DAILY LIVING SKILLS

When establishing  educational goals for low functioning autistic children's programs, it is important to remember that few have achieved the same level of self-reliance as their peers due to deficits in both social and language skills.  Consequently self help skills must be taught, in order for them to become less reliant on others and more integrated into society. Open communication between school personnel and the child's parents is essential to ensure continuity and success from one environment to another. Many autistic children's levels of functioning vary from day to day, primarily due to the amount of difficulty experienced while trying to overcome both internal and external factors from their environment.

Teaching these skills must begin with tasks that are small and relatively quick to carry out, as attending skills will be minimal.  Instructions should be short and
direct, with immediate positive reinforcement given to the child after each
successful attempt. At the onset, it may be necessary for the assistant to actually place the object in the child's hands and guide them through each step of the task using a hand-over-hand manual method of instruction.

Many strategies currently used to teach the low-functioning autistic child self-
help skills are similiar to occupational therapy techniques used to teach mentally
retarded children.  Before teaching a particular skill, it is particularly helpful
to do a task analysis, in other words, write down and number all steps involved
from the onset to completion of a given task.  The assistant should endeavor to
use key words and phrases while children use specific items or perform a task.
Accompanying photographs for  activities may be laminated and placed nearby,
or compiled in a photo album labelled with a short phrase.

EATING

Many autistic child prefer times of constant running or darting, which directly interfers with sitting at a table during mealtimes.  Food preferances are often limited to salty, spicy or crunchy fingerfoods and snack items. By the time these children attend a school program, their parents have already experienced extremely frustrating mealtimes in attempts to have their child participate in the usual manner, and decided to search out less stressful alternatives. These may include the child receiving a bag of chips or a juice box to consume as they run about, or sit in a corner or under a table while rocking from side to side  Due to autistic children's strong resistance to change, behaviors are often more difficult to shape into safe and socially acceptable forms, however  with a great deal of patience and time, these are attainable. Sitting behaviors can be reinforced throughout each day if children are required to complete their favorite activity while sitting at a child sized table beside the assistant.  When establishing daily schedules there should be considerable gaps between  set  snacks or mealtimes.  If the autistic child becomes either over or under stimulated due to the presence and noise levels of others, it may be necessary to have the child eat their snack in a quieter, calmer setting.  If the child is not distracted by these factors, it is an excellent time to reinforce social skills as they sit among their peers.

 Children should be encouraged to assist in setting the table with a bowl, spoon and glass and assisted to pour cold beverages or put food in their bowl. A clear glass is often easier for the child to make the association between cause and effect while pouring or drinking.   If the child eats only dry crunchy foods, the use of a spoon can be incorporated if the food is broken into small bite sized pieces as it is placed in the bowl. Associated skills such as cleaning up, sweeping the floor or wiping the table should also be taught.  When placing each item on the table, the assistant may choose to name each item.

Handwashing before and after snacks should also be modelled. Eating times should be closely supervised, with the assistant sitting either beside or across from the child.  If simple commands are understood by  the child, they could practise opening and closing their mouth as the assistant says "open" and "close". The amount of food given to the child at one particular time should be limited in order to increase opportunities for non-verbal communication.

 Occasionally autistic children may exhibit very peculiar eating behaviors such as repeatedly touching the tip of their tongue to very small pieces of food, licking or placing pieces of food in their mouth, then spitting them out or throwing them across the room.  They may sniff food or rub it back and forth under their nose, in their hair or over their hands.  When they no longer show an  interest in eating the food, it should be removed and offered at a later time.  Selectively ignoring negative behaviors may help to extinquish them as opposed to constantly reinforcing them through verbal repremands.

 Many kindergarten programs have a snack program in place whereby a different snack is provided each day, with emphasis placed on  proper
nutrition. Autistic children should be encouraged to try these foods, however it should never be forced upon them.  A supply of their favorite food items  is often provided by the parents for all eating times throughout the day. Some variety throughout the week may be possible, depending on how limited the child's preferances have become.
 

TOILETING

Many autistic children remain incontinent for years despite much patience and persistance by parents and assistants. Within school environments children must be taught tasks associated with bathroom routines,  such as appropriately
entering and exiting the bathroom, sitting unassisted on the toilet, voiding and wiping. Other associated skills such as flushing the toilet, dressing and proper handwashing must also be taught.  Daily toilet routines should be scheduled shortly after snacks, lunch, running or outdoor activities for a higher probability for success.

