#069: Autism Self Care Skills: Potty Training, Sleep, Dressing & More
Self care skills, such as potty training and wiping, showering, sleeping and dressing are all best learned when you can set down a routine and stick to it; but these are also skills that are best learned when you’re at home for longer periods of time. That’s why today’s episode is all about autism self care skills and how to start teaching them! I’m going to briefly cover several skills, as well as give you a four step plan that is important to follow no matter which skill you decide to tackle.
Did today’s episode give you something to think about? Do you have a question for me, or a topic you would like to see covered in the future? Email me at [email protected]!
Mentioned in this episode:
— marybarbera.com/workshops (Sign up for a free online workshop for parents and professionals)
— MaryBarbera.com/join (free guide!)
— Potty Training Autism: Toilet Training Guide & Tips for Parents and Professionals
— #030: Autism and Sleep: How to Improve Sleep for Children with Autism
— Coronavirus Makes Teaching Hand Washing to Kids with Autism Even More Important
— No More Diapers: Potty Training Children With and Without Autism (Free E-Book)
— Stop Playing Musical Beds: Solving Sleep Problems in Children With and Without Autism (Free E-Book)
— Teaching Hand Washing (Video)
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You’re listening to the Turn Autism Around podcast, episode number sixty-nine, and I’m your host, Dr. Mary Barbara. I’m thrilled to be presenting today a Facebook Live session where I discussed self-care skills for children with autism and how to do those in your home as a parent, or if you’re a professional then helping parents how to teach children skills such as potty, hand-washing, showering, nose-blowing, shoe tying, you name it. I’m covering it. So I hope you listen. There’s a wealth of resources and links in the show notes at Mary Barbara.com/69. So I hope you like this session, teaching self-care in the home.
Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, behavior analyst and bestselling author, Dr. Mary Barbera.
This episode is all about how you can teach self-care skills in the home, whether you a parent or professional trying to help teach self-care skills. It’s actually, you know, most advantageous to do it in the home or at least to practice both in the home and the school, remembering that the parent is going to be the person in the child’s life in the long term. So it’s really not a help to be teaching these skills without parent involvement.
So as you know, the time of this recording is March of 2020. We are in hopefully the middle of a pandemic, but I fear that we might be at more of at the beginning, when many parents are at home with their kids unexpectedly. But if you are listening to this podcast episode in five years from now, I mean, who knows? You can use these same techniques to teach any self-care skills in the long term. A lot of these self-care skills like potty, for instance, potty training, I do recommend right out front that you should have like two to three weeks where you’re home a lot. So we’re home a lot right now and we can utilize this time.
But either way, whether you’re in the middle of a pandemic or whether you’re just, you know, have a week vacation from school, it really does make a lot of sense for a parent… unfortunately, it’s usually well, I don’t know about unfortunately, but it’s usually the mom. I mean, we do have a few dads in our online course, but I’d say 90 to 95 percent of our participants are female. They’re either moms, grandmoms and many, many professionals who are also mostly female, such as speech-language pathologists and OTs and teachers and therapists, which tend to be female.
I came up with this idea for this episode when some of my online participants started putting in our private online Facebook group for members of my online courses, they started writing in that they were, you know, very thankful that they had been a participant and my online course and that they were really thankful that they knew exactly how to teach her child because they had studied with me for a few months and in some cases a few years. And one person, in particular, said she was really going to utilize this time to teach her three-year-old to potty train. And I think that is a great thing. So we are going to talk about potty training. We’re also going to talk about, you know, I’ll briefly cover several more areas of self-care, including, like I said, potty training. We can cover how to teach wiping after a bowel movement or for girls. I’m going to gloss over how to teach sleeping in their own bed through the night. We can talk about dressing, grooming, things like hand-washing. We can also talk about how to wean from a pacifier or bottle, how to teach eating with utensils. And then for higher learners, higher level learners, I’m going to talk to to you about teaching, shoe tying, nose blowing and things like showering.
And all throughout this episode, I am going to be giving you a lot of resources that will be in the show notes of the podcast, and this will be episode number sixty-nine. So you can get all the resources that I’m talking about at MaryBarbara.com/69 once this podcast is live.
Before I get to each individual self-care task, I do want to give you four steps that are going to be important no matter which of these tasks you’re doing, and the four steps that we need are important. Now, if you’ve listened to other podcast episodes and Facebook lives or you’ve read my book, The Verbal Behavior Approach, or you’re in my online world in some capacity, you probably can guess the number one step for all of these tasks. The number one step for all of these skills always is assessment. Generally, I’d like to know the age; the general ability level and the level of problem behaviors. So if you say your child is two-years-old and not talking and also not potty trained and of course they can’t blow their nose or tie their shoes, they’re only two-years-old. So I would actually recommend that you probably don’t work on any of these skills.
