Safety

Maintaining a safe environment at home is very important when you have a child with autism.
Maintaining a safe home can help ensure a child with autism is less likely to injure themselves and require a trip to hospital, which can cause enormous distress to the child and family.

High fences, lockable gates, locked cupboards, locked windows (especially in a 2 story dwellings) safe electrical appliances and power points are a must. Children with autism can and do easily work out locks, gates and other safety precautions. Watch your child carefully for signs they have figured out the safety precautions, as you may need to change your strategy.

Ensure that any homes you visit regularly with the child are also safe- this includes grandma’s house, your friend’s house or a holiday house. Thinking ahead about safety can save a lot of time, distress and even avert a tragedy. Children with autism are unpredictable and easily get into dangerous situations. It is almost guaranteed the child with autism will be fascinated with something that is dangerous.

Water safety
• Ensure pools, ponds or dams are fenced and inaccessible to the child with autism. Children with autism often have a fascination with water.
• Enrol in swim classes early to help teach the child the correct way to enter the water-from the steps or side of the pool, not to jump straight in.
• Never leave buckets or tubs of water around and keep the bathroom shut or locked.
Toys
• Safe, nontoxic toys without sharp edges or peeling surfaces are important as children with autism often mouth objects constantly.
• Non toxic crayons, paints, pencils, glue and play dough is important as these items will often end up in the child’s mouth.

Around the house
• Furniture needs to be stable and secure as it could be used to climb on, up or over. Ensure furniture does not have sharp edges.
• Small objects such as batteries, buttons, marbles and coins should be put away as children with autism can and do ingest these items. This can cause choking or even require surgery to remove these items from the stomach and intestines.
• Ensure all medications are kept secure in a lockable cupboard off the ground
• All toxic household cleaners need be in a locked cupboard
• All toxic items in the garage must be locked up.
• Plants in the garden should be non toxic as children with autism will often ingest plan matter.
• Ensure cords from blinds are short and secure
• Ensure appliance cords are not hanging over benches and are in good repair
• Have power point plug guards, children with autism are often fascinated with power points and light switches.
• Ensure fans have guards that the child cannot fit their fingers through; children with autism are often fascinated with fans.
• Ensure the stove is guarded
• Lockable kitchen cupboards and drawers are important

Windows
• If the child is prone to head banging or hitting windows replacement of glass with plexiglass or Perspex should be considered, as children/teens with autism can become very strong when agitated and easily break windows and injure themselves, with little understanding of the potential consequences.
• Windows on the 2nd floor that can be opened more than 10cm must be lockable or have a security screen fitted. A fly screen is not designed to take the weight of a child.

Animals
• Never leave a child with autism alone with an animal and ensure that animal food, drink and litter are secure as children with autism may play with or ingest any of these.
• Children with autism often will not understand if an animal has had enough and do not read the “body language” of an animal, leaving them open to being bitten or scratched, or harming the animal.
• Children with autism can greatly benefit from contact with animals, but it needs to be done in a supervised environment to ensure the safety and comfort of both parties.

Road Safety
• Children with autism are impulsive and often have no road sense or understanding of road rules.
• Road safety must be repeatedly practiced from a young age and never assume that a child with autism has developed road sense, it takes longer to develop than in typically developing children.
• Helmets- ensure the child with autism always wears a helmet when riding their bike or scooter- you can encourage and reward helmet wearing from a young age.
• In the driveway- if you need to move a car ensure the child with autism is in a secure location – either in the car with you or in the house. A child with autism will easily run into the path of a car without thinking. Keep play areas separate to the driveway.

Car safety
• In victoria a child up to the age of 7 years must be in an appropriate child restraint.
• Always ensure the child with autism is in their seat and is wearing their seatbelt or harness.
• If the child will not leave their seatbelt or harness on there are devices available which make it difficult to undo the seatbelt.
• Always transport a child with autism in the back seat of the car on the passenger side with the CHILD LOCK ON. Children with autism are unpredictable and will try and get out of a car even if it is moving.
• Remove any objects in the back seat in of the proximity of the child which could be eaten, broken or thrown.
• NEVER leave a child with autism alone in a car.
• Always ensure the car is locked when in the driveway and the keys are in a safe place.

