How does insistence on sameness differ from routines in autism?

PostedDecember 9, 2025

UpdatedDecember 9, 2025

ByMy Patient Advice

Author: Beatrice Holloway, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Sameness vs routines in autism might sound interchangeable, but they reflect different aspects of how autistic individuals experience the world. Routines are often structured and purposeful, helping someone navigate daily life with predictability. Sameness vs routines in autism, however, becomes a meaningful distinction when we look at emotional responses to unexpected change.

The autism routines difference lies in flexibility. Routines like brushing teeth after breakfast can usually adapt without distress. Insistence on sameness, by contrast, is more rigid. A slight variation in how someone speaks, moves, or interacts can trigger significant anxiety. This can feel overwhelming, especially when the change comes without warning. The insistence and sameness distinction helps clarify why some changes are tolerated while others feel unbearable.

Clinicians often observe repetitive habits in autism early in development, and these can be signs that sameness not just routine is deeply embedded in emotional regulation.

Signs to Look Out For

Understanding the subtle cues can help with tailored support:

Fixed order of tasks

A child may insist breakfast comes before getting dressed, even reversing the order causes distress.

Scripted conversations

Repeating exact phrases or questions daily can serve as reassurance that things remain familiar.

Resistance to harmless changes

Swapping a favourite cup or changing a route may seem minor but can cause outbursts or shutdowns.

Distinguishing between these behaviours enables more compassionate and accurate support.

Visit providers like Autism Detect for personal consultations and help understanding how to support behavioural needs.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Insistence on Sameness.

Beatrice Holloway, MSc

Author

Beatrice Holloway is a clinical psychologist with a Master’s in Clinical Psychology and a BS in Applied Psychology. She specialises in CBT, psychological testing, and applied behaviour therapy, working with children with autism spectrum disorder (ASD), developmental delays, and learning disabilities, as well as adults with bipolar disorder, schizophrenia, anxiety, OCD, and substance use disorders. Holloway creates personalised treatment plans to support emotional regulation, social skills, and academic progress in children, and delivers evidence-based therapy to improve mental health and well-being across all ages.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.