Performing self care tasks involves a series of complex processes, such as sequencing, motor planning and body awareness. Other areas also have to be considered: adequate attention levels are required if the activity is to be achieved and sensitivities to tactile experiences have to be overcome, e.g. from clothing etc.
Dressing can be a complex process and children need to be able to master a number of skills. These include:
- Motor Skills: where a child needs to be able to move their limbs and body in a full range of movements requiring muscle strength and flexibility at their joints.
- Coordination: where a child needs to be able to create co-ordinated movements, using one arm and both arms. A child also needs the control of hand movements that require fine motor skills, such as fastening buttons.
- Balance: being able to maintain their balance whilst changing posture/ position both with eyes open and shut
- Fine motor skills: being able to reach, grasp and release objects in order to complete tasks such as buttoning or holding the item of clothing.
- Perception: having an understanding of various sizes and shapes of buttons and also knowing the size of arm holes.
- Stereognosis: being able to feel their way without relying on sight such as finding arm holes with a jumper over their head or fastening buttons behind at the back.
- Body schema: being able to tell right from left and the difference between arms and legs.
- Sensitivity to fabrics is often one of the first sensory issues that a parent notices. There may be particular fabrics that the child just can't tolerate. A child who is sensitive to tactile input may be feeling their sock seams or shirt cuffs all day long.
- Some children are more comfortable in loose clothing or if they wear tight clothing beneath their other clothes, like school uniform for example. Sports/ cycling shorts (such as the all-cotton ones from www.sensory comfort.com), tights, 'too small' T-shirts, sports vests and so on. A hooded sweatshirt/ hoodie provides great input when the child pulls the hood up, sticks their fists in the pockets, and pushes downward, tightening the fabric.
- Buy softer fabrics: cotton, fleece, and flannel. Avoid items made of polyester blends, which can become uncomfortably rough.
- If your child can only tolerate well washed clothing, wash new clothes multiple times.
- Consider using laundry products without added perfume or dye. Fabric softener may or may not be helpful; it does make clothing softer but the strong scent may bother some children.
- Before your child gets dressed after a bath or shower, rub in a moisturiser while their skin is still damp. This is especially important in winter, when skin tends to get dry and itchy.
- Use comfortable clothes; consider the type of fabric and length of sleeves. Experiment with different weights of clothing, as well as different fabrics. One child might prefer loose heavy clothing while another might prefer lightweight, stretchy clothing.
- If the child cannot tolerate labels, cut them out. Look out for typical clothing irritants: elastic at the wrist or ankles, scratchy backings on appliques or patches that rub against the skin, tight collars, or waistbands that don't have cloth covering the elastic.
- If the child cannot tolerate seams, undergarments can be worn to reduce friction.
- Try washing and drying clothes in unscented products.
- Dressing can be done in front of a mirror so as to provide visual cues to assist with sequencing, motor planning and body awareness.
- Be aware of other visual or auditory noises in the room which may be off-putting.
- Try ultralight, flexible glasses. These weigh far less than regular glasses and can be twisted and bent without breaking.
- Try an elastic strap to hold glasses on. The extra pressure against the head might be comforting to the child as well.
- Some children will pull glasses off when the frames get a little bent. So check to see if they are still in shape or need adjusting.
Hats, gloves, and mittens
- Massage your child's head and hands before she puts on a hat or mittens.
- A tighter or looser hat, gloves, or mittens might be more tolerable for your child, try snug glove liners beneath mittens.
- Look for fleece hats, gloves, and mittens, which are less scratchy than acrylic and wool.
- A tactile sensitive child might need a hood or hat to protect them from the uncomfortable feeling of even a small amount of rain or snow falling on their head.
- Some children can tolerate a hood better than they can tolerate a hat.
Shoes, shoelaces and boots
Feet are one of the most sensitive parts of the body, especially the soles, so it's no surprise that a lot of children are very particular about socks and footwear. Some are uncomfortable being barefoot, and some insist on having something on their feet at all times. Others have trouble adjusting to a new pair of shoes, which can be a real problem as feet grow and seasons change. Also, tying shoelaces is a complex task that requires more advanced, fine motor, visual-perceptual skills, and proprioceptive processing skills.
- Desensitise your child's feet before trying on shoes. When you go to the shoe shop, bring along seamless socks that your child tolerates well.
- Try slippers or moccasins, or canvas shoes, which are breathable.
- Investigate whether very tight, thin socks or really thick socks or seamless socks make shoes more comfortable.
- Many older children prefer high top trainers that provide some ankle support.
A Practical Approach at Home for Parents and Carers: Autism Spectrum Disorders Children with Disabilities Team Occupational Therapy Falkirk Council www.falkirk.gov.uk/cwd
Is it Sensory or is it Behaviour: Behaviour Problem Identification, Assessment, and Intervention by Carolyn Murray-Slutsky and Betty, A. Paris.
Raising a Sensory Smart Child by Lindsey Biel and Nancy Peske.