"Why Do Changes Feel So Difficult?" Understanding Routines in Autism

One of the things I often hear during autism assessments is:

"I know it seems like a small change, but it completely threw me."

Sometimes it's a meeting being moved to a different room.

Sometimes it's a favourite item in the supermarket no longer being available.

Sometimes it's a last-minute change of plans or an unexpected visitor.

To someone else, these events may seem minor.

To an autistic person, they can feel surprisingly significant.

Over the years, I've realised that one of the biggest misunderstandings about autism is that people often assume routines are simply a preference.

For many autistic people, they are much more than that.

Routines Create Predictability

Every day, our brains make thousands of decisions.

For many autistic people, having predictable routines reduces the number of decisions that need to be made.

Knowing what will happen, where it will happen and when it will happen can make everyday life feel much more manageable.

Routines provide structure.

They reduce uncertainty.

They create a sense of safety in a world that can sometimes feel unpredictable.

It's Not About Being Inflexible

One misconception I sometimes hear is that autistic people are simply stubborn or unwilling to compromise.

In my experience, that rarely reflects what is actually happening.

The difficulty is not usually the change itself.

It is the amount of mental effort required to adapt.

Imagine setting off for work using your usual route only to discover that the road is unexpectedly closed.

Most people would find it mildly frustrating.

Now imagine that feeling happening repeatedly throughout the day.

Unexpected changes require rapid adjustments, new decisions and uncertainty.

For many autistic people, that process can be exhausting.

The Hidden Impact of Uncertainty

One thing that often becomes clear during assessments is that uncertainty can be far more difficult than change itself.

If someone knows in advance that plans will change, they often have time to prepare mentally.

It is the unexpected nature of the change that creates the greatest challenge.

This is one reason why giving advance notice, where possible, can make such a difference.

A small amount of preparation often reduces a great deal of anxiety.

Routines Are Not Always Obvious

When people think about routines, they often imagine someone eating the same breakfast every day or following exactly the same timetable.

Sometimes routines are much less visible.

They may involve sitting in the same place during meetings.

Taking the same route home.

Organising belongings in a particular way.

Following the same order when getting ready each morning.

These routines often help reduce mental effort rather than simply reflecting personal preference.

Small Adjustments Can Help

Families sometimes ask how they can make changes easier.

Often, the answer is not to avoid all change.

Life is full of unexpected situations.

Instead, it can help to make changes more predictable.

Explain what is happening.

Give as much notice as possible.

Allow time to ask questions.

Where appropriate, involve the person in planning the change rather than simply announcing it.

These small adjustments can make transitions feel much more manageable.

Understanding Yourself

For many adults, receiving an autism diagnosis helps explain something they have noticed throughout their lives.

They realise that they were not "bad at coping."

They were someone whose brain found uncertainty particularly demanding.

That understanding often changes the way they approach future situations.

Instead of criticising themselves for struggling with change, they begin planning for it.

And planning is often one of the most effective strategies available.

A Final Thought

One of the most important things I've learnt from working with autistic people is that routines are rarely about avoiding life.

They are about making life more manageable.

When we understand this, routines stop looking like unnecessary habits and start looking like practical tools.

The goal isn't to eliminate routines.

It's to understand why they matter.

Because when we appreciate the role that predictability plays, we are far better placed to support autistic people through the moments when life inevitably becomes less predictable.

Sometimes, a little preparation and understanding can make all the difference.


Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry