Routines, structure and predictability in everyday life

Why routines can matter

Under the diagnostic criteria (DSM-5), as presented in the expert overview, features of autism include inflexible adherence to sameness, to routines or ritualised patterns. ^[1] Why routines matter to some people is explained in the article Routines, repetitive behaviour and special interests.

In an interview study from the USA (36 respondents, including 13 young adults on the autism spectrum) that the S3 guideline reports, young adults on the autism spectrum described “structuring oneself” as one of several helpful strategies for the transition into adult life: planning demands precisely and creating more predictability. The guideline points out that the sample is selective and the results can therefore only be generalised to a limited extent; the study shows individual experiences, not proof of effectiveness. ^{[2, Ch. C.2.2.1]}

What structure can look like in practice

The 2021 S3 guideline named structuring the environment and sequences of actions, for example through visual means, predictability and consistency of people. ^{[2, Rec. 3]} The following examples are suggestions from the editorial team. There is no evidence of their effectiveness in the sources cited:

• Visual daily or weekly plans, with pictures, symbols or text, depending on age and preference.
• Fixed routines for recurring situations, such as the morning routine, homework or going to bed.
• Clear announcements: what happens, when, for how long, with whom?
• Consistent places and people, where possible.
• Checklists for tasks with several parts.

Which form suits depends on the person. Some prefer an app, others a note on the fridge.

When something changes

Changes cannot always be avoided. The following can help:

• announce and explain changes as early as possible,
• make the new routine visible,
• plan intermediate steps, for example looking at the new place together beforehand,
• plan time to recover after the change.

Bigger transitions such as changing school, moving house or starting a job are covered in the article Preparing well for changes and transitions.

Not too much and not too little

The 2021 guideline pointed out that under- and over-demand should be avoided. ^{[2, Rec. 3]} Structure should relieve, not restrict. If someone wants more flexibility, it can be loosened step by step (suggestion from the editorial team).

Sources and literature

1. Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie 2024;(4+5):27–32. – Expert overview (in German)
2. DGKJP, DGPPN et al. S3-Leitlinie Autismus-Spektrum-Störungen, Teil 2: Therapie. AWMF 028-047, 2021 (Empf. 3; Kap. C.2.2.1). – Guideline (in German); validity expired on 23 March 2026 according to the DGKJP overview ^[3]
3. DGKJP: Aktuelle Leitlinien (Übersicht mit AWMF-Registernummer und Gültigkeitsdatum). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)