Last week's post provided an overview of how Positive Behavior Support (PBS) strategies could help establish a calm and predictable environment that allows the person with Autism to slowly be able to explore their world and learn new skills. Over the next several weeks specific PBS strategies will be outlined to help put these principals into practice. It is important to remember that each of these strategies will need to be tailored to the individuals' preferences and abilities, but hopefully this will give you a general direction in which to start. Also keep in mind that each individual may respond better to some PBS strategies over others, so do not get discouraged if one of the strategies is working more effectively than the others.
The first PBS strategy to be discussed is establishing a schedule. This is typically the first strategy offered by therapists who serve individuals with Autism because it provides the foundation and reference point for all of the others strategies. Setting up a schedule establishes a predictable routine and sets up expectations for the day, week, work routine, etc. Schedules are most effective when they are consistent with the person's abilities (e.g. using pictures for those who communicate nonverbally) and the schedule is reviewed with the person prior to starting the activity. Here are some examples of different types of schedules:
Daily Schedule - List the daily activities in the order that the person is expected to do during the day. This is just as important for home as it is for school. Include daily self care routines/activities as well as time for school work, chores, free time and play. Inclusion of preferred activity in the schedule is very important so the person knows there is something positive to look forward to. Sometimes placing a preferred activity directly behind a work or chore activity can serve an incentive for completing the work. With individuals who go to school or work, it may be important to schedule some free/down time immediately upon returning from school or work so the person can wind down from the stressful day before having to exert more effort and concentration. Transition times are typically best when they are 30 minutes or less because if the persons with Autism relaxes too much it will take too much effort for them to get started again. Nonnegotiable/special interest activities need to have their own place in the schedule. This schedule should be reviewed daily, with any changes in the schedule reviewed prior to the change.
Weekly/Monthly Schedule - This is typically used for scheduling special events that are not part of the daily routine. This could include a family trip, visit to a doctor (if not a regular appointment), or a holiday. The idea behind this is to prepare the individual for the changes associated with these special events. This type of schedule can also be helpful with planning long range work projects or term papers by having different stages of the project scheduled intermittently.
Work Schedule - Work activities can be more easily completed when the work is broken up into a series of discreet steps and the steps are detailed on an ordered list. Including time constraints may be important for some individuals so they become aware of how much time/effort to devote to a specific activity. For those who are more obsessed with time, however, the inclusion of time constraints may make the person too anxious and interfere with their ability to complete the activity.
Once these schedules are established programming for educational, social, and family activities becomes easier. They key is for consistent review of the schedule with the schedule being visible, understandable, and accessible. The schedule can always be used as a reference during periods of uncertainty. Consistency in reviewing and implementing the schedule is necessary, as it may take some time for the person to get used to following it. Once the person with Autism gets used to the schedule, however, it will be hard for the person with Autism, as well as the people supporting them, to imagine life without it.
Steven C. Altabet, Ph.D.