By:Spencer Ramsey, BCBA, Senior Behavior Analyst
Maintaining a daily hygiene routine is important and developing good habits as a child will help ensure a healthy lifestyle moving forward. Articles, web sites and television shows tend to focus on weight management, healthy food choices and daily exercise as being the hallmarks of good health, but implementing a proper hygiene routine is equally as important.
Effective hand washing can prevent the spread of colds, the flu and other germs; brushing our teeth regularly helps to prevent cavities and gum disease; and regular showers prevent odors and infections.
As a behavior analyst, I work with children with autism every day and often hear parents complain about the challenges of implementing a daily hygiene routine. These daily routines can often trigger problem behaviors that make it difficult for parents to ensure these important self-care skills are carried out regularly.
If your child engages in severe problem behavior to avoid a task, your Board Certified Behavior Analyst (BCBA) can develop a specialized program to desensitize your child to the averseness of the task. For example, if a child does not want to wash their hands after going to the bathroom, a process to desensitize them to the skill might include having the child stand in the bathroom with the water running, then putting their hands under the water for five seconds, followed by putting their hands under the water for 10 seconds with soap. Breaking the skill into small steps will help make the activity more easily reinforced until the child is able to accomplish the target behavior on their own. You won’t see a change overnight, but this process is effective.
The next thing we evaluate is motivation. As adults, we shower, brush our teeth and dress because we are motivated to look our best. Often, children with autism do not have these same concerns. If they want to take a bath, they will. If they choose not to, they are typically not worried about the judgement of others. If your child is capable of executing the task, but choosing not to, your therapist can implement a plan that includes providing a reinforcement once the task is completed. For example, if your child likes to watch television before school, keep it turned off until teeth are brushed, clothes are on and hair is combed. Build in ample time between waking up and leaving for school to ensure your child has time to complete the tasks and enjoy his/her television show. If stories and snuggles are special to your child as part of their bedtime ritual, develop a routine where these activities immediately follow bath time. By arranging your schedule so a reward precedes the tasks, you may increase your child’s willingness to comply.
If your child requires assistance with some of the daily hygiene tasks, your BCBA can develop a task analysis so your therapist team can focus on teaching these important skills. A task analysis is a list of smaller steps that must be completed before you tackle the whole routine. For example, the task “brush your teeth” may include locating the tooth brush and tooth paste, opening the tooth paste, putting it on the brush, wetting the brush, brushing and rinsing. Your BCBA can write out the steps needed to complete the tasks to ensure everyone teaching your child completes the steps in the same order each day. This consistency will help your child learn more quickly so they can start completing the task independently.
It is also critical that staff and family members systematically fade their prompts in order to teach independence. Therapists, parents and family members who care for the child should aspire to slowly reduce the amount of prompting needed to encourage them to complete a task. Caregivers should be trained in how to prompt behaviors and fade prompts with time as the child becomes more willing and able to accomplish tasks on their own. Fading prompts help ensure a skill is able to transition from training situations into natural daily routines.
If your child can complete tasks independently, but has difficulty doing them one after the other to complete a routine, consider developing a checklist or a visual schedule. You can post a picture or the name of the reward in a prominent place to help encourage him/her to complete the entire routine instead of one task.
No matter the barrier to good hygiene, your BCBA can conduct an assessment to determine if there is a problem or fear of completing the task, a lack of motivation to complete the task, or a lack of ability to complete the task independently. Based on the assessment, your BCBA will develop a plan to address the issue to help your child gain more independence.