Lessons In TR

One of my riders with autism has difficulties making decisions. It is interesting: when asked to make a decision outright, such as “Would you like to lead your horse by the reins or the lead rope?” she has an extremely hard time and takes at least 5 minutes with assistance. It seems she has absolutely no preference either way, and nor does she even know how to go about making the decision. However, interestingly, if I ask her to ride through all the pairs of cones in any order (without asking her which one first, second, etc.), she picks a path no problem. So of course now I’m looking up what I can and sharing my findings!

However, in order to know how to help someone, you need to know why it’s hard for them, so we’ll start there.

Why Decision Making is Hard for People with Autism

A man at my church with a child with Autism said to look up “Executive Function” skills, so I did. Executive Functions are the mental skills that help you do things, such as time management, paying attention, switching focus, planning, organizing, prioritizing, remembering details, applying past experience, impulse control, emotional control, flexible thinking, self-monitoring, etc. Disabilities of many kinds can cause issues with executive function, such as Autism, learning disabilities, brain damage, stroke, Alzheimer’s, and more. Issues with executive function can cause trouble with planning projects, planning timing, starting activities, finishing activities, making decisions, and so on.

Basically, executive function is the “how” of knowledge (Von Hahn). Trouble with this makes the very act of making a decision difficult, all on its own, regardless of whether there is a right or wrong, or consequences or not. The brain physically can’t make a decision. Sometimes stress aggravates this: when the person is stressed their brain stops working as normal and can’t even take the normal steps toward making a decision that they normally would. A study in the journal Autism indicates that people with ASD have more trouble making decisions that need to be made quickly, involve a change in routine, or involve talking to others, and that the whole experience of making decisions was reported as exhausting, overwhelming, and causing anxiety.

To delve in further, here are some more reasons decision making can be hard for people with Autism. Some overlap with executive function. All are recurring factors I saw listed in multiple sources (some of which the most fascinating are blogs by people with Autism, BTW).

• Difficulty Applying Past Experiences – Someone with Autism might remember the past well, but have a hard time applying those experiences to the present, such as imagining potential results of the options of the decision.
• Difficulty with Transitions – When transitions themselves are stressful, the person can get stuck considering options and have trouble transitioning to choosing one.
• Difficulty with Attention Shifts – Making a decision requires stopping what you’re doing, thinking about different options, moving on to actually choose an option, then acting on it. Attention shifts take a long time for people with autism, and prompts to hurry up can interrupt the process.
• Rigid Thinking – When their mind is used to working a certain way, is comforted by taking a certain path, it is hard to change the plan and consider new options.
• Perseveration – Getting stuck on details can make one get stuck on the details of each option or go off on tangents.
• Difficulty with Nuances – Literal thinkers may not be able to make a decision because what they want seems completely out of the question. “You might ask your son if he wants a glass of water or a glass of milk, and the choice becomes impossible for him to make because he wants it in his sippy cup.” (Oakley)
• Difficulty Identifying Feelings – If they have trouble identifying their feelings, they will have trouble using memories of past feelings to help them know which option they’d prefer. Most decisions involve some element of emotions, and if you’re unable to identify these, you need some other method of decision making. Also, if they know that others often have a preference, they may think that someone else should make the decision because that person cares more.
• Perfectionism and Anxiety – If they worry over making the wrong choice, choosing becomes quite stressful. If they don’t like any of the choices, they may have trouble letting that go so they can make a decision anyway.
• Mental Exhaustion – People with Autism spend much of the day being “on”, focusing, dealing with sensory stimulation and overload, so by the time they have to make a decision, they’re already mentally exhausted.
• Difficulty Organizing and Executing – People with autism may be able to spontaneously do something, but when asked to by another person, have trouble organizing and remembering the steps to get there.
• Inconsistent Opportunities – The brain is a muscles and often can learn new tricks, but only if given the opportunity – and the more opportunities the better. However, when it’s just easier for someone else to make the decision, the person with Autism loses the opportunity to practice making a decision.
• Thinking Too Fast – Many people with Autism think faster than they can act, so sometimes the body has trouble keeping up.
• Feeling Pressured – Sometimes the more one tries to think, the more hard it is to find the answer, the more they draw a blank. They may even start to focus instead on how they can’t think of an answer and if they look stupid.

Help Walk Them Through the Steps of Making a Decision

The same man at our church said that to help his child make a decision, he has to explain to his child all the options and where they lead. I was thinking I might need to do the same thing with my rider, since she genuinely seems to not know how to make a decision. So we need to break the decision down into steps.

