Attitude Plus
by Steven R. Wertz
Parent
Our family is just starting a home therapy program. My child isn’t
interested in personal hygiene. She is 5 years old and she often won’t
let us brush her hair or her teeth, change her clothes, or pick up her
room. She can be very rigid and wants everything in the room lined up
exactly the same way and gets upset when its not. Our volunteers and my
family would like some suggestions that would encourage her to be less
rigid.
Steven
First of all, it is important to help yourselves and your volunteers become
comfortable with your child’s refusals and expressions of apparent
anger and frustration. When someone is uncomfortable with your daughter’s
lack of cooperation, there are many things that you might see as a result.
An uncomfortable adult may push her to perform, and your child could become
more resistant. Other people will avoid the issue altogether. Someone
else, when thinking about encouraging teeth brushing, will approach it
with a sense of dread. That dread will show on their face, be heard in
their voice, and be a quality in the touch before the actual teeth brushing
takes place. Your child will sense that something dreadful is about to
happen and become tense. In these circumstances, there is an attitudinal
stance that invites success.
Attitudinal Stance
- Look forward to the task. The goal is to create your attitude
before you begin, and maintain it as you work on the issue. I worked
with a woman who loved to cut the hair of children who were resistant.
She saw this as a strength of hers and a challenge that she enjoyed.
She looked forward to the haircutting with genuine enthusiasm. She even
at times had the feeling, that the greater the challenge, the more rewarding
the results could be.
- Be comfortable with expressions of distress. It’s OK if
the child cries, pushes you away, yells, etc. It is their attempt to
take care of themselves and often to communicate. Use it as an opportunity
to practice keeping your own center – your peace, comfort and emotional
stability. Breathe evenly. Be comfortable with not getting it done.
If you need to get her teeth brushed, her hair brushed, the room cleaned
so that you can feel good, then you are in trouble. You will have a
“push” quality to what you do. Be ready to be comfortable
if it doesn’t happen.
- Be comfortable with delays. It might be necessary to spend
the better part of a day returning several times to the issue of teeth
brushing. If you are ready to take as long as it takes, you are in a
much better position.
- Love personal hygiene. If you can create the feeling in yourself
that teeth brushing is sensuous and delightful, that clean teeth feel
incredibly good, when you have your hair brushed you want to purr, etc.,
then you are much more likely to sell it to a reluctant buyer.
You can wait until the person comes along who can do all five of the above. Maybe you could advertise. But the most practical thing to do is to learn how to shape your own feelings so that you are the one to do the job. Believe you can. Create a clear intention. Each day there will be opportunities to practice.
Become Theresa (or Timothy) Teeth
Try becoming a different character like Theresa Teeth who already has the 5 attitudinal stances. Dress up a little. Love teeth brushing as much as the Count on Sesame Street loves to count. You may find it easier to adopt the attitude of the character you portray. Believe that you can do this genuinely. This is method acting at its best. It is quite possible that you might not get permission, but the character you portray will.
The Rigidity Crutch
One
of the driving forces behind cognitive development is the desire to bring
order out of chaos. When there are no labels, no categories, no classifications,
there is only chaotic space. As children, we began to label, and by doing
so changed the chaos and ordered it for ourselves. “Mama” is
an experience different than other experiences. Where before there was
chaos, now there is “Mama” and “Not Mama.” As there
are more labels, there is more order. Add to this our ability to identify
and name places, our ability to name times of day, we see that the human
mind becomes more and more oriented and the world appears more and more
ordered. As we become more sophisticated, we begin to use judgments to
order the world. Ice cream is not only ice cream, it is yummy. Spinach
is spinach, and it is yucky. We begin to name qualities, characteristics,
and see things in terms of their function.
We insatiably line things up in our heads. For some children it is a struggle to “order” the world. Cognitively or linguistically, there is something happening that makes this challenging task even more challenging for them. They struggle to create order and to hang onto it. The child who is having trouble ordering their perceptions and the contents of their minds may focus on ordering their things and their environment. A child may be ordering things from the outside in, and not the inside out. If they line things up, and you put them away, it may be as if you reached into their minds and took away their understanding. It may be as if you interrupted a sacred act.
The same child may also have made decisions about other experiences, for example that teeth-brushing is a bad thing that they fight every day. That is part of the rhythm and stability of their universe. The same child might have a very limited diet. They may have foods that they like, and foods that they do not like. If the order is changed or disrupted, then the world itself is not ordered. Perhaps certain clothes must be worn. Things must be done in a certain order. Some experiences are welcomed. Others are not.
We sometimes inadvertently take part in this process to our disadvantage. Some people will talk about the children in their presence. Someone might say, “She hates to brush her teeth.” The child hears this, and it becomes part of the ordering. The child may be trying to gain some sense of self and to order it. They may be understanding more than we know. They may have a list of ideas about themselves that they are ordering. What would your child’s list be?
