An Ounce of Prevention

by Molly, Reilly, BCBA

Molly Reilly is a BCBA in Connecticut and works with autism families daily

We are amidst a situation in which everyone’s world is being turned upside down as our regular schedules are thrown out the door and we live a life of self-quarantine. The massive changes in our daily lives and uncertainty surrounding the situation is difficult for everyone and is especially so for individuals on the Autism Spectrum and their families. I will describe a number of strategies that are general good practice but will be especially helpful during these uncertain times. The strategies will be presented in two individual blog posts. In the first post I will discuss preventive strategies and in the second I will discuss the importance of helping teach self-regulation and functional communication skills as well as reinforcement strategies. 

Here are some strategies to possibly prevent problems or at least prepare your child for them.  They include:  1) ways to maintain routines and ensure predictability in those routines, 2) use of simple language in directions, 3) integration of social stories to demonstrate the routine, and 4) ways your child can feel that he or she has more control over the situation.   

ROUTINES AND PREDICTABILITY –  it is critical to maintain previous routines as much or possible, or develop new routines during this time.  This can be done through:

Visual schedules.  Visuals are concrete tools  to help reduce frustration by making life more predictable.  They should be built around the basics like waking up, eating meals, preparing for bed, exercise, free time, bath time and screen time.

First you will want to have a draft of the routine, and decide how activities will be represented (e.g. pictures for children who cannot read, text for children who can read).  You will also want to decide how many activities to present.  If the child is not familiar with a visual schedule it would be best to keep it simple such as First-Then Board.  Then move on to Morning, Afternoon, Evening schedules, and finally an all day schedule for more advanced learners.   When creating the actual schedule allow the child to be an active participant by taking pictures, selecting pictures from your smartphone or from google images to print out, writing words, etc.

There are a number of resources with examples of social stories you can use.  It is different than a visual schedule, but they may help you explain things like washing your hands, why school has stopped or how to try and prevent spread of germs:  They are: 

 Movement breaks or brain breaks are key. During the day, you will have alternate periods of sedentary and movement activities.  You can use Gonoodlecosmic kids yoga, animal movement cards or even an obstacle course to help structure activities.  If your child is able you can go on bike rides (making sure to distance 6’ to other people also outside), develop scavenger hunts, and even go on a hike. Games like Follow the leader and Simon Says offer great opportunities to work on following directions.  Parade magazinealso has some ideas of what to do.  

As much as possible, maintain a consistent routine.  Be sure that everyone in the household is aware of what the schedule is and follows it accordingly. This is especially important for caretakers because you need to present a united front so make sure you have everyone’s buy in.  If possible,  try to mimic your child’s school schedule.

Utilize transition cues when transitioning between activities.  Timers help give reminders visually (e.g. sand timer) or auditorily (kitchen timer).  You should also offer warnings to signal a transition is coming (e.g. 5 more minutes, 2 more minutes, 1 more minute, and then countdown from 10).

Remember that the schedule is not set in stone – I have made several modifications to the schedule I made for my daughter will most likely continue to do so :).  Feel free to add in activities that you forgot to include, especially if your child loves them.    Remember:  If a particular activity does not work, that is okay! If your child is really not enjoying it, end the activity and transition to another activity to avoid frustration.

SIMPLE LANGUAGE Avoid too much verbal language, keep it simple and to the point. Also try and state things using First – Then language.

For example, Say “First shoes, then outside” rather than “Bobby, you need to get your shoes on your feet before we can go outside.”

CONTROL Provide your child with opportunities to have some control over their environment.  This is especially difficult because parents feel this loss of control.

There are some things you can do to help them feel in control.  For example, jobs and chores are great ways to help your child feel some sense of control over the surroundings and can include  feeding your pet, watering flowers,  planting something to grow, swiffering, etc.   To help kids feel empowered, share ways that they can help their community such as covering their cough, keeping their hands away from their face, washing their hands, etc. as demonstrated in an infographic from:    

Offer choices whenever possible – which writing instrument to use doing a writing activity, which seat to sit down at the table, what color playdough to open first, hike in the woods or walk down the street for outdoor time.  Many times the open ended question is not going to help, so you should provide 2-3 concrete options.   For example, during snack time avoid asking “what do you want for snack” because the options are infinite and your child may request  something that you do not have in the house! Instead, ask your child if they would like pretzels or applesauce for snack.   Visuals are always helpful – utilize visual or textual choice boards or menus if appropriate.

Hopefully, the strategies discussed in this post will help prevent the occurrence of undesirable behaviors during this uncertain and unpredictable time.  I will also be following up this blog in the future about how to strengthen skills during the crisis, rather than focusing on building new skills.  Good luck!