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Repetitive Routines and Rituals in Kids with Autism Spectrum Disorder [ASD]

Some kids with ASD [High-Functioning Autism] develop a resistance to (or fear of) change, that then involves being rigid in their approach to their environment. Insistence on sameness, routines and rituals begin. For example:
  • Particular silverware and plates must be used or the ASD youngster refuses to eat or drink.
  • Objects may be stacked or lined up in a repetitive manner.
  • Certain routes must be followed to and from familiar places.
  • Certain items must be placed in particular places and not moved.

Confusion about coping in a world that is overwhelming influences this behavior, so the youngster with ASD responds to this uncertainty by being in control of their immediate environment, the objects in that environment, and the people in it. Repetitive motor mannerisms may occur when some kids are excited, anxious, or worried. For others, sensory sensitivities and physical enjoyment may drive repetitive jumping, arm flapping, twiddling of fingers in front of their eyes and covering ears and eyes with their hands.



Repetitive behaviors and mannerisms in ASD children is a somewhat neglected area of research. In the past, these behaviors were associated with lower levels of functioning, because repetitive motor mannerisms are also seen in kids with intellectual disability who do not have autism. These behaviors were also thought to increase during the preschool years. There is now some evidence that repetitive motor mannerisms develop differently to insistence on sameness and these behaviors follow different paths over time.


Restricted and repetitive behaviors show different patterns of stability in autistic kids based partly on the ‘subtype’ they belong to. Young kids with low NVIQ (i.e., non verbal IQ) scores often have persistent motor mannerisms. However, these behaviors often improve in kids with higher nonverbal IQ scores. Many kids who do not have “insistence-on-sameness behaviors” at a young age acquire them as they got older, and some kids who had these behaviors sometimes loss them. 

What should moms and dads do about routines, rituals and repetitive motor mannerisms?

First, ask yourself the questions: “How much of a problem is it?” and “”Who for?” The answer is often that these behaviors are a problem for the mother or father, educators and counselors rather than the youngster himself (who is quite happy to be preoccupied in these ways). Therefore, it is unlikely that the youngster will want to change his behavior. The rules of thumb when making decisions about whether or not to intervene or change routines, rituals and repetitive motor mannerisms are to ask yourself:
  • Will the behavior be acceptable in 5 years time?
  • Does the behavior interfere with or preclude participation in enjoyable activities and an education program?
  • Does the behavior increase the likelihood of social rejection or isolation?
  • Does the behavior endanger the youngster or others?

In preschoolers with ASD, adherence to non-functional routines and rituals and displaying repetitive motor mannerisms may be judged inappropriate because they fall into one or more of these categories, or may be tolerated by the family and others and are not seen as problematic.


The most successful treatments for ASD children with repetitive rituals are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps children learn to change thoughts and feelings by first changing behavior. It involves gradually exposing children to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur.

Some treatment plans involve having the youngster "bossing back" the repetitive rituals, giving it a nasty nickname, and visualizing it as something he can control. Over time, the anxiety provoked by certain unwanted stimuli in the environment and the urge to perform rituals gradually disappear. The youngster also gains confidence that he can "fight" repetitive rituals.

Repetitive rituals and routines can sometimes worsen if it's not treated in a consistent, logical, and supportive manner. So it's important to find a therapist who has training and experience in treating this issue. Just talking about the rituals and fears has not been shown to help repetitive rituals, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a youngster cope with repetitive rituals.

Many children can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your youngster and family learn strategies to manage the ebb and flow of symptoms, while medication often can reduce the impulse to perform rituals.

==> Videos for Parents of Children and Teens with ASD
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Loneliness in Kids with Autism Spectrum Disorder

It is hard to know if kids with ASD (high functioning autism) are as lonely as their moms and dads believe they are. Therapists do know that playing with a friend, making a friend and being with a friend are "overwhelming skills" for ASD children. Kids without autism make no sense to "autistics," because they are totally preoccupied with their own agendas.

Teaching ASD children social skills is a big task for moms and dads and educators. It is not like teaching the child how to ride a bicycle or tie a shoe, but rather trying to teach something no one formally taught you. How do you teach someone how to read a room, especially someone who has no understanding of other individual's emotions and body language? 

Kids with autism have no idea about how to reason socially and come up with proper courses of action in social situations (e.g., one guy with ASD level 1 got lost in the school corridors on his way to gym. He had forgotten the route, but he did not think to simply follow his classmates to the gym).

Yet therapists emphasize the need to teach ASD children social skills because they desperately need them to get along in life. The child's lack of social understanding virtually colors every other experience in his/her life. Yet the question of whether kids on the spectrum are truly lonely and want friends is a different discussion. Like all kids, some are extroverted and others are more withdrawn. Like all kids, they probably vary in their need for social interactions.


When researchers ask kids with ASD about friendship, they are usually very negative. They think of friendship with other kids as too much work and often prefer grown-ups. For example, when a teacher was forcing a six-year-old to participate in a playgroup with other kids, he said, "I hate kids. I don't play with kids. I'm not a kid. I was born a grown-up." 

Michael, a fourteen-year-old with Aspergers advises other Aspergers children, "If you like being on your own, then be happy with your own company and don't let anyone convince you its wrong." His advice to ‘pushy moms and dads’ is "Never force your youngster to socialize. Most ASD children and autistic individuals are happy to just be by themselves."

However, these kids might be happier by themselves because social activity has caused them so much pain in the past. In one study, gifted kids with ASD could not describe friendship in positive terms such as "a friend is someone who is nice to you." They had only negative associations such as "a friend is someone who does not hit you." These kids told interviewers only about how mean other children had been to them and seemed to lack any idea of what reciprocal friendship really means.

Yet as autistic children go through the teen years, most realize that they are missing out by not fitting in. It is at this point in their lives that they crave friendships with peers, yet this unfulfilled desire on top of high school pressure to conform, constant rejection and harassment can often cause depression in ASD teenagers. They grow more isolated even as they crave more interaction with other teenagers. Young kids with ASD often believe everyone in their class is the same and everyone is a potential friend. ASD teenagers know better.

Research shows that the more time a person with ASD spends socializing, the happier she is. Autistic children can and do form friendships. When they do, research shows that even one friendship will speed up their entire social development.


People married to someone with ASD often talk about their own feelings of loneliness. They tell counselors that marriage to a person with autism feels like living alone. An ASD husband/wife often does not attend to details like anniversaries, may not connect with the couple's kids on an emotional basis, and may not benefit from marriage counseling. A parent of a youngster with ASD may feel rejection when their youngster refuses to cuddle or express affection. 

The youngster's needs are unrelenting and yet the moms and dads' rewards are sometimes rare. Brothers and sisters hide their lonely feelings about living in a family where their autistic sibling monopolizes their moms and dads' precious time and they miss the normal give and take of sibling relationships. Many siblings believe that the ASD child's “disability” is an advantage …a passport to special attention, recognition and privilege.

Helping kids with autism spectrum disorder develop social skills will no doubt become easier in the future. Every day educators are developing better techniques. Researchers are closing in on the genetic and environmental causes of autism and may someday develop a cure. There is promising new research being conducted in a study on "Friendship and Loneliness in Individuals with ASD." Perhaps someday the answers will be clearer for individuals with autism and those who love them.

ASD Teens and Social Isolation—

In the teenage world where everyone feels insecure, teens that appear different are ostracized. Autistic teens often have odd mannerisms. For example, they may talk in a loud un-modulated voice, avoid eye contact, interrupt others, violate others’ physical space, and steer the conversation to their favorite “weird” topic. These teens may appear willful, selfish and aloof, mostly because they are unable to share thoughts and feelings with others. Isolated and alone, many of these adolescents are too anxious to initiate social contact.

Many teens on the spectrum are stiff and rule-oriented and act like little grown-ups – a deadly trait in any adolescent popularity contest. Friendship and all its nuances of reciprocity can be exhausting for a person with ASD, even though he wants it more than anything else.


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