This is the first article in a series on teaching children daily life skills. Our goal is to give autistic children skills that will allow them to be independent adults. In this article, we will go through the steps to teach a child with autism how to shower.
Here are some practical tools on how to teach a child to shower independently. Everyone can use these tools, but they are mainly intended for children with autism.
More (upcoming) in the series: potty training, independent dressing, and feminine hygiene.
Showering is a complex process. It does not come easily to children with autism. They have difficulty remembering to perform all the actions while being overwhelmed by sensory processing disorder in the shower.
How to Teach a Child with Autism to Shower
When children are very young we do hygiene activities for them: bathe, change diapers, etc. Most children learn over time spontaneously or by a relatively short period of teaching by the parent how to bathe themselves and wash their hair.
Around the age of 6, most children become independent. You can gradually let them bathe on their own.
For children with a problem understanding instructions, such as children with an autism spectrum disorder or children with an intellectual disability, this does not always happen naturally.
And so, we must create a routine for them through repetition. Repetition (sometimes over many years) ingrains the ability to carry out hygiene actions independently.
What Prevents a Child with Autism from Learning to Shower Independently?
There are several possible reasons for difficulty in acquiring skills:
The child may not be able to remember the actions, or there is difficulty in retrieving the memory. ADHD is a common problem in children with autism. Along with the different autistic ways of thinking, they are not always organized to learn such skills effectively.
In addition, it is likely that the senses get overwhelmed by everything that happens while bathing. for example:
- The sound of running water can overwhelm the sense of hearing.
- Hypersensitivity to touch can make even the touch of a soft sponge really painful.
- The smell of the soap can induce nausea.
- They don’t always understand how to adjust the temperature to be pleasant.
These and more, make it difficult to acquire this skill. Accurate observations will be needed to learn how to help a child with autism learn to shower.
It is advisable to do trial and error to understand.
Using Routine for Teaching a Skill
A routine can be used to guide the child to perform the series of actions required to complete a process. Eventually, the full process is performed automatically and independently.
It might take a long time to help the child perform all the actions independently. The child performs the actions through mediation time and time again, until he begins to perform them automatically.
As part of the mediation, you can hold and guide their hands in the actions.
Reinforcements can be given for the correct execution of the entire process or parts of it.
Tools for Success in the Routine Method
Some children with autism need dry preparation before real shower practice. Practice performing the actions outside the shower. There’s no one plan that will fit everyone. Here are some tips to pick and choose from:
Prepare a social story (a story with pictures that demonstrates what is happening).
Place a laminated navigation card (order of actions in the pictures) in the shower. Here’s an example on Amazon.com.
If it suits you, you can even sit in the bath with them (in a bathing suit is okay). Show them how to use a sponge first on you and then on them.
Keep in mind that learning these skills independently may be a very long process. Some may be partially independent, some fully, but some may never learn.
The main thing is to try and let them have as pleasant an experience as possible.
I found that using a song was helpful. I picked a consistent chant on which I changed the body parts that need to be scrubbed now.
How to Deal with Sensory Processing Disorder in the Bathtub
A bathtub might be easier to work in it than in the shower. The noise of the flowing water, and the touch of the stream on the body, may overwhelm the senses. (Some children will feel the opposite, so pay attention to their sensory profile!)
If your child is willing, use a washcloth. That might help. Otherwise, pour a little soap into his hands at a time.
Let them experiment until they actually wallow in the soap over an extended period of time. (Every once in a while, let them pour soap by themselves or with help and let them feel the substance).
I used to buy fancy whipped cream soap because it was pleasant for them. However, even cheap soap of the kind sold in gallons will do. There will probably be more soap than water in the bath at times.
Put a little soap on a sponge or cloth and lather. Take the sponge and gently rub only their hands. At first with help, and later let them play with it alone. While they play, we can quickly wash everything else ourselves.
You can also sing “This is the way we wash our hands” or any song you like.
Work gradually and patiently
Every time we work another body part into the routine, we also add it to the song.