Fire safety
• Ensure any lighters, matches and candles are securely locked away.
• Ensure any flammable liquids are stored in a secure location.
• Ensure there are working smoke detectors in the house. (A smoke detector in the child’s room is a good idea)
• Do not leave the child alone with a heater- children with autism may sit in front of a heat source and not realise when they are too hot or that their skin is starting to burn.
• Practice what to do when the smoke detector goes off, and do an evacuation drill of the house.
• Some children with autism may want to hide or run away at the sound of the fire alarm or during a fire drill.
• A social story can help explain what will happen and alleviate some fear of what happens during a fire drill.

Learning to STOP
• Teaching a child with autism to respond to their name and STOP is critical to assist in emergency and dangerous situations.
• STOP needs to be taught early on and can be incorporated into games and other areas of play.
• Always attract the child’s attention by saying their name first and using a very firm STOP. With repetition the child may learn this important command.

Further info on child safety visit –
www.kidsafevic.com.au 

Coping With Meltdowns

“Every time we go to the supermarket billy will have a tantrum which turns quickly into a meltdown. I have to leave the shopping and go home again and people stare and make rude comments. I feel I can’t take him anywhere.”

Why do meltdowns happen?
Meltdowns occur for two main reasons.
• Sensory overload
• Wanting something the child cannot have.
Each scenario needs a different approach and response.

Sensory overload meltdowns are very common in public places and supermarkets or shops in particular. There are many sensory stimulants in a supermarket or public place.

• Lights- Fluorescent bright lights that can flicker or hum are very annoying for people with autism.
• Temperature variations- colder areas near the deli and produce or freezer, warmer near the bakery can be irritating.
• Smells- many large stores have delis. Fish, meat, bakery and hot items such as chickens  emit smells that may be uncomfortable for a child or person with autism to process.
• Smell of other people – other shoppers may be wearing perfume or have body odour.
• Noise- large noisy crowds, loudspeaker announcements, registers beeping, other unexpected unfamiliar and abrasive noises, terrible supermarket background music.
• Noisy air-conditioning units
• Proximity of people- crowded isles, bumping into people, lining up to pay for items.
• People with differences- sometimes children with autism may not understand people with differences and may want to comment on it very loudly at the time – why is that man fat? Why does that lady have one leg, why is that kid in a wheelchair? That baby looks funny.

The parent or carer may already be stressed, tired and distracted and miss some of the cues that the meltdown is impending.

The sensory overload can build up quickly and the child will then engage in behaviour to escape the environment.  This will usually manifest as some sort of tantrum or self injurious behaviour with mum or dad making the quickest exit possible with the child, lots of stares and no shopping.

Wanting something the child cannot have.
When a child with autism wants something they cannot have the resulting tantrum is a great cause of distress for the child and their family. The item is usually related to the child’s particular obsessive interest, and thus the distress of not getting the item is very great and expressed at loud volume! The resulting tantrum can find the parent trying to exit the store very quickly, very embarrassed and upset with the child and shopping in tow.

Tips to avoid these meltdowns
• Avoiding the particular aisle – I.e. the toy aisle at the supermarket can be very helpful in this instance.
• Avoiding particular shops is also a good idea.
• Being firm with the child and rewarding good behaviour is preferred.
• Have a distraction in your bag, or use a reward system where the child can pick a desired item as a reward after earning enough points.
• Stand your ground. Children with autism still need to know they cannot always have what they want.

Preparation
Preparation is essential to avoid problem behaviours and to be able to respond appropriately to them if they arise. Preparing the child helps them know what behaviour is expected. Children with autism will not automatically know how to behave in particular situations. Cue the behaviour you want before you go into the shop. You can do this verbally or with a social story.

Distract
Have something handy in your bag for the child to child play with as a distraction. Sometimes a high functioning child with autism may like to look at the shopping list or map of the store and help locate items. Weighing, counting, adding and measuring are also good distractors.

Physical supports
Ensure the child has something that can help mask noise if it is a problem – a music player, earplugs, a hat or a jumper with a hood may work.
Sunglasses can be useful if fluorescent lights are too bright.

