As children grow, their care routines gradually shift from their parents’ realm to their own. From brushing teeth to making a bed, the steps involved in common self-care tasks aren’t always obvious to a child with autism. That’s why Board Certified Behavior Analysts and ABA therapists at Gateway Pediatric Therapy teach individuals self-care activities they will carry out for the rest of their lives.
“Self-care includes a wide variety of daily tasks, such as dressing, bathing, and preparing meals, all of the activities we need to be able to do in daily life to be as independent as possible,” explains Shantinique Jones, Assistant Clinical Director at Gateway Pediatric Therapy in Owosso, one of 10 Gateway Pediatric Therapy locations in Michigan. “We work with individuals in a way that is tailored specifically to their skill level, current needs and home environment.”
Start with the most important skill
While a younger child might not need to know how to do laundry, they do need to learn to use the bathroom independently, Jones says. “Regardless of age, toileting is an important self-care activity that can provide an individual with a sense of independence, and decreases reliance on a caregiver,” she says, adding that parents can develop greater peace of mind when they know their child can use the bathroom in a variety of environments without needing support.
In addition to the important skill of toileting, ABA therapists at Gateway Pediatric Therapy target other self-care skills based on the priorities of the family. “We talk with parents and the family to learn about overall expectations of the household,” Jones says. “If the family is not ready to focus on how to do laundry or wash dishes, we talk about other areas of self-care that might be important. We ask what a child can learn in the environment to make them more independent and to help the family as well.”
These choices involve selecting activities that fit with the child’s skill level, then breaking down the task into more manageable components. Learning how to wash dishes, for example, starts with a list of all the steps needed to get the job done. “This includes all the prep work, like plugging the drain, adding water to the sink, adding soap and finding a sponge,” Jones explains. “We break it all down and if there are 10 or more steps, that can sometimes be overwhelming.”
As a starting point, the Behavior Analyst will assess what the individual is able to complete on their own and build from there. “Depending on the tasks or the individual’s skill level, we might help them complete all the steps. It’s a balance of allowing them to practice independently and jumping in where help is needed. We might point to the plug if they forgot to put it in, and then we step back,” Jones says.
Mastering the skill
Where possible, practice helps solidify the process. Once a child begins to build the skills needed to complete the task, they may even learn that the steps can be carried out in a different order. “When we are first teaching a self-care skill, there will be a set order. Then, as they build an understanding of the process, they learn they can choose a different way to do something that doesn’t affect the outcome,” Jones says.
It may be helpful to have each stage of the task listed — with words or pictures — as an aid to assist the child as they learn. “We will do a task analysis and take data on the individual steps as the client practices. Maybe handwashing is 12 steps, so the technician will record that they did one step on their own or skipped another step,” she explains.
How parents can help
Continual communication from parents helps therapists not only prioritize which self-care skills are most important for the family and the child, but also helps everyone work on skill development across different settings, which is key to independence.
“If a family wants to work on handwashing, we all need to practice this goal across environments. If we recognize that a child starts to scrub their hands on their own for five seconds, that’s great feedback that we share with parents so they are aware that their child is still learning but doing some things on their own. The family can have the same expectation at home, and they can communicate this with grandparents and across all the different environments where a child would wash their hands,” Jones explains. “Everyone can do their best to have the same expectations.”
With some aspects of self-care, Jones encourages parents to look to the future. Maybe parents do laundry for the child now, but what about when they are grown? “Where would you like to see your child in five years? What would you like them to be able to do on their own? It’s important to explain that it can take longer to learn a task, so it might be good to work on it now,” Jones says. “People don’t always realize how long it can take. It’s desirable to learn in the natural instances of carrying out a skill. If we are teaching laundry, there are only so many times we can do laundry in a day, so this might take longer to learn.”
Gateway Pediatric Therapy offers best-in-class ABA therapy services at 10 locations in Michigan. Visit gatewaypediatrictherapy.com.