Potty training for two or three-year-old of typical development with full language and compliance and understanding is one thing. But when you have a two-year-old that’s not talking and not understanding probably, their developmental level and their language level is so low that teaching any kind of complex skills like potty training early is probably not going to be beneficial.
Now, if you say, on the other hand, I have a ten year old child who’s almost conversational and I want to teach him to wipe his bottom after a bowl movement or I want to teach him nose blowing or shoe tying or showering, then that is probably, you know, that’s probably fine. So how do you know? Because it really does depend on the child. So I do have a one page assessment that I’m in the process of of revising to make it better. But the one page assessment I’ve had for more than a decade and you can find that within a three step guide and we will put that in the show notes. But it’s MaryBarbara/join to get that free guide.
You also want to download Mark Sundberg, Dr. Mark Sumberg, who wrote the VB-MAPP and the original Abels with Dr. Partington. Dr. Sundberg, when he did the VB-MAPP back in 2008… I can’t believe it’s been that long. He also created a self-care checklist and inter verbal sub tests. And the self-care checklist is a supplement to the VB-MAPP and is super, super important to do because what it does is it outlines the skills of a typically developing child that, you know, what should a typically developing 18 month old have accomplished in terms of dressing? Can they pull the hat off their head or at 18 months? Can they pull down their pants, you know, to go potty? Eventually washing hands is in there. So they have a section on grooming that be things like hand-washing and washing their face and those sorts of things. They have a whole section on dressing, a whole section on feeding. Like when should they be drinking out of an open cup? And those sorts of things. And then they have a whole section on potty training.
So what I like to do within my online courses is do the one page assessment and do the self-care checklist at the same time. And you might say, well, I have an eight-year-old. This is just typically developing for four-year-olds. Well, typically developing four-year-olds can actually do quite a bit. And even if you have an eight-year-old that you consider a pretty quote-unquote, high functioning, I did a podcast episode on high functioning versus low functioning at MaryBarbara.com/four. And, you know, even if your child has language and… But if they’re self-care tasks, if they’re not dressing themselves, if they’re not picking out their clothes themselves, if they’re not eating with utensils, they have some deficits of a child that’s four. And so I like to just be on the safe side.
Let me give you a quick story about for the one-page assessment, too, which is just really a very brief one-page assessment to get up your finger on the pulse of what’s going on. So I went to this nine-year-old’s house one time and I had no idea how high her language was. And I sent an email to the mom my one-page form, and this is years ago, and she filled it out. But when I got to the house, I realized that this girl, this nine-year-old, was fully conversational. And she didn’t have a diagnosis of autism yet. She was just you know, she had very different skills than what I was used to. And so I quickly realized that my one-page assessment and my, you know, early learning programs were certainly out the window. And so the mom handed me the one-page form, which I was just like… Well, obviously, she’s going to have all this completed. But I glanced down at the form and what I noticed was the mom actually had filled out that the nine-years-old was fully potty trained, but she wore a diaper at night. And I said to her, is the diaper wet in the morning? And she said, well, she wakes up and as part of her routine, she pees in the diaper and then takes the diaper off and sits it in the middle of the bedroom for me to throw away.
So obviously if you just assume that the child is so high functioning that they don’t need the one-page assessment or don’t need the self-care checklist, you’re probably… You might be missing something. And so, you know, from that little lesson, it was like, whoa. And all this girl needed was a reinforcement system to get out of that routine or habit. And I often think, like, what would happen if I wouldn’t have had her do that one-page assessment? Because nobody’s asking about potty for a fully conversational nine-year-old. So whatever you’re doing, step one is always assessment. You know, you don’t have to have like a full VB-MAPP assessment, although in my online courses, especially the VB bundle, the verbal behavior bundle, is where we really get into detail about teaching you to do the VB-MAPP assessment and teaching these really hard skills to early and intermediate learners that you’re you’re just not going to be able to piece together with all this free information.
So I am giving you the steps here, but know that these are mostly free resources that I’m directing you to. And, you know, you could start working on something and that could spike problem behaviors. And so I also can’t give you specific information about how to help your own child or client because ethically and legally, I haven’t assessed them. So there’s a fine line between… None of this information can be considered medical or behavioral advice. It’s just free resources that might at least point you in the right direction.
So step number one is assessment. Not just the party skill or the feeding skill. It’s a whole assessment. Because you may have bigger fish to fry or skills that really need attention more so than the skill you’re thinking. And you can’t work on dressing unless the child can undress, for instance, because otherwise it’ll just be a struggle. So you want the base skills to be super solid and go from there. So step one assessment.
