ADLS

Activities of Daily Living Activities of Daily Living

Autism Spectrum DisordersAutism Spectrum Disorders

Importance of ADL Training Importance of ADL Training Needs to be done at the earliest Needs to be done at the earliest Child must never acquire an inappropriate Child must never acquire an inappropriate

behavior that is later difficult to unlearn.behavior that is later difficult to unlearn. A family can lead a very comfortable life, travel, A family can lead a very comfortable life, travel,

socialize .socialize . Danger of abuse if the person depends on Danger of abuse if the person depends on

others for ADL activities like toileting, dressing, others for ADL activities like toileting, dressing, bathing etc bathing etc

A A MUST MUST for the respect and honor of any for the respect and honor of any person person

PRACTICAL DIFFICULTIESPRACTICAL DIFFICULTIES

Sequencing steps of tasksSequencing steps of tasks Not understanding concept of finish.Not understanding concept of finish. Over or under sensitive –touch/ smells/ Over or under sensitive –touch/ smells/

sounds/tastes/ sightsounds/tastes/ sight Motor planning issuesMotor planning issues Limited exposure to perform independently.Limited exposure to perform independently. Developmental delays / lack of basic skillsDevelopmental delays / lack of basic skills

Organization Organization

Toilet training Toilet training

Skills neededSkills needed1.1. Body awarenessBody awareness2.2. CommunicationCommunication3.3. Social understandingSocial understanding4.4. Motor skillsMotor skills5.5. Planning and organizing skillsPlanning and organizing skills

Why does my child take longer to Why does my child take longer to be trained ?be trained ?

Poor self awarenessPoor self awareness Sensory issuesSensory issues Do not have the understanding of privacyDo not have the understanding of privacy Find difficult to communicate need for Find difficult to communicate need for

toilettoilet Dressing undressing difficultiesDressing undressing difficulties Fascinations- water/ tiles/ drains/taps etcFascinations- water/ tiles/ drains/taps etc

Training Training

Break the training into steps Break the training into steps Steps-Steps-1.1. Put the child on a toilet schedule or a toilet Put the child on a toilet schedule or a toilet

time table/ toilet routinetime table/ toilet routine• Use very simple words- “Toilet time”/ “toilet Use very simple words- “Toilet time”/ “toilet

chalo.”chalo.”• First place – a convenient one First place – a convenient one • Praise /reinforce sitting or eliminationPraise /reinforce sitting or elimination• Ignore accidentsIgnore accidents

Next stepNext step Move from the convenient pot to real toilet Move from the convenient pot to real toilet

seat.seat. Structure/ modify the toilet according to Structure/ modify the toilet according to

needneed

AdaptationsAdaptations

Support for balanceSupport for balance Cover hole Cover hole Eliminate smellsEliminate smells Dry areaDry area Reinforcing environment- music/stress Reinforcing environment- music/stress

less timeless time

Washing Washing

Backward ChainingBackward Chaining1.1. CleaningCleaning2.2. Pour water+ cleanPour water+ clean3.3. Fill water- pour water+ cleanFill water- pour water+ clean FlushFlush adaptations adaptations

Cleaning Cleaning

The adult pours water for the child .The adult pours water for the child . Gives physical and verbal prompts to Gives physical and verbal prompts to

clean. Instructions need to be specific- up / clean. Instructions need to be specific- up / down.down.

Gradual withdrawal of prompts.Gradual withdrawal of prompts.

Pouring Pouring

The adult fills the water.The adult fills the water. The child can now use one hand for The child can now use one hand for

cleaning.cleaning. The adult prompts the child physically to The adult prompts the child physically to

pour water .pour water . Specific instruction- pour waterSpecific instruction- pour water Gradually the prompts are faded.Gradually the prompts are faded.

Filling water Filling water Once the earlier activities are mastered Once the earlier activities are mastered the adult prompts the child to fill mug from the adult prompts the child to fill mug from

a bucket and pour.a bucket and pour. Jets and other modern equipment is Jets and other modern equipment is

useful.useful. Use hose pipes/jets for Use hose pipes/jets for convenience,.convenience,.

