Help at home

Unexpected changes can be hard for a person with autism. Here are strategies to help people handle unexpected changes and participate more successfully:

• Establish routines to help prepare the person for what is coming next. This gives them time to process and get ready for the tasks of the day. Whenever you can, build routines into the person’s daily life to increase structure and predictability.
• Create a visual or written schedule to help the person follow their routine. Similar to a planner or reminders on your phone, a schedule will help the person organize their day and prepare them for any changes to their typical routine. Use first-then statements: “First wash hands, then dinner.”
• Try to limit the introduction of several new activities or changes at one time or without advanced notice. This could become overwhelming to a person with autism. If an unexpected change does occur, talk about the change using a social story.

Visual learning is often a strength for people with autism. Auditory information might be more challenging for them to process. Some strategies:

• Limit verbal instructions. Give instructions in as few words as possible. Pause for processing time and repeat the instruction if needed or pair with a visual.
• Create visuals to outline expectations or show desired responses. Visuals might include social stories, visual schedules or other resources to help people with autism and their families at home and in the community. Examples of visuals:
  • Pictures
  • Written words
  • Gestures
  • Objects within the environment
  • Arrangement of environment
  • Timers, planners, calendars
  • Highlighted key words
  • Modeling

• Stop before you react
  • Evaluate for unmet needs, such as lack of sleep, being hungry or missed medications.
  • Evaluate the environment. Make sure that the person is safe and that others are safe. Then, evaluate if there are sounds, smells or someone who is triggering the person's behavior. Decrease sensory stimulation or transition them to a quiet place where they are safe
• Avoid giving demands or instructions when the person is demonstrating aggressive or self-injurious behavior. Try to avoid any verbal communication that can potentially escalate the behavior.
• Rule out pain, injury or medical condition that might be causing the person to be aggressive or injure themselves. Find resources on the Health Care and Wellness webpage to help the person access medical services.
• Present choices. Choices give the person a sense of control when everything else seems to be out of control. It also shows that you value their input. Presenting choices in the form of visuals enables you to communicate without raising your voice or asking questions. Avoid open-ended or indirect questions, such as “What do you need?” or “How can I help?” Instead ask, “Do you need a break or a snack?”
• Use communication cards to help the person indicate, "I don't like this," "I need a break" or "It's too loud" or to indicate a pain scale. Present these as pictures or written words.
• Self-observation: Ask the person to rate the level of frustration on a pain scale or point to pictures of what is upsetting.
• Distract or redirect to a neutral activity
• To try to prevent aggressive or self-injurious behaviors in the future, try these proactive strategies:
  • Notice and encourage appropriate behavior
    • Give praise. For example, “you found your fidget to calm – good idea!”
    • Give a high-five, hug or back rub when they are not demonstrating aggressive or self-injurious behaviors.
  • Enrich the environment. Offer proactive breaks and be sure that the person knows how to communicate effectively when they need a break.
  • Decrease non-essential demands and denials.
  • Practice and model self-regulation techniques in front of the person. Find more information under Emotional regulation.
  • Use positive directions -- “walk with quiet hands” rather than “We don’t hit others.”

• The Road Map for Behavior Support (PDF) offers a step-by-step guide to help support individuals with unwanted or interfering behaviors. The road map will help identify what might be going on, gather additional information and ask key questions, as well as offer options for possible interventions and supports.

• In young children, you can encourage language by:
  • Babbling, singing or making noises during play
  • Model imitation by repeating sounds or words back to them.
  • Reward them for imitating any sounds or words
  • Get down on their level or practice making sounds in a mirror so they can watch how your mouth forms words.
  • Pair sounds with actions or objects. Pointing out animals and the sounds they make in books or saying, “Up, up, up” when they are reaching to be picked up.
• Build receptive language skills. Often before a person speaks, they learn to understand what others are saying. Responding to their name or following simple instructions will help them develop expressive language skills.
• Offer rewards or praise for any attempts at language. Shape their responses from sounds to words to phrases.
• Speak simply and clearly. A person is more likely to imitate words that they can understand.
• When possible, use visuals to communicate.
• Explore augmentative and alternative communication devices or other Assistive technology and equipment.

• Avoid open-ended questions. Present two to three choices.
• Avoid sarcasm and idioms. People with autism are often very literal.
• Teach social skills directly using social stories or modeling. Show them examples of behaviors that are “friend makers” vs. “friend breakers.”
• Special interests might help the person develop relationships, increase community engagement and recreational opportunities, as well as stay motivated. Special interests can help to establish rapport with an individual, increase social interactions and build new skills.

