Personal care incorporates the daily and weekly activities people engage in, such as showering, teeth brushing, washing hands and dressing. It also includes tasks which take place more infrequently, such as hair cutting and dental visits.
Many autistic children and young people may be reluctant to engage in any number of these activities. They may develop fears and phobias associated with a personal care task, which then creates extreme anxiety and a refusal to participate in personal care routines.
There are several factors which can create this reluctance and anxiety around such activities, including:
- Sensory sensitivities,
- Limited understanding of the purpose of the task,
- Infrequent exposure to some activities, for example hair cutting or nail cutting.
Successful engagement in personal care activities also requires the following skills:
The child or young person needs to be able to process interoceptive information from within the body to know when they need to respond to personal care needs. Examples of how interoceptive awareness affects engagement in personal care tasks includes:
- Knowing when to go to the toilet and knowing when we have finished at the toilet
- Recognising body temperature and responding by putting on or removing a layer or clothing to regulate temperature
- Awareness of pain (e.g. toothache, ear infection), identifying the location of the pain and being able to communicate this with a supporting adult Link here for visual support symbols
- Planning and sequencing
Many personal care tasks require the ability to plan a complex sequence of steps and follow them through in order. Consider how many steps are involved in a simple task such as washing and drying hands, and then consider more complex tasks, such as shaving. Some activities also require the organisation of objects and materials required in a task, for example showering requires organising soap/shower gel, shampoo, a towel and clothing, and then placing them appropriately and in the correct order for use.
These complex planning and sequencing skills require a high level of executive functioning and can be challenging when there are difficulties in understanding and retaining the information required to complete a task.
- Motor Skills
Many children and young people with autism and SLD have associated difficulties in the development of motor skills. Fine motor skills specifically refer to the use of the hands to control and manipulate objects in a broad range of activities. If there are delays or difficulties in fine motor skill development, it will have a direct impact on the ability of the child or young person to carry out personal care tasks, such as dressing, putting toothpaste on a toothbrush, using a spray deodorant.
- Body Awareness
Children and young people who have sensory differences, especially within the proprioceptive, tactile and interoceptive systems, may have limited awareness of their own bodies. This creates difficulties in tasks such as dressing, wiping their bottom after the toilet, and washing.
- Adjusting to Change
Puberty brings many changes to personal care needs and so the young person needs to be able to accept physical changes and respond to new personal care needs, such as shaving, washing more frequently, applying deodorant and using sanitary products. This requires flexible thinking and the ability to learn new skills.
Strategies to Promote Engagement and Independence in Personal Care
When teaching personal care skills to children and young people with autism and complex learning needs, the following factors are important:
- Ensure Child/Young Person is Calm and Regulated
A child or young person is less likely to engage in personal care if they are in a state of anxiety
- Engage them in a calming activity before commencing personal care
- Consider when you will engage them in a personal care task. Avoid times when they may already be in a heightened state of anxiety, for example, straight after school
- Reduce sensory stimuli around them, for example dimmed lighting, quiet room
- Reduce social demands and interaction.
- Provide regulating input during the task, for example, weighted item, calming music
- Provide a favourite activity which will distract them during some activities for example, completing a puzzle or sorting activity, watching a favourite programme
- Use a visual timer or other countdown method to show how long the task will last. Alternatively, putting on a favourite song of suitable duration can indicate when a task is over for example, brushing teeth for the duration a favourite nursery rhyme
- Address Sensory Sensitivities
If a child or young person is very sensitive to the sensory input involved in an activity (e.g. the feeling of water on their skin, the smell of soap, the taste of toothpaste), they will need to be very gradually introduced to the activity. This graded exposure is called desensitisation. In most cases when using desensitisation, it involves gradually increasing the time spent in an activity, but it may also involve gradually changing an activity.
Additional ways in which sensory sensitivities can be addressed are:
- Use alternative products, for examples soaps, shampoos and deodorants which have little or no scent. Avoid heavily perfumed products for those who are sensitive to smells. Consider toothpastes which have alternative or no flavour.
- Allow the child or young person to try a range of different products to determine a preference for example, electric or manual toothbrush? Wet shave or electric razor? Wire bristles or soft bristles on a hair brush?
- Consider if there is an alternative way to achieve the task which is more tolerable for the child or young person e.g.:
- Filing instead of cutting nails,
- Washing at the sink/basin instead of in the shower,
- Washing hands with a cloth instead of under a tap
- Address interoceptive awareness
Link to section on Interoception in Sensory Processing Section of this resource.
- Provide a concrete outcome/purpose
A simple Social Story, supported with photos or symbols, can be used to explain the purpose of engaging in a personal task. Concrete reasons can increase motivation and willingness to participate. For example, showering makes us smell good, brushing our teeth stops them becoming sore, washing hands keeps them clean. Link here for an example social narrative for hair cutting
It is a good idea to use individualised photos in social narratives, which make them relevant and relatable for the child or young person
- Provide a visual step-by-step support for each activity
The visual support may use objects, photos or symbols, depending on what is meaningful and easily understood by the child or young person. Examples are provided below in the links to specific activities.
- Set materials out in sequence If the child or young person has significant difficulties in planning and sequencing, set out the materials/objects required for the task in the correct order
- Home school partnership While most personal care tasks take place at home, schools can support the students and parents by offering opportunities to practise skills in school for example, changing shoes for PE, washing hands after using the toilet. This will further reinforce learning and skill development. School staff will be aware of which learning methods are effective for the individual and could then be extended into personal care tasks. Teaching methods, supports and resources should be shared to ensure consistency across home and school.
- Encouraging independence
The ultimate goal of personal care is always to make children and young people as independent as possible. Completing a task independently can provide a sense of achievement and fosters greater self-esteem.
Additionally, independence allows the child or young person to have more control over the task, which can reduce anxiety and increase motivation. For example, if they brush their own hair, they can control the pressure used and know what part of their hair they will brush next, and this often makes it easier to tolerate the task. While not all children and young people will be ready to complete a full task independently, they may be able to complete some steps independently. Consider which steps are achievable and start with those.
- Make adaptations
Children and young people who have difficulties in motor skill development may benefit from simple adaptations to make it easier to achieve the task independently, for example, Velcro fasteners, both on clothing and shoes, learning to dress with items which are a size too big as these are easier to take on/off.
Links to Personal Care Resources
There is a webinar on Personal Care and a pre-recorded presentation on Toileting within the Online Learning section of the Centre’s website.
Link here for a podcast on personal care
Link here for an information leaflet on personal care
Links to Specific Activities
- Hand Washing
- Washing hair
- Brushing teeth
- Going to doctor or dentist
- Personal Care in the Teenage Years
Read previous: ← Broad Approaches that Support the Autistic Learner
Read next: Play and Leisure →