Routines | Ambitious about Autism
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Routines

Understanding rituals, consistency, predictability and change.

Boy lining up toys © Photo by Sara Dunn

One of the earliest signs of autism can be a love of ritual, consistency, predictability and routine.

Some routines can be harmless, but others can cause serious inconvenience. Suppose, for instance, your son or daughter will only use one toilet at school: what happens the day it goes out of order?

Or suppose they’ll only eat breakfast out of a particular bowl: if it breaks or you forgot to wash it the previous night, come morning there’s going to be trouble. A degree of regularity in life is no bad thing, but when a child can’t cope with changes in that regularity, life starts to get difficult.

Why is routine so important to my son or daughter?

For a child with autism, the world can feel like an unpredictable place – and since children with autism tend to be anxious, unpredictable equals frightening. What’s the natural solution? To try to make things as predictable as possible: to try to control the environment to make sure that no new situations come along that make everything frightening again.

The word ‘control’ sounds very loaded, but some children with autism sometimes have quite serious control issues. Not all of them; children with autism are unique individuals like everyone else, and some of can be pretty laid-back – but there is a fair proportion of children who deal with their anxiety by trying to keep control of everything around them.

There’s no denying that the need for routine can get inconvenient when it applies to a lot of things. Common areas where fear of the unknown kicks in include:

New food or drinks. Food issues are a big one and, if extreme enough, can cause worries about malnutrition.

Leaving or entering the house; you may have to perform a lot of rituals to get your son or daughter to cooperate, which isn’t easy if you’re in a hurry.

New people. Visitors to the house or a new person in a familiar place (such as a supply teacher) can cause a lot of anxiety.

Going to new places. Some of these, like hospital appointments, can’t be avoided.

Arranging the familiar environment. If your son or daughter has decided that the living room door should be closed at all times or that the soap belongs on the left hand side of the sink, even a small change can be a big deal.

Doing ordinary routines in a particular way. It may not seem important to you whether your son or daughter flushes the loo before or after they wash their hands, but it can seem very important to them.

‘Transitioning’. This is the technical term for switching between toys, activities or tasks: once your son or daughter has settled down to one thing, changing to another can be surprisingly hard.

Routines can creep up on you, because your child can start applying them to anything. You might not even realise that a ritual has developed until you cross it; for instance, you happen to buy the same toothpaste a few times in a row, and think nothing of it until you pick up a new brand on special offer and find your son or daughter won’t touch it.

Within reasonable limits, routines aren’t a problem, but past a certain point they start to make life unmanageable.

When is a routine a problem?

A moderate amount of routine can be good for your son or daughter; anxiety is painful, and a bit of regularity can help to keep that in check, not to mention speeding things up when it’s time to get ready for school.

However, if they start to get so dependent on the routine that they panic if it looks like it’s going to be disrupted, then at that point it’s stopped preventing anxiety and started causing it: no one can control every possible variable at all times, and routines do sometimes get disrupted. If your son or daughter can’t make it through the day when that happens, then the routines are starting to do more harm than good.

In these cases, difficult though it is, you may need to start trying to change the routine before it gains a complete stranglehold.

How do you know if a routine is a problem? In some cases, of course, that’s a silly question: if your son or daughter is having a meltdown because you hung their coat on the wrong peg, then asking ‘Is this doing more harm or good?’ would be ridiculous.

You may be dealing with something a little less obvious, though, or you might need to explain the situation to a teacher, social care worker or therapist; in those cases, these questions can help you clarify the issue:

  • Is the routine actually harming them or anyone else?
  • Is it helping them to manage their anxieties, or is it making them more anxious?
  • Does it make things easier or harder?
  • Is it affecting their ability to learn?
  • Is it affecting their social life?
  • Is it affecting our family’s ability to carry out day-to-day activities, or to go on holidays or trips?
  • How would I feel if this routine is the same in a few years? (For instance, if a four-year-old boy kisses everyone he meets, that’s adorable, but if he’s still doing it at seventeen then that’s unacceptable)

Some of these questions will have very clear answers, while others may need more thought. Families always involve compromise, but if the compromise is in no one’s interests, it may be time to address the routine rather than accepting it.

