Learning personal hygiene presents a particular challenge for many autistic children. Sensory sensitivities (water on the skin, toothpaste sensation, towel texture), fine motor difficulties, resistance to imposed routines, and challenges in understanding action sequences can turn bathing or tooth brushing into stressful moments. However, acquiring these skills is essential for independence and social integration. This guide offers tailored strategies to gradually teach hygiene routines.

Understanding the challenges related to hygiene

The hygiene difficulties of autistic children are not due to unwillingness. They result from several factors related to autistic functioning. Sensory peculiarities play a major role: water may be perceived as too hot or too cold, the shower spray may be unpleasant, toothpaste may have an unbearable taste or texture, and the rubbing of the towel may irritate.

Difficulties in planning and sequencing (executive functions) complicate the steps of a care routine. The child may not know where to start, forget steps, or struggle to transition from one step to another. Low body awareness (interoception) may prevent the child from realizing they need to wash or that they are dirty.

Bathing and showering

Adapting the sensory environment

Start by making the bathing environment as comfortable as possible. Test the water temperature with the child to find the one they tolerate best. Some children prefer bathing (controlled immersion) to showering (unpredictable spray), and others the opposite. The lighting can be dimmed if the bathroom light is too bright. Fragrance-free toiletries or those with an acceptable scent for the child are preferable.

Structuring the routine

A visually structured bathing routine helps the child know what to do and in what order. Create a visual sequence displayed in the bathroom: photos or pictograms showing each step (undressing, entering the bath, getting wet, soaping the body, rinsing, washing hair, rinsing, getting out, drying off, dressing). The child can check off each completed step.

The regularity of bath time (always at the same time, in the same context) creates reassuring predictability. Announce bath time in advance to avoid surprise. A visual timer can indicate the duration of the bath, helping the child accept getting out when time is up.

Tooth brushing

Specific challenges

Tooth brushing is often one of the most difficult care tasks for autistic children. The mouth is a particularly sensitive area. The taste and texture of toothpaste, the sensations of the brush on the gums and teeth, the noise of brushing, the gag reflex triggered by the brush at the back of the mouth: everything can be a source of discomfort. However, dental hygiene is crucial to avoid problems that would require even more difficult dental care.

Adaptation strategies

Experiment with different toothbrushes: manual or electric (some children prefer vibrations, others hate them), soft or medium, small head for less intrusion. Test various toothpastes: with or without flavor, gel or foam texture. Some children tolerate brushing without toothpaste better at first.

Gradual desensitization helps increase tolerance. Start by allowing the child to hold the brush, then touch it to their lips, then briefly put it in their mouth, then brush a few teeth, and so on. Each step is practiced until it is comfortable before moving to the next.

Other hygiene care

Hand washing

Hand washing, a gesture repeated many times a day, can be problematic if the child dislikes the sensation of water or soap. A visual sequence above the sink guides the steps. Choosing a soap with an acceptable texture and scent facilitates acceptance. Songs or nursery rhymes during washing make the moment more playful and ensure sufficient duration.

Hair styling

Brushing hair can be painful for children who are hypersensitive on the scalp. Special detangling brushes reduce pain. Starting at the ends and gradually working up avoids tugging. Offering the child the chance to hold the brush or style their own hair gives a sense of control.

Nail trimming

Nail trimming can be very anxiety-inducing. Desensitization (first touching the nail clipper, then placing it on the nail, then cutting one nail, etc.) helps progress. Trimming nails after a bath, when they are softer, is less unpleasant. Some children tolerate nail files better than clippers.

Teaching gradual independence

Gradual guidance

Teaching hygiene routines uses gradual guidance: the adult first helps completely (total physical guidance), then gradually reduces their help (partial guidance, then simple indication, then independence). This progression can take months or years depending on the child's skills, and that’s normal.

Forward or backward chaining

Chaining involves teaching a complex routine by breaking it down into small steps. In forward chaining, the first step is taught independently, then the second, and so on. In backward chaining, you start with the last step (the child finishes alone), then add the second-to-last, etc. Backward chaining allows for always finishing on a success.