Other ideas to help
• Choose a time when the store is less likely to be busy – sounds obvious but going at a quieter time can make a world of difference.
• Be particularly aware of times close to public holidays, Christmas/Easter when there are extra distractions in the shop and checkouts are extra busy.
• Ensure you know the quickest and safest exit route out of the shop/shopping centre/restaurant /movie theatre etc. Being able to exit quickly can help in a meltdown situation.
• Social stories and photo stories about the supermarket can help and can be tailored to each individual situation.
• If all else fails and it is completely impossible to get to the supermarket with your child, home delivered groceries ordered online are an option, or utilise some respite time so you can shop whilst a respite carer stays with your child.

Meltdowns

What you can do
• REMAIN CALM This is the most difficult aspect of handling a meltdown. Your child needs you to be calm now more than ever.
• Speak in a soft firm voice. If the child is in overload a loud voice will only add to the confusion. A soft firm voice can provide the child something to focus on and some comfort.
• Use minimal words – talking too much will not help the child, it will only overload them further
• Use the child’s name. Say stop. Stand up. Time to go.
• Take them by the hand, arm, back of pants if necessary and walk them firmly but calmly away from where they are having the meltdown. You may have to leave the centre completely.
• Safe space- The child will need somewhere cool and dark, or familiar to calm.
• Cool down- Ensure the child is not overheated or dehydrated- overheating and dehydration can cause or exacerbate meltdowns.
• IGNORE OTHERS –
Members of the public will stare, make comment and be generally unhelpful. Ignore them. Autism awareness cards available from Autism Victoria and Gateways stating-
“Please excuse my child’s behaviour he / she has autism”.

Remember all behaviour is an attempt at communication – it could mean
Overloaded
Bored
Frustrated
In pain or unwell,
Get to know the signs of each type of behaviour and the best response to help calm the child.

Difficult Appointments

Health checks and appointments are often very stressful for parents of children with autism. This is compounded by the number of extra visits a child with autism will need to various health care professionals, therapists and for further testing. Early life with a child with autism can feel like it is spent in the Doctor’s waiting room.

Visiting the Doctor
Children with autism often have many health concerns and require a lot of Doctor’s appointments.
• Finding a GP or paediatrician that understands autism is essential. Try and keep the same Doctor/paediatrician to help with consistency and lessen disruption.
• Be aware that the smells, lights, equipment and noises at the doctors can be problematic and cause sensory issues for the child with autism.
• Waiting, crowds and close physical touch will also be very uncomfortable for the child.
• Social stories/picture stories with photos of the Doctor, the treatment and waiting rooms and pieces of equipment can help the child understand why they are going to the doctor and what will happen.
• other visual aides can  help depending on the age of the child and their level of understanding.

An example of a script for social stories about using doctor’s equipment may go something like this-

Stethoscope
The doctor will listen to my chest with a stethoscope.
This helps him/her hear if I am breathing properly and my heart is working well.
The doctor will lift up my shirt, put the stethoscope against my chest and ask me to breathe in and out.
The stethoscope will feel cold and may tickle but it will not hurt.
I can do this for the doctor and he/she can tell I am ok.
The doctor will be happy and mum will be happy.

Blood pressure cuff.
The blood pressure cuff is used to measure the blood in my body.
It will squeeze my arm like giving it a cuddle.
I will sit still and this will not take long.
This helps the doctor tell if I am well.

Taking my temperature
Sometimes if I am sick I get very hot.
The doctor needs to know how hot I am.
He will take my temperature with a thermometer.
He will put the thermometer in my ear,
I might hear a beep or click noise, and this will not hurt.
The doctor can see if am sick. Then he can help me get better.
The doctor will be happy and mum will be happy.

Taking medication
It can be very difficult for a child with autism to take medication, depending on the child’s oral sensitivity and level of cooperation required.
• Sometimes liquid suspensions may be better if the child can swallow them without gagging. Liquids could be flavoured or clear depending on the child’s sensitivity to taste.
• Sometimes liquid medication  can be mixed with milk if appropriate to aid swallowing. (check with Doctor first)
• Tablets can be more difficult for children with autism to swallow as they may have an overactive gag reflex or want to bite or chew the tablet.
• Sometimes tablets can be hidden in yoghurt, crushed or added to food to avoid this issue.
• Always check the child has actually swallowed the tablet and isn’t holding it in part of their mouth or under the tongue.
• If the child has asthma, using a spacer with their inhaler is important as children in with autism often do not have the coordination required to effectively use an inhaler.
• Regular medication can be prepared by a chemist into a ‘Webster or dosette” pack that makes administration each day easier to administer
A social story or picture/photo prompts about taking medication may be needed.