Toilet facilities must be readily accessible, include a proper diaper changing
area, have storage for extra diapers or clothing and have a sink appropriate for
the child to use.  If the washroom is one that other students use, schedules must allow for the assistant to accompany the child at all times.  It is often easier to have boys sit on the toilet while voiding.  Underwear or pants should be pulled down to the ankles.  For the child whose feet do not touch the floor, or who cannot balance themselves, a small foot stool may be placed immediately in front of the toilet.  The child should be encouraged to sit back on the toilet seat with legs together.  It may be necessary for the assistant to hold the child's hands at first for balance. All successful attempts should be immediately rewarded with verbal praise.  Complex tasks such as tearing the toilet paper from the roll require the ability to grasp and release, finger dexterity and motor control. Entering and exiting must be carried out quickly to eliminate undesired fixations like repeatedly flushing the toilet or playing with the water in the toilet bowl.

DRESSING

The majority of dressing routines are usually carried out in the home, however tasks such as putting on a coat, shoes, socks, boots, mitts, or toque sould be taught within a school program.  The child usually requires assistance with zippers, buttons, snaps, laces and buckles.  Autistic children may insist on wearing inappropriate clothing for weather conditions or overlook finishing
touches during dressing routines.

When trying to determine which skill to teach first, closely observe the child to see what items they remove on their own.  It is easier for children to take things off then to recall the steps needed for putting them on.  Many autistic children
learn more readily by sensing how things feel, rather than by being told or shown.  At first the child's fingers may feel limp as the assistant uses the hand-over-hand method of taking them through all steps of the task.  When the assistant begins to feel slight tension in the child's hands, prompting is reduced to pointing or verbally cuing the child to initiate and carry out the task.  Stategies
which require the child to complete the final step of a process first are referred to
as backwards or reverse chaining procedures.

Items of clothing which are slightly oversized with large buttons, zippers and snaps are much easier for the young child to conquer.  Velcro or elastic waistbands should be used as much as possible, since small belt buckles and jean buttons are very difficult for most low-functioning autistic children.  Since autistic children usually experience difficulties with points of reference such
as back/front, left/right, up/down or copying the actions of others, it often
helps if the assistant stands directly behind the child and reaches forward over their shoulders or waist to guide them through the steps using the hand-over
hand method.

GROOMING/HYGIENE

When autistic children enter school programs they usually lack the skills and knowledge necessary to carry out tasks such as washing their hands and face,
brushing their hair and teeth and wiping their nose.  When these are reinforced
on a daily basis, their level of functioning goes from very passive to slowly
participating in them. These do not have to be isolated skills, rather accompanying ones such as handwashing along with snacks and toilet times.

Teaching these tasks within the school environment requires minor modifications be made to staff bathrooms or special need's washrooms.  A separate facecloth, handtowel, liquid soap dispenser and a wall mirror all at child's height  help the child transfer skills from one setting to another.

When teaching the child to wash their face and hands they should learn to turn on the water, wet and lather hands or face, rinse and turn off the water before drying.  They should also be encouraged to hang up the washcloth and towel in an orderly fashion.  Once completed a final look in the mirror is used to help bring the activity to a close.  If the child fails to look down at their hands, a small bell can be hidden in the assistant's palm and jingled throughout.  Water play activities involving bubbles and cloths help the child learn cause and effect.

During the early stages of programming, hairbrushing can be designated as a
"workbasket task"  as the child sits at a table to complete the task.  If using a
large wide-toothed comb, it is helpful to attach a sticker to the edge of the comb to indicate which side they must grasp.  A small hairbrush is often easier for them to grasp in their palm and sense the weight of.  Songs like "This is the Way
We Brush our ....(hair)" and "Brush, Brush, Brush Your Hair" are excellent for the
assistant to sing to the child as they attempt the task.

The autistic child must also be taught how to brush their own teeth.  This is
primarily carried out at home, however it should be reinforced on a daily basis
through school programming.  A soft child-sized toothbrush, toothpaste and disposable cups  should be purchased, clearly labelled with the child's name and
stored in a secure cabinet close to a sink.  The child should be taught how to grasp and hold the toothbrush, put toothpaste on, open their mouth and brush their teeth in an up/down and back/forth direction.  Making up songs about the routine help extend the activity.  Hand-over-hand guidance will usually be required throughout most stages of the activity.  After completing brushing their teeth, encourage children to rinse with a small amount of water and dispel in the sink.  Removing the cap of the toothpaste or placing it back on, requires more sophistication of fine motor skills and can be encorporated at a later time.

Nasal hygiene must also be reinforced within the child's daily routines, particularly if they suffer from "runny noses" due to upper respiratory problems and infections.  They must be shown how to open up a facial tissue, place it over their nose in a tent-like fashion, gently wipe or blow it, and discard the tissue.

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