Express toilet needsExpress toilet needs

Catch signals Catch signals Single words Single words SignSign Picture exchange-Picture exchange- Knocking the doorKnocking the door

Eating HabitsEating Habits

WE WANT-WE WANT- Eat while sitting in a placeEat while sitting in a place Eat neatlyEat neatly Eat a varietyEat a variety Eat at a desired speedEat at a desired speed Avoid overeating/ eat enoughAvoid overeating/ eat enough

Eating -sitting at a placeEating -sitting at a place

If the child does not sit and runs around If the child does not sit and runs around while eating-while eating-

Serve food after he/ she has sat.Serve food after he/ she has sat. Have a designated area for eating.Have a designated area for eating. Use visual cues.Use visual cues. Take away food if the child gets up.Take away food if the child gets up. Serve small amounts of preferred food .Serve small amounts of preferred food .

Eating neatlyEating neatly

Serve rice and curry mixed in a bowl.Serve rice and curry mixed in a bowl. Make rice and dal ballsMake rice and dal balls Chair close to table.Chair close to table. Serve small amounts of food.Serve small amounts of food. Instruct to extend or bend head forward Instruct to extend or bend head forward

while taking in spoon to mouth or hand to while taking in spoon to mouth or hand to mouth.mouth.

Aprons and hand towelsAprons and hand towels

Eat variety of foodEat variety of food Check whether any sensory problem.Check whether any sensory problem. Give small amounts of new food.Give small amounts of new food. Reward eating of the small amount of new food Reward eating of the small amount of new food

with a preferred reinforcer.with a preferred reinforcer. Select a new food that is somewhat similar to Select a new food that is somewhat similar to

the old onethe old one Dosa- bason cheela- idli-pohas.Dosa- bason cheela- idli-pohas. Bread- rusks- stuffed chapati- chapatti and curryBread- rusks- stuffed chapati- chapatti and curry

Allow the child to touch/ small/ see the Allow the child to touch/ small/ see the new item .new item .

NEVER FORCE TO EAT.NEVER FORCE TO EAT.

OVER EATING OVER EATING It is often a way of passing time.It is often a way of passing time. Plan the activities for the childPlan the activities for the child Meal times need to be visually presented.Meal times need to be visually presented. Structure the environment.Structure the environment. Do not have any junk food available.Do not have any junk food available. Family will need to be disciplined reg meal timesFamily will need to be disciplined reg meal times Never allow the child to eat from others’ plates. Never allow the child to eat from others’ plates.

Bath timeBath time

Sensory issues need to be ruled out.Sensory issues need to be ruled out. Pour waterPour water Applying soapApplying soap Cleaning selfCleaning self Pour waterPour water Use towelUse towel Instructions / id of body parts Instructions / id of body parts

Teach the stepsTeach the steps

Task Analysis Task Analysis Go to the bathroomGo to the bathroom Remove clothesRemove clothes Pour water Pour water Pick soapPick soap Apply soapApply soap ScrubScrub Pour waterPour water Wipe with towel Wipe with towel Wear clothesWear clothes

Try different kinds of soaps, lotions, sponges, Try different kinds of soaps, lotions, sponges, brushes.brushes.

Bath with mug vs. shower If the child wants so.Bath with mug vs. shower If the child wants so. After bath, wrap in soft towel or linenAfter bath, wrap in soft towel or linen Pat dry if the child avoids rubs.Pat dry if the child avoids rubs. Try to figure out what bothers the child- head bath, Try to figure out what bothers the child- head bath,

rubbing towel or soap?rubbing towel or soap? It could also be a wet floor that bothers him.It could also be a wet floor that bothers him.

BATHING

Find out if there is anything that bothers Find out if there is anything that bothers the childthe child

Example-sound of filling water, touch, the Example-sound of filling water, touch, the bathroom structure.bathroom structure.

Use sponge/ fill water in advance/ prepare Use sponge/ fill water in advance/ prepare the child for contact/ stand in front/ give the child for contact/ stand in front/ give gentle prompts/ pass string through the gentle prompts/ pass string through the soap and put around the child’s necksoap and put around the child’s neck

  If child does not like wearing some If child does not like wearing some colors and textures, respect his colors and textures, respect his decision. decision.

Child does not like wearing woolens, Child does not like wearing woolens, he can wear several loose layers of he can wear several loose layers of clothing, wind cheater or jacket. clothing, wind cheater or jacket.

Do not let your own desire of making Do not let your own desire of making the child look smart bother him in any the child look smart bother him in any way.way.

