Strategies for Habilitation in Autism

The following habilitation strategies used at Bittersweet Farms have frequently proven effective in addressing the challenges discussed above. These practical approaches are based on principles of structure, order, consistency and predictability (Kay, 1991).

1. Environmental Organization
The environment needs to be clearly defined and highly organized (Van Bourgondien & Mesibov, 1989; Mesibov, Schopler & Hearsey, 1994). This applies to the physical setting, roles of personnel and program format. Physical space must accommodate specific daily tasks and activities and allow enough room for each person to function and feel comfortable. Personnel maintaining similar roles from day to day can get to know habits and preferences of each worker and adapt effective modes of responses to them. Program format must be clear to all involved so moments of indecision, ambiguity and confusion are minimized or actually avoided. Daily schedules should have predictability over time and be clearly communicated in a format that participants can process, be it verbal, written or pictured (Smith, 1990; Mesibov, et al., 1994).

The order of events is important. Activities and tasks need to be logically sequenced in finely graded steps to be understood and carried out by these adults. Over time, if alterations need to be made in the established order, they should be made very gradually. Consistency of basic elements of routines from day to day and week to week provides predictability for these individuals who are otherwise easily unsettled by unexpected change.

2. Meaningful Activities
In order to sustain attention and involvement, and promote understanding of sequences of events, activities are best presented in meaningful contexts (Lettick, 1983; Kay, 1991), and the impact of the work should be seen at some point. In the horticulture setting (Collins & LeFevre, 1991), adults with autism plant seeds, watch them grow, weed the gardens, harvest the vegetables and then cook and eat the food. Stages of this process are observable, concrete and fully experienced by each person.

In other projects, wood is cut to burn in the stove to keep warm; chairs are built to sit in. These outcomes are visible and an integral part of real-life activities.

3. Structured Programming
Program activities are guided by carefully planned schedules that are presented with strong visual cues (Mesibov, et. al., 1994). For those who can read, there are written lists; for those who cannot, there are sequences of pictures depicting the order of events (Giddan & Giddan, 1984; Scholper & Mesibov, 1983). Such visualized cues guide events and are used to structure each and every task. To reduce abstraction, instructions are presented in the most basic terms possible and specific steps are indicated in the finest detail. For the young woman who "turned" the cake over in the microwave, instructions might be written as "rotate the cake pan to the left." Such specificity overcomes the challenges of abstraction and helps avoid errors.

To clarify implied meanings, directions might specifically say "sit down," turn the page," "remember to turn off the oven" or "go tell your supervisor you are finished."

When judgment is a problem in movement toward independence, circumventing the responsibility for making important decisions is often the best remedy. In meal preparation, instructions like; "use the large green pot" can prevent the pouring of a large quantity of food into a small container. With regard to monitoring the drying of clothes, prescriptive directions to prevent error can be "dry your clothes for thirty minutes."

In handling change, provision of ample warning often helps to alleviate anxiety that comes with disruption of schedules. These, written or pictured allow for advanced notice and serve as a reminder of what is coming that will be different. For a young man who has difficulty with changes in work routines, the item on his schedule, "choose a new job from the job jar," allows him to independently and easily alter his day.

When an entire repertoire of behaviors has to be altered, a more gradual fading program can be put into place as can be seen in the program for the young man who had difficulty relinquishing the after lunch swim. At first when he removed his clothes he was allowed to put on his swim trunks and go out to the pool to wet just his legs. He wet less and less each day until he was only touching the water. Eventually, the ritual was reduced to just changing his clothes. Finally, he accepted going to another activity after lunch.

To overcome apparent lack of initiative, task lists are developed to cue the men at the horticulture center. Upon arrival they pick up their clipboards, read the attached schedule and directions, and carry out their tasks. As they no longer wait to be told what to do, their on-task time and productivity are improved.

When initiating self-care practices is a concern, the strategy of posting lists of self-care routines in bedrooms is effective. As these adults follow their printed or pictured directions week after week, they eventually master the sequence and repeat the practices as new habits or rituals.

Strategies for Habilitation in Autism Continued