Today, for example, I told Dolev that we were washing our hands and arms. I also demonstrated the process on my arms. I told him to wash the inside and the back of his hand. Then when we moved on to the arm, I demonstrated washing the arm from the outside, the inside, the armpit, and so on.
It took me years to reach this stage with Dolev, my eldest, who is now 7 years old. He is moderately functional, and until recently did not really understand instructions.
Nevo at 4 years old, simply refuses to cooperate. He is still in the stage of wallowing in soap. I’m really okay with that. Because I recognize his difficulties, I set goals accordingly.
[This article was originally written in 2020. In July 2021 Dolev underwent his fourth stem cell therapy. Within a month he became completely independent in the shower at the age of 8.]
The Bucket and Washcloth Method
For children who refuse to enter the water: try the “Bucket and Washcloth” method. In this method the child doesn’t get in the water. The method is easier to do in the shower or bathtub.
Take 2-3 buckets and fill them with warm water that is pleasant for the child. Take a washcloth for lathering and a cup for washing. Or alternate 2 washcloths, for washing and lathering.
We will use one bucket for washing and the other for soap. Soak one cloth in water and add soap. Lather up the child’s body while adding warm water and soap from time to time. Don’t put soap on their faces.
You can start with one part of the body, wash and continue. You can even start with the child dressed for those who also find it difficult. After lathering, we will use a clean cloth to wash off the soap. If we use a cup of water, we also dry the area.
We work from the face and hair downwards of course. If hair is not urgent then we can skip it.
With the help of another adult, the child’s head can be tilted back. This way, the water does not touch the rest of the body.
You can sit on a chair during to make the process easier for the child.
Dealing with Refusal to Enter the Water
A common reason in autism for refusing to shower can be due to a sensory processing disorder. The child might be hypersensitive to the touch of water. But it can also be psychological – meaning fear or reluctance.
Either way, you have to try to make the washing experience positive.
To help the child with autism overcome fears, try to make shower time fun. Use a variety of bath games to try to make the bath more exciting.
Another issue might be with transitions. The transition between the preliminary activity and bath time may not be clear enough. For children who have difficulty, use a variety of tools to ease the transitions:
- Use one consistent song to symbolize the transition. We use a Signing Time bath song (minute 22:40).
- Put bath time into a visual schedule for the evening routine.
- Before you start, make a “forecast.” Inform the child that the preliminary activity is about to end and that in five minutes we will go to the bathroom.
Conclusion – How to Teach a Child with Autism to Shower Independently
To teach your child with autism to shower independently, try the tips I detailed in the article:
- Observe your child to understand their sensory profile. What makes them recoil from the bath? What is pleasant for them?
- Set practical and measurable goals for yourself. Don’t expect your child to suddenly be able to take a shower independently.
- Work consistently and patiently to achieve one goal before setting a new goal
- Give the child games and time to enjoy being in the bath. Avoid pressure to take a quick shower and go to bed. It is important that they feel comfortable in the bath before starting to work.
- Create a visual evening routine schedule that includes bath time. Announce a few minutes before you start the transition to bath time.
You are welcome to reply in the comments. Have you used similar tactics? Do you have different tactics that worked for you? There is no right or wrong in this process. Just try to maintain a healthy and repetitive routine for them and a lot of positive atmospheres.
It takes a village to raise a child
I recommend looking for support groups with experienced special needs parents. For this purpose, we have opened another Facebook group for parenting skills. This is in addition to our Stem cell therapy support group for families looking for information about the treatment based on umbilical cord blood or stem cells. Both of these groups are mainly for Hebrew speakers but you are welcome to join if you think it can benefit you.
For those who are not active on Facebook, join our silent WhatsApp group, where you will receive notifications about events we organize. Again most of these will be in Hebrew, but you can catch the odd English lectures. You can find recordings of these on our youtube channel.
The Autism Essentials Israel blog is written by Hagai and Shira Reiner, two parents of children with special needs – autism, epilepsy, and more. We focus on the essentials of raising special needs children in Israel, but much of our content will be relevant globally
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