First thing, as soon as I opened my email for today, I learned that stock prices have fallen and the markets are going into a spiral again. And I am not a Coronavirus expert, I am a registered nurse though and I’m married to a emergency medicine physician, but just a few times last week I had situations where the Coronavirus was definitely impacting the autism world. For example, the California ABA conference was scheduled to go on and an hour before preregistration, CalABA pulled the plug on the whole conference. Many of the speakers including Dr. Amanda Kelly and Dr. Mark Sundberg were both scheduled to speak at the CalABA conference and it was canceled the hour before the conference. So it is affecting us in the autism world quite a bit.
So teaching hand washing is also the bridge for how to teach other self-care skills. My book, The Verbal Behavior Approach in chapter 11 is all about potty training, but on pages 156-158, I also provide specific feedback on how to start teaching hand washing. One of the things about teaching hand washing that is so important is you want to break down the task. And we’re going to talk about this a little bit more in a second, but in my book I talk about teaching hand washing, and in my list of steps I state to grab both knobs and turn the water on. So this is my house. I have two knobs in the sink that we were going to practice on, but some of your sinks have just one handle that pushes up. Some of them have a knob that turns side to side.
So each breakdown or task analysis as we call it needs to be individualized so that you have the steps broken down. Why are we focusing on teaching hand washing as one of the first, if not the very first self-care skill to teach? It’s because by 18 months, and this is from Dr. Mark Sundberg’s self-care checklist, kids should be able to wash hands with assistance. By four years of age, children should be able to definitely wash their hands.
It’s also in the self-care checklist under toileting and it is one of the important skills to teach before potty training so that we can quickly go in from sitting on the toilet peeing and then getting up, pulling up pants, which is part of dressing, and then wash your hands. So teaching hand washing is important. It’s an important skill at home, at preschool, after pottying, before meals. The other really important reason that I like to start with teaching hand washing as opposed to starting with a dressing or wiping your bottom is because it’s easy to prompt from standing right behind the child. So if we think about wiping your bottom after a bowel movement, you can’t easily get behind the child in order to prompt that. So those are the reasons I like to start with teaching hand washing.
Now, in addition to my book, I also really like the book Self Help Skills for People with Autism, which is written by four people of which two are listed as BCBAs and the other two have doctorals. It’s a very good ABA friendly book with really good advice for all kinds of skills including potty training, hand-washing, tying shoes. There’s also a really nice what we call a task analysis sheet, which allows you to break down the information into what we call component parts.
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This is a TAGTeach kind of rule and now we use that. For a previous client, Cody, his task analysis sheet had push up sleeves, turn water on, wet hands, gets soap, rub hands, count to five, hands underwater, turn water off, dry hands. Then we’d record the data and mark with a V for verbal prompt, G for gestural prompt, or I for independent. And we would also have whether it was a full physical prompt or partial prompt. And in the bonus video, which you can get and see the whole video of me working with Cody and his mom, you will see the need for more physical. While Cody is resistant to mom helping him pull up his sleeves, he’s really good with imitating.
So in the end we end up doing a video model of his mom actually going through the tasks herself, saying each item like push sleeves up, turn water on, as she does it. And with the use of video modeling it was really what helped Cody become fluent with washing his own hands, which has been great. So you might say, well, what about having like a visual schedule of that. And what I found is that this technique of walking through kids through prompting from behind very gently of course, if if they are resistant to physical prompts using something like a video modeling, or imitation is really much better for many kids then using a visual schedule where they’re kind of breaking the chain as they go. And so each kid might be different though.
So the key is, is that kids need to learn to wash their hands and in light of the Coronavirus they need to learn as quickly as possible how to wash their hands. And so my take is that the best way to start teaching hand washing is by breaking the task down. Like I said, for your sink, for the sink that they’re going to mainly practice on. And there may be a sink at school and a sink at home and you may be just at home with your child and you can just have it set up like the home one. He might need more assistance at school until it’s fluent. So even if you have the hand soap on the right side, but it could go either way, but at school it’s mounted to the left side. You might want to put it on the left side just to get the child to go over there so that they can generalize better to other sinks.
I mean most people just don’t think about like all the generalization that’s needed for teaching hand washing. Where are the soaps located? Whether it’s a one handle push up or knobs where you have to turn both. There’s temperature control. All these factors, whether you use foam soap versus regular liquid soap, regular liquid soap, you know, you do three or four versus foam soap. You get a totally different amount of soap. You don’t want too much. You don’t want too little. I have found that counting, really helps with teaching hand washing.
And up until now, I don’t think I have any free videos on teaching hand washing. So now I have one that’s out, which is at Marybarbera.com/handwashing. If you enjoyed this video/article, I’d love it if you would share it, and leave me a comment and for more information, how you can help kids increase talking decrease tantrums and learn about self help skills like teaching hand washing. I would love it if you would attend a free online workshop marybarbera.com/workshops and I hope to see you right here next week.