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The importance of predictability

For two years now, I have been working with people that are in the Autisctic Spectrum. Some are very high functioning and can do a lot by themselves and others need a little bit of support. With autism, there are normally a few extra conditions that can compromise independence and overall wellbeing. A lot of the people I have met and work with all this time, suffer from a wide range of anxieties that go from anticipatory to sensory related.

It caught my attention that most of the service users I began working with would have two bath/showers a day. When I asked Therapysts the reason for this, they pointed out that by doing so, we can establish the beginning and the end of our day, which seems very reasonable and helps our service users going through the milestones in their days.

Many times, boredom, not knowing what’s happening next or just the lack of activity can cause a great deal of stress in our guys, so in order to address that need, there is a lot of work put in place for an autistic person, their careers or support workers to know what’s happening, how to deal with a situation and how to manage moods and behaviours.

Apart from set routines for morning and night, there are also lots of ways to add predictability to someone’s life:

  • Weekly planners. We use these to have a full range of planned activities that will offer meaning and education at the same time. They normally very consistent from week to week with variations that can offer a person with independent choice, i.e. visits to places of interest of a choice of a preferred activity through the week. In the company I work for we use a method called “active support” in which all activities are focused onto teaching new skills, maintaining already acquired ones and promote their independence in all aspects of life. Depending of the processing capabilities or each individual, the whole week planner can be displayed somewhere visible for visual reference or can be broken down into days or even small “now, next and then” schedules.
  • Schedules. If an individual cannot cope with a great deal of information in advance, we can make step by step schedules in which we focus on what we are doing now and what will happen next. There can also be “then and after” if our service user can deal with a little more information and even do morning and evening ones, which will almost always end in some kind of rewarding activity (lunch, dinner, snacks, baking, favourited activity…) As we all know some everyday tasks can be very boring and unappealing, so it helps massively to know something enjoyable is going to happen.
  • Routines. We’ve talked about morning and night routines as a way to start and finish our day, but there are many ways to also add predictability through different routines. Some preferred activities will always fall on the same days. Swimming will always be on a Saturday while horse riding happens every Tuesday and family visits on Tuesdays, Thursdays and Sundays. Now imagine you’re a non verbal person, with the ability to understand some spoken language (or a lot) but cannot express your needs in words. If you had no concept of days and date, knowing that certain activity takes place the same days you will be seeing your mum would definitely help you cope with the wait between visits. Or if you can speak and tell which day of the week it is, it would give you a lot of stuff to look forward too, like trips on the weekends or a visit to the pub for a meal on certain days.
  • Consistency. This should really be part of the routines, but I’d like to pay special attention to the way things an autistic person would expect to go. When I first began I met one of the most fascinating persons I have ever met. He is non verbal, so communication was a bit tricky. One of the issues we found with him was he wasn’t taking baths as often as it would be reasonable, having a bit of a negative impact on his life. We spent weeks trying all sorts of tricks but unfortunately, none of them would work, and although he would take a bath now and then, we relied too much on his mum to get him bathed. One day, someone had an idea: “let’s play that song his mum sings for him when he jumps in the bath” and there it was, it worked and from that moment on, he would get in the bath as soon as he heard the song, and it wouldn’t matter who was playing it because we all managed it consistently. That is a very graphic example but consistency is needed all the time in all different kind of circumstances.

To help us carers or support workers understand our individual’s need there are this wonderfully useful tool called PBS (Positive Behaviour Support), which is a document written on the person’s behalf, by the therapysts, doctors, key workers and sometimes relatives in which all aspects of a person’s personality are reflected

In a PBS plan, we can find likes and dislikes, abilities and struggles etc.  From them, we can learn how to identify early warning signs for a potential challenging behaviour and the techniques we should use to try and redirect the situations. We then know where we stand, what we can do and say to help and how to manage a potential situation when and if it happens.

If we think about it, we all like predictability in our lives, and pop music is a great example of it. We like to know what to expect from every situation and the not knowing can be stressful, even more so if you have a autistic spectrum condition.


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