap dispenser / get soap
5. Push soap dispenser
6. Rub hands with soap
7. Rinse hands
8. Turn off water
9. Get towel
10. Dry hands

There are so many variables in washing your hands, different locations, different types of tap, different soaps, different smells, people and ways to dry your hands etc.  For many autistic children all these changes are overwhelming and can provide a block to being able to complete the task of washing hands. 

The best way to teach is with a predictable routine that is the same as much as possible. Take each step at a time, depending on age and ability some steps will be easy and other may not be possible and require help.  Then using visuals and physical prompts you can follow the same routine regularly. 

As the routine becomes familiar you can reduce prompts and as the child becomes comfortable with the routine you can begin to introduce changes and teach generalisation (different soap / drying methods).

Reducing anxiety & improving development

The more we can identify routines we already have and provide predictability within them the better. To start with make the routines exactly the same and over time you introduce change and flexibility.  The first job is to create the foundation of the routine, movement comes later.

Visuals are really important to provide clarity over the sequence of the routine.  You can use Social stories to introduce new things and cement routines. Using a visual daily timetable is really helpful to understand what is happening and when.  Below is my visual timetable on my phone using the Tiimo app which allows my son to see what is happening now, what is happening next and what will follow that.  It also allows me to make changes easily when needed. 

The structure of using familiar processes around routines can really help a child to develop. Being consistent and working with all care givers (grandparents / nursery) to ensure you are following the same routine makes a big difference.  A major issue early on for us was a lack of consistency around bedtime routines between my husband and I meaning there was no predictability for my son.  Once we worked together and got a set routine in place it became much easier for all of us.

Communication and language in a routine

Communication is another key area. Be aware that even kids with good language and understanding may have difficulty communicating when anxious and upset leading to challenging behaviour. Take advantage of daily routines and add to language and skill development. If you use clear consistent language within a routine it will become part of that routine and the speech and language understanding will also develop.  So when putting your shoes on you may consistently say ‘socks on’ and ‘shoes on’. 

When reading familiar books and nursery rhymes, make it fun and offer the opportunity for your child to speak.  If the routine is familiar, cue your child and wait for them to fill in the gaps. If you are using the Picture Exchange Communication System with a child you can use it with your familiar routines, snack time is a great first place to embed PECS in a daily routine.

Increase independence, as a routine becomes familiar and prompts can be reduced you are teaching independence.  You can build on this such as introducing a choice of clothing in the morning routine. Some children also respond really well to rewards to support learning.

You can use routines to support play and interaction with children, see my post on play routines.

The TEACCH method for teaching autistic children is a really great example of using a routine to support development.  Find out more in my post on TEACCH.

A great place to start with routines is bedtime.  Create a visual to support the routine, ensure all care givers are being consistent and take time to embed the routine.

Using Tiimo for our daily routines

Tiimo is a visual scheduling app that is designed to support people who thrive on routine.  You can easily add your regular routines alongside daily activities using their free web calendar.  This can then be shared on the app on your phone, tablet or smartwatch to provide reminders and support going through the routine.

A really useful function on the Tiimo web calendar is creating routines. I have set up our morning and evening routines and I have different ones for weekdays and weekends. These routines are then saved so I can add the whole routine to a day in one go (saving lots of time), I am also able to choose the start time of the routine and if it needs to be repeated daily or weekly, every two weeks, just for weekdays or weekends.

Once you have a routine in a familiar format it is easier to introduce changes. We are working on toilet training so adding in going to the toilet as a activity in the usual routine has been really simple. Plus Tiimo then provides the reminder for my son so I just need to show him:

If you want to try Tiimo for your daily routines you can get more information here and use the web calendar for free – Tiimo.

Do you find routines helpful with your family? What routines or rituals do you have?