One of the primary diagnostic criteria for autism spectrum disorder (ASD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is that the individual shows restricted, repetitive patterns of behavior, interests, or activities. And one of the key items of evidence to support the diagnosis is an insistence on sameness and an inflexible adherence to routines… extending down to minute details with things like the placement of toys, silverware, or bath towels… or into types of foods available at certain meals and the order in which they may be eaten… or the exact words and even tone of voice used in a bedtime story.
This insistence on routine and sameness can only be categorized as obsessive and compulsive
Any deviation from any of these particulars, even one almost undetectable to a neurotypical individual, can result in enormous anxiety and tantrums from an ASD patient. Adherence to routine becomes obsessively important and any sort of change is a major cause for alarm.
This resistance to change is one of the oddities that applied behavior analysts (ABAs) have to learn to deal with when working with ASD patients. In fact, it might be one of the symptoms that an ABA is expressly asked to treat, using the techniques of applied behavior analysis to help patients adjust to new situations or alter their routines.
Researchers are investigating whether or not there is a neurobiological basis for this insistence on routine but currently there is little or no understanding of the mechanisms that underlie the symptom.
Routine For Autistic Individuals Isn’t All Bad
Routine can actually be a powerful force in helping ASD patients deal with the depression, anxiety, and uncertainty that ordinarily confronts them in daily life. It’s well understood that kids and adults with ASD turn to routine, sameness, and even seemingly obsessive repetitive behaviors (as is the case in the most acute forms of autism), as a way to comfort themselves and to bring calm and self regulation to an otherwise anxious mind.
But resistance to changing routine can also create problems when those changes are unavoidable; for example, moving between classrooms when going up in grade levels at school, or when a new sibling is born.
Though it might seem counterintuitive, reinforcing routines can actually help those with ASD to stop relying on them so much as a crutch. Routine can be powerful in reinforcing a feeling of well-being and stability for autistic individuals. When that sense of stability and wellness is fulfilled, then it can actually be easier for them to handle other changes.
Talking Autistic Kids Through Change
Communication is another key to helping with change management. Changes that are unexpected are the most traumatic. Communicating the change before it happens helps the autistic individual prepare to handle it more easily.
Using visual aids and other methods of communicating that are easier for ASD patients to understand can also be helpful. Much of the shock of changes comes from the difficulty that ASD patients have in making sense of what is happening. Sensory and verbal communication deficits make it difficult for them to quickly grasp new situations. Accommodating their strengths in visual perception versus verbal and social skills when discussing changes can help them settle in more rapidly and feel more at ease with the situation.
Not all changes are equal and not all ASD patients react the same way. High-functioning autistics confronted with a minor change in their daily routine or living situation might feel uncomfortable but have sufficient self-control to show no outward signs. On the other hand, a low-functioning child with autism whose family is moving to a new home might have a full-blown meltdown on the first day.
Because ABA has proven to be an effective treatment both to break down resistance to changes and to build routines that reinforce positive behaviors, it remains one of the most popular therapies for helping ASD patients deal with transitions. Applied behavior analysts are adept at using the repetitive nature of autistic patients to create patterns and methods that are beneficial to their long-term well-being and social skills.