Self-care video transcript
Hello. My name’s Briony and I’m an Occupational Therapist in the Social Communication Team. This video will be looking at your child’s self-care and how we can best support them.
For the purpose of this workshop, when we speak of self- care, we are talking about tasks such as washing, dressing, brushing teeth and brushing hair.
If your child is experiencing particular difficulties with toileting, eating, or sleep, please watch the separate information videos specialising in these areas. These are available on our website.
Firstly, its useful to think of a self-care goal to work towards that would be most beneficial at this time.
Think about what your child finds difficult. What are their needs? Where do you want to start, and can you make it part of the routine? And most importantly is this the right time (both for you and your child)?
The strategies that we discuss in our workshops all address many different areas- so even it may not seem it, by working on one thing you are likely working on another area.
It may not go according to plan! Which is why it’s important to be realistic and break down goals to maintain motivation.
Next in this workshop I will be talking through the potential difficulties autistic children can have with self-care tasks and the strategies that we can use to best support them.
Looking at this pyramid of components we can better understand the difficulties experienced by autistic children with these everyday tasks. These are all the components required so that we can complete a new task.
Starting with the pink area (sensory)- it could be that a feeling of a certain clothing is distressing, or bristles on a toothbrush or comb are too hard. Perhaps the water from a shower is too powerful, or your child seeks the sensation of water so does not want to get out of the bath to move onto getting dressed. Please watch the sensory video if have not done so already, to better understand sensory regulation.
These sensory based reactions can impact on the orange part of our pyramid (attention). This is being able to remain focused on the task and to follow instructions.
We know that changes in your child’s routine can be distressing. This could be brought about by the change from winter to summer clothes or perhaps the order your child gets dressed is changed slightly. All of this can impact on their sensory regulation and therefore their attention to the task.
In order to learn self-care tasks your child needs to be able to plan and coordinate their movements whilst also having the physical strength to do so. This is the blue part of the pyramid (motor/posture). It may be that your child loses balance, is avoidant or becomes frustrated when trying new tasks. This could be down to motor planning difficulties.
Finally, the green area is our fine motor skills. In self-care tasks, they are required for fastening buttons, strapping Velcro, holding a toothbrush or holding a hairbrush. It is only once all of the other components in our pyramid are addressed are we then able to achieve these fine motor skills.
In this video I will talk through the strategies that can support difficulties in each of these areas.
Starting with sensory needs and getting your child’s attention to the task.
As mentioned, some autistic children can be hypersensitive to the sensation of clothing on their skin, or water- making bath time and dressing stressful. If your child responds well to deep pressure, you could trial calming strategies such as squashes or squeezes before and after these tasks. This could be in form of a firm hug and perhaps rocking; use of bath time songs to signal the start and end can also be reassuring. You can include these on a visual timetable or social story so that your child knows they will happen at start and end. I will give an example of a social story in the next slide. Deep pressure can also be used if your child enjoys the water sensation, and struggles with the transition out of the bath, to calm them down.
Depending on your child’s hair type, it could be useful to keep a spray bottle of conditioner/oil available for hair brushing. This could be used when hair is dry as well as wet to ease the sensation on the scalp. There are many sensitive combs and brushes that can also be purchased.
The change from winter clothing to summer can also be difficult- not just because of the change in clothing routine, but also the loss of sensory input that winter clothes may have been providing. Winter clothes can be heavy and snug which can help your child feel more aware of where their body is in space. If they are struggling with lighter clothing, you could trial them wearing a small rucksack with small bottle of water inside to help with this, swapping that sensory input and helping them feel a bit more grounded.
Use of squeezy toys can also be held in the bath, for your child to regulate, or when they are sitting and having their hair done.
It is worth thinking about the sensory implications of the environment too, so the noise, smells, temperature, and the potential impact these could be having.
Here is an example of a social story for washing hair.
Social stories are unique to how you and your child complete a certain task at home-they can be given to your child so that they know what is going to happen- and this can help them to maintain their regulation and focus.
You may want to use real life pictures of yourself and the bathroom/hairbrush/toothbrush etc, as well as whichever strategies are working for your child at the time. So, for example, a particular toy.
These stories can be adapted for other self-care tasks. There are more examples of social stories available on our website.
During bath time, by involving your child in the task- such as getting them to pour a jug of water over their head, or to rub in their own shampoo, can enable them an element of control over situation and predictability, which can feel safer for them and less distressing.
