Autism in nursery: notes for professionals

What can burden everyday life in nursery

According to the guideline, it is especially being together with many children, “rule-free” times such as breaks, spontaneous changes in the daily routine and the many different stimuli that can be a great burden. Individual solutions should be found for them, also for over-sensitivities, problems with self-regulation and learning. ^{[1, Ch. C.10.2]} Children with autism also often have great problems dealing with peers, because the basic rules of social interaction and communication are often hard for them to understand and implement. Particularities of sensory processing, particular interests and stereotypies can also influence the ability to function in a group and integration into nursery. ^{[1, Ch. C.10.2]} How this shows in the individual child varies.

What nursery professionals should know

According to the guideline, early-years educators should receive training or comprehensive information about autism and about dealing with people with autism (consensus-based recommendation, strong consensus). As contents, it named: ^{[1, Rec. 109]}

• features and course of autism,
• frequent co-occurring conditions, such as anxiety disorders, obsessive-compulsive disorders and depression, physical problems such as epilepsy, sleep disorders and other neurological developmental disorders such as ADHD,
• the importance of key transition phases, for example the move to school or to other caregivers,
• the own experience of children and adolescents with autism,
• the effects of autism on the family including siblings.

The guideline also pointed out that autism-related particularities are as a rule already present in early childhood and affected children may therefore need special support from the start of nursery care. ^{[1, Ch. C.10.2]}

What can help in everyday life

For nursery children, the guideline named as examples of individual support clearly worded instructions for action and visualised structuring of the day. Added to this are clear and small-step guidance in an organisation of play and craft activities geared to the individual child, where appropriate the possibility of using a (low-stimulus) separate room, and hearing protection. The measures should be designed individually, their necessity reviewed over time and adapted. ^{[1, Rec. 109]} In addition, for everyday interaction (not specifically for nursery), it named in a consensus-based recommendation: concrete, direct communication, structuring of the environment and routines, for example through visual means, predictability and consistency of people, maintaining physical distance and avoiding strong sensory stimuli; under- and over-demand should be avoided. ^{[1, Rec. 3]}

Whether and how this can be implemented in your setting depends on the circumstances. Further notes on structure and visualisation are in the article Structuring and visualisation in practice.

Cooperation and support of the child

According to the guideline, early-years educators in nursery should be informed about the autism-specific support of the child concerned and, depending on the requirements of the respective intervention, trained or at least informed using the methods used in therapy for children. If a child attends an inclusive nursery with a high staffing ratio, the additionally employed remedial, special-needs or other educational staff there should be informed and trained about the effective therapy methods and use them with the child within their working hours. ^{[1, Rec. 109]} For the therapy itself, the guideline recommended additionally guiding educators and integration assistants in supportive interaction with the child (evidence level 2 to 3, grade of recommendation A). ^{[1, Rec. 10]} What such a therapy comprises is in the article Autism-specific therapy and support.

According to the guideline, therapeutic interventions should not be taken over by educators or teachers. ^{[1, Ch. C.10.2]} A support plan tailored to the needs should be formulated in writing with professionals, implemented in a binding way and reviewed regularly. ^{[1, Rec. 109]}

Transitions

The guideline described the phases of transitions, for example from nursery to school, as particularly burdensome. Individual and forward-looking planning and provision of suitable help were necessary and sensible. It was also suggested to take precautions for periods of increased strain, for example at the start of school, a change of school or the birth of a sibling. ^{[1, Ch. C.10.2]} According to the guideline, transition phases should be accompanied by case management. ^{[1, Rec. 6]} Further notes for families: Autism in nursery.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. Interdisziplinäre S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Langversion, Stand Text 02.05.2021 (Empf. 3, 6, 10, 109; Kap. C.10.2). – Guideline (in German); validity expired on 23 March 2026 according to the DGKJP overview ^[2]
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)