Day #12 Routines and Rituals.

Repetitive behaviours are common to those on the autism spectrum. Repetitive behaviours can present in a number of ways. Some repetitive behaviours include: flapping hands or arms; spinning; rocking; humming or clearing the throat repetitively (also often referred to as stimming or stims). Repetitive behaviours can also extend to the spoken word. Some individuals like to repeat phrases or words or repeat lines from movies (echolalia). Some develop routines of categorising things and some may develop OCD like behaviour, washing their hands a lot or needing objects to be in a certain place to feel OK, to feel calm and at peace.

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J has a number of routines and rituals that he likes to follow to feel calm. When he was little he was absolutely attached to his dummy, bottle and a silk edged blanket for soothing. Whenever the day got too much he would seek all three items out. It was very difficult to find a dummy replacement when the time came and it took many months and the support of an amazing OT to wean him off it. He did a lot of toe walking, flapping and spinning, and he’s always been echolalic. He didn’t talk until he was nearly 5 but he made lots of repetitive noises. When he began talking he repeated the last few words of every sentence he heard. He still does this at times. Water has always calmed him – baths, playing in water, swimming, playing under the hose.

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These days when J’s really concerned or fixated on something he needs to seek reassurance repeatedly. For example, when he gets in the car after school he will ask, “Mum, can I please play the Xbox when we get home?” The answer is always the same from me – “Yes J – you can play the Xbox for one hour after we finish our jobs”. Every day the question is asked at least three times and every day the answer is the same. I make jokes with him about being a ‘broken record’, repeating things over and over – but he just says, “Sorry Mum – it’s just how I roll!” J likes to go to bed with a cup of ice, his water bottle, two pieces of sugar free chewing gum, the night light on and the door left slightly ajar. Every night he has to talk me through the process even though I’ve pretty much got this routine sorted. It is just a process and routine he needs to go through to settle for the night and following this ritual makes him feel at peace.

T also has a number of routines and rituals he likes to follow. When he was little T was all about his trains. He liked to sort and organise his trains, and he would remember huge pieces of dialogue from Thomas the Tank which he would re-enact with his train set. T is big on baths. He likes Epsom salt, essential oils, a little bit of coconut oil, warm water (not hot and not cold) and his iPad so he can watch Minecraft clips on YouTube. He needs to give long instructions about how things should be prepared from sandwiches to his bed to the consistency of his ice when I’m crushing it. When he goes to bed he always takes at least 2 ice packs (no matter what the weather is doing), a water bottle, a cup of ice and a couple of minifigures (usually wrestlers or Star Wars characters).  He tends to do a lot of organising, ordering and categorising of his toys (minifigures mostly) and often his play is about sorting the characters or directly re-enatcting scenes from his favourite shows such as Dr Who (see picture below).

Now, before you go thinking, “Oh my goodness! These children are totally over-indulged! She’s practically running a Hotel over there!” Yes! I’ve heard this once or twice before you know. Have an honest and objective look at your day. Are there not things that you do that bring you comfort? Making sure all the cupboard doors are closed; parking in the same car spot at work; using your own special mug for coffee at work; having your bread toasted to a specific degree; having your music on in the car; having a glass of wine after dinner? We all have things that we do throughout the day that bring us comfort and help us to feel calm. Don’t we?

What I’m trying to do is to teach the boys that everyday strategies like baths, watching TV, going for a walk, playing the Xbox – all those things are easy to do and appropriate in any context. If I remove these rituals we tend to revert to undesirable rituals and repetitive behaviours such as self harm (in particular biting their cheeks and chewing their fingernails to the quick) and sleeplessness. Or they want to spend all day on their own in their bedrooms because they feel overwhelmed and need to retreat from the world.

My advice … if the repetitive behaviours or rituals in the house are causing dysfunction then try to work out what need the child is attempting to meet and see if you can replace the old ritual or behaviour with a more functional one. For example, if your child is chewing everything in sight in an effort to self soothe, provide them with oral motor activities; chewy foods and thick, iced drinks to give them the oral input they are seeking. I’m sure you will then find that their need to chew other things diminishes. If however the repetitive behaviour and/or ritual does not interfere with the daily functioning of the individual and those around them, just embrace it and let them do the same.

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