Self-care skills: Toward independence in dressing/undressing for autistic children

Occupational therapists are trained in analysing and assessing multiple domains of activities including productivity (Work/volunteering), leisure (hobbies, interests), and self-care (hygiene, grooming) activities. Together, these different categories of occupations make up our daily habits and routines. 

Occupational therapists may often observe your child completing a challenging task. This is to better understand your child’s strengths and challenges, the task environment as well as the complexity and steps of the task itself. Through this clinical observation, occupational therapists create intervention plans to optimise the “fit” between the child, task and environment in order to promote independence and participation in a specific activity.

A BCBA/psychologist is trained in learning and behaviour. By that, we mean breaking down skills into small, teachable steps and using what motivates the child to teach these steps. Learning opportunities should be fun and engaging so that your child will be motivated to participate in the learning process. Similar to an occupational therapist, a BCBA/psychologist may observe your child completing a task that they find challenging to assess which components of the task your child can do and which components are difficult. 

One example of a potentially challenging self-care skill is dressing and undressing. For many children, this can be a tricky skill to master due to its complexity and the physical and cognitive demands required to effectively complete this. 

Getting dressed may seem simple, but there are many components that make up the task.

Getting dressed involves:

• Planning (what to wear, which items go first)

• Initiating movements (Starting the task and sequencing the steps)

• Bilateral Coordination (Using both hands to pull pants up, buttoning up a shirt)

• Gross and fine motor skills (Balancing, postural control, finger isolation and control needed for zips/buttons). 

• Attending to the task (Remaining focused whilst getting dressed, especially if other distractions are present in the environment) 

• Working Memory (Remembering the steps and the order in which they need to take place)

• Visual attention (picking out a pair of socks from a full drawer)

…And those are just a few examples of the building blocks that go into completing this self-care task! It’s no wonder that for many children this task can become a tricky and frustrating part of their daily routine.

The Importance of Encouraging Independence

In order to support children’s autonomy, self-esteem and self-confidence, it is important to work towards promoting independence in dressing and undressing themselves. This often takes time and patience for parents, as it can be tempting to assist with difficult tasks when rushing to get ready or when your child becomes frustrated by a particularly challenging task. However, by consistently jumping in and helping when getting dressed becomes difficult, your child may miss a great opportunity to learn and further develop their skills. 

How can Occupational Therapy and/or BCBA/Psychology services Help?

At Acorn, our clinicians can observe your child completing self-care tasks like dressing/undressing and assess what is making the task so difficult.

The clinicians can then make suggestions to either modify the task (dressing/undressing), environment (clothes being worn, bedroom, people present) or the underlying physical or cognitive components (e.g. motor skills, working memory, sustained attention). 

In practice, this may involve making the task more simple by first practising with baggy or stretchy clothes before gradually increasing the difficulty. This ensures that your child is engaged and motivated to complete the task, as it is not too challenging, nor too easy for their capabilities. Focusing on the underlying components may involve improving fine or gross motor skills through games and craft activities or practising cognitive strategies to promote skill acquisition.

The clinician may also break the task down into small teachable moments. For example, pulling up trousers may be broken down into:

1. Putting left foot in left trouser leg

2. Putting right foot in right trouser leg

3. Grasping left side of waistband with left hand

4. Grasping right side of waistband with right hand

5. Pull trousers up over legs and bottom

We may also try to find things that are extra motivating for your child. We can then focus on supporting your child to complete one step of the task at a time and slowly work towards them completing more steps on their own. To do this we may provide physical support such as hand-over-hand guidance, modelling, pointing prompt or verbal prompts. We also ensure that there is a positive outcome for your child when they complete the steps so they are motivated to be more independent with the task in the future. 

Tips for Independence at Home

Here are some easily implemented strategies to try at home in order to promote independence with dressing. 

• Visual schedule- Many children with ASD have stronger visual processing skills than auditory processing. Having a visual guide which breaks down the steps for dressing can reduce the cognitive load, thus making the task easier. 

• Wearing stretchy/baggy clothing without buttons/zips. This can reduce the fine motor skills needed to dress/undress. Over time, clothing with zips/buttons can be added to increase the difficulty. 

• Creating a routine- Similarly to a visual schedule, practising dressing/undressing in the same order and with the same verbal cues can aid independence.

• Ensure clothing is comfortable for your child. Some children with ASD have sensory processing difficulties which make certain materials or clothes very uncomfortable. See the blog post on sensory processing for more information. Clothing that is comfortable for your child’s sensory needs is more likely to motivate them to practice dressing/undressing themselves. 

• Breaking the skill down into each step that is required and focussing on teaching one step at a time

• Consistency- Encourage your child to attempt to dress themselves whenever the opportunity arises. Start fostering independence so that it becomes a habit for your child. 

• Provide help, only when your child needs it and slowly fading out the support you provide. Initially you may need to hand-over-hand support your child to do the step, but you should be able to fade this support as your child becomes more confident at the step. 

• Make it fun and have a positive outcome. This is going to be specific to what your child enjoys. Perhaps your child can leave the house to go to the playground after getting dressed or perhaps they’d like tickles or lots of praise for doing well. What motivates each child is different and you know your child best!

Contact Acorn Autism for more suggestions and specific recommendations for your child.