Increasing Independence in Adults with Autism Spectrum Disorders: Using a "To Do" List
Contributed by Catherine Davies, M.Ed., M.Sc., LMHC and
TEACCH® Certified Advanced Consultant
TEACCH® Certified Advanced Consultant
As adults, we all need to be able to carry out tasks independently whether this is in the area of work, college, daily living skills or leisure activities. This is no different for individuals with autism spectrum disorders (ASD). ‘To Do’ Lists (also known as Work Systems) have been shown to increase on task behavior, number of tasks completed and reduce instructor prompts required for both children and adults with ASD (Hume &Odom, 2007; Hume et al., 2009). Additionally, adults living and working in a highly visually structured setting (one aspect of which was ‘to do’ lists) have been shown to have increased independent work skills and quality of life and a decrease in behavior difficulties when compared to adults in other less structured settings (Van Bourgondien et al, 2003). ‘To Do’ lists are one element of Structured Teaching as developed by the TEACCH® program (see Mesibov et al., 2005; Mesibov & Shea, 2010 or http://www.TEACCH.com for more information).
This article explains how to set up ‘to do’ lists for adults of all levels of cognitive functioning across any setting. (For more information on using ‘to do’ lists with children see Hume, 2004.)
What Does a "To Do"List Need to Include?
The ‘to do’ list should tell the individual what to do (this differentiates it from a visual schedule which tells the individual where to go). All types of ‘to do’ lists need to visually provide the individual with answers to the following 4 questions (Mesibov et al.,2005):
1.What task or activity do I need to do?
2.How much work (i.e. how many tasks) is required during this work period (or how long will the activity last)?
3.How much progress is being made and when the work will be finished?
4.What happens next after the work or activity is completed?
How to Set Up a ‘To Do’ List
A. Decide on the type of ‘to do’ list that is likely to be most effective for an individual as follows:Left to Right System
For individuals who have significant cognitive disabilities and are primarily non-verbal, the most effective type of ‘to do’ list is likely to be a left to right system. Items are placed on the person’s left for them to complete (person gets items from left or from top to bottom as shown below) and s/he puts them on his/her right when they are finished.
For individuals who have good matching abilities (test this by having them match the thing you are going to use in the system- if they can match 100% correctly then they have good matching abilities) the most effective type of system is likely to be a matching system. This system is very effective for individuals who can match and also have a strong interest in something (e.g. numbers, letters, or a character from a TV show) because the system can utilize the item of interest and thus increase their focus and motivation.
Written List System
For individuals who have higher cognitive abilities, a simple written list is likely to be the most effective system. As they become more practiced at organizing and planning, some of these individuals may also be able to develop their own lists. Initially the system will be most effective if developed by others.
B. Decide how many tasks the individual is likely to be able to complete in one session. Initially this will be a guess based on your knowledge of the person and the environment. For example, if previous reports state that an individual struggles to complete any tasks independently, you might try starting with just one or two tasks.
C. Decide how the individual is going to see the progress of the session (e.g. crosses items off a list or moves tasks to a finished box).D. Decide on a visual way of adding a symbol or word that tells the individual what to do when they are finished with their tasks. This could be something from their visual schedule (such as an object or picture that tells them to go to the break area or just something that tells them to check their schedule). If you ensure that the next activity is something they enjoy, this can help to motivate the person to complete their tasks.
E. Teach the person how to use the system. Prompt the individual from behind using non-verbal techniques (point to visuals, tap materials or if needed, use hand over hand instruction). Using minimally invasive prompts, which you fade as quickly as possible, you can avoid the individual becoming overly dependent on being verbally prompted through each part of the system (Hume, 2004). Similarly, avoid sitting alongside the person as this will indicate to them that they are going to be helped. Instead stand back and only step in to prompt when necessary.
F. Monitor their progress and responses. This can be done informally by just observing but it may be helpful to take some notes on things such as the types of tasks they are successful with, things that cause them difficulty or environmental considerations (e.g. distractions).G. Make changes if needed. For example, if your observations indicate that the person usually completes two tasks successfully but then their attention wanders when faced with a third task, you may decide to try giving them only two tasks per session (they can then take a short break and return for another session to ensure all tasks are completed).
‘To do’ lists can be an effective tool for increasing ndependence in individuals with ASD. Once an individual is successfully using a ‘to do’ list in your setting extend this by having the individual use it in multiple settings (e.g. home, community, work). Train others who work with the individual so that they understand how to set up and teach the system. Support more advanced individuals to set up their system themselves in different environments. In this way the ‘to do’ list can enable the individual with ASD to generalize skills to other settings and maximize their potential to live an independent life.
Hume,K. (2004). “I can do it myself!” Using work systems to build independence in students with autism spectrum disorders. The Reporter, 10(1), 4-6, 16.
Hume, K. &Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and DevelopmentalDisorders, 37, 1166-1180.
Hume,K., Loftin, R. & Lantz, J. (2009).Increasing independence in autism spectrum disorders: A review of three focused interventions. Journal of Autism and Developmental Disorders, 39, 1329-1338.
Mayer-Johnson LLC (1981-2005). The PictureCommunication Symbols©All Rights Reserved Worldwide.
Mesibov, G.,Shea, V. & Schopler, E. (2005) The TEACCH® Approach to Autism Spectrum Disorders. New York: Plenum Press. Book describing the history of TEACCH® as well as the principles of structured teaching and how these can be applied.
Mesibov, G.B.& Shea, V. (2010). The TEACCH® program in the era of evidence-based practice. Journal of Autism and Developmental Disorders, 40, 570-579.
VanBourgondien, M., Reichle, N. & Schopler, E. (2003). Effects of a model treatment approach on adults with autism. Journal of Autism and Developmental Disorders, 33, 131-140.
Davies, C. (2015). Increasing independence in adults with autism spectrum disorders: Using a ‘to do’ list. The Reporter E-Newsletter 20(8). Retrieved from https://www.iidc.indiana.edu/pages/increasing-independence-in-adults.