- May have motor difficulties which affect individual’s ability to manage buttons, zips, laces etc.
- Difficulties in planning and sequencing so unsure of what order to put on clothes.
- Difficulty in making choices about what clothing to wear.
- Tactile sensitivities meaning that child/young person refuses to wear some clothing e.g. school uniform.
- Slow to get dressed so parent/carer dresses child, thus creating a learnt dependency.
- Set clothes out in left-to-right or top-to-bottom sequence so child/young person can put clothes on in correct order.
- Use a photograph or symbol sequence to show order in which clothes should be put on.
- Visual instructions using symbols
- Written instructions
- Allow child/young person to dress independently when there is more time available e.g. at weekends. In school, set aside a specified time to teach dressing.
- Avoid teaching independent dressing when there are time pressures e.g. child/young person needs to be dressed in time for school bus.
- Teach child/young person how to dress independently one item at a time rather than trying to teach all items at the same time. For example, once the student can put on jumper independently, teach him/her how to put on trousers.
- Teach simple garments first (e.g. T-shirt, trousers) and leave more complex skills until a later date (e.g. socks, tying laces, tying a tie).
- If the child/young person has motor difficulties, consider easier options e.g. Velcro instead of laces, elastic school tie.
- Provide visual cue demonstrating clothes which are worn on warm days, and clothes which are worn on cold days.
- Link to specialised clothing.
2. Hair cutting
- Does not understand why hair needs to be cut.
- Dislikes the physical change of hair being cut.
- Dislikes concept of any part of body being ‘cut’.
- Tactile sensitivity may cause hair cutting to be experienced as painful.
- Auditory sensitivity will cause child/young person to dislike noise of scissors or razor.
- Child/young person may experience sensory overload in busy hairdresser/barber.
- Use social narrative to explain why hair needs to be cut.
- Use a photograph or symbol sequence to show order of steps at the hairdressers.
- Visit hairdresser frequently for trims rather than significant hair cuts. This means shorter times spent in the hairdresser, and also means that the physical change will be less significant and noticeable.
- Frequent visits to the hairdresser/barber also allows the child/young person to desensitise to getting hair cut more easily than only going to the hairdresser every few months.
- Provide proprioceptive input to keep child/young person calm while getting hair cut. Examples of deep pressure input may include weighted lap cushion, squeezing stress ball, chewing gum, dried fruit or chewy tube.
- Identify a hairdresser who will come to the house as this will avoid the sensory overload in a busy salon.
- Desensitise child/young person to hair cutting by gradually introducing the individual to the hairdresser’s or barber’s.
3. Head Lice
- Anxiety due to lack of understanding about head lice.
- Limited tolerance of treatment methods due to tactile sensitivities e.g. cannot tolerate sensation of comb or repeated hair washing.
- Sensitivity to the smell of treatment shampoos.
- Use a social narrative to explain about head lice, emphasising that they will not cause pain or harm.
- Use a social narrative to explain how to treat head lice.
- If the child/young person is capable of carrying out their own research, encourage them to find out about head lice and treatment methods so they feel a sense of control over what is happening.
- Use a visual timer to indicate how long hair is to be combed.
- Comb hair for short frequent episodes rather than one lengthy session.
- Provide proprioceptive input to help keep child/young person calm while combing hair e.g. weighted lap pad, stress ball, chewy food or item.
- Provide a distractor while combing hair e.g. TV, iPad, favourite activities.
- Keep room well ventilated if there is a sensitivity to the smell of the shampoo and use a favourite smell e.g. scented candle
4. Nail cutting
- Anxiety at the idea of a body part being ‘cut’.
- Lack of understanding about why nails need to be cut.
- Tactile sensitivity to input to hand/foot, which can be perceived as painful.
- Some children/young people may prefer to have one nail cut each day rather than all 10 finger nails and/or toe nails cut at the same time. However, others may prefer to have all cut at one time.
- Use a visual card to show how many nails will be cut.
- Parent/carer should hold hand/foot with firm pressure when cutting nails as this is more calming that light touch input.
- Child/young person may wear a glove or sock (with toes/fingers cut out) to reduce tactile input when hand or foot is being held.
- Avoid using word ‘cut’ and instead say nails are going to be ‘trimmed’ or ‘shortened’.
- Allow child to cut own nails as soon as he/she is capable of doing so safely as this makes the tactile input predictable and within the child’s control.
- Use social narrative to explain why nails need to be cut.
- The young person with autism may not understand the importance of relaxation for overall physical and emotional wellbeing.
- The young person may not be able to identify and differentiate between feelings of stress and feelings of relaxation. He/she may not recognise when they are stressed and in need of relaxation.
- The young person may not be aware of which activities are the most relaxing for him/her and may have to try several different activities and resources before identifying suitable choices.
- The young person may only use relaxation activities when in a high state of anxiety, by which in time it may be too late as he/she has already reached crisis point. They need to view relaxation strategies as activities which should be part of their daily routine to prevent a build-up of anxiety.
- The young person may find it difficult to generalise relaxation strategies to different settings e.g. home, school, relatives’ houses.
- Teach and explore with the young person what ‘stress’ and ‘anxiety’ feel like e.g. increased heart rate, changes in breathing rate, sweating, inability to concentrate, feeling a need to escape.
- Teach and explore with the young person how to recognise when they are relaxed e.g. slow and even breathing, muscles are not tense, no feelings of nausea or panic.
- Give the young person the opportunity to explore a broad range of relaxation activities and resources to determine which will be effective for them.
- Relaxation activities will be individual to each person but some ideas include cardiovascular activity, progressive muscle relaxation, breathing exercises, mindfulness, use of scented candles, favourite music, reading, art and craft hobbies.
- TV, computer games, use of iPad etc are sometimes considered to be too stimulating. However, for some young people these activities offer a form of escapism and enjoyment which is relaxing. They can therefore be built in to the daily routine but should be time limited and avoided in the hour before bed.
- Solitary activities tend to be more relaxing for most people with autism as social interaction is often stressful.
- Allocate time for relaxation on a daily schedule to prevent a build-up of anxiety. Relaxation strategies will be particularly important before and after potentially stressful events e.g. relaxation before school, relaxation breaks in school, relaxation after returning home from school, relaxation activity before/after a social event.
- In addition to planned relaxation activities, the young person will need a range of strategies which he/she can use if there is a sudden incident which causes stress. An individualised ‘stress kit’ can be put together for the young person, containing resources which he/she has identified as relaxing e.g. tactile and fidget objects, photos of favourite people or pets, scented oils, stress ball. This kit should be portable so they young person can take it to any setting.
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