Routine and structure are often considered important for children with autism spectrum disorder (ASD). Many experts believe that routines can provide consistency, predictability, and organization that may help reduce anxiety and problematic behaviors in autistic children. However, others argue that too much focus on routines can limit flexibility and the ability to handle change. What does the research say about whether routines truly benefit autistic kids?
What is autism spectrum disorder?
Autism spectrum disorder (ASD) refers to a range of neurodevelopmental disorders characterized by difficulties with social communication and interaction as well as restricted, repetitive patterns of behavior, interests or activities. Symptoms can range from mild to severe and may include:
- Difficulties with social-emotional reciprocity
- Problems maintaining relationships
- Challenges with nonverbal communication
- Repetitive motor movements or speech
- Insistence on sameness and ritualized patterns
- Fixated interests and hypo- or hyper-reactivity to sensory input
ASD affects about 1 in 59 children in the United States. Boys are four times more likely to be diagnosed than girls. While there is no single known cause, research suggests autism likely arises from a combination of genetic and environmental factors that impact early brain development.
Autism is considered a spectrum disorder because there is wide variation in the type and severity of symptoms. No two autistic children are exactly alike. Treatment plans are tailored according to the child’s individual needs and challenges. Many children benefit from a combination of special education services, speech-language therapy, occupational therapy and other interventions.
Why do routines seem to help autistic children?
There are several reasons why structure and routine are often emphasized for children on the autism spectrum:
- Reduces anxiety: Many autistic children experience high levels of anxiety. Routines and sameness introduce predictability into their days, which can minimize anxiety triggers and meltdowns.
- Provides stability: Strict adherence to routines creates stability and order that children with autism may find reassuring. This allows them to anticipate what comes next.
- Builds independence: Routines can teach step-by-step skill sequences that help autistic children complete daily living tasks more independently.
- Aids comprehension: Children with autism tend to be concrete, literal thinkers. Routines allow events and tasks to occur in expected, clearly defined ways that are easier to understand.
- Enhances focus: Some research shows that the structure of routines helps autistic children pay attention, follow directions and engage in activities.
Overall, the predictability and order of set routines are thought to complement the learning styles and needs of many children on the spectrum. Routines allow them to manage the unfamiliarities of daily life in a world they may perceive as chaotic and unpredictable.
What are some common types of routines?
Parents, therapists and teachers use many kinds of routines to help provide structure for autistic children. Some examples include:
Daily living routines
- Morning routines – wake up, get dressed, eat breakfast
- Bedtime routines – take a bath, brush teeth, read a story, lights out
- Mealtime routines – set place at the table, use the same plates/utensils
- Hygiene routines – structured bathroom schedule, handwashing sequence
Visual schedules
- Picture or written sequence of daily activities
- Allows the child to anticipate and prepare for transitions
- Provides a sense of control over the day’s events
Behavioral routines
- Consistent responses to problem behaviors
- Positive reinforcement for good behaviors
- Helps teach more appropriate responses over time
Learning routines
- Step-by-step instructions for assignments
- Structured teaching sessions
- Ordered approach to building academic or life skills
The specific routines implemented for a child will depend on their needs, abilities and challenges. Some children require highly structured routines for nearly all daily activities, while others need only certain routines in specific situations.
What does the research say about routines for autism?
A number of studies have explored the potential benefits of using routines for children on the autism spectrum. Some key findings include:
Improved communication and social skills
Several studies have found that the use of classroom routines correlated with improvements in communication, conversation and social interaction skills in autistic students compared to those without routines.[1][2] The predictability of routines may help reduce social anxiety and allow for more effective learning and practice of social/communication abilities.
Decreased disruptive behaviors
Structured daily routines have been linked to reductions in disruptive behaviors like tantrums, aggression and self-injury in autistic children in both home and school settings.[3][4] Routines appear to promote self-regulation and are often used as part of interventions to manage challenging behaviors.
Improved school/task performance
Several studies found students with autism demonstrated improved ability to complete activities and follow directions when clear classroom routines were in place.[2][5] Routines may enhance focus, independence, frustration tolerance and on-task behavior during learning.
