In this episode we’ll explore what might be autism therapy’s biggest blind spot, and I’ll give you a practical strategy that can start to shift a preference for routines.

Now let’s jump in!

The Power of Routine

The book Atomic Habits was on the New York Best Seller List for over three years. Author James Clear preaches the power of creating incremental small habits that he calls atomic habits which become the building blocks to larger habits and success. Selling 20 million copies, he hit squarely on a public need for more self-discipline to combat procrastination and self-doubt.

Habits and daily routines are an important part of living efficiently.

In my field of education, it is also well established that repetition accelerates learning, at least initially. And it’s important to note that repetition, used to form habits, is a foundational learning principle in applied behavior analysis for autistic children.

By repeating a task like sorting blue and red coloured blocks into separate piles, over and over, their neurology, the brain and nervous system, build stronger and stronger pathways to allow them to remember and to reflexively do the task in the most efficient way possible. We build habits as the saying goes; “Practice makes perfect!”

Applying the power of repetition, millions of autistic children have been sat for hundreds of hours each doing repetitive tasks, like sorting and counting and pointing to pictures of named animals. And most of them learn. It works.

In fact, ABA therapists might argue that their highly structured routinized approach is a perfect match to the autistic brain that apparently seeks out routine!

But is it in fact true that the autistic brain prefers routine? And what happens when a routine is interrupted?

Is there a downside to training the brain solely with repetitious routines and atomic habits?

Autism and Routine

I sat by the phone one morning waiting for the parent of a 3-year-old autistic child to call for a scheduled parent coaching session. Although she was already 20 minutes late, I wasn’t fussed because, ironically, as much as we try to plan and make a child’s daily routine predictable, I know there is nothing predictable about raising an autistic child!

When the mother finally called, she explained that on the way to driving her autistic daughter to daycare there was a road closure due to construction. They were forced to take a different route. But that isn’t what made her late. It was her daughter’s uncontrollable upset and meltdown at the fact that her mother took a different route than usual to daycare. The routine changed, and the mother couldn’t explain the reason to her non-speaking 3-year-old. It took 10 minutes to calm her daughter down which really only happened once they managed to get back to a familiar street and the daycare itself.

It is well-documented and explained by autistic people themselves that their sensory processing differences along with heightened anxiety and divergent cognition can all add up to our busy and chaotic world being overwhelming and confusing for them. For these reasons they tend to seek predictability in repetitious behaviors and in routines.

The mother swore to herself and me that she would forever check for construction announcements before leaving the house. But I offered a different solution: The possibility of introducing unpredictability one little step at a time. To build up “atomic flexibility” if you will!

The Autistic Brain

In 2014, researchers at Stanford University found that the brains of autistic children function differently than most children when switching tasks. Any parent will tell you that their autistic child struggles with transitions from one activity or one environment to another. But is it really because they can only function well within routines?

Using brain imaging, the Stanford study showed autistic brains registered less activity in the brain region responsible for transitioning when specifically switching from a resting state to a task. They concluded the autistic brain may be less flexible to task switching because they have less neural connectivity in this area compared to typically developing children.

As I read this research, I kept in mind the massive body of research on how plastic the brain is – how through education and repetition it can change and grow. Is it possible that autistic children can be taught to manage or even enjoy changes in routine?

The Pitfall

In the short chapter on autism I read in one of my very first university courses, sadly named at the time “Abnormal Psychology", I learned that autistic individuals need routine and predictability in order to make sense of an otherwise unpredictable and overwhelming world.

Without picture schedules and consistent daily routines, an autistic child will get confused and anxious. This belief of the autistic need for routine is echoed on every autism center website, in every book about autism, and in every pediatrician’s office.

And when I started my career visiting special education classrooms and training parents and professionals, almost every classroom and speech therapy session I’ve ever observed provide picture schedules for autistic students to know what the sequence of events and tasks will be.

Like a daily travel itinerary,  autistic students are given schedules so that all of the transitions between activities are predictable. They can know that recess comes after math and that there is only one more  play time before the school bus home. This reduces anxiety and upsets.

