Practical daily-living skills: strengthening independence in everyday life

Why daily-living skills are a topic of their own

In people with autism, intelligence and daily-living skills do not automatically go hand in hand. The guideline stated that skills in this area are strongly linked with a positive developmental course and are of particular importance in adulthood because of self-care. ^{[2, Rec. 49, 52]} Among the reasons, it named that many of those affected first need a longer period to build a relationship with therapists and find it harder to transfer what they have learned to other situations (reduced generalisation and flexibility). ^{[2, Rec. 47]} More on structure in everyday life: Routines, structure and predictability in everyday life.

What the 2021 guideline recommended

• Toddlers and preschool children: Daily-living skills should be agreed as goals with the parents within comprehensive early intervention programmes and trained with practice-based, behaviour-therapy-grounded methods; parents and educators should be guided. Practice should continue until the child masters the skill in different situations. ^{[2, Rec. 44]} If aggressive, hyperactive or oppositional behaviour makes practice harder, it recommended a targeted parent training first or in parallel. ^{[2, Rec. 45]}
• Primary school children without intellectual disability: a manualised individual therapy, limited to about ten sessions, on emotion regulation with daily-living exercises and homework, involving parents and teachers (grade of recommendation B, majority agreement). ^{[2, Rec. 46]}
• Adults without intellectual disability: a group therapy limited to about 20 sessions (weekly, 90 minutes) on stress and anxiety, self-organisation and adaptive and social skills, with homework (grade of recommendation B). ^{[2, Rec. 50]} Further approaches had rarely been studied in randomised trials. ^{[2, Rec. 51]}
• With intellectual disability (primary school age to adults): individualised, highly structured, practical exercises in everyday life by parents, carers, integration assistants, special-needs teachers or staff of residential groups and workshops, building on existing skills and with natural reinforcement, preferably in small groups; goals named were independent dressing, personal hygiene, eating, housework, working in a workshop, hobbies and meaningful leisure activity. Visual plans and behaviour-therapy methods should be combined; if there are problems with implementation, a behavioural analysis according to the SORKC model should be carried out. ^{[2, Rec. 53]}

What was not recommended

For school children without intellectual disability, the guideline advised against computer-based training of working memory or cognitive flexibility to improve daily-living skills (grade of recommendation A), and likewise against horse-riding therapy for this purpose. ^{[2, Rec. 48, 56]} On medication, it stated that no psychotropic medicines and no substances for “neuroenhancement” should be used to promote practical daily-living skills (grade of recommendation A). ^{[2, Rec. 54]} More on medication: Medication in autism: possibilities and limits.

What can help you in everyday life

The following points are suggestions from the editorial team that follow the guideline; they do not replace an individual assessment:

• One skill at a time: First record what already works well and where it gets stuck, then choose one small step. ^{[2, Rec. 49, 52]}
• Practise in real everyday life, not only in therapy, because transfer is often hard. ^{[2, Rec. 47]}
• Visible aids such as picture cards or action sequences as a plan: Structuring and visualisation in practice.
• Suitable demands: Avoid over- and under-demand. ^{[2, Rec. 3]}
• Have a say yourself: Goals should be set together with the person. ^{[2, Rec. 1]}

Sources and literature

1. DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021. – Guideline (in German); expired on 23 March 2026