Does your autistic or Asperger’s child fight you when you want him/her to shower, or change their clothing? Do they avoid brushing their teeth unless forced to? Is a trip to the barber shop for a haircut a struggle? They may be experiencing sensory difficulties associated with these everyday tasks. Understanding where the difficulty is stemming from can help you to work through some of these issues.
Sensory Processing Disorder
Many autistic children experience difficulty with sensory processing; sensory processing dysfunction (SPD). Their sensory systems are in a constant state of overdrive. The world around them can be over-stimulating and over-whelming. Their hyper-senses can be troublesome even when faced with the seemingly simple everyday tasks of personal hygiene and grooming.
Your child needs many reminders to brush his/her teeth; they may be simply forgetting, or they may be avoiding brushing like the plague. For many autistic children brushing teeth can be a painful experience. First the toothbrush may actually hurt. The brushing up and down, and side to side, can feel like someone is scouring your gums with steel wool—even when the bristles on the brush are soft. Brushing ones tongue is even worse, like sandpaper trying to scrape your skin off, and an enhanced gag reflex (when sensitive in this area) is most often triggered when the tongue is touched. Additionally, the taste or smell of the toothpaste may make the child gag, and brushing with cold water may feel like being punched in the mouth. Overall, a painful, unpleasant experience that most neuro-typical, person without autism, do not experience.
Standing under the flow of a shower head can be a similar experience. The water flow and temperature are usually an issue for persons with sensory processing difficulties. On particularly sensitive days the water flow can feel like “shards of glass” tricking down onto your skin—unnerving at best, and painful at worst. A soft shower flow is typically worse for the sensitive child than a powerful flow. It is very similar to the difference between a soft touch and a firm squeeze. Autistic people tend to shy away from a soft wispy touch like when someone lighted brushes their arm, but are comfortable with a firm hold. In addition to the shower flow, due to temperature regulation issues, the water may constantly feel too hot, or too cold.
Face and Hair Washing
If the child is avoiding washing their hair in the bath or shower, it may be because of the flow of water over their faces. This waterfall over their eyes and mouths can cause a feeling of panic. In addition to the possibility of soap reaching sensitive eyeballs, the water running over the nose can give you the feeling of not being able to breathe. Even when they are tolerating showers fairly well, washing hair, and allowing water in their faces from a flowing source can be problematic.
Getting a Hair Cut
The barber shop is a scary place. There are strange people, loud sounds, and buzzing noises that are getting increasing close to your head. A stranger is approaching with a pointy metal object and you are being held down by someone larger than you in order to be “kept still.” The scissor is cold, and making a “scraping” sound and feels like someone is running nails down a blackboard, and the buzzing is making your teeth hurt. The buzzer gets closer, and now your head is vibrating from the movement in addition to the sound. Sound scary? It is for the autistic child. These sights and sounds that you may be accustomed to, or not even hear are amplified to your child’s ears. It feels like the whole world is being played in surround sound, even when no one else hears the noise.
Why Didn’t They Tell Me?
They simply think that you already know. These sounds and sensations are a part of their everyday lives and it does not occur to them that everyone does not experience life the same way—an example of “mind-blindness.” The assumption is that you feel the hurtful water, taste nauseating toothpaste, and hold your breath when you wash your hair. They also may not be able to pinpoint or articulate what they are feeling easily. But—now that you know, there are some things you can do to help.
What Can I Do?
Understand; understanding what your child could be experiencing will help you find ways to make their lives easier—and yours as well. No one enjoys a power struggle over tooth brushing. Be willing to try new products. Try changing the toothpaste; you may need to go through many flavors and textures to find one that is tolerable. Use different toothbrushes; some children will find that soft brushes work best, while others will want the firm feeling. Don’t require them to brush their tongue if it is uncomfortable. Experiment with both hot and warm water when brushing, or you can even try finding a watery toothpaste and brush without water rinsing with a children’s mouthwash that they enjoy. Allowing a bath when possible in lieu of a shower can help. The water will be a more consistent temperature and there is no rain from above making the bath more comfortable and soothing. If a bath is not feasible, ensuring the temperature of the water and the room is as consistent as possible. The smell of shampoos and bath soaps can be a source of soothing and comfort for some, and having the choice their own scents can make bathing more enjoyable.
Distinguishing between disobedience and avoidance can be a challenge. If your child has developed a habit of avoiding these tasks due to the unpleasant way they are experiencing them, it may take a while to eliminate this avoidant behavior. They many need multiple reminders and encouragement to take the initiative where their personal hygiene is concerned. Use frequent reminders or a list so your child knows which tasks to perform every day. A chart and reward system can also help to remind and motivate them. Behavioral, occupational, and sensory integration therapies can help when needed.