Many people with autism can struggle with personal hygiene. There are a variety of reasons for this, and the specifics can be as widely varied as the individuals with autism themselves. But it becomes the number one question I’ve had parents ask me, particularly in toddlerhood and when teens hit those tricky teenage years. Therefore, I’m going to touch on a couple of the biggest reasons for difficulty with personal hygiene for individuals on the spectrum: lack of social skills to have the same idea of “appropriate hygiene”, sensory issues, and lack of appropriate routine.
For the first one, your child likely cannot smell themselves like you can. Many people with autism may need to be told specifically that they may not be pleasant to others if they are besmirching showers for days at a time. For younger children, where it’s age appropriate not to care or notice in the first place, this is doubly true. Social stories and short descriptions can be helpful to give a “why” we should clean ourselves, change our clothes, brush our teeth, etc. For some children, this alone may be helpful. Others may still not worry about their hygiene, as it’s “other people’s problem.” In that case, I have found it helpful to explain why it is personally beneficial to maintain appropriate hygiene. You can get sick. You may get a rash. Your teeth may get cavities and hurt. This isn’t even an autism-specific issue, in my experience. Young teenagers who are suddenly dealing with body odor may honestly not realize that their smell is unpleasant to others, and they have better things to do than shower and brush their teeth, of course. Explaining to them tactfully that their bodies are changing, and they need to wear deodorant, take showers and change their clothes is helpful, and the need for frequent reminders are even age appropriate.
Children who do not have verbal abilities and may struggle with cognition can benefit from an explanation, too, in my experience. Keep those explanations shorter and simpler. Use photographs or pictures. Do not assume that, because your child does not speak, your child does not understand. However, be mindful that many people with autism are more visual than auditory, and a lot of auditory input can overwhelm them. One of the services that I can provide is helping you create and utilize appropriate visuals for your child’s specific needs.
Second, children with autism have a lot of different sensory needs. Some may seek sensory input in unusual ways and like to chew on things, which can be harmful to their teeth. They may chew on their clothing, causing rips and tears. Some like to pull their hair because of the way it feels. Some may be sensory avoidant, and not want to shower or brush their teeth because they do not like the sensory input. Your child’s specific needs will dictate how to handle this best, but I do have some general advice.
For sensory seeking children, getting chew necklaces or bracelets can help them avoid chewing on their clothing. There are a number of places that sell these items that don’t look like toddler chew rings and may just look like regular, age-appropriate jewelry. If your child does not care for jewelry, they also have items you can put on pencils or that your child can carry around with them. Teeth brushing can be difficult, too. Try several different types of toothbrushes and toothpaste. Some children may find soft bristles irritating in their mouths whereas some may find hard bristles too much to bear. Some may want a heavier handle. They have sonic toothbrushes where the child can simply chew on the toothbrush or electric ones that do the job quicker if your child can bear the sensory input or desires it. Trying different toothpastes can help. Flavors may be overwhelming, so try some of the natural brands that have less added taste, or try different flavors. Some children may hate gels and some may hate paste. Like most things autism, there isn’t a one size fits all approach, but getting to the bottom of what the sensory issues are can be helpful. If your child can speak, you can ask them. For some, it may even be as simple as the water. I have had some clients who needed the water to run over the toothpaste after the toothpaste was put on because the “squish” of the toothpaste was too much, so putting less on and using the water to push it into the bristles was helpful.
Flossing can also be problematic. Using handled flossers instead of regular dental floss is almost universally helpful. Many kids with autism require help with flossing well past when you would expect a child need help, though, because they do not care for the way the floss touches their gums. Alternating brushing and flossing can help so that they are not overwhelmed by flossing completely through at once.
Hair washing and brushing can be a pain, as well. Showers can be problematic because of the way water feels. A lot of people who are not on the spectrum love showers but hate standing in the rain. Several people with autism have expressed to me their complete confusion at this, because, to them, it is the same sensation. I always caution households with children with any kind of disability that keeping the hot water heater set to no higher than 120 degrees is of absolute importance to keep them safe. Some people with autism like very hot, and some may even like cold. Try a few options and see what your child likes. Some people with autism strongly prefer baths, whereas others cannot stand them. Again, it is personal preference, but be mindful of your child’s sensory needs.
One unexpected hygiene difficulty related to differing sensory needs that I have found is that people with autism may be much more sensitive to smells than you expect. They may be able to smell (and hate the smell of) shampoos or soaps that you don’t even notice. The detergent on their clothes may be unpleasant. Some people with autism also have very sensitive skin, so you will need to experiment with what does not cause rashes or itching.
Finally, routine. Many kids with autism require a set routine in order to be successful, as well as frequent (visual) reminders that the schedule is the schedule. For kids who do not have autism, simply saying “brush your teeth before bed” will eventually work. Children with autism will do better, for the most part, if bedtime is always at a particular time, and teeth brushing and showering have their set times, as well. Visual reminders throughout the house can help with this. Even if your child reads well, it is often helpful to have these in picture form. A schedule in their room of what needs to happen when they get up is very helpful, as well as visuals in the bathroom or by the door. Kids with autism can also require a lot of repetition to learn things, so these visuals may need to be in place long after you would expect them to know what to do.
Older children with phones or tablets can also benefit from reminders. Using a household device like Alexa or Google Home to state reminders can help. As much as possible, you would want the routine to be based on something that reminds your child without you having to do so yourself. This serves two purposes. One, you want your child with autism to grow up as independent as possible. The more they can do themselves, the better. Two, a visual schedule that dictates their routine takes the onus off of you and reduces the likelihood that you will end up in a power struggle. It isn’t your fault that this is what needs to be done. It just is. See? It’s written right there. You can reduce verbal when meltdowns occur, which is very important (and look for a future article about managing meltdowns). Just point. Hand them a card. Give them space.
This will not be an overnight process. However, if it is helpful at all, remember that so many other parents have gone through this successfully. You can, too. And I am happy to help! Just give me a call and I can start the process of making your life just a little bit easier.