May refuse to bathe.

 

1. Establish a bath time routine.

2. Use Visual Schedules to add structure and predictability through preparation.  This may also involve sequence strips for tasks.

3. Break the visual schedule down further into ‘Now’ and ‘Next’.  Include where to wash, how much product to use etc.

4. Use timers to indicate when the bath will start and when it will be over.

5. Have a bath kit which includes everything they will need i.e. shampoo, soap etc.

6. If they struggle with the scent of certain products allow them to choose their own or try different products until you find one they can tolerate.  Maybe try unscented or low scented products.

7. Allow them to wash themselves so they can control the pressure.

8. If they dislike baths, try the shower.

9. If they dislike the feel of showers (may feel painful due to sensory issues), try baths.

10. If they struggle with water, start by introducing water play in a small bowl and gradually increase the water when tolerated.  Make it fun.  Introduce toys/bubbles etc.

11. Ensure the room/water is warm enough. 

12. It may help to keep the room and bath temperature similar if they struggle with the change in temperature.

13. Warming their towel may help.

14. Move bath time to a different time if this makes bath time calmer.

15. Have favourite toys in the bath/shower.

16. Use a Social Story™ to explain the need for good hygiene.

17. Use a Social Story™ to explain hygiene rules.

18. Use positive reinforcements and rewards if appropriate.

19. Use distractions and make the experience fun.

20. If they feel unsteady in the shower, use a shower chair.

21. If they feel unsteady in the bath, use non slip bath mat.

22. If they struggle to judge where the edge of the bath is, use tape to define the edges.

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May have a fear of baths, showers or water.

 

1. Use Visual Schedules to show what they can expect.

2. Run the bath whilst they aren’t in the room.

3. If they dislike the feel of showers (may feel painful due to sensory issues), try baths.

4. If they struggle with water, start by introducing water play in a small bowl and gradually increase the water when tolerated.  Make it fun.  Introduce toys/bubbles etc.

5. Use positive reinforcements and rewards if appropriate.

6. Use distractions and make the experience fun.

7. If they feel unsteady in the shower, use a shower chair.

8. If they feel unsteady in the bath, use non slip bath mat.

9. If they struggle to judge where the edge of the bath is, use tape to define the edges.

10. Use hair guard/goggles to stop shampoo/water going near their face.

 

Dislikes the sound of water.

 

1. Run the bath whilst they aren’t in the room.

2. Allow them to wear noise cancelling headphones whilst the bath is running.

3. Allow them to wear earplugs in the bath/shower.

 

Enjoys running water, resulting in flooding.

 

1. Allow them to run the bath under supervision.

2. Use a Social Story™ to show the consequences of running too much water.

3. Use timers to indicate length of time needed to run the bath.

4. Add locks high up on the outside of bathroom doors, if necessary.

 

May refuse to have their hair combed, washed and cut.

 

1. Establish a routine.

2. Use Visual Schedules to add structure and predictability through preparation.  This may also involve sequence strips for tasks.

3. Use timers to indicate when shampooing will start and when it will be over.

4. Warn them before you are about to touch them and ask if it’s ok.

5. Let them know exactly what is going to happen and how long it will take.

6. Have a hair kit which includes everything they will need i.e. shampoo, conditioner etc.

7. Use a Social Story™ to explain the need for good hygiene.

8. Use a Social Story™ to explain hygiene rules.

9. If they struggle with the scent of certain products allow them to choose their own or try different products until you find one they can tolerate.  Maybe try unscented or low scented products.

10. Use hair guard/goggles to stop shampoo/water going near their face.

11. Use positive reinforcements and rewards if appropriate.

12. Use distractions and make the experience fun.

13. When touching, use firm pressure not light touch.

14. Briskly rubbing the skin before touch may dull the sensation for a while.  This may help with haircuts etc.

15. For haircuts some people can’t tolerate clippers but can cope with scissors.

16. Use hair guard etc to stop cut hair going on their face during haircuts.

17. Allow them to complete activities themselves so they can control the pressure i.e. combing/washing hair.

18. Use leave-in conditioner if they struggle with their hair being combed.

19. Try using a tangle tease hair brush.

20. Avoid the use of a hairdryer if they struggle with the noise.

 

May refuse to use deodorant.

