14 January 2009

Refusing to Bathe

Daily Living Skills Health and Nutrition Rituals and Routines Social Skills

Because of issues with sensory sensitivity and obsession with routines, it can be difficult for some people with autism to maintain an appropriate level of grooming. Extreme tactile defensiveness can stand in the way of showering, shaving, and tooth brushing. Some of my teen and adult friends with autism talk of their aversion to the loud sounds they encounter in bathrooms: hair dryers blowing, bath water running, toilets flushing, and heaters or bathroom fans roaring. Parents have reported that their child with autism is very resistant to interrupting their regular daily routine with bath time.

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Although these sensory and scheduling issues are understandable, poor hygiene is a serious problem. Unpleasant body odor, bad breath, dirty clothes, and a messy appearance can hamper social relations. Cleanliness is important, not only for the individual’s health, but also for the comfort of people around them. So, how can we soften the blow of bathing and other grooming tasks for our friends with autism? Let’s look at three basic principles.

ESTABLISH A ROUTINE. Make grooming a regularly scheduled part of the daily routine. Do what you can to make this an adventure rather than a chore. Help your friend with autism assemble his or her own grooming kit with their choice of personal shampoo, soap, deodorant, cologne, lotion, brush or comb, toothbrush, and toothpaste, floss, and mouthwash. For an extra incentive, provide a terry robe with their initials on it or let them buy their own towel.

INTRODUCE CLEAN-TOP-TO-BOTTOM. At a certain time every day, have your friend with autism grab their grooming kit and head to the bathroom for a simple “clean-top-to-bottom” process: (1) take a shower or bath and wash hair, (2) put on deodorant if necessary, cologne, and hand lotion, and comb hair, (3) put on clean undergarments and clothes every day, and (4) brush and floss and swish mouthwash, Encourage folks to do as much of this without your help as possible so they can gradually develop independence if possible.

AVOID NAGGING about bathing, tooth-brushing, and other issues. Be positive and matter-of-fact, making “Clean Top to Bottom” part of the regular routine. Don’t hesitate to use rewards to help encourage this critical skill. In a firm and positive manner, make grooming a regular part of every single day. It may take a long time to establish the pattern, but, in the long run, the daily routine of grooming will work better than trying to fit it in at irregular intervals throughout the week. Be patient but firm. You are building a skill that will last a lifetime.

TIP FOR THE DAY: People with autism often find routines comforting, and they may even learn to deal with sensory sensitivities if given daily exposure. Patient application of these grooming strategies can pay off in the long run for your friend with autism and all those around him.

NOTE TO READERS AND LISTENERS: I am Cathy Knoll, a board certified music therapist and long-time friend of many folks with autism. At FAQautism.com we are committed to providing free, practical, everyday tips for making life better for people with autism. Feel free to send me a confidential email at talk@FAQautism.com with your thoughts or challenging situations or innovative solution. And don’t forget to check out our website for a wealth of ideas and a glimpse into the world of autism. http://FAQautism.com

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