Visiting the Dentist
Children with autism are often prone to dental problems, poor dental hygiene and have poor dental health. A visit to the dentist can be a very challenging ordeal. With some preparation and an understanding dentist you and your chill can get through it.
Children with autism may have a high tolerance for pain and not indicate if they are experiencing toothache or some other dental problem. A change in behaviour may be the only indication of a problem or severe pain.

Causes of dental problems for children with autism;
• Normal mouth and tooth development
• Eating objects /mouthing objects
• Self injurious behaviour
• Eating soft sticky foods /sweet drinks
• Epilepsy/trauma injury
• Medication
• Poor oral hygiene

Teeth brushing
• Children with autism often do not have the physical dexterity or capability required to brush their teeth properly,
• May not understand why they need to brush their teeth,
• May not understand how to brush their teeth and for how long.
• Children with autism may find the taste of toothpaste overwhelming and have an overactive gag reflex.
• They may be very uncomfortable with the close physical proximity of having someone else brushing their teeth.
• They may need to be shown hand over hand, use an activity sequence, visual reminders or use an egg timer to undertake the task correctly and for the right amount of time.
• Plain water or children’s toothpaste can be used if the taste of toothpaste is too much.

Visiting the dentist with a child with ASD can be very difficult. The child may not fear the dentist in the same way most people do, but find certain aspects of the dentist’s visit frightening or overwhelming to the senses- i.e. smells, sounds, tastes, sensations such as suction.

The child with autism may have difficulty with the dentist for the following reasons-
Problems with
• Smell of the waiting room or dentist room
• Waiting with other people
• Sounds of the drill, chair, suction and other tools
• Sitting in the chair
• Keeping mouth open and breathing through nose
• Having someone poking around in their mouth
• Being in close proximity to the dentist

Overcoming issues at the dentist:
• Use a social story and or photo book talking about the dentist visit
• Seek out a sympathetic dentist used to working with people with disabilities or people with difficulties visiting the dentist.
• Discuss your child’s needs with the receptionist and or dentist.
• When making appointments try to get a time when the surgery is likely to be less busy
• Use music/earmuffs/sunglasses to lessen the noise and impact of bright light
• Take a favoured toy or object for the child to hold whilst in the chair.
• Explain what is happening at each step
• Practice and reward good sitting
• Work with an occupational therapist to overcome issues with taste and gaging.
• Take someone familiar to the child as a support for you and the child as it can be distressing.
• If all else fails the child may need to have dental work completed whilst under anaesthetic, however this situation should be avoided if possible.

The costs of dental visits can be offset as part of the Helping Children with Autism Package under the Enhanced Primary Care Plan if the child has dental issues that can be attributed to their autism- i.e. teeth grinding, refusing to brush, eating non-food items or engaging in behaviour that damages their teeth. A referral is required from either a GP or Paediatrician.

A download of a book for carers regarding oral hygiene is available at –   http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/DentalCareEveryDay.htm

Visiting the Hospital

If you are having a planned visit to the hospital you will have more time to prepare your child.
Social stories about hospital can be helpful for the child to understand where they are going and what may happen.

Have a bag with items your child may need ready – food , drinks, favourite toys , drawing materials, books , nappies, change of clothes, specific items like sipper cups , earplugs/headphones/music player and special toys.

• Be prepared for long wait times.
• Be prepared for your child to be very unhappy/uncomfortable and likely to have some sort of problematic behaviour or meltdown. It may not happen but be ready for it.
• Be prepared to advocate for your child and tell your story repeatedly with many different staff changes through out your child’s stay.
• Be prepared to undertake some or most of the care and supervision of your child- often staff in hospitals are often too busy to provide the level of care and supervision required by children with special needs and will expect the child’s family to do so.
• The staff may not know how to respond to your child’s needs. Staff may even seem rude, uncaring or insensitive towards your child, their needs and behaviour.
• Seek support from the hospital social worker or counsellor /chaplain if needed. This can be a very stressful time for you and your family.
• Take someone with you that knows your child well and can help.

