When a child is first diagnosed with autism, typically communication and social skills are the most obvious areas of concern. Without these skills, a child is unable to get their needs met, interact appropriately with others around them, and may have increased tantrums or other challenging behaviors as a result. Frequently early intervention programs will focus on these areas. One skill deficit area that tends to be overlooked, however, is the area of self-care skills. These may include basics such as bathing, dressing, toileting, toothbrushing, and as the child gets older will extend to shaving, cleaning his/her bedroom, putting on deodorant, fixing their hair, and vocational tasks.
Tasks that seem quick and easy to us may be far more complex for a child with autism. Fine motor delays can exacerbate their difficulties. Breaking a task down into basic, teachable components helps to isolate each step for the child in such a way that makes it easier for them to understand and learn. After giving a short initial simple instruction (e.g. “Pull up your pants”) the parent can then provide physical prompting as needed to assist the child through a series of steps. Here is an example:
1. Stand up
2. Grasp sides of waist with two hands
3. Pull up pants to knees
4. Pull up pants to waist (by sides)
5. Pull up front of pants
6. Pull up back of pants
Depending on the child’s skill level, you may choose to work on teaching all of the steps at once, or you may begin at the very beginning or very end of the chain, teach the child one step at a time, and you complete the rest of the steps until the child has reached independence on that initial step. It is always best to use physical prompts when possible, ranging from guiding the child’s hand with your hand, to less intrusive “nudges” in the right direction as the child gains independence.
Another prompting method that can be used to teach these skills is the use of visual checklists. This may consist of pictures (e.g. drawings of the body parts that need to be targeted during showering) or, for children with reading skills, a checklist that they can read and check off as they move through the steps. This has the additional benefit of teaching children self-management strategies that they can use in other settings (e.g. making a to-do list for homework assignments or job duties).
One of the most common errors made by parents, teachers, and other caregivers is the use of verbal prompts. Many children without development disabilities are able to learn tasks easily with the use of verbal prompts, so it is only natural that we would default to this style. Unfortunately, many children with autism become prompt-dependent very easily with verbal prompts, and it may be difficult to fade these prompts over time. When your child is 4, this may not be a concern, but having worked with a variety of individuals up into their 30s, I always caution my clients about waiting too long to address these skill deficits and prompt dependencies. It is still possible to teach a 35 year old woman to shower independently, as I have done in clinical practice, but it would have been much better for her quality of life if she had been taught at a younger age using fading physical prompts rather than the verbal prompts that she relied on for years.
Many children with autism have sensory issues that may interfere with self-care skills. They may get defensive about having their head touched during hair brushing, or may refuse to let the toothbrush near their molar teeth. These issues can be addressed through positive reinforcement and a systematic desensitization program designed by a behavior analyst to help your child gain compliance and independence with these skills. It is important to remember that with any skill, we need to start out with basic steps, deliver reinforcement for compliance and success, and gradually increase the level of complexity until the child has reached mastery. It may take some time, but over time your child can acquire the skills they will need to have greater independence as an adult.