Staying Clean and Healthy

Contributing factors include difficulties with:

• Sensory processing
• Changes and transitions
• Executive functioning
• Co-ordination difficulties
• Vestibular system challenges
• Lack of concern about what other people think

Whilst these difficulties may cause challenges, there are often many things you can try to help minimise or even solve some of these tricky issues. You may need to ‘think outside of the box’ and be prepared to sometimes do things a bit differently from the ways that are usually expected.

Sensory processing differences

Autistic people tend to have differences in their sensory processing system. This can mean that they struggle to tolerate some sensations – and may not recognise or be aware of other sensations.

For example, they may find the smell of certain soaps or deodorants unbearable – and might be oblivious to having body odour that others find unpleasant.

They may not notice their long toenails rubbing in their shoes – and find cutting their toes nails exceedingly difficult, due to high pain sensitivity.

They may not be aware that their hair looks or feels greasy – and find the sensation of water on their head or a hairbrush running through their hair to be intolerable.

They may not realise if they drop food down their jumper – and struggle to tolerate the sensations of wiping their jumper with a cloth or removing their jumper ready for the laundry.

They may not notice if their sanitary product has leaked and needs changing.

What might help?

• If you cannot tolerate the sensation of a shower may prefer to have a bath instead.
• If the texture of a flannel causes distress, try just using your hand to wash.
• Some people find the smells of some soaps, shower gels, shampoos and deodorants are too overpowering. If this is the case, try something more neutral.
• Some people are sensitive to certain washing powder or fabric conditioner – so you may benefit from switching to an alternative for sensitive skin.
• Some people love fragrances and buying a shampoo or soap that contains these might encourage a person to bath or shower more often.
• Try different towel materials to find something that is most comfortable. Some people may prefer a soft towel – some may prefer a coarser texture.
• Try cutting nails when you have soaked them in water, so that they are softer and easier to trim.
• Goggles could protect sensitive eyes from shampoo and water
• Think about distraction tactics that could help your toleration of sensations that might otherwise be unbearable. For example, listen to music or your favourite podcast whilst you are in the bath – or have fun playing with bath toys or soap suds with your autistic child.
• Minimise temperature variations when bathing.
• Think about how to make the bathroom environment meet your sensory needs – such as reducing lighting or noise levels or making sure the temperature is comfortable.
• Cut out tags and buy seamless socks and underwear, if sensitive to seams.
• Click here to view an article about Sensory Processing

Difficulties with changes and transitions

Many autistic people find it hard to switch focus from one activity to another. This is especially so if they are absorbed or ‘hyper-focused’ with an activity -such as their favourite hobby or interest.

This may make it hard for them to do things like bathing or teeth cleaning as often as is needed.

It is quite common for autistic people to struggle to initiate getting in the shower or bath and /or to dislike the change of sensation of going from dry to wet. However, it is also common to find that once they are in the shower or bath they struggle to initiate getting back out again – perhaps put off by the prospect of having to go from wet to dry.

Autistic people often have specific clothes they prefer – due to the comfort of familiarity and sensory sensation. This can result in them wearing the same clothes and /or shoes every day – rather than putting on something clean and fresh.  They may dislike putting things in the laundry as it may mean they have to go for a while without their favourite things to wear. It can also mean that they wear old favourites even when they are falling apart or are getting too small.

What might help?

• If possible, buy duplicates of your favourite clothes.
• For children, you could plan and buy a bigger size of their favourite item ready for them to grow into.
• Plan a routine of when and where your self-care activities will take place – include daily washing and teeth-cleaning, regular showers and /or baths, laundry.
• If you are supporting an autistic child or adult to do this, respect their autonomy and make sure to give them choices, rather than insisting on your own preferences.
• Make/use diaries, phone alerts or a visual timetable as a reminder of what you need to do / what to expect.
• Click here to view an article about visual schedules

Executive functioning difficulties

Many autistic people struggle to remember, plan, and organise when and how to do things – and this includes the types of activities that contribute to keeping clean and healthy.

This can lead to them not doing things as often as needed – such as washing, bathing, laundry, shaving, cleaning teeth, washing/brushing/cutting hair, cutting nails, changing sanitary products, applying deodorant, going shopping for hygiene products (e.g. soap, shampoo, toothpaste, sanitary products).

It may also mean that even when they plan to do something, they struggle to organise the best time to do it – and may also find it hard to get together everything they need.