Emergency visit-
Unfortunately you may not have time to prepare. Try and keep calm. If your child is injured they may be distressed, seeing you panicking will not help.

If you need to go to hospital
If you have to stay in hospital then you will need to do some preparation with your child.
• A social story explaining where and why you are going can help lessen distress.
• Prepare the child for any changes to routine such as someone new caring for them in your absence.
• Keeping the child’s usual school or care routine is important to lessen the disruption.
If the child is kept home and you aren’t there without any explanation or preparation it could cause extreme confusion and distress.
• Ensure you have left a copy of any important instructions and household the routine for the person caring for your child. Following medication schedules, meal instructions and keeping to the household routine can be very important to avoid stress on your child and meltdowns whilst you are away.
• If you have not already accessed respite, then this may be a time to do so, as you will need support for your child during and after your hospital stay.
• Discuss with the service provider a meet and greet visit where the carer can meet your child and get to know them. This may be a shorter visit. Your child will need to get used to other people caring for them by school age and beyond to help you have a break and to prepare for the future. This can help with socialisation of the child and lessen stress on the family.
• For more information on where and how to access respite – see Respite
For some visual supports for hospital visits see

http://www.boardmakershare.com/Activity/847203/Hospital–Emergency-Board-Set

Blood tests:
Blood tests are an unfortunately necessary part of life, and can be distressing for people with autism. The child with autism may have problems with the blood test for the following reasons
• Waiting
• Sitting in the chair
• The physical discomfort of the blood draw,
• Smell of chemicals/disinfectants in the room,
• Having someone touching and poking them
• Fear of needles/ sensation of the needle

Tips that may help
• A skin numbing patch may be applied prior to the visit which can help with pain or discomfort at the site of the blood draw.
• A social story or photo story explaining what will happen during the draw will help prepare the child.
• Discussing your child’s needs prior to your visit and making an appointment for your blood draw are useful.
• Ensure the nurse knows the best way to approach and speak to the child.
• Take something to distract the child with or plan a reward afterwards.
• Take a friend or support person with you to assist

Haircuts
Getting a haircut with a child with autism is often extremely difficult.
Children with autism often fear having their hair cut because

• They do not realise hair grows back
• Sitting still in a chair is difficult
• The mirror may be distracting or annoying
• Someone is touching them in a sensitive area
• Noise of the salon- hairdryers, clippers or people talking is uncomfortable
• Smells of the salon – dyes, bleaches etc are strong smells which could make a person with autism feel quite ill.

Overcoming difficulties with getting a hair cut:
• Get a hairdresser to come and cut the child’s hair at home
• Use a social story or photo book about getting a haircut.
• Reward afterwards with a toy or chosen activity or a chosen food reward.
• Give the child something to hold or play with/ chew tap etc whilst in the chair.
• Reward good sitting
• Use an egg timer to indicate how long the child needs to sit for their haircut.
• Build a good relationship with a local hairdresser and go to the same place for haircuts whenever possible
• Go in a quiet time, out of hours,
• Choose an easy hairstyle – for boys a short haircut with clippers is often quicker and more practical than using scissors.

• Autism awareness cards available from Autism Victoria and Gateways stating-
“Please excuse my child’s behaviour he / she has autism” can be a quick fix in a situation where your child is acting out and members of the public are having an issue with their behaviour.

Example of a social script about a haircut;

Getting a hair cut
When my hair gets long I need a haircut.
It is important to have a haircut so I look good.
I will look different with my haircut. Looking different is ok.
My hair will grow back again.
When I have my hair cut we will go to X hairdresser- insert photo
I will sit in the chair quietly. .
The hair cut may tickle but it will not hurt
When the hair cut is finished mum will say “finished now” and i can get out of the chair.
Mum will be happy, the hairdresser will be happy.
My hair will look different and it will look good.

