My last post on the use of visual schedules as a way to add structure to the day, got me thinking about one of the most common requests I get from parents, namely “How do I get my child to shower (or bathe, or actually clean themselves when they do shower, or not use all the hot water, or remember all the steps they need to complete in the bathroom – you pick!). There is a great deal of angst involved in trying to get an ASD child to become independent in the body cleaning department. Part of the problem is who experiences it as a problem (usually the parent), although many ASD kids will complain about what they perceive as endless nagging. However, the children involved are rarely complaining that they want to learn to do a better job brushing their teeth, or wearing deodorant, or shampooing their hair. In fact, I don’t think I have ever had an ASD child complain about these topics, but I hear it every day from parents! Looking clean or smelling good is not the highest priority for most autism spectrum kids – these goals just do not compete with building the greatest lego fortress ever or reading the four latest installments in a favorite manga series.
So I like to think of ways to either use a schedule, or some other kind of visually assisted routine, that can help with this process. I have always liked the idea of a laminated visual checklist that goes through the different steps to cover in the washing routine (as I mentioned in the last post, it could be done either with words or pictures). This can replace the parent either being there in the bathroom reminding about each step, or even doing each step for or with the child. Much of this depends on the child’s age and abilities, but eventually we would like all the children to develop the ability to get clean independently without a parent in the bathroom with them! If you are still physically assisting your child with bathing and it is getting past the time when this would be age appropriate, start using some forward or backward chaining techniques – which involves doing all the steps you have usually done for your child except the first or last, and coach him/her to do that one step independently. Once that is fully mastered, continue dropping steps in the chain, one by one.
Going from one step to the next
Some parents have mentioned that although a checklist might help, their children may get stuck not knowing where they are in the list. We just try to get creative – one idea is using soap crayons to mark off the list so the child can keep track of where they are in the process. Recently, for a girl who loves to sing, we came up with the idea of putting a separate song for each region of the body on the checklist, and she could sing as she washed, thus helping herself remember where she is on the list. For another boy, we came up with putting some music on in the bathroom, and whenever one song ended, he knew he should move on to the next region of the body! Of course, both of these approaches would require fairly short songs but even with longer songs this approach would be an improvement over what had been happening. Maybe the parent and or the child could make some kind of audio recording that could then be played in the bathroom guiding the child through the steps!
Setting up the bathroom
Sometimes, the bathroom products could be separated into two waterproof bins, one “to do” and the other “done.” The child’s job is to use the product (as intended) and when done move it from the first bin to the second. For instance, the “to do” bin for the shower products might include soap, shampoo and conditioner (although if it works for your child try out those body wash products that can be used for the body and for hair – however many of them have too strong a scent for our ASD children or teens). The child would use the soap from the “to do” bin on all relevant body parts, and then move the soap to the “done” bin, then use and move the shampoo, then the conditioner. This can also be done on the bathroom counter, and included such items as toothbrush, toothpaste, floss, facial wash or soap, brush or comb, and deodorant & acne medications for the teens. As one product gets used, it gets moved from the “to do” bin to the “done” bin, and then next product gets chosen.
Cautions about rewards
It can be helpful to associate successful completion of the steps with your reward program, but be careful. I have known quite a number of kids who will use just the tiniest bit of shampoo on their head so it will pass their parent’s sniff test about whether their hair was washed, but come to find out only a few hairs got the benefit of the shampoo rather than the child’s whole head of hair. The same tricks often get used related to brushing teeth. You don’t want to set up your reward system so that these tricks end up earning a reward!
Setting up routines that will help in later years
A couple of tips. Given that change is hard for our ASD children, remember to work on transitioning the child from the bath (typically the method of choice for younger children) to the shower (typically the method of choice for older children and teens) since they may not naturally make this transition on their own. Also, for those younger children who don’t bathe daily, I suggest not waiting to puberty (when it is really needed) to change to a daily shower – by then the routine of bathing less often may be more entrenched and harder to change. Lastly, by sometime later in elementary school, try to have your child in a routine that would work for high school and even for the adult years. For some, it might be showering every night before bed, and for others when they first get up every morning. Then that routine will continue to work through out their lives.
Question: what sorts of ideas have worked in your home for hygiene routines?
I also have a YouTube video on hygiene routines.