 

1. If they struggle with the scent of certain products allow them to choose their own or try different products until you find one they can tolerate.  Maybe try low scented products.

2. Roll on deodorants may be less of a shock on the skin.

3. If they don’t like the feel of roll on deodorants, try spray deodorant.

4. Establish a routine.

5. Use Visual Schedules to break tasks down into steps.

6. Use a Social Story™ to explain the need for good hygiene.

7. Use a Social Story™ to explain hygiene rules.

 

May refuse to clean their teeth.

 

1. Allow them to complete tooth brushing themselves so they can control the pressure.

2. Try different types of toothbrushes i.e. smaller heads/soft bristles/silicone bristles/electric/3 sided/light up/character.  Maybe let them choose their own.

3. Try different types of toothpaste i.e. flavourless/fruit flavoured/mild until you find one they can tolerate.

4. Establish a routine.

5. Use Visual Schedules to add structure and predictability through preparation.  This may include ‘now’ and ‘next’.

6. Use Visual Schedules to break tasks down into steps.

7. Use a Social Story™ to explain the need for good hygiene.

8. Use a Social Story™ to explain hygiene rules.

9. Use timers to indicate when it will be over.

10. Have a teeth kit which includes everything they will need i.e. toothbrush, toothpaste etc.

11. Model good teeth hygiene by doing them at the same time or taking turns.

12. Use distractions and make the experience fun.

 

May not remember to bathe/clean teeth/change clothes/use deodorant/clean clothes.

 

1. Establish a routine.

2. Use Visual Schedules to add structure and predictability through preparation.  This may include ‘now’ and ‘next’.

3. Use Visual Schedules to break tasks down into steps.

4. Use Visual Schedules for morning and night routine.

5. Use a Social Story™ to explain the need for good hygiene.

6. Use a Social Story™ to explain hygiene rules.

7. Use kits for each activity which includes everything they will need i.e. teeth kit, wash kit etc.

8. Set out clothes the night before.

9. Use Visual Schedules for changing clothes i.e. How often you change each item etc.

10. Use Visual Schedules washing clothes i.e. How to wash, settings, amount of washing powder etc.

11. Set reminders on timers/mobile phones to prompt the individual.

 

May not be able to tell you when the need to use the toilet.

 

1. Begin by changing their nappy in the same room as the toilet, so they can relate toileting to that room.

2. Encourage habit training by getting them to sit on the toilet at set times through the day.

3. Encourage sitting on the toilet after meals as the body has natural digestive contractions which may help if they do not feel when they need the toilet.

4. Have set times in between each toilet visit that can be increased once they are remaining dry for longer.

5. If their toileting follows a pattern, sit them on the toilet at these times.

6. Use Visual Schedules to establish a routine.

7. Use Visual Schedules to explain the toilet process.

8. Use DVDs/Books about potty training (with their favourite characters).

9. Use positive reinforcements and rewards if appropriate.

 

​May be incontinent / not sense when their bladder is full.

 

1. Encourage habit training by getting them to sit on the toilet at set times through the day.

2. Have set times in between each toilet visit that can be increased once they are remaining dry for longer.

3. Use Visual Schedules to establish a routine.

4. Use Set reminders on timers/mobile phones to prompt the individual.

 

May not be dry through the night.

 

1. Encourage frequent toilet breaks during the day.

2. Limit drinks at night (but check with doctor first).

3. Remind them that they are allowed to go to the toilet during the night if they need to.

4. Try getting them to go to the toilet at the start of the bed time routine (before routine starts) and at the end (before they go to sleep).

5. Use pull ups/nappies or waterproof bottom sheets.

6. Take them to the toilet during the night.

7. Use a bedwetting alarm, which alerts them at the first drops of urine during the night.  This helps to wake them so they can get to the toilet to finish.

8. Use a bedwetting drinking programme to increase the connection between the brain and bladder, this may also gradually increase bladder size. 

 

May struggle with constipation.

