# Autism Intervention Every Day!

## Embedding Activities in Daily Routines for Young Children and Their Families

by **Merle J. Crawford, M.S., OTR/L, BCBA, CIMI** and **Barbara Weber, M.S., CCC-SLP, BCBA**

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### Contents

1. **Autism and Early Intervention**.....1  
2. **Supporting Parents from Suspicions to Diagnosis to Services**.....9  
3. **Principles of Behavior and Teaching Strategies**.....19  
4. **Model for Addressing the Core Deficits of Autism**.....31  
5. **Building Skills to Support Regulation**.....39  
6. **Building Skills to Support Making Sense of Self, Others, and the Environment**.....53  
7. **Building Skills to Support Flexibility**.....77  
8. **Building Skills to Support Social Communication**.....85  
9. **Daily Routines and Common Challenges**.....107

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# About the Authors

## Merle J. Crawford, M.S., OTR/L, BCBA, CIMI
Merle is an occupational therapist with a private practice in central Pennsylvania. She holds a bachelor of science degree in special education and elementary education and a master’s degree in occupational therapy. Ms. Crawford has graduate certificates in applied behavior analysis and autism, and is a Board Certified Behavior Analyst. She focuses on working with infants and toddlers, integrating strategies from her varied training when coaching families.

## Barbara Weber, M.S., CCC-SLP, BCBA
Barbara is a speech-language pathologist who has a private practice in central Pennsylvania. She received her bachelor of science and master’s degrees in communication disorders. Ms. Weber is a Board Certified Behavior Analyst and has over 30 years of experience working with children and adults with disabilities. She primarily focuses on collaborating with families to integrate routine-based interventions.

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## Building Skills to Support Flexibility

The ability to adapt to changes is crucial for infants and toddlers as they interact with multiple caregivers and experience changes in their routines. Cognitive flexibility involves shifting attention, holding information, and inhibiting distractions to achieve goals. Individuals with ASD often struggle with flexibility, displaying rigid behaviors and resistance to changes. This rigidity can affect daily routines significantly.

### How to Incorporate Flexibility into Routines

**Strategies for Different Daily Routines:**
1. **Bath Time:**  
   - Change the time or place of bath time occasionally.  
   - Offer choices, like deciding the order of washing different body parts.  
   - Use a variety of colors of towels and washcloths.

2. **Bedtime:**  
   - Offer choices for books or songs.  
   - Vary farewell phrases at bedtime.

3. **Community Outings:**  
   - Choose different routes for outings.  
   - Change transportation methods, such as using a stroller or walking.

4. **Diapering and Dressing:**  
   - Vary locations for changing and dressing.  
   - Change the order in which clothes are worn.

5. **Grooming and Hygiene:**  
   - Change aspects like toothbrush types or scents of toothpaste during routines.

6. **Mealtime/Snack Time:**  
   - Involve children in cooking to encourage food variety and acceptance.
   - Use playful strategies to introduce new foods, perhaps during playtime.

### Tips for Supporting Flexibility
- Use preferred items to ease transitions.  
- Offer simple warnings before transitions occur, providing clear and concrete instructions.
- Engage in playful distractive methods during transitions, such as counting steps or singing.
- Encourage gradual exposure to changes to avoid overwhelming the child.

## Inflexibility Related to Eating

Eating routines can often be particularly inflexible, requiring specific strategies. Children with ASD may resist changes in food presentation or item familiarity. Inflexibility may involve preferences based on taste, texture, or visual familiarity.

### Strategies for Mealtime Flexibility:
1. **Change Food Presentation:**  
   - Cut sandwiches into different shapes or present them in different colored plates.  
   - Gradually vary the temperatures or the appearance of preferred foods.
2. **Engagement in Food Preparation:**  
   - Involve the child in selecting or preparing meals to increase willingness to try new foods.
3. **Positive Reinforcement:**  
   - Use successful methods like successive approximations to help transition to new foods, reinforcing small steps positively.

By embedding flexibility into daily routines and using playful adjustments, caregivers can help children with ASD better manage transitions and adapt to their environments.