Devlin Ostrowski loves chicken paprikas, a richly hued Hungarian dish his mother Deanne often cooks. The 17-year-old was determined to learn to make it himself, but Deanne didn’t have a recipe for the complicated concoction. She had learned as a child to prepare it based on look, smell and taste. “There are no recipes for old Hungarian dishes; you just learn them from your grandmother,” she says.
That method wasn’t well suited to Devlin, who has autism and sometimes has trouble remembering multiple steps in complex tasks. So mother and son endeavored to create a written recipe that Devlin could follow. They made the dish several times, with Devlin asking questions along the way. Together, they figured out how to lay out the directions in a way that made sense to him.
The pair were so excited with the result that they created a book detailing the recipe with pictures and step-by-step instructions, which they made available on Amazon. “One person left a five-star review,” Deanne says. “She said it tasted like the paprikas of her childhood.”
The Ostrowskis’ project is a delicious example of how to teach daily living or adaptive skills. These include basic tasks such as taking a shower, ordering a meal at a restaurant and paying for groceries.
Research shows that daily living skills are extremely important for helping teens with autism become more independent adults. Indeed, adaptive skills may be more important than intelligence when it comes to predicting which teens will get a job or live on their own.
For example, one preliminary study assessed 300 adults with autism who underwent adaptive skills testing as children. Researchers found that those who had higher scores on basic skills, such as brushing teeth, making a purchase, and simple cooking, were more likely to be employed as adults. And those who were employed generally had a higher quality of life, less anxiety and more social contact.
“For us, this was heartening news, because we can absolutely teach this,” says Laura Klinger, Executive Director of the TEACCH Autism Program at the University of North Carolina, Chapel Hill, who led the study. “The challenge is figuring out how to provide support.”
Klinger and others are developing new programs that address these skills, which can often fall through the cracks. “It’s not a set of skills we’re really targeting clinically,” says Aime Duncan, a psychologist at Cincinnati Children’s Hospital in Ohio, who runs a clinic for adolescents with autism.
Schools tend to ignore adaptive skills, because they involve tasks that take place outside the classroom. And parents are often focused on academics and social skills to help their teen navigate through high school.
“We want to raise awareness that this is an area that’s really important and can be taught explicitly,” Duncan says. “Doing laundry, taking a shower every day — those are things that you can learn to do and will make you more successful in the classroom and in the workplace.”
Step by Step
Typically developing teens often pick up life skills automatically, watching their parents make a sandwich, for example. “Teens with autism need more instruction and more practice,” Duncan says. Tasks that appear easy to typically developing adolescents may need to be broken down step by step. “Cooking a grilled cheese might take 9 or 10 times for them to feel comfortable at it,” she says.
Duncan’s clinic includes group sessions for teens, where they work on building a morning routine — packing a backpack or making lunch — as well as cooking and money management.
In the clinic, teens first watch someone perform a task, such as doing laundry or making scrambled eggs. Just as Deanne and her son did for chicken paprikas, instructors break down the task into a series of steps. The clinic often uses the website Allrecipes.com, which has videos demonstrating the steps of a recipe.
Teens then practice the task themselves, both in class and at home. “That generalizes the skills from a clinic setting to a home setting,” Duncan says.
Part of Duncan’s approach is targeting parents. “Parents need help figuring out what to teach and how to make it fun,” Duncan says. Parents are charged with making sure their children practice the tasks and with providing some reward, such as extra video game time or getting to pick where the family goes out to eat that week.
Sometimes it can be difficult for parents to let go. “Families are used to being there and helping — we often have to tell them it’s okay to step back,” Duncan says. “It’s important for teens to become less dependent on their parents.”
At Home in the Kitchen
Cooking, Duncan says, is by far the most fun part of the training. Some teens come in having no interest in cooking for themselves or their family. “Within a few weeks, they’ve learned to make everything from cookies and cupcakes to buffalo chicken pasta, because it’s their favorite meal, or grilled cheese for their niece,” Duncan says. Cooking also teaches a number of other skills, including safety and cleaning up.
Following a recipe, which requires learning how to break down a task into smaller steps, is a broadly useful skill that can be transferred to almost any task. The process teaches teens that they don’t have to memorize how to do something. Rather, they can write out the instructions and refer to them along the way, just as Devlin did with his recipe for chicken paprikas.
“It helps to make the process less overwhelming,” Duncan says. “We use the idea of a checklist or list of instructions as a way to make things that might be difficult or abstract really concrete.”
One of the most challenging parts of the program has been teaching money skills. “It’s eye-opening as a clinician to see how many teens have never purchased anything in their whole life,” Duncan says. “They have very little understanding of the basics of how much things cost.” To remedy that, teens are given a money assignment each week, such as finding out the cost of milk or deodorant.
Adaptive skills programs like Duncan’s haven’t traditionally been a central component in autism therapy, but that’s changing. As more children with autism transition to college and the working world, schools, scientists and therapists are beginning to realize just how important these skills are.
“As we work with more teens and adults with autism and see what’s holding them back, I think the importance of daily living skills and adaptive behavior is suddenly becoming obvious to us,” Klinger says. “When you go to work, your employer expects you to do some things independently.”
Klinger and her team are now developing two new programs to help teens transition to adulthood. One will focus on skills people need in college and the workplace, such as organization and professional social skills. The other program will focus on daily living skills at home.
For parents in search of adaptive skills training, some schools offer life skills programs, Duncan says, as do some clinical and community mental health centers. “A lot of occupational therapists are excellent at being able to target these skills and helping families decide what to prioritize,” she says.