Building Tolerance

Some individuals with autism are extremely resistant to change. Meltdowns often occur when they encounter a change in routine or food or clothing or other aspects of their daily lives. Although we might be bored with the same, predictable routine every minute of every day, we need to acknowledge that resistance to change is a natural characteristic of autism. At the same time, it might be good to help our friends learn to tolerate change because the real world does not allow for a steady, unchanging routine every day of their lives.

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A colleague wrote of a young adult who wanted to sing the same songs in music therapy every week. When the therapist introduced a new song, the student shouted “No you don’t,” ran to the couch, covered her head with a pillow, and signed “finished.” In an effort to help the young lady learn to tolerate a new song, the therapist began with some old favorites, then introduced a new song. When the student protested and ran to the couch, the therapist sang a song with the student’s name: “Lydia is gone…Where can she be?….She’s sitting on the couch….She is mad at me….Lydia, Lydia…where are you?…. come back, please.” When the student calmed down and returned, the therapist finished the new song, then allowed the student to pick one of her old favorites. Gradually, the new song became a familiar “old” song, and the therapist started the process over by introducing another new activity. The youngster is staying in the area now rather than moving to the couch. For now, the therapist is allowing the verbal protests (“No you don’t”), but will gradually help the student learn a more appropriate, quieter way to express her dissatisfaction with a new addition to her old familiar song list.

So the keys to success in this strategy are as follows:
(1) Recognize the source of inappropriate behavior. In this case, the student isn’t shouting and running to the couch because she is “bad.” That is her way of communicating that she doesn’t like hearing new songs.
(2) Introduce one small change in routine every day. Don’t back off this goal just to avoid confrontation. Because everyone needs to learn to tolerate of change, the therapist consistently introduces new activities.
(3) Respond calmly and firmly to inappropriate behavior. In this case, the therapist didn’t say, “You’d better quit shouting and get over here right now.” Instead, she acknowledged that the youngster was frustrated while at the same time expecting her to come back to the area of the activity.
(4) Provide a way for a person to express their frustration and intolerance for change. For now, the therapist is allowing the student to say, “No you don’t,” but will be introducing a more appropriate response.
(5) Anticipate gradual improvement in tolerance. The therapist is patient, not expecting the student to just suddenly begin tolerating change in her environment. In fact, the therapist doesn’t expect the student’s intolerance will ever disappear. Her goals are simply to help the student react to change more calmly and to help the student learn to express her anger and intolerance more appropriately.

NOTE TO READERS AND LISTENERS: I am Cathy Knoll, a board certified music therapist and long-time friend of many folks with autism. At we are committed to providing free, practical, everyday tips for making life better for people with autism. Feel free to send me an email with your thoughts or challenging situations or innovative solution. Send email to And don’t forget to check out our website for a wealth of ideas and a glimpse into the world of autism.

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