Teaching Patience with AutismBy Psychologists Kenneth Shamlian and Brenna Cavanaugh
Response by psychologists Kenneth Shamlian and Brenna Cavanaugh, of the University of Rochester Medical Center – one of 13 sites in the Autism Speaks Autism Treatment Network (ATN). Dr. Shamlian directs the medical center’s behavioral treatment program, where he and Dr. Cavanaugh both practice.
Our 6-year-old has autism and gets really impatient to the point of tantrums. No matter how many times we explain "waiting," he doesn’t seem to understand that he can’t always get what he wants right now. How do we help him understand?
Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.
Thanks for your great question. Learning to wait is a crucial life skill that proves difficult for many children – and adults, for that matter. Teaching this skill to children with autism can be particularly challenging for many reasons.
Understanding the challenges
First, it’s common for parents and other caregivers to try to explain, or verbally teach, the importance of being patient. Similarly, we tend to use words to comfort and assure a child who is feeling impatient. Although this works for many children, children who have autism often have trouble following verbal explanations. They hear only the “no.” This can be true even when someone with autism has good language skills – particularly when they’re upset.
Another common, autism-related challenge is the strong need for routine. Many people who have autism feel extremely anxious when things don’t happen when and how they expect. For example, let’s say your son typically gets to watch a favorite program before dinner. But one day you’re running behind schedule and ask him to wait until after dinner. While this is reasonable, the change in routine can prove upsetting to someone who has autism.
Autism-friendly strategies using visual supports
Considering these challenges, we have several suggestions for improving your child’s patience. Remember, improving patience takes time. So we have to be patient, too, while teaching this skill.
As just mentioned, people who have autism tend to do best with structure and predictability. So we encourage you to use the following strategies and tools to set clear and consistent limits and rules around the things you anticipate your child will want at times when you can’t provide them. In other words, it can help to establish expectations before your son even asks.
We also mentioned that many people who have autism have difficulty following verbal explanations. Fortunately, they typically respond better to information that’s presented visually.
Below are some examples of what we call “visual supports.” Many of the children and families we see in our practice find them helpful.
We’ve found visual timers to be particularly helpful when someone with autism needs to wait a few minutes. Examples include sand timers, wind-up timers and countdown apps such as those shown below. All these devices visually convey the passage of time. Say, for example, that your son wants to use his electronic tablet, but it needs to charge first. If you know how long it will take to charge, you can set a visual timer, hand it to your son and show him how to track when the time is up.
A wait card can prove useful when you don’t know exactly how long your child needs to wait. It can help your child understand that you’re not saying “no.” You’re just asking him to wait. Take the example of the electronic tablet. But this time you don’t know how long it will take to charge. Hand him a “wait” card and when the tablet is ready, exchange the tablet for the card. With practice, this routine can become reassuring. The card in his hand becomes a tangible signal that he will eventually get what he wants.
A related visual support is the “first/then” card shown below. It’s useful when you need your son to complete something before the activity he wants.
Visual schedules and calendars
Visual schedules and calendars are helpful when your child needs to wait longer than just a few minutes for something he wants.
Visual daily schedules (shown above) use picture and/or simple words to outline the day’s activities. Many parents find it helpful to the show their child the schedule in the morning and briefly go over the day’s events. Then you can prompt your son to check the schedule when he asks about an upcoming activity.
For example, perhaps your son asks repeatedly for a snack that he gets twice a day – say, after school and before bed. When he asks for it at other times, you can show him the daily schedule and point to the picture of the snack in its place on the schedule. Or you can simply prompt him to check his schedule each time he asks.
Visual calendars such as the sample below can help your child understand when he has to wait more than a day for something. Let’s say he loves to go to the toy store, and you can take him on weekends. Using a wall calendar or printed calendar template, tape a picture of the store on the day you plan to take your son and/or write the word if your son can read. You might try starting each day by looking at the calendar with your child, even asking him whether it’s a “toy store day” or not. Or you may find it works better to prompt your son to check the calendar when he asks.
Choice-no choice boards
Sometimes you don’t know when you’ll be able to provide something your son requests. For example, you may not know when you can go to the toy store when he asks. Such uncertainty can be particularly difficult for children with autism. A “choice/no choice” gives you the flexibility to change activities, as needed, while still providing supportive structure for your child. As illustrated above, on the red side, you can stick pictures (or words) that convey activities or things that are NOT available right now. On the green side, place pictures or words representing acceptable choices. You can encourage your son to refer to the board often. Or you can redirect him to check it when he requests something. If he wants something on the “no choice” red side, you can help him choose an alternative on the green side.
Increasing expectations over time
When used consistently and incrementally, these strategies can help your child better understand the passage of time and develop more and more patience about getting what he wants – a crucial life skill. By incrementally, we mean gradually setting higher expectations – such as waiting a little longer or being a little more flexible – and reinforcing even small improvements with praise and perhaps a small reward. (You know what motivates your child.)
Thank you again for your question. We hope these tips help you and your family.