Marina Sarris

Date Revised: November 5, 2024

David struggled to make it to his college classes on time. His mother called him every morning to make sure he got out of bed. If he didn’t answer his phone, she drove the 20 minutes to his dorm to wake him up in person.¹

That might seem like an extreme case of helicopter parenting and teenage immaturity, unless you also know that David has autism.

Research shows that the skills of daily living — everything from waking up on time, showering, making lunch, cleaning, managing money, and getting to school or work — can be challenging for people with autism.

These skills may seem less important than academic and communication skills, at least when children are young. But researchers say that daily living skills are the building blocks of independence in adulthood.

“If you’ve got the skills to take care of your body and yourself, to take care of your home, navigate the community, and manage your money, it’s going to be easier to transition to college, to get and maintain a job, and live independently or with other people,” says Amie Duncan, Ph.D., a psychologist at Cincinnati Children’s Hospital, a clinical site for the SPARK autism study.

That is one reason some researchers and behavior experts encourage families and schools to make a higher priority of teaching daily living skills to children across the spectrum.

A Messy Dorm Leads to a New Research Interest in Autism

Amie Duncan has been researching daily living skills, and how to teach them, for about 15 years. She first became interested in the topic as a graduate student, when she worked for a program that helped autistic students adjust to college. She was surprised by what she found in those students’ dorm rooms: old food cartons, dirty clothes on the floor, medicines that needed refilling, and a bad smell.

Dorm rooms are notoriously messy, especially for teens who are not used to cleaning up after themselves. But this was different. If these students didn’t learn how to clean, shower regularly, manage their meal plans, and follow a routine, she realized, they would struggle with more than just college.

The Disconnect Between IQ and Daily Living Skills, in Autistic Youth

Years later, Duncan and her research team published a study that examined daily living skills in autistic teens who had average and above-average intelligence. Half of the teens had daily living skills that were significantly below expectations for someone of their age and IQ. And about one fourth scored in a very low range.²

“For autistic teens who do not have intellectual disability, we know that their daily living skills are about six to eight years behind their peers. That’s a big gap. That means that a 16-year-old who is in high school has life skills that are closer to an 8- to 10-year-old,” explains Duncan, an associate professor at the University of Cincinnati College of Medicine.

Daily living skills, along with communication and social skills, are part of what psychologists call adaptive behavior. Adaptive behavior describes the skills that enable people to function independently at home, school, and work.³

When autistic children are young, their parents, teachers, and health care providers may focus on helping them with other skills. Their priorities may include academics, speech and communication, social skills, and managing emotions and behavior. That leaves less time to work on skills such as using an alarm to wake up, making a sandwich, and organizing school papers.

Busy parents may decide it’s easier to do these chores for their children, especially if their children are struggling in other areas.

“A lot of families with kids on the spectrum do a lot for their kids, as opposed to letting their kids do it on their own,” says Peter F. Gerhardt, Ed.D., a behavior expert who has spent decades teaching daily living skills to children and adults with autism and intellectual disability.

But without frequent practice, those children may not learn to manage daily living skills independently by the time they are adults, he warns.

“People don’t realize how omnipresent daily living skills are. They are everything that’s not academic skills,” says Gerhardt, executive director of The EPIC Programs, which includes a school for autistic children and youth. “Making a meal, doing laundry, and taking my dog for a walk are much more important to me on a day-to-day basis than factoring a binomial equation or diagramming a sentence.”

Are Daily Living Skills Hard to Learn?

Daily skills often take time to learn and practice. That’s particularly true for autistic people, who are more likely than others to have trouble with motor coordination, sensory sensitivities, or executive functioning, which could affect daily living skills.

Like a central control center in the brain, executive functioning helps people plan, exercise self-control, and follow the steps needed to complete a task, even when they are interrupted or distracted.⁴

Executive functioning issues may explain why some teens struggle to complete a task by themselves even when they know how to do it. “They might get started on laundry, but the clothes stay in the washer for 24 hours, until I remind them to switch them to the dryer,” says Duncan, who works with autistic teens on these skills. “Then I have to remind them to take clothes out of the dryer and fold them.”

Some teens may need a lot of practice with tasks, which can be more complex than they appear. Learning to cross a busy city street involves visual memory, planning, decision making, and motor skills, Gerhardt says. He teaches students rules to follow. “You have walk/don’t walk light signals, and you can follow other people when they cross,” he says. Suburban parking lots are much harder. “Crossing a parking lot at a mall is a nightmare because there are no rules. It’s like Mad Max in Thunderdome,” he says.