- I am nonverbal.
- I cannot talk.
- I hate to have my teeth brushed.
- I won’t eat anything except bread.
- I can’t go to sleep alone.
- I am autistic.
- I don’t like new people.
- I will be upset if you touch my things.
A child who is struggling to hold onto order will hold on to these ideas and these behaviors. They may feel that if you change them, you are weakening the foundations of their entire organizing system.
Suggestions
- Join Your Child In Structuring The World.
Create consistencies. Create visual order. Line things up. Here we can take an idea from Structured Teaching (the TEACCH Program). Create a visual schedule according to their guidelines. Have a schedule for the morning routine. Perhaps use objects to represent activities. A role of toilet paper can represent the toilet, a wash cloth can represent washing, a toothbrush represents teeth brushing, and a plate and cup represent breakfast. You can have a place where you keep these objects in a line (try using Velcro,) or place them on shelf. You don’t have to use objects if your child understands pictures, or two-dimensional representations. This line up becomes a kind of schedule. Refer to it. Go to the line up – take the first object or picture, and begin to do the activity. Return the object when done, and get the next object. Let your child see how things are ordered and structured. Be as consistent as possible. Consider doing things at the same time each day. Don’t be disturbed if there is a disruption in the routine. Your child may not catch on right away. Do this day after day. Teeth brushing can become part of your child’s ordering. Your child may then insist on doing it as well as hair brushing and other hygienic experiences.
- Change The Way You Talk About Your Child In Their Presence.
(and not in their presence - the walls have ears)
“My child is learning to love teeth brushing.” “Julie is verbal! She says Papa and ball!” “Tom loves to be clean”, etc. Sometimes you will have to take the smallest amount of evidence to create your new statements. Sometimes you will have to make them up. Give your child consistent ways to think about themselves and categorize themselves that will work better for them.
- Insert Stronger Supports.
When a child is using ordering as a crutch, it is not useful to attack the crutch or try to rip it away. The child will function less well, and you will not be seen as friendly or supportive. What we suggest is to insert stronger supports. If you help your child have even more consistency, structure, and order, they will hold onto their crutch less and less. They will be more relaxed, flexible, and changeable.
Sensory Integration
Be open to the possibility that your child has sensory differences. If we have something crawling on us we will look, and brush it away. Our sensory defensive signals are pretty good. We usually only feel defensive if we have a real reason to. Some children have difficulty interpreting sensory information and experience touch as a discomfort or as a threat. A hairbrush could make their skin crawl. A toothbrush in their mouth could feel like a monstrous intrusion.
Seek out an open-minded Occupational Therapist from your area to help you learn various sensory integrative techniques. You could have the therapist come in once or twice a week to work directly with your child, but we have found that it is most effective if the therapist is willing to train the parents. Find an Occupational Therapist who is happy to train you and your volunteers. The OT might want to spend some time with your child before suggesting techniques and teaching you. Watch them and make sure they are respectful, not forcing your child, and that they present ideas to your child in a way that is playful.
Consider finding workshops on sensory integration in your area. Read The Out of Sync Child by Carol Stock Kranowitz.
Fun and Familiarity
The more fun and the more familiar you can make a hygiene activity, the more likely it is to become a welcome part of a daily routine. Even if your child is not allowing their teeth to be brushed, it might be fun to have the child brush your teeth. Brush the teeth of dolls, toy animals, pretend play mates, etc. Create teeth brushing stories and storybooks. Brush each other’s teeth in front of your child and ooh and aah over it. Play with different toothbrushes and toothpaste. Try an electric toothbrush. Make the activity fun and familiar. This can be done at times when you are not trying to brush your child’s teeth as well as when you are. Your volunteers might join in the process of making hygiene activities fun and familiar.
The “Sensitive” Tank
Recently, I asked a boy to participate in an activity as I was working with him. He refused, so I said, “OK. You aren’t quite ready. I’ll give you a minute.” After a minute, I said with excitement, “Now!” He reached up and pushed the activity away. I cheered him for reaching out and touching it, and told him that that was a good start. I was sensitive to his cues, but continued to persist in a way that was positive, fun and believed in him, never forcing him. In a few minutes, he decided to participate. Someone observing me, later said that I seemed like a “sensitive tank.” If you have the above in place – if you have a great attitude, if you are sensitive to your child’s desire for structure and control, if you are aware of sensory integrative issues, then find ways to persist. Persist and persist – with strong conviction and deep sensitivity.
Copyright
©July, 2000, Special Solutions, Inc.
15096 115th Avenue North, Jupiter, Florida 33478
Phone: 561-748-9697 Fax: 561-748-6543
Copyright © Growing Minds Autism Programs,
1999
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