Overcoming Roadblocks to Good Personal Hygiene for a Child with ASD

Children do not come into this world able to care of themselves. In the beginning they are dependent upon their parents for everything, but gradually they learn to wash, dress and feed themselves. Typically, a child will master daily self-care skills with relative ease. Many are self-motivated as is demonstrated by the words of a young child who wants to be like mom or dad, “I do myself.” Of course they can easily revert to “I can’t do,” within the next second.

Children with an Autism Spectrum Disorder often ‘can’t’ or ‘won’t’ take the initiative to become more independent in their self-care. ‘Can’t’ because they lack the necessary motor skills or ‘won’t’ due to sensory issues, inability to sequence or just don’t understand the social importance and why it is necessary.

Children on the Autism spectrum may need a few extra steps added to learn how to manage their physical self-care, such as prompting, modeling and specific teaching or training. Most kids with ASD do not learn basic hygiene skills through observation alone.

So how do you get your child to be independently responsible for his own self-care needs? You start early. I know it is often easier and less time consuming to do it ‘for her’ but think about the habits you are enforcing, the long-term dependence you are establishing and the social awkwardness you may be contributing to.

Let’s take hygiene for instance. No parent wants their child to be ridiculed or ostracized at school for an appearance or an odor that can be prevented. Children with ASD are already vulnerable enough to bullying as it is - there is no need to add fuel to the fire.

So what are you doing now to help your child learn how to care of her physical needs and appearance? If you have tried various things and you don’t feel like you are getting anywhere here are some strategies to consider.
- Determine where the struggle is. Identify and eliminate (or at least reduce) any possible roadblocks. Does your child lack the necessary motor skills to button a shirt, comb her hair or brush his teeth? Does the thought of touching a slippery, slime-y, wet bar of soap make washing hands an everyday battle? If so, seek out the help of an occupational therapist to address muscle weakness or sensory sensitivities.

• Break instruction down into small steps – one action at a time. Example: The goal is to wash face. Step 1 – Get towel. Step 2 – turn water on. Step 3 – wet face (with or without cloth). Step 4 – apply soap, and so on and so on. Depending on your child, you may even create more steps, such as finding the right water temperature when you turn it on. Practice each step until your child has mastered it, praising her very specifically for effort and/or accomplishment.

• Create a visual that labels each step. Many children cannot sequence a series of steps in their mind and fail to remember what comes next or they may have such a short attention spans that they lose their train of thought. Having a visual to refer to will help prompt them through the process and is handy for them to have when you are not able to be there. Remember to identify when the task needs to be done (time and place)– ex. after eating, before bed . . .. Writing a social story for each task that can be read repeatedly will help as well.

• Explain why good hygiene is necessary – never assume your child ‘gets it’. Find ways to help your child understand the social importance of being clean, smelling fresh and looking good. Create a vision board titled, When I Look and Smell My Best, Good Things Happen, cutting out pictures from magazines and using personal photos of what it means to have good hygiene and what the results are for doing so. Then hang in your child’s room as a constant reminder.

- Pay attention to the environment. Sometimes simply making your child’s bedroom and bathroom user-friendly and sensory-friendly can have a positive impact on his motivation to keep himself well groomed. Making clothing easily accessible, finding an unscented shampoo she really likes, having towels with just the right texture available, and even adding some music in the bathroom, or shower, can help.
As children approach puberty it becomes more and more important that they master a self-care routine. Reaching the pre-teen years presents more and more hygiene issues that need to be addressed such as shaving and menstruation. Remember, when teaching any child or young adult to care for their body it is always good to teach within the natural setting and, if possible, during a time when stress levels are low.