How can I help my child adapt to change?

It’s important to understand that routines can be a mixed bag when it comes to positives and negatives: the same routine might help in some ways and hinder in others. A routine can be particularly helpful at the start of something – when you go to a new place, doing it in a predictable way can make it less scary – but start to interfere as time goes on.

There’s no hard-and-fast answer, but as a general rule, it’s good to accommodate routines up to a point, but keep gently pushing to incorporate new things so that your child starts learning to cope.

Protecting your child from anxiety is one of your jobs as a parent, but so is preparing them to deal with a world they can’t entirely control, and you have to strike a balance. Too much stress is bad for the brain, but if we’re never exposed to it at all, we never learn to deal with it – and that ‘exercise’ is sometimes best done in a loving home with parents who can provide comfort and reassurance as well as a bit of variety.

So, let’s say that you want to make a change in the routine. How do you introduce it with minimum pain for all concerned? The best thing to do is to make things as clear as possible. Some of your son or daughter’s anxiety will be the inevitable result of changing something, but it can be exacerbated by confusion – and the confusion is something you can keep to a minimum.

For instance:

Use visual supports to explain what’s going to happen. Pictures of new places, written lists, ‘now and next’ boards, calendars: all make it easy to literally ‘see’ what’s going to happen. If you put the information where they can look at it and take it in in their own time, that may be a lot more comfortable for them.

If you’re going somewhere new, let them have a look at it in advance. Drive through the area, and if possible let them come in for a visit during a quiet period (for instance, visit a new school after hours so there aren’t so many other children making things overwhelming). That way they’ll have at least some idea what the ‘unknown’ will be, and hopefully they’ll start to accept that it won’t be anything terrible.

Use social stories. Tell the same story a few times in advance to help them do what’s often so difficult for them to do unaided: imaginatively rehearse what’s going to happen.

Prepare them for changes with a timer. A cheap stopwatch or an app can give them a nice clear countdown. If they know that, say, you’re going to leave the house when the timer goes off, they’ll have some time to get used to the idea.

Make back-up plans. Sometimes things change unexpectedly, so try not to get left with too much unstructured time if a plan falls through: bring toys, books, music etc to fill the time, or have a second-choice place to go. In making these plans, think about ways to calm a nervous child as well, such as breathing exercises, deep pressure compression, or bring along a favourite comfort object.

Praise, reward, reinforce.  If your child follows a new routine or copes with an unexpected change, that’s a real achievement for them: tell them so, and if verbal praise isn’t enough to make the point, give a small tangible reward as well. One of the best ways to cope with anything scary is knowing you’ll feel proud and get approval if you do it: that way you’re not just coping with something bad, but aiming towards something good. It’s true for non-autistic adults, and it’s true for children with autism. Make it worth their while and let them know you’re pleased with them.

You might also want to think about points in the day where it’s okay to have a bit of a ritual. A good place to start is bedtime.

For one thing, it’s manageable: it’s the end of the day when there’s nothing else to be done and you’re in the privacy of your own home, so your control over the environment is pretty good and a routine is less likely to get disrupted. For another, it’s a time when you’ll want to be soothing and relaxing anyway; it can help your son or daughter sleep, and it gives you the chance to at least try to end the day on a cosy note.

The same story, the same lullaby, the same toys: these are things that can help your son or daughter feel that there is some predictability in the day, which might lower their general anxiety levels.

If they start getting obsessive about it you might need to rethink, but one or two daily rituals can give them some safe points in the day to look forward to and relax in, which might lower their overall anxiety levels. A nice routine is soothing, and knowing that mum or dad has a regular point in the day where they do something soothing will help a child feel loved by and connected to you.

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