ROUTINES, RITUALS & COMPULSIONS:
discussion & practical strategies for parents

Written by Barry K. Morris B.ScWk

People with autism or Asperger's syndrome are often inclined to develop intense, very narrow fields of interests. There is also a tendency to develop repetitive behaviors and routines, some of which may make life very difficult for the family, and be very hard to change.

To some extent, families will need to learn how to avoid the triggers for some of these behaviors, as well as how to cope when the behaviors occur. In many cases, it may be better to develop a tolerance rather than look at prevention. There may also be opportunities to turn obsessions into a positive outcome, such as teaching your child how to find further information on a favorite topic through libraries and the Internet.

the positive side of routines, rituals & compulsions

A well known woman with autism, Temple Grandin, talks about the positve side of her fixations in one of her many articles, Inside View of Autism:

"Today I have a successful career designing livestock equipment because my high school science teacher, Mr. Carlock, used my fixation on cattle chutes to motivate me to study psychology and science... some of the most successful high-functioning autistics have directed childhood fixations into careers".

In his article, What does being different mean? Jim Sinclair says:

"The problem I see is when autistic people are subjected to intensive, stressful, and often very expensive treatments simply for the purpose of making them appear more normal: eliminating harmless behaviors just because non-autistic people think they're weird."

Does the issue require attention?

Decide if the routine, compulsion or obsessive thoughts need attention, can be lived with, or shaped into broader interests. Usually change is only needed if it could affect the child's development negatively, leads to socially unacceptable behavior, or it is causing the family too much stress.

Many people in the autism rights movement argue for neurodiversity, where autism is seen more as a different way of being, than a disorder. It would argue that fixations, compulsions and repetitive behaviors should not be necessarily seen as a problem if they aren't hurting others. It certainly pays to understand the world through your child's eyes, and do what is best for your child, not simply try to conform your child's behaviors to what the world expects of them.

COMPULSIONS

Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

Examples could include needing to follow an exact route to school each day, family members needing to sit in particular chairs during meals, or only wearing blue shirts. When compulsions seriously disrupt a child's life, it may fit the diagnosis for Obsessive Compulsive Disorder.

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. The thoughts, impulses, or images are not simply excessive worries about real-life problems.

The person attempts to ignore or suppress such thoughts, impulses, or images, or may try to neutralize them with some other thought or action. When obsessive thoughts seriously disrupt a child's life, it may fit the diagnosis for Obsessive Compulsive Disorder.

routines

Children with Autism Spectrum Disorders tend to appreciate order, routines and repetition far more than neurotypical children. Any disruption to this routine can lead to high levels of anxiety and emotional outbursts. While many routines may be helpful, others can be very disruptive. They may be very time-consuming and can increase in complexity over time.

look for the underlying issues

It helps to understand the underlying reasons before attempting to change any behavior. There may be a sensory issue involved, whether it is the sight, sound, smell or feel of an object or activity. Where the preoccupation is potentially dangerous or inappropriate, understanding the sensory issue may make it easier to substitute a better activity or object in place.

Mind-blindness is the inability to know how other people think differently. A child may simply not realize that other people don't share the same thoughts, routines or obsessions, or how disruptive these can be to other family members.

Children on the autism spectrum often experience a lot of anxiety; routines and compulsions can be very calming due to their familiarity. This is why routines and repetitive behaviors can be extremely intense when the child is anxious. Instead of tackling these behaviors head on, parents may find it much more useful to deal with the cause of the anxiety in each case.

practical strategies

Set rules and use contracts

Set plenty of rules, children on the autism spectrum tend to love clear logical rules. These rules can set time limits for routines, and the contexts they are allowed to happen. It can help to even write these down in a contract.

Shaping the existing behavior

Look for ways to 'shape' the preoccupation into something constructive i.e. a fascination with butterflies can lead to discussions about biology and other insects. Children with autism often don't see the 'big picture', so it always helps to try to broaden the narrow interest into a wider one!

Desensitization

Where sensory problems are involved, desensitization is a behavioral technique that can be useful when a child experiences anxiety or fear over a certain obsession or failing to do a set routine. The child is gradually exposed to the object or event that creates fear, but with plenty of positive reinforcement. Examples of this include free time, verbal praise or special food treats.

Reinforce desired behaviors

Reinforcement provides a response to a child's behavior that will most likely increase that behavior. It is “differential” because the level of reinforcement varies depending on the child's response. Difficult tasks may be reinforced heavily whereas easy tasks may be reinforced less heavily. We must systematically change our reinforcement so that the child eventually will respond appropriately under natural schedules of reinforcement (occasional) with natural types of reinforcers (social).

Reinforcement can be positive (verbal praise or a favorite activity) or negative (an emphatic 'no'). Positive reinforcement is an incentive given to a child who complies with some request for behavior change. The aim is to increase the chances the child will respond with the changed behavior. Positive reinforcement is given immediately after the desired behavior has occurred so that it will shape the child's future behavior.

Medications

While any concerned parent or doctor will try to avoid medications for children's behavior, it must be acknowledged that there are times where therapy does not work and medication might. For example, a child diagnosed with Obsessive Compulsive Disorder may respond to medication in a way that creates far less stress for exhausted families. Always consult an experienced autism specialist when considering the use of medication for children.

Click here for the full range of Asperger's and autism fact sheets at www.autism-help.org