"At Home with Sylvia Miller"

Visual Supports in Real Life

(An Excerpt from 'My Very Own Tool Supply' by Sylvia Miller)

Personal Hygiene

It is my belief that all children--whether special needs or not--should be able to tend to their own personal hygiene long before they reach puberty.  Of course that is easier said than done with my boys.  You see, dad was around until a year ago and waited on them hand and foot.  He was responsible for just about all of their personal care.  He cut and combed their hair.   He bathed them and brushed their teeth.  He even wiped their little (or not so little) bottoms when they used the toilet.  So, except for the fine details like nail clipping, ear cleaning, applying lotion to dry skin (I don’t think it’s considered “macho” to lotion skin….my poor sons (smile), and making sure their clothes were color coordinated and fashionably acceptable, all their personal hygiene needs were being met.

The red flag went off when he was no longer around to cater to them and my teenage daughter drew the line at wiping “brother butts” if I couldn’t get to it.  Personally speaking, when they grow hair on you know where, I draw the line too!  So it became a top priority situation, especially with the boys being ten and twelve respectively and puberty barreling down on both of them.

To make the task of cleanliness a lesson worth learning, I not only had to make it visually clear to them, but I had to give it value, make it interesting, and at the same time, make it fun.  There is a visual schedule to show them the steps to brushing their teeth.  There is a visual to help them regulate the water temperature for their bath.  The fact that they have both overcome their fear of water (as long as it’s not sprayed directly on their faces without warning) and have replaced it with (in my older son’s case) an obsession with soaking that leaves them completely pruned, I also had to give it limited duration. 

Washing hands is an activity that has become part of almost every function in our household.  I am motivated by white living room furniture and white walls (smile).  The boys wash their hands as part of their afternoon schedule when they come home from school.  They wash their hands after every meal, every messy activity and every time they use the bathroom.

The steps to proper toileting were visually introduced and what was not a problem for my oldest son, requires backwards chaining for my youngest, who has far more sensory issues, and considers wiping his bottom to be a "stinkey! yuckey! poopey! activity that borderline traumatizes him.  

Their slow movement and the rushed morning schedule usually makes taking baths before school next to impossible (barring nightime accidents which thankfully don't happen much anymore), so, their morning schedules show the steps for washing up and I have set a general schedule for bath time, which is usually an hour after dinner every night (that gives me time to clean up and “lock down” the kitchen).  I have worked really hard on teaching my guys flexibility with every opportunity, so they take turns on who goes first and depending on our daily activities, our visual schedules will always reveal a change of plan.  Next I introduced the timer, which is strategically placed outside the bathroom door (they learned very quickly how to reset it and so extend their time). 

My younger son follows directions well enough that he only requires minimal reminders.  He prefers the “bathing wheel” which is used to cover the parts of the body as they are washed.  

  My older son needs more cues and enjoys putting things in sequence, so he uses the number game which shows every step in numerical order and flaps are closed as each step is completed.    

I introduced both of these methods by giving them the baths myself while showing them how the visuals corresponded with each action.  Then I verbally prompted them by giving them a set number of times to perform each action.  Of course they still require some prompting and occasional supervision, since given the opportunity they would much rather sing while they float around in bubbles until they fade away and the water becomes ice cold, or empty the tub so they can watch the water swirl down the drain in fascination over and over again, before turning on the faucet to watch and feel the running water flow through their fingers before wiping the tub dry with the towels, and then repeating the process.  

I obtained the pictures and materials for these visual supports from my local Center for Autism and Related Disabilities (CARD) and from various resources on the Internet.  I have come to rely on them to help me teach my sons this valuable and vital lesson, and they cost nothing more than time.

Bath time is a very personal and private time.  It should be taken alone.

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