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Breaking it Down

Dec. 22, 2021

When teaching Daily Living skills, both the skill and the motivation need to be taught.  Often the motivation is harder to teach than the skill.  To teach the skill, demonstration and practice may not be enough.  It can be helpful to break tasks down into small steps and have pictures of each step posted on a wall or digitally on a device as reminders to ensure no steps are missed.  For example, brushing one’s teeth involves the following steps:

1.       Put water on toothbrush

2.       Put appropriate amount of toothpaste on toothbrush

3.       Brush inside bottom teeth – front, center and right

4.       Brush outside of bottom teeth – front, center and right

5.       Brush tops of bottom teeth both sides.

6.       Brush inside top teeth – front, center and right

7.       Brush outside top teeth – front, center and right

8.       Brush tops of top teeth both sides

9.       Put water in mouth from small bathroom cup to rinse mouth

10.   Spit rinse water in sink

11.   Run toothbrush under water to rinse it

12.   Put toothbrush away

We take for granted that all of these steps will be completed when we tell someone to brush their teeth, but this may not be intuitive to everyone.  Written, picture and digital checklists can help the process become second nature.  But, teaching the motivation to complete this daily living skill twice daily over a lifetime may be more complicated.  When I was in elementary school, I was not very dedicated to brushing my teeth thoroughly in the morning and at night.  Then, I got three cavities and had to have them filled.  After that painful experience, I was motivated to brush my teeth regularly.  However, we don’t want cavities to be the motivation for individuals with neurodevelopmental disabilities.  Visits to the dentist may require medical or behavioral intervention and filling a cavity may require anesthetic making these basic procedures more dangerous.  It is important to identify, and trouble shoot the barriers that may exist to completing each task at the frequency required.  Sensory issues may make the task more difficult to tolerate.  Some tasks may have negative feeling associated with them because of childhood power struggles over doing “chores”.  A variety of strategies may need to be tried to overcome these issues.  For example, an individual with sensory issues may be more comfortable with a different toothbrush.  An individual who has negative feelings about a task may benefit from watching YouTube instructional videos.  This allows instructions to come from a neutral source that is not an authority figure in the individual’s life.  The biggest asset that individuals with autism possess is their dependence on routine.  We usually don’t think of this as an asset because of the resistance to change it brings into the individual’s life, but once daily living becomes a part of the individual’s routine, it becomes an asset.  The routine dependence will ensure that daily living routines are completed regardless of holidays, residence changes, roommate changes or any other life events.