Tolerating Crowds & New Places in Children with Autism

Grocery stores, restaurants, kids gyms, hospitals and schools are some common places that children frequently visit. Among the many things these places have in common include loud noises, and that they’re usually crowded.

 

The noise and crowd in these places may be overwhelming to children and adults alike, especially those with autism. For individuals with autism, on top of managing the distress due to noise and crowd, they may also struggle in going to new places due to unfamiliarity, and not knowing what they will need to face.

 

To help your child learn to tolerate crowds and visit new places, the most effective way would be an individualised plan following the key ABA strategies: Break Skills Down, pairing learning with Reinforcement, and sufficient practice.

 

In this lesson, a simplified plan to build tolerance towards crowds and new places are introduced, where further adaptations may be required to meet your child’s needs. 

Prerequisites:

  • Basic cooperation & compliance with First Then instructions
  • Understanding of basic instructions 
  • Safety in the Car and in the Community skills 

Materials:

  1. Going outSocial Story
  2. Video of the destination
  3. First Then board
  4. Rewards!
  5. Self-occupying activities, comforting items or belongings
  6. Weekly calendar (indicate and foreshadow time before the visit)
  7. Visual Schedule (to communicate changes and transitions) 

Before starting the programme:

Check the baseline: assess your child’s current level of coping with going to crowded or new places. Ask these questions:

  • Which situation can they handle better than the other?
  • How long do they normally last before showing any anxiety?
  • Who would be the best ones to accompany them in these situations?

Steps:

Items List for Going Out

 

1. Communicate expectations: 

  • Use visuals and videos to communicate the “what”, “when”, “where”, “why” and “how”
  • Use social stories, videos of the new place, and a calendar to foreshadow the first visit. 
  • If necessary, give your child a few days to get used to the place through images and videos. 

 

2. Probe: 

  • Ensure that your planning involves identifying the peak and non-peak hours of the place.
  • Begin at non-peak hours before gradually moving to more peak hours. Don’t rush this phase, especially if your child gets very anxious about new places.
  • Start with just driving by the place. Once you’ve reached the new place, park your car and if permitted, show the place to your child from the car.
  • Consider going to the basement parking lot too, if necessary. Keep it short (2-3 minutes), then head back home.
  • Reward your child before you begin driving back! 

 

3. Practice: start getting out of the car and venturing into the less crowded areas of the new place. 

  • If there is an outdoor place before going into the building, allow your child to sit in the outdoor area first and engage in self-occupying activities with you.
  • Once your child is done with the activities, you can pack up and leave.
  • In subsequent practices, gradually move closer to the crowded areas.
  • At this initial step, your child is not yet expected to get into the indoor areas of any place, or any crowded areas.

 

4. The BIG DAY: going to the new location, or begin targeting the crowded areas 

  • Continue practices of Steps 1 and 2.
  • Bring your child to the crowded area or indoors of a new place.
  • Allow your child to hold on to their favourite item if necessary. Refrain from stopping here and there, just keep walking around. Pause or stop only when your child needs a break. 
  • If there are chairs, allow them to sit and perhaps drink some water, or do an activity. Foreshadow the end of break time with a timer and continue on until the expected duration is met. 
  • Duration can be gradually built up, but it’s best to continue with one constant place first until your child is more comfortable with it.
  • Keep the rewards frequent and consistent throughout the practice and remember to have a big reward for completing the visit!

 

5. Review: Generalisation or Troubleshooting 

  • Once your child is able to cope with one place, introduce different places but continue with the flow from Steps 1-3 for each place. 
  • Choosing places: begin with the ones that your child visits daily, or on an emergency basis (schools, hospitals). Places for leisure can be considered to be introduced at a later time.

The Full Routine

  1. Read the “Going Out” Social Story, and show the First Then chart to your child.
  2. Show videos of the place to your child. 
  3. Inform your child what is going to happen through showing them the visual schedule.
  4. Head out to the car and drive (continue with targeted Step).
  5. Reward your child with minor treats for minor success, and one big reward for completing a visit.

Your Turn

Pick a place to introduce to your child. Plan:

  • The off-peak hours to visit with your child
  • The major reinforcement needed
  • The visuals required to communicate to your child
  • The comforting items to be packed along 

 

Begin teaching your child to tolerate going to new places and the crowd.