Step two is making a plan and setting goals. And a lot of this teaching is going to have to be done on a regular basis. So while you have time, set up a schedule. Sometimes things like hand-washing can be practiced five times a day or more. But skills like showering are going to be, you know, once a day at nighttime or something like that. But if you are working on something, something like bathing or showering, I would encourage you to to do it nightly or in the morning, because, you know, if you’re only bathing your child like every other day and sometimes in the morning, sometimes that night, it’s going to… So part of the plan is picking the time you’re going to work on it, picking the reinforcement that’s going to be there, and also creating what we call a task analysis, which is a step by step breakdown of the tasks. You can’t work on everything at once. So that’s where the assessment is going to be important. You need to figure out what is reasonable, what’s the next step that would make the most difference for your child and your family and yourself.
Step three is all about the intervention or following the plan. So I’m going to now go over the different tasks and give you some of the resources, which are also going to be in the show notes eventually when this podcast is broadcast. We’re also going to have these in the comments. So a few weeks ago, when the Coronavirus first started making headlines, I actually had just started my Facebook lives weekly at 1:00 p.m. Eastern Time at MaryBarbara.com/Facebook. So I had just started that a week or two before the Coronavirus started making news. And so we quickly pivoted and turned this into something you need to know about how to help your child during the Coronavirus, lockdown or shelter in place or whatever we’re doing in your neck of the woods. So a few weeks ago from this recording, I did a Facebook live where I talked about hand-washing and how hand-washing was one of the first skills that I would teach to kids because you could prompt from behind. It was a task you could practice multiple times a day. It’s really important for the home, for school, for preschool. It’s also really important now that we’re being told to wash our hands. So I at that point released a free bonus video where you can see me teaching Cody and his mom, Jenna, to do prompting from behind and eventually video modeling. And Jenna, Cody’s mom, was also interviewed on podcast number 24 a few months back. And her podcast is about siblings and when you have autism, plus other disabilities; like Cody has mild cerebral palsy as well as visual impairments. So in many cases it’s not just autism. But anyway, the hand-washing bonus video is that MaryBarbara.com/handwashing.
Okay. The next self-care skill that we’re going to talk about very briefly is potty training. And as I said, usually I say to families that it’s best to start it when you’re not like in the middle of a move or having a second baby or the child is starting a new school; that’s not the time to do it. The time to potty train really is when you have a chunk of time at home or mostly at home with your child. So I created a podcast episode on potty. There’s a pre-video blog. And I created a potty training guide recently, and that is that MaryBarbera.com/potty. So one thing I do want to say about potty training, and in the guide I talk about this pretty much, is I did a survey of parents and professionals way back when I was working on potty training information. And so while most typically developing kids are potty trained by three or at the latest four, only I think, I don’t have the potty guide in front of me… But I think only 50 percent of kids with autism are actually potty trained by five. So they’re delayed with potty training. So huge stress to families. And a large majority of parents and professionals who told me that their kids were potty trained, were still struggling with things like wiping, bedtime wetting and those sorts of things. So I do cover that in the free guide on potty. But I have a system where I taught Lucas to wipe and that is something that we practice, not just when he has a bowel movement, but actually, in the beginning, we practiced where we would even have him fully clothed and sitting on the potty and just practicing pulling out the toilet paper and ripping the right amount, which is, you know, a challenge, too. So lots of resources around that.
Okay. Let’s move on to sleep. Many children with autism have sleep problems, and I struggled with sleep, too. When Lucas was nine, I think, I wrote my first book, The Verbal Behavior Approach. For those of you that don’t know, I am in the process of writing a second book that should be out in April of 2021. But when I wrote my first book, my husband said, Lucas was like nine or ten, and my husband said, do not put anything about sleep in your book because we are literally playing musical beds half the time. And it’s so annoying. So you really don’t know what you’re doing with sleep. And in his defense, I did not. So this was twelve years ago? Well, actually, thirteen years ago when I wrote my book.
So I didn’t put anything about sleep in my book. But then when I went to present in Ohio, I met another behavior analyst, and she actually walked me through some of the tips for helping kids sleep through the night. And I went home, Lucas was ten, in the middle of the night he would jump in, run in my room, jump like on me or over me to try to get into the middle of our king-sized bed. And I was just afraid, like, he’s going to break my nose, because it was at this point he was over 100 pounds. He was ten years old. And he would just barge in and hop over me and, you know, half the time I would just let him sleep there because I was just like, I need sleep and I was hedging my bets like if I just let him sleep with us then I have a better shot of actually getting some sleep, versus going over in his bed and taking him back and I might get a problem behaviors.