• Limit or remove distractions in the environment. You can add them back in later, but it helps the person focus while they are learning a new skill.
• Ensure that you have the person’s attention before giving an instruction or presenting a task.
• Have clear expectations. Be clear and direct about what is expected. Use clear, short instructions.
• Allow for extra processing time and make sure they know how and whom to ask if they have questions about a task.
• Use visuals, such as modeling. Model the task or skill.
  • For example, when teaching conversation skills with peers, model asking a peer about their new backpack, then have the child imitate your actions
  • Try using video-modeling or have peers demonstrate the skill
• Use momentum. Start with easier or well-known tasks before presenting harder tasks. For example, “Pick up your pencil.” “Write your name at the top of the page.” “Complete the first math problem.”
• Build in breaks. Be sure they know a break is coming and how to ask for one.
• Break down the desired skill into steps. Teach the steps through repeated practice. Track progress over time.
• Offer rewards for attending, correct responses or effort as they are learning new things. Use high fives, hugs, back rubs or incorporate special interests into the learning activity.
  • Special interests might help the person develop relationships, increase community engagement and recreational opportunities, as well as stay motivated. Special interests can also help to establish rapport with a person, increase social interactions and build new skills. Incorporate aspects of their preferred interest into that lesson or activity.
• Practice the skill with a variety of materials, people and in different places.

It might not always be clear to us, but the repetitive behaviors a person engages in are serving a purpose for them. Repeating the same words or actions might help the person to organize their thoughts or be a form of communication. Ask yourself; is the behavior harmful to the person or others? If it is, you might want to try strategies that address aggressive or self-injurious behaviors. Are they trying to tell me something? Is there something I can do to meet their need?

• Be aware of the person’s sensory needs. Determine if they need less or more sensory input. Evaluate foods, smells, noises and other sensory inputs. Use strategies such as:
  • Headphones
  • Lamps instead of fluorescent lights or install dimmer switches
  • Breaks
  • Stress balls, fidgets
  • Activities that require the person to exert energy
  • Removing distractions such as flickering lights, white-noise, smells from candles, cleaning supplies or perfumes, tags on clothing
• Schedule a consultation with an occupational therapist who can help to design a sensory room or space in your home.
• If you know the person will be entering an environment where sensory input will be challenging, prepare ahead of time using visuals and practice utilizing the strategies listed above.

• Identify emotions and talk about them in books or in mirror. When you can identify how the person feels, you can more easily identify how to support them.
• Model calming behaviors until they join in, rather than directing them to follow. Proactively practice these behaviors so they can implement during times of disregulation.
  • Practice deep breathing.
  • Take a walk or movement break.
• Develop long-term coping strategies:
  • Eat healthy
  • Try to get outside in the fresh air at least 20 minutes a day.

Transitions can be particularly challenging for people with autism. Going new places, moving between activities, meeting new people or experiencing new things might cause anxiety and stress.

• Why is the person struggling with the transition? What aspects of the transition are hard? Is it going to new places, seeing new people or experiencing an unexpected change?
• Visual schedules: establish a routine so they know what to expect.
  • First/ then chart
• Reduce transitions or prepare for them with a social story. National Autistic Society has more information on social stories and comic strip conversations.
• Create routines to increase consistency and predictability.
• Teach flexibility with routines if unexpected changes occur.
• Use timers or verbal reminders: “In five minutes we will line up to go to lunch.” “In two minutes we will clean up the blocks.”
• Offer a break
• Provide a transition object
• Use momentum. Start with easier or well-known tasks related to the transition, before delivering the instruction to transition. For example, “Point to the blue block.” “Hand me a red block.” “Help me clean up the blocks.”
• Use a reward system.

A person with autism might have allergies, co-occurring conditions, sensory sensitivities or other challenges that lead to food refusal or restricted diets. Consult with the person’s primary medical provider, speech-language pathologist and occupational therapist for feeding services or referrals.

It is important to be able to self-advocate or advocate across education, health care and other settings. Build the following skills:

• Question-asking or requesting help (e.g., raising hand to ask for help in school or ask for more information)
• Self-awareness: Use the one-page profile (PDF) to describe yourself — what people like about you, what is important to you and how to best support you.
• Use person-centered planning guides and tools to develop a vision for a good life that reflect your personal strengths, preferences and personal interests.
• Negotiating skills or protesting effectively (e.g., “I need more time to finish” “Can I work on this later?” “I don’t want to do this.”)

Haircuts can sometimes be challenging for people with autism. Here is a collection of helpful tips and strategies that you can practice before, during and after haircuts.

