We Did It! Hooray!!

Working with young children and having several of my own, daily achievements are often celebrated Dora The Explorer style by singing "We did it! We did it! We did it! Hooray!" This is one of the first things that came to mind when I discovered that a client of mine, a 12-year-old boy with ASD, had learned to shower and toilet with minimal intervention.

My last blog post focussed on a particular therapy session, spent role-playing the steps involved in wiping after using the toilet. I had mentioned this particular client to help explain the many ways in which OT's work with people to improve their ability to participate in daily living activities.

This last session was one of many that had been spent developing and introducing schedules for daily self-care tasks. Weeks before had been spent discussing the steps involved in tasks such as showering and toileting, role-playing each step, and perfecting posters for actual use, in addition to coaching the child's mum on how best to introduce these concepts at home.

Mum had been particularly worried about this last point. After years of developing a routine that worked, this was a big step for both of them. It was bound to cause some stress as any change in routine often does, and it was going to be a time consuming process.

I never expected to be so excited and proud when I discovered that my client had learnt to both shower and wipe himself when toileting with only minimal supervision required for each activity. Only months beforehand, he had been completely dependent and showed little interest in changing that fact. We now have new goals for therapy based on other daily tasks and I can't wait to see what else this amazing kid can do. Hooray!

Back to Basics

I have previously blogged about my therapy sessions focussing on skills such as handwriting and age-appropriate play. Occupational Therapists work with their clients on a very broad range of daily living skills, including self-care.

One of my clients is a 12-year-old boy who has Autistic Spectrum Disorder (ASD). His mum has up until this point assisted with all self-care tasks, including toileting.

As a school camp was coming up, we decided to dedicate one therapy session to helping this child learn the steps involved in toileting independently - in particular wiping. First we discussed why it was time to learn this skill and reassured him that Mum would be close by to assist when needed. Kids with ASD find change to routine challenging and it's important to introduce change slowly, and with as much information as possible. Children with ASD respond well to visual cues and step-by-step instructions, so this was the method employed for this boy.

After discussing the steps involved, we role-played going to the toilet. If you ever had any illusions that OT was a glamorous career choice, they will be shattered forthwith!

I grabbed a role of toilet paper and we sat on our chairs. I explained that we are pretending to have just been to the toilet. I showed my client how we wrap the toilet paper around our hand and then wipe ourselves clean. We discussed how we knew when we were clean and what to do with the paper once finished. Mum and I explained why it was important to be clean for hygiene reasons and because we don't want to smell!

The 12-year-old was able to copy my actions and respond to my verbal instructions. After a few goes, he was better at pulling the paper off the role and wrapping it around his hand. We felt that he was ready to try this by himself at home in the lead up to school camp.

Following this session, I was really satisfied by what we had achieved and excited by the prospect of this child learning such an important life skill.

Showered With Love

The patience and devotion shown by parents who have kids with special needs, is a constant source of inspiration for me. The more time I spend with these people, the more I wonder where they find the strength to get through each day. Mums and Dads who have kids with conditions such as ASD, Asperger's and Cerebral Palsy love their children as all parents love their children. They want the best for their kids as all parents do. They worry and fret as parent worry and fret, and their days are also filled with the usual highs and lows. And on top of all this, they have to cope with the extra things that happen as a result of these conditions being a part of their lives. And these conditions do affect the whole family in ways that I am only beginning to understand.

I was asked to consult with a mum about her 12-year-old son. He had Autism and was still very dependent upon her to complete self-care tasks. Due to his age, and the fact that her son would soon be entering adolescence, she was keen for him to start showering independently. For most, this seems like a fairly easy task and can be done without too much thought. For someone with Autism, the number of individual steps involved in the process can be confusing and anxiety-provoking - rendering the whole task impossible.

Think about it. When you take a shower, what do you do? You get in the shower, you wash yourself, you get out right? Not quite. Break it down further. When you get in the shower, you need to take off your clothes. First your shoes and socks, then your pants, and underwear and so on. Then you step into the shower.

When you step into the shower, you may need to adjust the screen door or curtain. You need to turn on the cold tap, then the hot, and adjust the temperature. This can be DANGEROUS. Make sure the temperature is right. You need to make sure the shower head is angled correctly. Then you find the soap and wash your body.

More steps! You need to wash your face, your neck, behind your ears. Then you wash your chest, your arms, your armpits .... And now you are beginning to understand.

The next step is to replace the soap, turn off the water, get out of the shower. Break it down further - and you can - and you will begin to see the complexity of this one basic self-care task. If you have difficulty processing and sequencing these steps, you will struggle to do this task without assistance.

People who have an Intellectual Disability or difficulties with Cognitive Processing often require visual and verbal cues to complete basic tasks. When you start to think about all the tasks you complete in a day, a picture begins to emerge of what a family experiences when they have a child with these issues.

The 12-year-old boy and his mother have many challenges to overcome, but I have faith that he will learn in time to independently complete some self-care tasks. We will use verbal cues, visual cues and lots of patience and devotion from his mum.