The power of a checklist

Not being able to anticipate what is happening next can create some very strong reactions from individuals with autism. We tend to say how inflexible they can be, however, it has been my experience that if they have some advance notice on a change or what is expected in certain situations, they can show great flexibility. The following example points this out.

For several consecutive summers, I worked as a TEACCH consultant/trainer at the NC Autism Society’s (ASNC) summer camp. Since many of the summer staff had no prior experience working with individuals with autism, it was my job to help train and teach them as coaches for the campers who came for one week.

I worked with a young boy named Derek, modeling the kind of structure that would help him to be successful during his camp experience. Derek was very large and strong for his age (he was 13, the last year I worked with him). He used some words and signs for communication. As sweet as Derek could be, when he became overwhelmed, he was prone to fits of aggression. During these times he would grab at his coach’s shirt and pull, usually tearing it. Or if one had long hair he would grab for it and pull hard. Essentially, my work was to structure Derek’s time in such a way that he would have a good, productive day with a minimum of overwhelm. If Derek did begin to act out, I then had the opportunity to demonstrate to staff in training a good way of handling him until he had calmed down.

ampfire.gifTowards the end of each camp week, the campers have a bonfire, where everyone gets to toast and eat marshmallows. Jill, a personable coach in training was passing out the marshmallows to each of the campers. Derek, who loves to eat, had 3 marshmallows, at which point the staffers agreed that he should stop and return to his seat. Upon being told that the marshmallows were finished, he became very upset and went first for the marshmallows and then for the person holding them. He grabbed Jill’s long ponytail and I had all I could do to ease his hand off of her and help him away from the circle of people to a secluded spot where he sat down and began to cry. By reducing any further demands on Derek, he became calmer and we were soon able to proceed on with our day as scheduled.

A year has passed and I am once again working with Derek and it is time for toasting marshmallows at the bonfire. Despite the passage of a year, the previous bonfire experience was still fresh in my mind.

This time, we created a checklist for Derek, showing him visually, through drawings, that he would be eating 3 marshmallows. After eating each marshmallow he would cross out that line and after the 3rd marshmallow, there was a chair pictured, indicating a return to his seat. Despite having seen similar visuals work with so many others that I had worked with over the years, I was still nervous as I handed Derek the checklist and showed him what he was going to do. He still liked to eat and was prone to aggressive outbursts, but now he was bigger and stronger than the year before.

Derek looked at the checklist, took a marshmallow from the young woman staff, crossed it out on his checklist, took another and crossed it out, took the third, crossed it out and returned to his seat very calmly and happily.

Looking back, I probably could have avoided the meltdown that took place the previous year had I anticipated the event by using a visual tool such as the checklist. For me, this experience strongly supports the power of the visual (in this case a checklist) in allowing an individual with autism to understand the totality of an event that is about to take place. It also affirms that, for someone who does not inherently have the ability to understand an event in context, expressing their objection through behavior may be the only option.   

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