In my work with persons with autism, fetal alcohol spectrum disorder and other developmental disabilities I am often asked to explain how to provide “structure.”
The dictionary definition of “structure” as a noun is “the way in which parts are arranged or put together to form a whole.” As a verb, to structure something means to “bring order and organization to. As an adjective, structured means “highly organized, arranged in a definite pattern.”
A skeleton is a structure that everything else is built upon.
Scaffolding is a structure with platforms that allow you to work from outside to renovate a building.
In behavioral support, structure means doing the same thing, in the same order, in the same manner (with the same cues and prompts) and with the same expectations. These are the “rules.”
Structure of this sort “anchors” a person. Making routines and expectations predictable stabilizes life. It is like a sea anchor in rough weather that stabilizes a boat and prevents it from being blown totally over.
Taking a structured approach to providing support is neither restrictive nor intrusive. Providing structure to assist the individual to overcome neurodevelopmental disabilities provides dignity by assisting the individual how to achieve their goals. For those who require intensive structure, “being intrusive provides for the dignity of the person.”
The functions of structure in persons with neuro-developmental disability.
Structure provides predictability:
Following “rules” substitutes for “understanding.”
Even if they don’t “understand” what to do, when the individual has a “rule” to follow they can act in a manner that will be successful.
Using step-by-step guidance allows the supported individual to always know what is coming next, and what they are expected to do next. This assists in overcoming their neuro-developmental difficulties in sequencing and organizing their own actions.
Structure provides concrete guidance:
Physical props substitute for having to remember what to do.
Physical props substitute for the individual’s inability to self-cue.
Even if they don’t independently remember what to do, placing physical cues and visual reminders in their environment allow an individual to “see” what they need to do.
Props allow a person to physically recognize in the immediate moment, what they have to focus on and what they need to do to be successful.
Structure provides positive expectations:
Expectations of support person substitute for individual’s inability to organize their own behavior.
Even if the individual is not able to plan or analyze what they need to do, a support person’s positive expectations ensure that individual always knows exactly what to do RIGHT. Individual is certain they will succeed by following routine.
Positive expectations are clear, explicit, and set at the individual’s level of ability. Individual is certain they will gain acceptance by following routine.
Structure provides continuity:
Routines substitute for individuals
lack of “time sense.”
Even if the individual is not able to really understand “how long” it is till three o’clock, habitual routines overcome memory deficits and difficulty with time concepts.
Routines allow individuals to connect prior actions to present and future actions.
Routines can become automatic “habits” and don’t have to be “remembered” to be done.
Structure provides trust:
Attaching to a support person substitutes for individuals
“learned helplessness”
Some neuro-developmental disabilities lead to “unsuccessful independence.” Even if the individual feels that it wouldn’t make any difference if they tried or not, they gain a sense of safety and security from relying upon a trusted support person to always give individual the “right answer.”
“Positive dependence” overcomes individual’s lack of personal continuity and inability to orient self in time.
“Positive dependence” overcomes individual’s sense that the world is a random, chaotic and overwhelming place.
Structure provides flexibility within a range of choices:
If something else has to happen it can happen.
Even if there needs to be a break in routine, the supported individual always knows what’s going to happen after some momentary change in routine.
After an interruption in routine, with structure, the plan is to carry on with the earlier established routine.
Individual doesn’t totally lose orientation, because they can go back to where they left off, and “catch up.”
Nathan E. Ory, M.A.
Registered Psychologist
24 February 2006
Island Mental Health Support Team
Nathan.Ory@viha.ca