Sleep

Children with ASD often have very disturbed or unusual sleep patterns. Children with autism often have a range of conditions that contribute to sleep problems and display a range of problematic behaviours relating to sleep such as

• Resistance to going to bed
• Insomnia
• Going to bed very late
• Waking very early in the morning
• Sleeping at odd times during the day
• Not being able to re settle
• Getting up and wanting to explore the house
• Being hungry thirsty or after some sensory stimulation
• Being scared, not knowing why it is dark
• Not understanding that it is inappropriate to be up in the middle of the night
• Incontinent /wet/ etc and wake up
• Sensitive to changes in the amount of light/dark in the environment – summer/winter /daylight savings change can be difficult for a child with autism to adjust to.
• Insomnia associated with anxiety or obsessive thoughts

Strategies to help

• A positive bed time routine that is age appropriate for your child which includes a bath or shower, cleaning teeth having a story and going to bed can help.
• A Social story about going to sleep can be helpful and tailored to the individual child’s sleep issue.
• A nightlight or dimmer switch may be helpful for the child if they are scared of the dark.
• Blackout curtains or sheets over the windows may help block out light if early waking is an issue.
• Diet and exercise
Ensure the child has plenty of exercise each day and eats a healthy diet. Cut sugar, artificial colourings and caffeine. A poor diet can affect a child’s behaviour.
• It is important for adolescents with autism to keep up their sleep routines so they do not fall into the trap of staying up all night and sleeping during the day – often missing out on school, work or day program activities.
• Ensure the bedroom is not over stimulating, the bed is comfortable and familiar, remove any distractions such as computer, hand held games, musical toys, TV’s if needed.

• Medication may be recommended in some cases to assist with sleeping- Melatonin is a natural chemical manufactured by the body to help regulate sleep and is often prescribed for people with sleep disturbances.
• For more information about melatonin speak to your child’s paediatrician.

Visual aides from www.boardmakershare.com

sleep sleep 2

Routine

Routine
• Having strong routine at home for a child with autism is vital.

• If the child knows what is happening next they can relax more easily and fewer behaviours of concern are likely to arise.

• A schedule is essential with pictures or photos to provide a visual prompt for what will happen during the day.

• Keeping the events of the day in some sort of order is important. Medication, meals and bath/bedtimes run more smoothly if they happen at the same time each day.

• Activity sequence cards to assist the child with visual reminders on how to undertake the activities of the day can be found at http://www.boardmakershare.com

autism_morning routine

Hygiene

How can I get my child to take a bath or clean their teeth? It is a battle every night.
• Hygiene and personal care can be a problem for children, young people and adults with autism. Families find it difficult to ensure the person with ASD engages in personal care tasks and people with autism find it a problem because they do not like the sensory demands that go with personal care routines.
• For people with Autism washing their face and hair, cleaning teeth, shaving or having fingernails cut is intensely uncomfortable, frightening or even painful. Many people with autism also do not see the point in engaging in this behaviour, as they do not see the problem with having poor hygiene or may not care what other people think.
• Young children with autism may be too busy engaging in self stimulatory behaviour or with their obsessive interest to want to have a bath and may become very defiant or difficult to manage at this time of the day.

Hand washing
Children with autism can be prone to avoiding hand washing. This is because they easily forget to do so, have sensory concerns such as water or soap avoidance or may dislike the bathroom, water or the sound of the hand dryer in public bathrooms.
Hand washing is important for health and hygiene reasons. Establish a strong and washing routine can help eliminate some of the common colds and gastro bouts that children are prone to.
• Hand washing after toileting, before meals, after handling pets is particularly important.
• Activity cards with sequence strips can help as can social stories
• Prompting the child after each toilet visit is important and the child may need to be physically assisted so they know what to do.
• Use unscented soap /get the child to choose some soap
• A pump pack soap may be easier than a bar of soap (also more hygienic)
• Use earplugs in noisy public bathrooms with hand dryers
• Support from an Occupational Therapist may be needed if sensory concerns are making hand washing a battle

An example of a social script about hand washing may read
I need to wash my hands because they get dirty. Dirty hands can make me sick.
I will wash my hands
After I go to the toilet
After I touch my pets
Before I eat
After I am finished playing outside
After I cough, sneeze or pick my nose.

When I wash my hands I need to
Go to the bathroom
Wet my hands
Get some soap on my hands
Rub my hands together and make lots of bubbles
Wash the soap off my hands under the tap
Dry my hands on a towel
I will do a good job washing my hands.
Pictures, photos or an activity sequence may be needed to prompt hand washing. Hand over hand support may be needed for very reluctant hand washers.

Autism Washing Hands

(http://www.boardmakershare.com/Activity/299757/handwashing-sign)

Showering/bathing /hair washing
For parents of a child with autism, showering, bathing and hair washing can be a constant battle.
• The child may be very resistant to undressing, getting wet, washing their face or hair.

• For those children or young people with autism who will shower, learning to wash themselves can be difficult.

• If not prompted a young person with autism will just stand under the water enjoying then sensory component of showering and not actually wash anything.
• Hair washing can be a difficult area for children with autism who often do not like getting their face or head wet when bathing.
• Activity sequences, photo stories or social stories can be useful helpers with bathing and showering.
• Activity sequences for drying and dressing can help if the child does not get dressed in the correct order.
• For school aged children with autism having a bath or shower can be a great way to unwind and calm down after school if they are agitated or upset.
• Build bathing or showering into the daily routine. Night time showers or baths before bed can be a great way for the child to relax and help to support a good sleep routine.

Useful tips-
• Use swim goggles to keep water out of eyes
• Use Kids shampoo/ baby shampoo/no sting shampoo
• Have plenty of towels ready
• A hand held shower attachment can be useful
• Older children will need to be told when to wash their hair as they will not instinctively know when it needs to be done.
• A kitchen timer may be useful to indicate the minimum amount of time the child will need to be washing their hair.
• Let the child select the type of soap or shampoo
• Have a special towel and washer or bath toys.

Autism Shower

Oral hygiene
Teeth cleaning can be very difficult for children with autism. Oral sensitivity or strong gag reflex may make teeth cleaning unpleasant. The child may not tolerate someone in very close proximity touching them to support cleaning their teeth, and they may not understand why cleaning their teeth is important.

• A social script, story or activity sequence will be very important to support why cleaning teeth is important and how to do it.
• The child may not tolerate toothpaste as mint flavors can be overpowering. Try different flavour’s of toothpaste, or just use plain water.
• An electric toothbrush may be tolerated more successfully than a regular toothbrush
• A kitchen timer may be useful to let the child know how long to brush their teeth.
• The child may need a photo prompt sequence or other visual reminder to clean their teeth.

Autism Brushing Teeth

A script for teeth cleaning may read;
I need to clean my teeth each day so they keep clean and healthy
I should clean my teeth in the morning after breakfast and before I go to bed at night.
When I clean my teeth I need
My toothbrush
Tooth paste
A cup
A towel or washer
Some water
I brush my teeth in the bathroom in the sink
I only use my toothbrush to clean my teeth my toothbrush is ………. (red, blue etc.)
I pick up my toothbrush. I put some toothpaste on it. I only need a little bit of toothpaste.
I put some water on my toothbrush and put it in my mouth.
The toothpaste tastes like ….. Mint, bubblegum etc. I do not eat the or swallow the toothpaste. Toothpaste is not food.
I take care to brush all my teeth up and down and in the front and back.
I can spit the toothpaste into the sink and get more water on my brush when I need to.
When I am finished brushing my teeth is spit the toothpaste out into the sink.
I can have a drink of water or wash my mouth out when I am finished.
I can wipe my mouth on a towel or washer when I am finished.
I have done a great job of cleaning my teeth. My teeth will be healthy and strong.

A booklet on dental care, for care givers can be downloaded from

http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/DentalCareEveryDay.htm

Fingernails
Cutting fingernails can often be very difficult to achieve but is important for hygiene and safety reasons. Children with autism are often resistant to nail cutting as
• It is a strange sensation
• A person is in very close physical proximity to them/ touching them
• They do not understand nails grow back
• They may not be able to keep still long enough

• Tips- try cutting the child’s nails after a bath or shower when they are more likely to be relaxed. Do it when they are asleep as a last resort
• Get into a routine and do it once a month. Mark it on the calendar so the child can see when it will happen next.
• You may need another person to support you whilst you cut the child’s nails.
• A social or photo story about nail cutting can be useful.

Final tips to support hygiene
• Use visual aides and social stories
• Make hygiene tasks part of the routine each day
• Include the child’s obsessive interest as part of the routine.
• Let the child choose the soap, toothpaste, shampoo etc.
• Praise and reward positive behaviour.
• Get support from an Occupational Therapist if needed.

Further resources –
Activity sequences can be downloaded from

http://www.boardmakershare.com