But using this other behavior analyst who is a sleep expert, her advice, I set a time. It was like a good time when I didn’t, you know, didn’t require as much sleep, like, okay. This week I am going to set it where I’m going to have him sleep through the night. And it’s outlined in my free sleep guide. But basically I ended up… And this isn’t good for everybody. I mean, if you have a young child then you’ve got to gate the steps, you might want to gate in the room. But an older child like Lucas was ten. He was potty trained. So at that point, you’re not going to want to gate them in their room for potty reasons. And he wasn’t one to wander down the steps and leave the home at that point. So what I did was I just locked my door and kind of practiced with him. Not that he really understood it, but like you’re gonna go knock on my door when you wake up and then I’m gonna help you get back in bed and I’m going to give you a special treat in the morning. That was like a special cookie treat. So the first night of my intervention, Lucas came over three times. I noted the time I brought him back. I reminded him of the reinforcer in the morning. He stayed calm, went back to sleep. So the first night he came over three times. Second night he came over two times. And the third night he came over one time. And then he slept through the night in his own bed. And that was ten years of me struggling with sleep.
So my new book will have a chapter on sleep, but I did create a free guide for you at MaryBarbera.com/sleep. So if you can’t remember, you know, all these links I’m giving you, you’re driving, you’re whatever, and you are wanting to find the resources I’m mentioning or wanting to find other resources that I’m not mentioning today, you can almost always Google ‘Mary’ ‘autism’ plus the topic and find a resource to at least point you in the right direction.
Okay, moving on to eating issues. And that’s where the self-care checklist by Dr. Mark Sundberg is going to be crucial. If you have a very young child who is still using a pacifier or a bottle, if they are over one year of age, you know, two, three, four, five… We’ve got to get them off the pacifiers and bottles. It is affecting their oral motor movement. It’s affecting their chewing. We’re plugging them up and it’s affecting their behavior problems because they whine and you’re just like, plug them up. But if they have a speech delay or autism, you plugging them up is making a problem behaviors go up, tantrums go up. And it’s affecting their speech, their eating and their talking. So what I’ve found is that we have to have to address the feeding issues early and effectively.
I also have a way to teach kids to use utensils. And breaking all that down is in my resources on feeding. Okay, so in addition to the hand-washing, which we did talk about, kids are also going to need to learn to dress, teeth brushing and a bunch of other skills like at some point. It really would behoove you to get the child from bathing to showering. I know we did that for Lucas. I forget what age he was, but that was a process. And within my online courses are specific videos, discrete videos of me teaching Lucas to shower; some of my clients, them learning to dress. Obviously, these are our critical skills, but I’m not really comfortable putting them out on a more broad basis. So those videos are within the verbal behavior bundle. And it follows basically the same procedure with hand-washing as you want to break the tasks down, and you want to teach the child and you want to make sure you have effective reinforcement going. And then for older kids, you may want to work on things like shoe tying and nose blowing, which I have videos on both of those, and with me teaching Lucas how to do both of those. And you really have to break the skill down, you have to teach it.
For shoe tying, I think I did a study on how to teach him shoe tying with tag teach. And I think all totaled to teach Lucas, who is pretty impaired, I think at 14 years of age, to teach him shoe tying took an hour and a half, five or ten-minute sessions over the course of six weeks. One of the keys to shoe tying is you don’t teach a child with their shoe on their foot. That’s too hard. Usually in my experience, you teach it with the shoe on the table.
And for nose blowing, which is demonstrated in the video blogs, we teach a child to blow with their nostrils, blow little pieces of a cotton ball or blow a paper and that sort of thing. And so I have all those procedures outlined in my free video blogs on the subjects.
So all of these steps, well we didn’t cover step four yet, but let’s just review. Step one is assessment. Step two is making a plan: plan for when you’re going to practice, plan for the goal, plan for what reinforcement you’re going to use, etc. And then the third step is the intervention, whatever the plan is. And you know, you can create your own plan and follow through. And then the fourth step is, regardless of which task you’re going to work on, is to take some data and to use that data to make decisions. So you may be yelling at your computer or yelling at me on your phone and saying I’m quote unquote, just a parent. I don’t know how to take data. I don’t want to take data. But it can be done easily and you want to make the most progress in the least amount of time. And without data, sometimes you can get away with it. Sometimes you teach a child to blow some cotton balls and you know, you don’t want to wait until your child is sick with a stuffed up nose to teach nose blowing. But, you know, sometimes you get lucky; you pull out my video, you teach a child and all of a sudden they’re blowing their nose and then you’re home free. You don’t have to take data.
But for most of our kids with autism or even kids with speech delays and that sort of thing, data is going to be necessary, even if it’s short term. You know, three days of sleep data showed me that my procedure worked. It could be a very short time. It doesn’t have to be that complicated throughout my course materials are all about how to take data, and you’ve got to use that data.
So again, the four steps are assessment, planning, intervening and taking and using data. And all of these resources are going to be in a very detailed show note at Mary Barbara.com/69. For those of you listening, thanks for joining me in this episode and I hope you tune in next time to the Turn Autism Around podcast.
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