So, for example a person may decide to have a shower first thing in the morning – not stopping to think that at this time the bathroom will be busy with other family members needing to clean their teeth. Or they might get in the bath and realise they have run out of shampoo or have forgotten to bring in their towel.

What might help?

• Make your personal hygiene activities part of the daily and weekly routine.
• Make a list of the things you or your child need to do – and plan when the best times will be to do them.  Try to keep the days/times regular and consistent.
• Use visual strategies as a reminder. You may need to experiment to see what works best for you or your child. This could be a visual timetable with photos displayed on the wall. You could use post it notes or a white board.  Some people use calendars or a diary – either paper or digital. Digital reminder systems can also send you sound alerts – which some people find helpful.
• If you or your child find it hard to remember the various stages of a task (e.g. showering, getting dressed, getting ready to leave the house) –– break down the task into simple steps and make a check list. Consider making a visual to remind you of the step-by-step stages – including what items you need to get ready.
• Use a 2-in-1 shampoo and conditioner to reduce time spent in the shower and less bottles to remember.

On Autism Space we have an article on Executive Functioning – it contains ideas of strategies and visual supports that can help. Click here to view the Executive Functioning article.

Click here for more information on Autism and Menstruation.

Co-ordination difficulties

Some autistic people struggle with co-ordination of their body movements – and may have features of developmental co-ordination disorder (also known as dyspraxia). This can make it tricky for them to do things effectively and easily – such as bathing, washing hair, cleaning teeth, changing clothes, folding/hanging laundry.

What might help?

• Do what you can to keep fit – such as eating healthily and exercising. This not only helps with co-ordination, but it also reduces fatigue and weight gain, which can otherwise contribute to poor co-ordination.
• Use the strategies that help with executive functioning difficulties to help you get organised for the activities.
• Think about any ‘life hacks’ you can do to make things easier – e.g. having somewhere to put your shampoo and hang your own towel that makes it easy to reach; having an easy to keep hairstyle.
• Try to do what you can by yourself – but do not be too proud to ask for help if you need it.
• If you or your child have significant co-ordination problems, consider asking your doctor for a referral to an occupational therapist or cognitive behavioural therapy
• Click this link for more information from the NHS about Dyspraxia

Vestibular system challenges

Autistic people often have poor vestibular system functioning. This can mean people often feel wobbly on their feet and suffer from gravitational insecurity (e.g., dislike of being upside-down, being suspended in mid-air or having their feet off the ground). Therefore, this could impact on bending forward over a sink or backward over a bath to wash hair or even just not feeling secure in a shower. Resulting in dizziness, anxiety, or mild panic.

What might help?

• If you have balance problems, consider a shower chair for use while washing hair.
• For added security use a bathmat in the bath/ shower to help with grounding.
• A secure non-slip towelling bathmat to prevent any slips on the wet floor when done.
• With hair washing, it may be that you need to adjust various aspects of the hair washing routine until you find the perfect combination that makes the task bearable (e.g. a jug in a bath with head tipped backwards, sat down with the shower head in one hand to have more control)

Lack of concern about what other people think

Whilst a lot of neurotypical people might be concerned about what other people think, it is common for autistic people to be less concerned what others think of them – and in many ways this is an admirable quality!

However, this may mean that to some autistic people, things like how they look, or smell can feel less important.  This may result in them washing or changing their clothes less frequently– which may cause offence or disgust to others.

What might help?

• Recognise that whilst you may not think you look or smell dirty, others may have a different opinion. This may be off-putting for them to want to spend time with you. This might make it difficult for you to sustain positive relationships, or to be treated respectfully whilst out in the community.
• Is there a trusted person in your life who would share their honest opinion with you on how clean you look and smell?
• If your child struggles to recognise that their lack of hygiene is off putting to others, talk to them about this in a way that avoids blaming and shaming them – but that also is honest about how this may cause them to be judged and treated negatively by others. You could consider making/using a social story (copyright Carol Gray) to help them understand and remember. Click this link to see more information about how to write a social story.
• Be aware that continually not taking care of yourself for some people may be an indication of poor mental health. If you think that this is something you could identify with, click this link to view an article about self neglect.

While a neuro typical child can usually master personal hygiene skills by the time they are age 10, autistic people often struggle with these tasks that are related to these skills. Therefore, they may require assistance with personal care for a longer period. Fortunately, as they become more familiar with the tools used for personal hygiene, these tasks will be much easier.