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Teaching Self-Care Skills to Kids with Autism

Dr. Mary Barbera

Many parents and professionals struggle with how to teach kids with autism activities of daily living. Activities of daily living include how to dress, how to shower, how to wash hands, and how to clean up for meals for instance. So today I want to talk about how I learned through this book, Activity Schedules for Children with Autism, and how you can create little books to make self-care skills and other daily living skills a lot easier to teach.

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What are activities of daily living?

I have done some video blogs in the past on things like teaching shoe tying which you can check out on my YouTube channel. I haven’t done a whole lot of videos though about how I taught Lucas and how I taught other clients how to dress, how to wash their hands, how to use utensils and all kinds of independent living skills, specifically, activities of daily living that often get in the way. I didn’t say it in this video introduction, but in addition to being a behavior analyst and an autism mom, I’m also a registered nurse and in the past as when I was a practicing registered nurse on a medical-surgical unit in a rehab setting, I always worked with neurologically impaired patients who oftentimes had strokes or head injuries or brain tumors. They had to learn or relearn a lot of things, like how to talk, to walk, to toilet train, to use utensils, and various other activities of daily living. And so a lot of my self-care practices that I now disseminate through my online courses and community are based a lot on my nursing background.

Task analysis: break down daily living activities

I have a couple of examples that I want to talk to you about. So one time I was in a verbal behavior classroom and it was early on, so this is probably 2004 or 2005. I was in a few classes and I went to this one class and it was an older child life skills class so not all the students in there had autism. In fact, a lot of those students didn’t have autism. They had other disorders like down syndrome.  I remember we were talking about this 14-year-old girl with down syndrome and the teacher was kind of upset because here we are going in and some of the other consultants were using words like the discriminative stimulus or the mands and tacts and these things were not in this 14-year-old’s IEP.
And so the teacher was getting really upset. She was an older woman and she looked at me the one day and she goes “that’s not in her IEP.” Not that she didn’t care, but she just felt like we weren’t working on the things that she wanted to work on. So I said to her, “okay, so what do you want to work on?” And she said, “well, in her IEP there is a goal for her to set the table.” Okay, we can work on that because ABA is the science of changing socially significant behavior. Setting the table for a 14-year-old with down syndrome is a more than appropriate goal. So I helped the teacher and I said, “okay, let’s talk about setting the table. Can she do any parts of setting the table?”

And she was a little iffy on that. So I said, “okay, so now we have to decide how we want her to set the table before we just try to teach her.” So do we want her to carry all 4 plates over at a time? Do we want her to gather the 4 plates and the utensils put them on top of the plate and carry it over? And she looked at me like I have no idea. I’m like, okay, well let’s decide and then let’s teach her the steps of setting the table. So everything can be broken down and everything, especially when you’re talking about self-care, leisure activities, vocational tasks and chores are chained procedures that shouldn’t involve a lot of talking. It should involve shaping and chaining and reinforcement so that the child is eventually doing it on their own, which are different techniques than what we teach. What I teach within my book, The Verbal Behavior Approach, for instance, is all really language development except for chapter 11, which talks about potty training and hand-washing. In that chapter, I do talk about a task analysis of writing the steps down to something.

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Another example is when we went to teach Lucas how to use knives and forks, so how to cut a chicken tender up. Because I’m his mom, the behavior analyst that was working on this goal came to me and said, “okay, we want to teach Lucas how to cut up his chicken. How do you cut up your chicken? How does his brother cut up chicken and then how does his therapist cut up a chicken?” It was amazing. There were some people who went through the tongs, some people who turn their fork over and cut, and some people who kept their fork positioned differently and started to cut.
So we need to break down the skill into a task analysis. All activities of daily living can be broken down. In my book in chapter 11, I break down the steps of hand-washing for instance. Another pivotal point in my journey with Lucas and trying to teach him some of these skills was when I read this book, Activity Schedules for Children with Autism, by Lynn E. McClannahan and Patricia J. Krantz, which is a very old book. This book was written in 1999 so it’s 2 decades old, but it is a very good book. It basically shows you how to set up activity schedules.

Create activity schedules that show each step in the routine

I also went on to create little books for Lucas. One of the books I show in the video is his morning book. He still uses this book even though he knows the routine. This helps if there’s me versus my husband versus another paid worker here that it is Lucas’s routine, not the way I would do something. So it just basically goes through the steps. Take your medicine, get out your turkey bacon, get your water out, put the bacon in the microwave for 2 minutes and see this is really helpful. Eat, clean up, wipe off the counter, and sweep the floor. He does that. In fact, we had a how to do wash book and when my younger son Spencer was going to college, he’s like, where’s Lucas’s little washing machine book? Because this can help anybody live independently through basic activities.
It can help you teach kids how to make a sandwich or to learn a whole routine that’s part of their activities of daily living. For Lucas, we put whole routines in here. We have a book for bedtime routine and when he gets a shower too. Some of the steps in that book help him floss his teeth, brush his teeth, and shave. All of these techniques really help. You can also do a fitness routine so you can do like 10 minutes on the treadmill, then lifting weights, whatever you want, you can put in little books. This has really helped with Lucas’s independence and he is very familiar as we teach him new routines.

If he gets a job, say as a janitor someday we can break down the tasks and we have in terms of like how to clean the bathroom or how to clean off the counter. It’s just a matter of breaking down the steps for the routine or self-care tasks. If you are going to use any kind of language make sure you use, for each step, five words or less. And make that language consistent. I do show that in the shoe-tying video that is on my YouTube channel as well. I break down the task into five words or less for each step, and then I fade out that language eventually too.

So hopefully you’ve enjoyed this video/article on how to increase self-care, teach life skills for autism, and help make activities of daily living a routine for children with autism with these little books. If you liked it, share it, give me a thumbs up, leave a comment, and if you’d like more information about joining my online courses and community where we can really help you help your child or clients get to the next level and reach their fullest potential, you can attend a free online workshop at marybarbera.com/workshop and I hope to see you right here next week.

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