Written by Elena Dezoraiev, MSEd, BCBA-LP
Under the diagnostic criteria of Restricted and repetitive Patterns of Behavior of Autism Spectrum Disorder (ASD), a subcategory of insistence of sameness, inflexible adherence to routines exists. A subcategory describing how an individual with ASD can become extremely distressed over various changes in his or her routines. When working with individuals with ASD, one of the main skills addressed as providers or, a concern expressed by a caregiver is how to prepare better and, or, teach skills such as waiting, the passage of time, understanding when and why an activity/event occurs or not, and excepting routine changes with “typical” behaviors. Changes such as we are currently experiencing in our lives from the COVID-19 (Cornonavirus). It can become challenging for an individual with ASD or a caregiver to handle sudden changes such as school closures and changes in providers, services, or even just remaining at home for days and weeks at a time. However, there are various resources and strategies that can be implemented and taught to individuals with ASD to help them cope with the sudden changes of routine as well as engage in less maladaptive behaviors.
Social stories are a great tool to explain or describe a particular situation, event, or activity tailored explicitly to the reader’s needs and repertoire of skills. The story can include pictures and words, sentences or simple phrases, comic strips, favorite characters, or even actual pictures of the readers engaging in any behavior. A social story can be used to describe the current situation and the reasons why someone has to stay at home, and it can explain and answer relevant questions and doubts that the individual may be facing. As well as describe and or list routines and day-to-day activities. Social stories are also an excellent tool for behavior strategies; it can help teach feeling and emotions of others as well as those of the learner. For example: “I feel mad because I can’t go outside/playground/school. I want to cry and scream. When I feel mad, I can tell my mom or dad, I can ask for a break or something to do.” When social stories are created, they need to be presented and rehearsed often to help clarify and solidify the information presented through the story.
When presented with information visually as well as verbally, following a routine and working through various changes can become less confusing and more fluent. Visual supports are concrete cues that provide individuals with information about their routine, activities/tasks, and events. Visual support can be in the form of calendars, schedules (hour-to-hour, daily, weekly, monthly), checklists, reinforcement menus, written rules and expectations, first-then, and more.
The concept of time can sometimes elude individuals with disabilities and, visual schedules can help them to anticipate tasks and activities; it can reduce verbal prompting provided by a caregiver and increase independence by the learner.
A general daily schedule can be created for a learner with actual events such as morning/evening routines, mealtimes, and interchangeable activities such as chores, academic tasks, leisure activities. Within that schedule, smaller step-by-step (Task Analysis) visuals can be presented for necessary activities (e.g., a step-by-step visual in the bathroom how to brush your teeth). When engaging in a highly reinforcing activity, or less reinforcing, a timer and a first-then visual can be implemented to solidify the understanding of when the activity is ending and what comes next. When creating visual support, the following must be kept in mind: the learning and understanding abilities of the individual. The setting event, or environment that the visuals will pertain too, how much support will the learner require to refer and follow the visual, as well as reinforcing the individual for using their visual support.
As providers and caregivers of individuals with disabilities, we may sometimes forget that even someone with a disability, regardless of his or her functioning or learning skills, can make their own choices if provided appropriately to them. Research has shown that choice-making opportunities are very effective in not only reducing problem behavior but also increasing motivation and task engagement. Choices can be given for practically any activity or task; academic tasks, leisure time, completing chores, meals, and even something as simple as morning routine of brushing your teeth first or getting dressed, and the same for the night routine. If possible, provide a choice of 2 and more per activity, task, or item. Choices should be present to the individual in a manner that best understood by them. Choices can be presented via pictures, written words, or just by verbally asking. Once a choice is made it must be honored by the caregiver. If a specific choice is not available at a particular day or time, either remove it from the presented choices or ask the individual to pick an alternative.