These seem to be the most common steps out there for decision making, from what I’ve read:

• Identify the problem (not always part of the process, but sometimes)
• Identify the options
• Compare them. Consider the pros and cons of each solution, the positive and negative consequences, how the outcomes affect others.
• Consider what is most important to you in this decision – personal preference, timing, what’s best for you now, what’s best for others, what’s best for your future, etc. (If the person mostly only remembers bad feelings, you may use them to eliminate options they don’t like).
• Cross out the solutions that don’t apply
• Make a decision

Other Ways to Help

Here are some more ideas beyond just talking them through the decision making process.

That study in the journal Autism suggest that it may be useful to:

• Provide lots of time to reach a choice
• Minimize unrelated information
• Use closed questions (would you like to do this or this vs. what would you like to do)
• Offer encouragement and reassurance
• Address general issues regarding anxiety

More ideas from everything I read include the following:

• Give them lots of opportunities to make decisions, so they CAN learn how to do it, and so they can practice. OR alternately, reduce the number of choices they need to make so they have more mental energy for those few choices.
• Offer choices earlier in the day when they’re less tired.
• Avoid offering choices when they’re stressed – avoid triggers.
• Give them lots of time to make the decision, don’t rush them.
• Don’t interrupt them – not responding may mean they’re thinking and if you interrupt, they’ll have to start all over
• Don’t overload them – especially if you’re talking them through all the options.
• Reward the try. Praise or reward them for participating in ANY step of the decision making process – even if it’s just recognizing a decision needs to be made, or just talking about the options, or just trying to make a choice – regardless of whether they actually make the decision or are successful.
• Allow them to give their choice nonverbally, such as by pointing or picking up the object or picture.
• Start with making decisions WITHIN an activity, instead of making decisions that involve starting a new activity (especially if they have trouble with transitions).
• Narrow down the number of options – instead of asking “what would you like to do next?” give them 2 options.
• Visually show the choices with written word or pictures or tactile representations. Use a “choice board” or a “visual map” to discuss the options and potential results.
• Visually show the steps to making a choice. Perhaps create a plan to making a decision together then check off each step as you go.
• Prepare the student with a list of decisions to be made that day. Use a “visual schedule” so they know when to expect them.
• Discuss the difference between big and small decisions
• Teach them to flip a coin for quick decision making
• Teach them to enlist the help of the questioner to make the choice. For example, if someone asks “What do you want to drink?” they respond “What do you have?” They can ask “what are the options?” or “can you help me think it through?” to any question. (MusingsofanAspie.com)
• If they think faster than they can act, help them find a way to catch up, or act as fast as they think, so they can get more in tune with themselves. (I have no idea how to do this, though.) Or at least try yourself to keep up with them.
• Once they get pretty good at making decisions, teach them to make faster decisions by using a timer or count down for each step.

That’s what I’ve found out so far. What has helped YOU teach or help your riders to make decisions?

Resources

• Oakley, Bec. “How To Make Choices Easier.” http://www.snagglebox.com/article/autism-choices
• http://www.autism-programs.com/articles-on-autism/improving-executive-function.htm
• https://musingsofanaspie.com
• https://askpergers.wordpress.com/2014/02/14/decision-makeing-for-people-with-autism-part-one/
• https://uk.edubirdie.com/blog/how-idea-protects-you-and-your-child
• http://www.webmd.com/add-adhd/guide/executive-function
• Von Hahn, Dr. L. Erik, MD & Bently, Benadette Murphy, MPA. “Executive Functions in Children with ASDs”. http://www.autismconsortium.org/blog/detail/executive-functions-in-children-with-asds
• https://access.bridges.com/usa/en_US/choices/pro/content/lessons/decisionmakingguide/dmg_usa_teachers.pdf
• http://www.srcp.org/for_some_parents/developmental_disabilities/activities_to_use_with_your_child/decisionDD.html
• https://www.autismaspirations.com/i-cant-decide-helping-kids-with-autism-make-decisions/
• Luke, Lydia and Isabel C.H. Clare, Howard Ring, Marcus Redley, an Peter Watson. “Decision-making difficulties experienced by adults with autism spectrum conditions.” http://aut.sagepub.com/content/16/6/612 explained at http://bestpracticeautism.blogspot.com/2013/01/decision-making-problems-in-adults-with.html for the whole study see https://www.repository.cam.ac.uk/bitstream/handle/1810/244860/Decision-making%20in%20ASCs_corrected%20thesis_DSpace.pdf?sequence=1
• Smith, John, Jane Donlan, and Bob Smith. Helping Children with Autism Spectrum Conditions Through Everyday Decisions. Jessica Kingsley Publishers, 2012

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Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgment!