Teen with Autism Needs Help with Hygiene & Appropriate Behavior

“How can we help our teenage daughter improve her hygiene and understand the difference between public versus private behavior?”

Today’s “Got Questions?” answer comes from (left to right) Cassandra Newsom, PsyD, director of psychology education at the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders, Nashville; Stormi Pulver White, PsyD, assistant professor of psychiatry at the University of Texas Southwestern Medical Center’s Center for Autism and Developmental Disabilities, Dallas; and Cora Taylor, PhD, a postdoctoral fellow at the Vanderbilt Kennedy Center. The Vanderbilt Kennedy Center is a member of the Autism Speaks Autism Treatment Network.

Helping your daughter learn hygiene skills is an important step on her path to independence and self-esteem. So, too, is distinguishing between appropriate public versus private behavior. Today, we’ll tackle personal hygiene. Next week, we’ll address teaching appropriate behavior.

Many teens with autism – boys and girls alike – don’t pay close attention to the social examples and cues of their classmates and peers. As a result, many need help understanding that these behaviors are important.

One way to get started is to work together on a hygiene picture book and hygiene kit that help her take responsibility for daily tasks. If your child has an occupational therapist, definitely enlist his or her assistance.

Here are our suggestions:

Create visual aids
A picture book guide can include images of important hygiene products such as soap, deodorant and pads. You can include a visual picture schedule of each step in their use.

In addition, this book can help your daughter select the items she needs for a particular task such as a shower. She can likewise use the book to create a shopping list for the things she needs. These are all important steps toward adult independence.

If your daughter needs help remembering what to wash, we suggest hanging a laminated action schedule in the shower. It should show which step comes after which; including shampooing and rinsing and which body parts to soap. Another option is to use a small plastic doll or laminated paper doll with removable parts. As your daughter washes and rinses each body part, she places that piece of the doll in a container labeled “finished.” Or, you can provide a list with a detachable tag for each step.

Does your daughter need help gauging how long to wash? Create a music CD equal to the length of time she should shower or bathe. Each song change within the CD can signal that it’s time to move to the next step on the schedule.

Assemble hygiene kits
The two of you can create hygiene kits for specific tasks. On the outside of each box, place a picture illustrating the task along with pictures or a list of the items in the box. For example, a hygiene kit for brushing teeth would include a toothbrush, toothpaste, dental floss and perhaps mouthwash.

As girls enter puberty, they may need to shower and wash their hair more frequently. This can be difficult for those with sensory issues around the feel of water or shampoo on their heads. If this is true of your daughter, try having her shampoo her hair with a soft sponge. If the feel of the shower water upsets her, try having her use a plastic cup to rinse.

Also, consider other sensory issues. Sometimes resistance to washing is an aversion to strong scents. Try unscented or mildly scented products. Some individuals with autism prefer weighted toothbrushes and razors. Medicated or pre-moistened wipes can make skin care more comfortable.

Teaching menstruation hygiene
Menstruation presents a new and significant hygiene challenge for most adolescent girls. Sensory sensitivities often add to the challenge for those on the autism spectrum.

Ideally, you’ll want to teach your daughter about menstruation before her first period. (Menstruation usually starts a year or two after a girl develops breast buds.) Discussing it in a clear, matter-of-fact way can help relieve anxiety. Help her understand that having a period is normal. Make sure she knows that the blood doesn’t mean she’s hurt.

In particular, explain that she will see some of the blood in her underwear or in the toilet bowl. You might even show her what it will look like with a few drops of food coloring on pair of underwear or in the toilet bowl.

Next, adolescent girls need a discrete way to bring pads with them to school and elsewhere. We suggest letting your daughter pick out an attractive but practical container that’s private and easy to access. This could be a small but distinctive bag, case or purse that she keeps in her backpack, locker or the school nurse’s office.

We recommend starting with pads rather than tampons. If the flow becomes too heavy for even maxi pads, talk with your daughter’s doctor about other options. Purchase different sizes and types of pads and let your daughter pick out the most comfortable. Again, it’s ideal to do this before she actually needs them. We suggest letting her wear a thin pad before her period starts to learn how it feels.  

A visual schedule can help your daughter through the steps needed to change pads. Slip a pocket-size version of this schedule in her “pad purse.” Keep another in a folder in your bathroom. The schedule can include reminders to check and change pads at set intervals during the day. For school, you might want to develop a plan with her teacher that provides her an easy way to request these breaks. Perhaps a token or card she can give the teacher.

These strategies are aimed at helping your daughter manage her period with independence. However, she may need extra help. If so, ask her teacher if a classroom aide or school nurse can assist her.

For more information on helping your child through puberty, Please see these additional resources:

* Autism Speaks Transition Tool Kit, created to assist families in transitioning their child with autism from adolescence to adulthood.

* The Healthy Bodies Tool Kits, created by experts at Vanderbilt for boys and girls with disabilities.

Please watch this blog column for Part II of our answer – teaching an adolescent child with autism how to distinguish appropriate public versus private behavior.

NOTE: All illustrations are copyrighted by the Vanderbilt Kennedy Center and should not be used in another context without written permission. To request permission, email kc@vanderbilt.edu.

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