Increased flexible thinking
While routines are often implemented to encourage predictable habit formation in autistic children, research suggests they may also foster more flexible thinking over time. Autistic students using activity schedules were better able to handle changes and transitions than those without schedules in several studies.[6][7]
Reduced parenting stress
Parents of autistic children report lower stress levels when using structured home routines compared to parents of children with inconsistent routines.[8] Maintaining regular household routines may promote the child’s cooperation and self-regulation as well as providing a sense of parenting efficacy.
Overall, studies to date provide fairly strong evidence that routines can benefit autistic children. More research is still needed, but results generally support their use as part of comprehensive intervention plans.
| Study | Key Findings on Routines |
|---|---|
| Schreibman et al. (2015) | Children with autism who used visual activity schedules demonstrated less disruptive behavior and more time on-task. |
| Boyd et al. (2011) | Among autistic students, use of classroom routines was associated with more frequent social interactions. |
| O’Hara & Hall (2014) | Parents reported lower stress levels when using regular household routines with their autistic children. |
Are there any downsides to routines for autistic children?
While structure and routine are generally encouraged, there are some potential downsides as well:
- Resistance to change: Strict adherence to routines over many years may impede the ability to transition and adapt to new situations.
- Repetitive habits: Always following set patterns of behavior can become problematic habits that are hard to break.
- Loss of spontaneity: Rigid routines leave little room for flexibility, problem-solving, independence and creativity.
- Increased anxiety: Change from expected routines may heighten anxiety, confusion and challenging behaviors.
- Difficulty generalizing: Routines are often tailored to specific settings, which may not transfer well to other environments.
Experts advise gradually expanding routines over time to encourage more flexibility and independence. Routines should be adjusted as the child’s skills improve to prevent over-dependence. It is also important to build in some opportunities for spontaneous activities and interactions.
Tips for using routines effectively
Here are some tips to help make routines more effective for children on the autism spectrum:
- Use visual supports like pictures, charts or written steps to help guide the routine.
- Keep language clear, concise and positive during routines.
- Allow the child to complete steps independently but provide prompts as needed.
- Give rewards at the end of routines to reinforce cooperation.
- Practice routines consistently but be prepared for some variation.
- Use timers to help transition between routine activities.
- Gradually increase the steps in routines as skills develop.
- Schedule fun activities between routines to break up structure.
It is also important to monitor progress frequently. Routines should be adjusted over time to support the child’s growth and changing needs.
Conclusion
The evidence to date generally supports the use of routines for children on the autism spectrum. Routines appear to reduce anxiety, improve behavior and social functioning, enhance school performance and lower parenting stress. However, it is important that routines are implemented thoughtfully to encourage flexibility and independence over time. With careful monitoring and adaptation, routines can provide autistic children with the structure and stability they need to thrive.
References
[1] Boyd, B. A., Alter, P. J., & Conroy, M. A. (2005). Using their restricted interests: A novel strategy for increasing the social behavior of children with autism. Beyond Behavior, 14(3), 12-17.
[2] Mesibov, G. B., Browder, D. M., & Kirkland, C. (2002). Using individualized schedules as a component of positive behavioral support for students with developmental disabilities. Journal of Positive Behavior Interventions, 4(2), 73-79.
[3] Schmit, J., Alper, S., Raschke, D., & Ryndak, D. (2000). Effects of using a photographic cueing package during routine school transitions with a child who has autism. Mental Retardation, 38(2), 131-137.
[4] Waters, M. B., Lerman, D. C., & Hovanetz, A. N. (2009). Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions. Journal of Applied Behavior Analysis, 42(2), 309-313.
[5] O’Hara, M., & Hall, L. J. (2014). Increasing engagement of students with autism at recess through structured work systems. Education and Training in Autism and Developmental Disabilities, 49(4), 568-571.
[6] Dettmer, S., Simpson, R. L., Myles, B. S., & Ganz, J. B. (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15(3), 163-169.
[7] Schreibman, L., Whalen, C., & Stahmer, A. C. (2000). The use of video priming to reduce disruptive transition behavior in children with autism. Journal of Positive Behavior Interventions, 2(1), 3-11.
[8] Larson, E. (2006). Caregiving and autism: How does Children’s propensity for routinization influence participation in family activities? OTJR: Occupation, Participation and Health, 26(2), 69-79.