Why Everyday Routines Can Be Hard for Children With Developmental Differences

Key takeaways: everyday routines and developmental differences

Why do everyday routines ask so much of a child?

A morning routine may look like one task: get ready for school. In practice it is a chain of smaller ones. A child has to wake up, move away from something comfortable, remember the order of the steps, tolerate the feel of clothing and the taste and smell of breakfast, keep an eye on the clock, and stay calm if something changes. Each link uses skills that develop at different rates in different children.

For children with a developmental disability, some of those links are harder still. The Centers for Disease Control and Prevention (CDC) defines developmental disabilities as “a group of conditions due to an impairment in physical, learning, language, or behavior areas,” including ADHD and autism, and estimates that about 1 in 6 U.S. children aged 3 through 17 has one or more.⁠² Many other children have no diagnosis but still develop some of these skills later than their peers. Our guide to developmental milestones by age shows the typical range.

How does executive function affect daily routines?

Executive function is an umbrella term for skills such as planning, remembering steps, starting a task and shifting from one activity to another. A child who finds these skills harder may know exactly what to do but struggle to begin, lose their place partway through, or get stuck when it is time to stop something enjoyable.

This is one reason routines come up so often with ADHD. The CDC’s description of the inattentive presentation of ADHD includes finding it “hard for the individual to organize or finish a task” and that the person “forgets details of daily routines.”⁠³ Executive function difficulties in children covers the signs and supports in more detail.

Why are transitions so hard for some children?

Many children, not only those with developmental differences, find transitions hard. The shift from home to car, car to classroom, or screen time to dinner can bring protest, shutdown or a flood of emotion.

Unexpected changes, such as a substitute teacher, a different route to school or a missing sock, can feel much bigger to a child than an adult expects. A predictable order gives a child fewer decisions to make and fewer surprises to absorb, which is why routine matters so much for children with sensory needs. School holidays, when the usual order disappears, are a common pressure point; winter break routines has ideas for keeping some structure.

How do sensory differences affect getting dressed, eating and bedtime?

Routines are full of sensory input: tags and seams, water temperature, toothpaste flavor, food textures, bright lights, and loud, crowded hallways. Some children are more bothered by these inputs; others seek more movement or touch.

Sensory differences are common. The American Academy of Pediatrics notes that difficulty tolerating or processing sensory information “may be seen in many developmental behavioral disorders,” including autism, ADHD, developmental coordination disorder and childhood anxiety, and advises that sensory processing disorder generally should not be diagnosed on its own.⁠¹ They are not limited to children with a diagnosis, either: in a survey of parents of incoming kindergartners in one U.S. school district, between 5.3% and 13.7% of children met screening criteria for sensory processing difficulties.⁠⁴

So sensory differences are one possible piece of the picture, not a label. Sensory processing difficulties explains the signs, and if mealtimes are the hardest part of the day, picky eating or a feeding problem? helps tell the two apart.

Why does a familiar routine fall apart on a hard day?

When a child is tired, hungry, overstimulated or anxious, even familiar steps get harder. A child who dressed without help yesterday may stall today because their capacity is lower, not because they have stopped trying.

Meltdowns and refusals can be signs of overload rather than defiance. Sensory overload or challenging behavior? explains how to look for the trigger, and sleep problems, which make every routine harder, are covered in sleep problems in neurodivergent children.

What helps routines go more smoothly at home?

No single approach works for every child. These are widely used starting points, and a clinician who knows your child can tailor them.

Make the routine visible

Pictures, checklists or a simple written sequence reduce how much a child has to hold in mind, and let you point to the next step instead of repeating it. Visual supports, defined as “a visual display that supports the learner engaging in a desired behavior or skills independent of additional prompts,” are one of 28 practices with evidence of positive effects for autistic children and youth in a 2021 review of the research.⁠⁵

Break steps down and keep the order the same

“Get dressed” can become underwear, shirt, pants, socks. Keeping the same order each day makes the routine more automatic over time.

Give transition warnings

A heads-up such as “five more minutes, then shoes,” or a visual timer, can soften the shift between activities. Pairing the warning with a clear next step helps.

Adjust the sensory load where you can

Try tagless clothing, a different toothpaste, dimmer lights, or noise-reducing headphones in busy places. Change one thing at a time so you can see what makes a difference.

Build in buffer time and choices

Rushing raises stress for everyone. A few extra minutes and small choices, such as which of two shirts to wear, can give a child back a sense of control.

Notice what goes well

Praising a specific effort (“You remembered your backpack”) tells your child exactly what went right, so they know what to repeat. Over time, the goal is for your child to do more of the routine on their own; encouraging independence has ideas for stepping back gradually.

When should parents ask a professional about routine struggles?

Occasional rough mornings are normal. It may be time to talk with a professional if routine struggles are frequent or intense, are getting worse, affect sleep, eating, school attendance or friendships, or leave your child or family consistently distressed.

A pediatrician is often a good first stop. The American Academy of Pediatrics recommends that all children be screened for developmental delays and disabilities at well-child visits at 9, 18 and 30 months, and for autism at 18 and 24 months.⁠⁶ Your pediatrician can also refer you to specialists such as occupational therapists, speech-language pathologists, psychologists or psychiatric providers.

Which kind of provider fits depends on your questions. Occupational therapists often work on sensory needs and daily-living skills such as dressing, eating and self-care; see occupational therapy for developmental delays, or search the DrSensory directory for therapists near you.

Could ADHD be behind daily routine struggles in older kids?

For older children and teens, ongoing trouble with focus, organization and daily routines sometimes raises questions about attention-related conditions such as ADHD. Only a qualified clinician can make that diagnosis. The CDC notes that ADHD is usually best treated with a combination of behavior therapy and medication, and that for children aged 4 and 5, behavior therapy, particularly training for parents, is recommended first.⁠⁷ Our guides does my child have ADHD? and ADHD treatment for children go further.

Some practices offer this care directly. For example, Dan Shalom Behavioral Clinic, a psychiatric practice led by a board-certified psychiatric mental health nurse practitioner, describes its ADHD care as including a psychiatric evaluation, medication management, and behavioral strategies for organization, time management and daily routines. The clinic sees patients aged 10 to 65, in person or virtually in Texas and virtually in Idaho. Families should confirm availability, fit and fees directly with any provider, and a clinic like this does not replace a child’s pediatric or therapy team.

Frequently asked questions