Tips for hair stylists:

• Educate yourself about autism and the specific strengths and needs of the child, youth or adult that you will be cutting the hair for
• Speak in a calm, low voice
• Approach the person from the front and avoid sudden or quick movements
• Keep directions short and simple and utilize functional communication strategies specific to the person (e.g., visuals, written instructions, verbal instructions)
• Try shifting their attention during the haircut, for example, sing a song, play a favorite video or tablet game, talk about a preferred interest. Take frequent breaks.
• Give them choices about the products you use, or the style of their hair cut. Let them smell and touch hair cutting tools and materials so they can become familiar. Offer ear plugs or use clippers and hair dryers on low settings to minimize the noise.
• Explore gentle, fragrant free products and utilize a wide tooth comb and detangling spray. A shampoo visor might be helpful to keep shampoo off their face and out of their eyes.
• Try to keep stray hairs off their neck and out of sight. Using a fan, towel or soft brush to clean off hairs

Tips for caregivers:

• Preparation: It's important to provide opportunities to prepare in advance. This might be visiting the hair salon or barber shop ahead of time to become familiar with the space, reading a social story, watching a video model or following a visual schedule. Review the steps of the hair cut several times so they know what to expect. This will help to alleviate fear and anxiety.
• Scheduling/ creating a routine:
  • Schedule an appointment when the salon is not as crowded or purchase supplies to cut hair at home. Ask the salon if they have experience with individuals with sensory sensitivities.
  • Avoid scheduling during nap times or when the person is sick, tired or overwhelmed.
  • Try to stick to a regular schedule or routine and plan haircuts at a similar time of day, every month or every other month, for example. Create a visual schedule and review the routine frequently.
  • Start counting down or give reminders as the hair cut approaches.
  • Potentially plan haircuts right before bath time or bring a change of clothes to clean off loose hair
• Practice:
  • Practice the steps of getting a haircut at home.
  • Try putting on the hair styling cape, introduce the clippers, combs and scissors.
  • Talk through the steps before you start cutting hair.
  • Try acting out the hair cut on a stuffed animal or doll.
• Shifting their attention and offering rewards:
  • Bring a familiar toy or item from home to keep them calm
  • Offer fidgets to distract them
  • Play a favorite song or show to shift their focus away from the haircut
  • Reward the individual throughout the process and following the haircut. We want to create an enjoyable and comfortable experience.

Sensory spaces are becoming more and more popular. From schools to movie theaters, concert venues, museums, sport complexes, community centers and religious organizations—sensory spaces can help increase engagement and enhance the experience for individuals with sensory sensitivities. They provide opportunities for sensory and emotional regulation, often by reducing the volume level and noises, dimming the lights, reducing strong smells, offering tactile experiences and the opportunity for more movement.

Sensory spaces may also try to limit the number of people in the space at one time or provide more one-to-one support as needed. It is important to consider various modes of communication and provide written and visual signage, as well as any personal accommodations needed.

Sensory items to include:

• fidget toys to spin, twist and manipulate
• lighting and sound they can control
• stuffed animals to hug
• sensory bottle, kaleidoscopes or a string of lights hung up on the wall
• bottles of bubbles or a bubble machine
• interactive wall tiles
• noise-reducing headphones to block out sounds that are overwhelming, white noise machines
• stress balls to squeeze
• building and interactive toys or games. Fat Brain Toys has many examples of toys available for purchase, and you can search by age or category.
• Fun and Function has calming toys, sensory clothing and equipment, products for the classroom and more.
• engaging one-person activities like activity books, individual board games, light bright, building blocks, coloring, puzzles, doodling or journaling, etc. Include both fine and gross motor activities. Lakeshore has many examples of furniture and learning materials available to purchase.
• sand and water table or boxes, rice, beans, dried pasta, play doh. This may also include little people figures, plastic bugs, or small toys that introduce different characters and social themes
• inclusive toys, books and learning materials, such as Persona dolls from AmazeWorks.

Large gross motor items to include:

• sensory swing or hammock
• thick foam tiles or crash pads
• wobble or balance boards
• climbing walls
• small trampoline
• ball pit
• yoga ball

Avoid items that people may be allergic to or scented materials. If there are scented items, ensure they can be contained for those that have sensitivities.

In small rooms that need to serve multiple purposes, you can set up quiet spaces with bean bag chairs, pillows, tents, blankets, tunnels, room dividers or black out curtains. This allows those individuals who need quiet and calm, to find that space to regulate. Fun and Function has examples of spaces that need to serve multiple functions.

Yoga enhances flexibility, strength and body awareness. It also supports concentration and relaxation. Here are a few tips to get you started:

• Let go of expectations
• Go for imitation over instruction: they will naturally start to copy what you are doing
• Yoga props, like blocks, bolsters and blankets are kid friendly and great for beginners. Have them use the props and get creative.
• Use books or cards for inspiration. For example, the Yoga Bug board book series by Sarah jane hinder
• Keep it simple and incorporate breath work. Imitate in the mirror or give them animal names