I once observed my field of autism’s autopilot adherence to this belief that autistic people adhere to routine. The main teacher flicked on and off the classroom lights which signals to the students to stop what they’re doing and put their hands on their heads to show they are listening. My autistic student followed his peers and did exactly what he was supposed to. I smiled. But in that same second, his educational assistant kneeled in front of him pointing to a picture card of a hand-drawn stick figure with arms up and hands on head. Although the young boy had already learned the routine, his aid was stuck on the picture schedule protocol. And when I asked her later on why, she repeated almost verbatim what my university textbook had said: “That’s our routine and he needs it otherwise he’ll feel confused and anxious.”  I left wondering who needed the routine more?

Nature or Nurture

As an autism therapist, I’ve been haunted by the nature versus nurture question for the past 20 odd years which, as far as I know, researchers haven’t looked at: My question is: Does the highly routinized ABA autism therapy that most autistic kids are exposed to reinforce the tendency for sameness in thousands of autistic brains? In other words, is the need for routine an autistic nature, or are we therapists nurturing and reinforcing routine?

Does making every minute of every day predictable reinforce their need for predictability? By believing that all autistic children have to have predictable routines are we doing them a disservice by not exposing them to variation? Wouldn’t it serve them better to specifically teach them how to manage the unpredictability of life?

I don’t know the answer to these questions, but research published in 2015 in the Journal of Autism and Developmental Disorders suggests that the longer a child is exposed to a specific routine, the more they react emotionally to changes in the routine.

I guess it’s the same for all of us. How do you react when your favourite restaurant that you’ve eaten at for the past five years closes for good. Or when they change the smell of the shampoo you’ve used for the past three years?

So if we expose a population of children who are predisposed to predictability to days and weeks and years of predictable routines, we shouldn’t be surprised that most of them aren’t able to handle changes in the routines. Right?

My Big Idea

Well here’s a new idea: From the very beginning of founding the Integrated Multi-Treatment approach over 20 years ago, my team of loving talented autism therapists and I have on purpose very specifically built variation into every activity and every routine that we do with our autistic students.

Whether verbal or non-speaking, sensory divergent or anxious, one of our key teaching strategies is diametrically opposite to ABA and most of the education system – we intentionally and systematically introduce micro-changes in routine. The author James Clear would call this building “atomic flexibility”.

We have now witnessed with hundreds of autistic children the brain’s ability to learn to manage change and difference. It IS possible for the autistic brain and personality to learn flexibility skills. Be it mindfulness strategies like taking a deep breath to relax the mind and body, or pausing to readjust, my team teaches a range of flexibility skills. We expose the child’s neurology to change. And we do it with compassion and gentleness and support.

Tito Rajarishi Mukhopadyay was a non-verbal child diagnosed with autism. Between the ages of 8 to 11 years old, he wrote a book called The Mind Tree (2000) in which he offers a few insights for our discussion today. He wrote, “The exposure to variations, be it clothes or food, place or timetable, help us to… tolerate and understand our role in the situation better” (p. 90).

The last part of this sentence is particularly insightful: “...to understand our role in the situation better”. When in a routine that is set and always the same, a person can be on autopilot. But when the routine is varied, one is almost forced to be more present and engage in decision-making.

Variation demands us to apply our agency in different situations. Changes in routine require us to problem solve, to maybe try a new solution, but most importantly being exposed to variations in routine prepares us for the unpredictability that is life outside of highly controlled one-on-one therapy. The unpredictable world that all parents of all autistic children live in…that we all live in!

Because of this, if you aren’t already, I suggest you begin to introduce variation into your child’s routines.

Your A.I.M.

This week, your AIM is to add some mini variations, some atomic flexibility, in your child’s daily routines. Maybe add some variation in your language, and in your own behavior, or in the way you play with toys and objects you present to your child.

Do this in a very very small micro-steps way. Be there to support them as they adjust, and give them a little extra time to think things through.

The more you can present variation, the more you will help your child’s brain and nervous system regulate to typical daily unpredictable life.