The ball boy hands him the tennis ball. He drops it to the ground twice, his torso bent over and neck extended, looking at his opponent. He swipes his face swiftly, touching his right cheek, nose, left cheek, and back to nose. He moves his water bottle just outside the boundary line. Wipes the sweat from his brow. Bounces the ball twice. Pulls at his shirt; looks up at his opponent. He readies the ball and racket above his head, and whack.
She stands in front of her bathroom mirror, reading over the affirmations on sticky notes around the mirror. She washes her face, massages in her face oil and lotion, letting her thoughts take her wherever they lead that morning. She puts on her thick robe, gets a cup of coffee, and sits in her corner chair next to the side table facing the window. She sets the coffee on the coaster, opens the drawer, gets out her journal and fountain pen, and begins to write.
He’s in the university dining hall. His stomach grumbles, hunger cues signaling a physiological need for food. He scans the room. It’s filled with options. He can’t find his friend. He paces in the corner, bending his knees and bouncing up and down twice. He wipes the sweat from his brow. Pulls at his shirt, looks up at the dining hall. He rocks back and forth, stepping onto the balls of his feet. He takes a deep breath in, exhales, and walks forward.
The above excerpts detail various forms of rituals. The first is Rafael Nadal, a famous tennis legend known for his pre-serve ritual. The second is an anonymous young mother who has ritualized the brief time she gets alone in the early morning before her family awakens. The third is a neurodiverse college student navigating an overstimulating environment.
While different in form, each of these rituals serves a similar function. In this article, we will explore the purposes that rituals serve in the lives of autistic and other neurodiverse individuals.
Autism is a spectrum neurological disorder characterized by focused and special interests, difficulties reading social cues, and sensory processing differences and is considered part of the umbrella of neurodiversity (Baron-Cohen, 2017). Autistic individuals often have “ritualized acts” (American Psychological Association, 2013).
The literature has varied definitions of rituals. This article points to the definition of rituals per the Occupational Therapy Domain and Process (3rd ed.), in which rituals are defined as meaningful symbolic acts that often reinforce an individual’s values (2014). Rituals are considered separate from, although related to, special interests and circumscribed interests of autistic individuals. Rather, rituals describe those acts which are repeated, predictable, and resultingly enable a propensity for action.
The very definition of rituals holds that they are meaningful. The assumption, then, is that they are not empty, purposeless acts. Instead, they can hold value in the person’s life and thus can impact well-being.
Over 90% of neurodiverse individuals have sensory processing disorder (SPD) or sensory processing differences (Crane et al., 2009; Dellapiazza et al., 2020). Sensory processing disorder is a neurological condition in which the brain cannot process sensory input effectively (Miller, 2014). Sensory processing differences can be a significant source of anxiety due to the unpredictable nature of the sensory environment. This lack of control can feel overwhelming for someone unable to modulate or filter out unnecessary sensory stimuli. Thus, they fall back on what they can control, such as their rituals. The rituals serve as a kind of shield from an unpredictable world. For example, an autistic female might engage in mindful breathwork through guided diaphragmatic breathing in her car before entering a social environment.
The nature of rituals is that they are repeated, predictable, and enable a propensity for action. These characteristics are known to be preferred by autistic individuals. They benefit from predictable, repetitive tasks. For example, when an autistic individual takes the time to line up his shoes in an organized manner, in the same order every time, he is acting in a way that aligns with his values (i.e., the values of orderliness, predictability, and logic).
Every human engages in regulating behaviors, and often, these are unconscious. Some twirl their hair, and some shake their legs or twiddle with their pencils. These small, ritualized acts are regulating. They are the body’s way of stabilizing cortisol, or stress levels. These ritualized behaviors look similar in autistic individuals but can often be exaggerated. Some autistic individuals rock back and forth, some flap their arms, and some engage in vocal scripting or tics. These small, ritualized acts, also known as “stimming,” are often regulating but pathologized and labeled negatively. These rituals are often helpful, if not necessary, for autistic individuals to function successfully in their social and physical environment.
Autistic adults have difficulty applying social pragmatic rules and modulating sensory input. These difficulties often result in an unpredictable and anxious experience of the physical and social environment. The ritualized patterns of behavior that have been pathologized in autistic individuals are what they often need to rely on for emotional and psychological stability and well-being.
Research has widely shown that individuals with autism have decreased well-being (Engel-Yeger & Dunn, 2011). If engaging in their rituals promotes well-being, we would be remiss to prevent or neglect neurodiverse individuals the opportunity for meaningful engagement.
In my practice as a mental health occupational therapist, I work with neurodiverse adults who greatly benefit from the identification and engagement in positive rituals. Often, these acts promote presence when their temptation is to disengage or dissociate. Rituals combat the state of dysregulation in the nervous system and promote neurological regulation.
People with autism have difficulty recognizing and adjusting to the small changes in socialization and the sensory environment. These nuances that neurotypical people can unconsciously adapt to often require a conscious effort on the part of autistic individuals. This effort carries a cognitive load and can be mentally and emotionally exhausting.
This is why they fall back on patterns of predictability and routineness. These patterns promote a sense of control over their environment and themselves. Rituals can promote both sensory regulation and emotional regulation.
Rituals are normalized in the neurotypical population and are widely recognized as meaningful consistencies that promote regulation, such as Nadal’s pre-serve ritual or a mother’s alone time. For neurodiverse individuals, rituals promote the regulation more profoundly.
In a world wrought with unpredictability and change, rituals can be a stabilizing and grounding anchor.
Sharon Eva is a Mental Health Occupational Therapist at Ascension Providence Outpatient Rehabilitation and an Adjunct Professor at Baylor University. She is passionate about strengths-based and neurodiversity-affirming occupational therapy practice. Her email is firstname.lastname@example.org. If you want to learn more about her practice or mental health OT, please visit her website at www.sharonevandc.com.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). (2013). https://doi.org/10.1176/appi.books.9780890425596
Baron‐Cohen, S. (2017). Editorial perspective: Neurodiversity – a revolutionary concept for autism and psychiatry. Journal of Child Psychology and Psychiatry, 58(6), 744-747. https://doi.org/10.1111/jcpp.12703
Crane, L., Goddard, L., & Pring, L. (2009). Sensory processing in adults with autism spectrum disorders. Autism, 13(3), 215-228. https://doi.org/10.1177/1362361309103794
Dellapiazza, F., Michelon, C., Vernhet, C., Muratori, F., Blanc, N., Picot, M., & Baghdadli, A. (2020). Sensory processing related to attention in children with ASD, ADHD, or typical development: Results from the ELENA cohort. European Child & Adolescent Psychiatry, 30(2), 283-291. https://doi.org/10.1007/s00787-020-01516-5
Engel-Yeger, B. & Dunn, W. (2011). Exploring the relationship between affect and sensory processing patterns in adults. British Journal of Occupational Therapy, 74(10), 456-464.
Miller, L. J. (2014). Sensational kids: Hope and help for children with sensory processing disorder (SPD). Penguin.
Occupational therapy practice framework: Domain and process (3rd edition). (2014). The American Journal of Occupational Therapy, 68(Supplement_1), S1-S48. https://doi.org/10.5014/ajot.2014.682006