Expert: Catherine Ridenour - 3/18/2006

Question
My daughter is 10 years,7 months old.  She was diagnosed with PDD 6 years ago. She is doing fine in everything except personal Hygene. She refuses to take a bath or shower on her own.  She must have a wash cloth over her face which makes it difficult for her to wash herself. She will say she is getting all wrinkly. Yet, we have a swimming pool and she is like a fish in it she lives in it during the summer. She has a very hard time dressing herself also (turning her clothes right side out). She has a very hard time with getting her socks and bra on.  I have talked to the OT at school but she has no answers. Please Help! Any suggestions would be great.
Susan Block

Answer
Hi Susan,

Situational fears or resistances are common in people on the Autistic Spectrum. Personal hygeine is one of the most difficult areas for many.

I think the key is a training method called successive approximation.  What that means is get as close as you can to the goal without hitting the resistance.  Reward the "approximate" success.  Stay at that level until you can move tiny bit closer and reward that.

I'm thinking, make the bath as much like swimming as possible. If she wears goggles while swimming, use them in the tub, too.  It will keep the water out of her eyes. Or, try using successively smaller cloths to cover her face. Give her two wash cloths, cut eye holes...maybe even let her bathe in her swimsuit at first?  I know, the most important cleaning will be difficult, but getting her to consent to a bath is key.  Also, get some baby wipes and put them by the toilet.  Teach her to wash with them a couple of times a day.

On the clothing, find a marking for the back neck label area that means on the inside to her. Practice laying a T shirt on the bed, face down with the bottom nearest her.  Show her how to put her hands into the bottom and raise them over her head and let the shirt slide on.  Do it the same every time.

Find a method for each article and repeat it the same way everytime.  Maybe underwear first would make sense.  For panties, sit on the floor, put the panties face up, trace the shape the legs make with her fingers.  Let her see that the waistband is bigger and the legs make an arch. Have her put her feet through the waistband and then the leg holes. She can wriggle them on from there.  If she likes numbers, number the top 1, the legs 2, etc. No one is going to see them under her clothing.

Now, I'm a fan of logical consequences and you will have to be the judge of how well she can respond to them.  But, with my daughter, if she did not get dressed, she could not go outside, or to the park, or whatever.  I know you want her to get to school on time, so weekday mornings are probably not the time to start this.  Can put on her swimsuit by herself? Perhaps you want to start with it this summer.  You want to swim = learn to put on your suit. Mainly, I'm saying don't enable helplessness.

I'm a bit surprised the therapist at school does not have some ideas for training self-care.  It's a very common problem in children with developmental disabilities.

Let me know if any of this works.  I learn as much from you all as you learn from me.

Best wishes,
Catherine