 

1. Try to work out why they are constipated i.e. diet, holding stools, medical.

2. Try stomach massage.

3. Encourage habit training by getting them to sit on the toilet at set times through the day.

4. Encourage sitting on the toilet after meals as the body has natural digestive contractions which may help if they do not feel when they need the toilet.

5. Let them take a quiet activity to the toilet i.e. book, hand held computer.

6. Encourage more exercise.

7. If constipation is diet related try to increase fibre and water if appropriate.

8. If constipation continues see GP for medication and diet changes.

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May have a fear of toilets (feel of the toilet seat/smells/fear of poohing/lights/flush/unsteady on toilet/hand dryer).

 

1. Use a soft toilet seat.

2. Use deodorising spray to cover the smell of faeces if necessary.

3. Use unscented products if possible i.e. cleaning products, soaps.

4. Use DVDs/Books about toileting (with their favourite characters) to reduce fear.

5. Use positive reinforcements and rewards if appropriate.

6. Try changing the lighting if the individual is struggling with certain lighting.

7. Flush the chain at the very end of the routine.  Start with them outside the room, then gradually reduce their distance to the toilet if appropriate.

8. Allow them to flush the toilet themselves, if appropriate.

9. Use a footstool if they feel unsteady on the toilet.  This may reduce the fear if they feel steadier.

10. Use a training seat (smaller than normal seat) if they feel unsteady on the seat.

11. When out, use the disabled toilets to avoid the chances of other people using hand dryers.

 

May enjoy smearing/playing with faeces.

 

1. Try to work out the purpose of the smearing/playing with faeces.

2. For smearing offer similar textures, smells, visuals such as play-doh, gelli baff and corn flour with water.

3. Use a Social Story™ to explain the need for good hygiene.

4. Try to show no reaction when they smear.

5. Rule out any physical ailments.

6. Try restrictive clothing such as bodysuits that don’t have poppers (if they are still in nappies).

 

May enjoy flushing the toilet/blocking the toilet.

 

1. Provide access to similar sounds.

2. Provide access to other items that spin.

3. Use distractions, if appropriate.

4. Use Visual Schedules to break tasks down into steps and encourage flushing once.

5. Use a toilet lid lock, if necessary.

6. Use a Social Story™ to show the consequences of blocking the toilet.

7. Add locks high up on the outside of bathroom doors, if necessary.

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May refuse to sit on the toilet.

 

1. Move closer to the Bathroom each time they appear to be trying, until they can tolerate being in the Bathroom.

2. Tip faeces out of nappy/pull up into the toilet to build the link between faeces and toilet.

3. Practice sitting on the toilet with the lid down and gradually increase the time.  Once they are happy with this, try getting them to sit on the toilet seat.

4. Use a footstool if they feel unsteady on the toilet.  This may reduce the fear if they feel steadier.

5. Use a training seat (smaller than normal seat) if they feel unsteady on the seat.

6. Use Visual Schedules to establish a routine.

7. Use Social Stories™/Visual Schedules to explain the toileting process.

8. Do not force them to sit on the toilet or hold them on the toilet if they do not want to, you may reinforce their fear.

 

May forget/struggle to wipe after going to the toilet.

 

1. Use Visual Schedules to break tasks down into steps.

2. Use a Social Story™ to explain the need for good hygiene.

3. Use flushable toilet wipes to help them clean themselves independently.

 

May avoid washing their hands after being to the toilet.

 

1. Establish a routine.

2. Use Visual Schedules to add structure and predictability through preparation.  This may include ‘now’ and ‘next’.

3. Use Visual Schedules to break tasks down into steps.

4. Use a Social Story™ to explain the need for good hygiene.

5. Use a Social Story™ to explain hygiene rules.

6. If they struggle with the scent of certain soaps/hand wash allow them to choose their own or try different products until you find one they can tolerate.  Maybe try unscented or low scented products.

 

May have little understanding of hygiene rules.

 

1. Use Social Stories™ to explain hygiene rules such as breaking wind, not talking about urine/faeces in front of strangers, not being naked in public, nose picking, not putting hands down pants etc.