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