Using a visual timer can help them to stay focused and regulated - plus sticking to the same length of time with each bath time. You could use a countdown with each step, for example: (5,4,3,2,1) shampoo finished. It’s important to honour the countdown, so not to add on any more time, even if your child is struggling with stopping what they’re doing.
We’re now looking at the motor skills required for self-care. Does your child prefer to sit on the floor in dressing or to stand? If balance is an issue- doing some dressing tasks in sitting can provide a more stable base, enabling your child to become more independent. For example, you might support with dressing top half, and then your child can pull up their trousers whilst they’re in sitting or put on their own socks. We know that with hectic schedules it can be a lot easier to fully support our children with all of the dressing. But it is so important that however small part your child plays in dressing, to enable them to do this, so that it can be built upon.
Part of the dressing routine might be laying out clothes on the bed where your child can easily reach them, so that they are not becoming unstable in their posture and at risk of falling. It also could help to them of what is going to be happening next.
Clothing requires a lot from our posture and fine motor skills- which is why it’s useful to keep clothing accessible. So, use loose clothing, big buttons. We want to set your child up to succeed at nursery and at school as well as at home with this so we can keep motivation to continue to build on their goals.
Easy grip toothbrushes and hairbrushes are good if your child struggles with their grip, allowing them to be able to participate in a task.
To learn any new task, such as dressing, brushing hair or teeth, motor planning is a skill which is needed. I will be using washing hands as an example to explain this.
First of all, we have an idea. I want to, or I need to, wash my hands.
Next, we plan our movement, so we position ourselves by the sink, so that we’re able to reach the taps and the soap.
Next, we wash our hands. So, we apply the soap, turn taps, rub our hands together.
Finally, we check - Do our hands feel or look clean? Do I know when to stop washing them or if it hasn’t been long enough? Do I know when they feel dry?
Does your child avoid doing these tasks, or perhaps gets frustrated when they try? They could potentially give up easily and repeat the same mistakes?
This could indicate a motor planning difficulty, and so supportive adjustments can be made to each of these steps which I’ll explain in the next two slides.
Using hand over hand, with your child, whilst brushing their teeth or hair in front of a mirror can enable them to feel the movement and also to see it. This can take repetition to learn.
Break down the activity into achievable steps, using visuals.
Give simple instructions, for example “bath, then soap”.
When thinking about a new motor task, such as dressing, backward chaining can be a useful approach. This helps your child to feel that they are succeeding with the task, as it is broken down into achievable steps.
For example, with putting on trousers.
First of all, complete all the steps with your child. So, pick up trousers, pull over their feet, up their legs and over their bottom.
Next, complete all the steps with your child, except for the last one. For example, support with their feet going into the trousers, pull their trousers up to their knees and then allow your child to pull their trousers up and over their bottom.
Once they are confident in doing this, you can complete all the steps of the task, except for the last two. So, support your child getting their feet into their trousers, and then allow your child to pull their trousers up from their ankles, all the way up and over their bottom.
You continue to do this until gradually your support with the task has completely reduced and your child is doing it by themselves.
Remember to repeat each step so your child gets confidence with this. It’s not always straight forward, and steps might need changing as you go. If you require to go back a step, that is okay. Consistency is key as well as maintaining your child’s motivation, so that they feel that they are succeeding.
To tie everything discussed in this workshop together, I will use an example of brushing teeth. In this example this child runs off at teeth brushing time and actively avoids it.
So, calming strategies are used before teeth brushing (big hugs, or squashes with a sensory ball), they are given a squeezy toy to have in their spare hand. The bristles on the toothbrush have been a bit hard, and so this toothbrush has been swapped for one with softer bristles.
Visuals are used of brushing teeth broken down into manageable steps.
Hand over hand with them is used, whilst brushing their teeth looking in mirror.
Use of games or songs are so important with self-care tasks and can motivate your child to want to stick at it.
It is not always straight forward and can involve a bit of detective work, to find out what your child’s behaviour is communicating to you, so that you know what strategies to apply. It also can take perseverance with approaches.
Thank you for watching. Please sign up for our next steps sessions on play, sensory, and self-care for further support. There are also a range of resources that you can access on our website, to help you implement these strategies.
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Last updated25 Jul 2024