When to Start Teaching Daily Living Skills to People With Autism

Autistic children begin to fall behind their classmates in daily living skills in preschool, and that gap widens as they get older, Duncan says.

“Adulthood begins in preschool,” says Gerhardt, who co-authored a journal article with that title.⁵ Even before they set foot in kindergarten, he explains, typically developing children learn skills that will carry over to adulthood, such as behaving differently with parents than with people outside their family.

Families can find ways to introduce daily living skills to their child on the spectrum.

Young children can learn to put dirty clothes in a hamper, explains Ernst O. VanBergeijk, Ph.D., MSW, a senior director of Elwyn Early Learning Services in Pennsylvania. As children get older, they can learn to move clothes from the hamper to the washer, and eventually, to operate the washer and dryer, he says.

Public schools can also teach daily living skills. Gerhardt says they are often included in special education plans, at least for students who are not expected to receive a high school diploma.

Students may learn to shop, order a meal, or cook in a school classroom. But they may not get enough opportunities to practice those skills in the places they need to use them: stores, restaurants, or at home. Or they may be taught skills, such as passing out a few erasers in class, that will not help them in the work world, he says.

Students who are on track to get a diploma may get little or no help with daily living skills at school, he says.

Another important skill is learning to travel in the community. “The number one barrier to employment for a lot of people is a lack of reliable transportation, so they have to learn to use mass transit,” VanBergeijk says.

He used to direct a program that taught college-age students how to take mass transit in New York – and what to do if something goes wrong. Instructors would intentionally miss a train to show the students how to respond safely. “One or two students might have a meltdown, but we teach them that other trains will come and how to deal with this,” he says.

Another challenge, especially in the teen years, may be personal hygiene, according to some parents, who remind their children to shower or wear deodorant. To complicate matters, soaps, deodorants, and toothpastes have scents, textures, or flavors that can trigger a teen’s sensory sensitivities, a common trait of autism. One autistic adult in the SPARK study said that she does not brush her teeth as often as she should because the taste and feel of brushing is unpleasant to her.

Gerhardt recommends that parents offer teens a wide choice of hygiene products. For example, buy different deodorants — stick, spray, roll-on, unscented, scented — and let the teens try and choose the one they like. They will be more likely to use it without reminders, he says.

A New Program to Help Families and Autistic Teens With Daily Living Skills

Duncan has researched and developed a 15-week program on daily living skills for autistic teens and their families.^6-8 Called Surviving and Thriving in the Real World (STRW), the program teaches autistic teens who do not have intellectual disability to complete these skills by themselves. Parents and teens typically work in groups or individually with a trained therapist.

The therapist helps the parent and teen as they break down a task, such as laundry, into each of its steps. The parent then demonstrates the steps, and the teen practices them, while the therapist coaches them over a video connection, Duncan explains.

Teens learn to use checklists and reminders (other than from a parent) to perform each step. For example, a timer or an alarm can signal it’s time to move clean clothes from the washer to the dryer. For homework, teens practice doing one or all of the steps independently during the week, with a parent helping as needed. At the end of the week, the teen receives a reward, such as extra screen time or picking an activity or restaurant for take-out. The therapist works with parents by themselves weekly, too.

The STRW program can be tailored to work on those skills that trouble a teen the most. For someone like David, the college student whose mother woke him up for class every day, the program could focus on using an alarm and following a morning routine.

After a year, David no longer needed his mother’s help to wake up on time. He went on to earn a bachelor’s degree.¹

Interested in joining SPARK? Here’s what you should know.

 Photo credit: iStock

References

1. Anderson C. and C. Butt Autism Dev. Disord. 47, 3029-3039 (2017) PubMed
2. Duncan A.W. and S.L. Bishop Autism 19, 64-72 (2015) PubMed
3. Oakland T. and M. Daley Adaptive behavior: Its history, concepts, assessment, and applications. In K. F. Geisinger, et al. (Eds.) APA handbook of testing and assessment in psychology, Vol. 3, 183-212, American Psychological Association (2013)
4. Harvard University. Center on the Developing Child. Executive function & self-regulation. Accessed Oct. 24, 2024
5. Gerhardt P.F. et al. Int. Elec. J. Elem. Educ. 15, 213-223 (2023) Abstract
6. Duncan A. et al. Clin. Child Fam. Psychol. Rev. 24, 744-764 (2021) PubMed
7. Duncan A. et al. J. Autism Dev. Disord. 52, 938-949 (2022) PubMed
8. Glover M. et al. J. Autism Dev. Disord. 53, 2600-2612 (2023) PubMed