Autism and the Need for Schedules

by Sally Burton Hoyle Ph.D. and Chris Curry. M.S.

Autism is a neurological disorder that impacts an individual’s ability to measure and understand the passage of time, place and space in the environment, auditory processing, retrieval and response to verbal and non-verbal communication as well as many other deficits that are part and parcel to the spectrum of autism. In today’s fast paced society, it is difficult for all of us to keep up with duties and responsibilities, but if you have autism these deficits make the difference between success and failure. Schedules are useful tools for everyone, but for individuals with autism using a schedule is more than just a useful time management tool, it is necessary in order to maintain the routine and predictability necessary for most persons with autism.

80-90% of persons with autism are diagnosed typically with 2-3 co-morbid psychiatric disorders by adulthood. Panic, Obsessive Compulsive disorders, autism, mood disorders such as depression are common with many persons with autism. Medication is usually prescribed by a qualified psychiatrist, but there are no medications that will help a person on the spectrum keep routine and predictability. A question I often ask a person with autism, or their parents is this: How do you or your child manage time? It is certain that without a reliable tool for time management the person will experience failure. An answer unacceptable to me is when a person answers my question with this: I have it all in my head. It is imperative that a person on the spectrum utilize some type of schedule. There are many different types of schedules: monthly calendars, daily planners, weekly planners, visual schedules, just to name a few. But schedules have only helped reduce anxiety when I was able to develop an individualized system.

Schedules can be written or digital, depending on what reduces anxiety. Some people will prefer having schedules and calendars on their ipad, tablet, or smart phone. Some people like them posted on a bulletin board and some people like then tucked away in a notebook – or maybe a combination. This is a personal preference that should be respected.

Individual schedule- Each person must have their own schedule. Their schedule is not to be confused with staff schedules. A good schedule is like a GPS, it directs the individual to the next activity and includes vital information that the person wants and needs. It has as much information as is needed and does not overload with pictures, or unnecessary information.How do you know a good infividual schedule has been developed? Observation of the individual must occur. If the perrson can follow it and completes the tasks then it is an effective schedule. It is typical to tweak the schedule but it should be as simple as possible, age appropriate and match the interest and sophisticaltion of the person using the schedule.
- Staff schedules. I have found that it works best when there is a separate staff schedule. The person using staff on a regular basis has less control over a staff schedule so separating it out form other schedules where a person has complete control makes sense. Even though a person may interview staff and select staff, schedules are often set by levels of care and what activity is being done during the time that the staff is present. If a person needs staff to help him/her get ready for bed, the exact times may be discussed with the individual but that will probably happen at the end of the day. Because the person doesn’t have complete control, I think it works best to have a separate schedule that gives a weekly over view of the staff’s name, the time they will be there and why they are there. That schedule should be reviewed weekly to make note of any staff changes and this schedule should include meetings or appointments with other care providers (O.T., Psychiatrist, etc.).
Positive and Regular Events Calendar. The plan is written out and for that day and the individual can focus on that day. That will help reduce anxiety. After each activity is accomplished, the activity is checked off. If there is a staff change during the day, the new staff looks at the list and makes changes as the day goes on. The last care provider for the day reviews everything that was done and notes those things that did not get done and moves those activities to another day. This creates continuity for the individual being assisted.
- The daily list can be as detailed as it needs to be to reduce the anxiety. If laundry is on the daily list, a list of all the steps to do the laundry can be included – separate clothes, put clothing in washer, put soap in washer, start washer, etc. The details (task analysis) on the daily list are used to help the person accomplish the steps of the task and are used as needed. These can be developed ahead of time.
- How do you know the schedule is working? When the person you are helping starts to refer to the schedule, checks their schedule, or says “Let’s put that on my schedule, so I don’t have to think about it.”
- Using technology.
  Technology can be a wonderful way to help people with and without staff. If someone is cooking without staff, a program can be designed to talk them through the steps of a simple recipe. The program can include reminders to turn the stove off and start the dishwasher. More info on this will be coming in our upcoming webinars. In the meantime, if you are helping someone who uses technology, start programing simple reminders that can be played during the day. “Good morning, The van will be here at 9:00 to talk you to work.” More to come!!!!
Positive and Regular Events Calendar. This calendar has important events that may or may not happen on a regular basis. It may include weekly tasks (shower, laundry, shopping) or it may only include events important to the individual (TV shows, dinner engagements). This is where I try to find out what reduces anxiety and what increases anxiety. If taking a shower makes a person anxious than he/she will not look at a large wall calendar or a monthly digital calendar that has “SHOWER” in bold letters on Wednesdays and Fridays. That might increase anxiety. However, payday might be a nice thing to see on the calendar along with special events like “Pizza night with John.” Because you want the individual to use this calendar to bring continuity and reduce anxiety, it has to be a calendar that he/she looks at.
The weekly planner.The weekly planner is used to reduce anxiety by having a sense of order through the week. For someone with anxiety disorders because of autism or other reasons, the weekly planner is vital. And for anyone who uses care providers on a daily basis, the weekly planner is crucial. Each day of the week should one or several assigned tasks. These tasks are determined by the individual being assisted. The tasks are listed on each day; “go to work” might be on several days, “shopping” might be on Tuesday, “Laundry” on Thursday, etc. It is important to assign times so that schedules are evenly paced and make sense across staff. I was developing a weekly planner with a young man and noticed that on Tuesday, shopping was scheduled from 3:00-5:00 with staff A, exercise class was from 5:00 – 6:00 with staff B, followed by Bible study from 6:30-8:00 where there was no staff. I asked the individual when he had dinner. He said he ate dinner at 2:00. Since he had had lunch at 12:00 this was obviously not a good plan. In this case, the young man had always gone shopping on Tuesday and had always gone bible study on Tuesday. After a discussion, the staff realized that the exercise class had been changed to Tuesday and, because there wasn’t a weekly planner, no one noticed the young man was eating dinner at 2:00 in the afternoon.
The daily list: Once there is a staff schedule, a event calendar, and a weekly planner in place, the next step is using all these time management devices to plan each day. The goal would be to have an individual write up a plan for each day independently but most of the adults I help have staff the majority of the day and the staff assists them in doing this. When a providers arrives, they look at the event and weekly schedules and use them to map out the activities for that day. The individual decides what activities will be done and when they will be done guided by staff. This allows for changes when special events come up. Perhaps laundry is not going to be done because there is a birthday party on that day. The staff can help the person rearrange the schedule and put laundry on a different day or skip it for a week. Or perhaps the staff looked ahead and the laundry was done on a previous day.

CHECK OUT THE UTUBE VIDEO WHERE DR.SALLY AND EUSTACIA CUTLER DISCUSS PROVIDING SUPPORT FOR STUDENTS WITH AUTISM IN COLLEGE.