DRESSING

Dressing UndressingDressing Undressing BACKWARD CHAININGBACKWARD CHAINING ExampleExample Adult puts pants for the child and pulls just up to Adult puts pants for the child and pulls just up to

thighs. Child pulls it upthighs. Child pulls it up Slowly the adult pulls the pant up less and the Slowly the adult pulls the pant up less and the

child pulls at a longer length.child pulls at a longer length. Child sits on a chair with adult at lower level Child sits on a chair with adult at lower level

child extends leg and the adult puts in one leg .child extends leg and the adult puts in one leg . The child starts putting in one leg independentlyThe child starts putting in one leg independently

The child puts in both the legs one by one The child puts in both the legs one by one with the adult holding the pant and the with the adult holding the pant and the child then pulls it up.child then pulls it up.

Provide physical and verbal promptsProvide physical and verbal prompts Fade physical prompts first.Fade physical prompts first. Let the garments be loose duringLet the garments be loose during the training. the training.

Concept of privacyConcept of privacy

During toilet training, changing clothes or During toilet training, changing clothes or bathing the door needs to be closed.bathing the door needs to be closed.

Adults should remember the same. Adults should remember the same.

Brushing Brushing

Try brushes of different kids of textures.Try brushes of different kids of textures. Soak the new tooth brush in water before Soak the new tooth brush in water before

use.use. Vibrating tooth brushes may be tried.Vibrating tooth brushes may be tried. Massage gums at other times.Massage gums at other times. Try toothpaste, powders, gels of different Try toothpaste, powders, gels of different

flavorsflavors

BRUSHING-contdBRUSHING-contd Instead of toothbrush, finger Instead of toothbrush, finger

may be used.may be used. Traditional methods: Traditional methods:

Datoon, Mustard oil and Salt Datoon, Mustard oil and Salt can be used can be used

Make the child drink plenty Make the child drink plenty of water.of water.

Avoid colas and chocolates.Avoid colas and chocolates.

Task Analysis for Brushing Task Analysis for Brushing TeethTeeth

1.1. Get your toothbrush. Get your toothbrush.

2.2. Take out toothpaste. Take out toothpaste.

3.3. Unscrew toothpaste cap. Unscrew toothpaste cap.

4.4. Lay cap on countertop. Lay cap on countertop.

5.5. Turn on cold water. Turn on cold water.

Take out your toothbrush. Take out your toothbrush.

Wet bristles of toothbrush. Wet bristles of toothbrush.

Put toothpaste on toothbrush. Put toothpaste on toothbrush.

Lay toothpaste tube on countertop. Lay toothpaste tube on countertop.

Bring toothbrush with paste up to mouth. Bring toothbrush with paste up to mouth.

Begin brushing teeth. Begin brushing teeth. Left back: top – outside then inside Left Left back: top – outside then inside Left

back: bottom – outside then inside back: bottom – outside then inside Then front: top – outside then inside Then front: top – outside then inside Then front: bottom – outside then inside Then front: bottom – outside then inside

Then right back: top – outside then inside Then right back: top – outside then inside Then right back: bottom – outside then Then right back: bottom – outside then inside inside

Instruction- “do this”- modeling Instruction- “do this”- modeling

Spit toothpaste into sink Spit toothpaste into sink Rinse toothbrush under water stream. Rinse toothbrush under water stream. Shake water out of brush. Shake water out of brush.

Specific activitiesSpecific activities

Nail cuttingNail cutting1.1. Cut nails after bathCut nails after bath2.2. Massage handsMassage hands3.3. Turn taking with sibling or parentsTurn taking with sibling or parents4.4. Cut one nail per dayCut one nail per day5.5. Cut nails while sleepingCut nails while sleeping

Hair cuttingHair cutting

See what bothers the childSee what bothers the child Sound of scissors/spray of waterSound of scissors/spray of water Touch or the falling hairTouch or the falling hair Prepare the childPrepare the child Eliminate distractionsEliminate distractions Use structure/ social stories Use structure/ social stories

ShavingShaving

Backward chaining or forward chaining Backward chaining or forward chaining stepssteps

1.1. Pick shaving creamPick shaving cream2.2. Apply shaving creamApply shaving cream3.3. Use the razor Use the razor 4.4. Movements of razorsMovements of razors5.5. Wash faceWash face

Other issues for independent Other issues for independent Functioning Functioning

Mainly preparing for long term –adult lifeMainly preparing for long term –adult life Prepare a snackPrepare a snack Move independentlyMove independently Follow routinesFollow routines Take care of belongingsTake care of belongings Carry messagesCarry messages Shopping Shopping Prepare own bed/ wash clothes/ utensils/ fill Prepare own bed/ wash clothes/ utensils/ fill

water for drinkingwater for drinking Leisure skillsLeisure skills

Follow survival signsFollow survival signs Attend to phone callsAttend to phone calls Self information.Self information.