April is autism awareness month.
Day 18 ADLs/ Bathing
Activities of daily living (ADL) are routine activities that people tend do every day without needing assistance. There are six basic ADLs: eating, bathing, dressing, toileting, transferring or walking and personal care. A person’s ability to perform ADLs is important for determining what type of long-term care may be required.
Thankfully, now a teenager, Dylan is not averse to bathing. In fact he is drawn to water and will spend many many hours in the bath. His enthusiasm does still require supervision however.
Hot water poses a real scald risk; with Dylan’s sensory differences he doesn’t seem to notice heat until it is too late and he feels burnt, even then he will go back and touch the heat again, almost to check.
An example of Dylan’s vulnerability around hot water happened yesterday when Dylan wanted to wash up some plates after dinner. With his enjoyment around water I supervised the first item being washed and then left him to complete the remaining couple of items. Dylan enjoys the bubbles and will play for a long time with the soapy suds. So I wasn’t concerned when he came to find me 5-10 minutes later. However his hands were so bright pink and hot to touch that I went to check the temperature of his washing up water. It turns out that he had put the tap on to rinse the bubbles off but when the water got too hot he didn’t think to turn it off or to put the cold tap on.
Thankfully after three minutes of running his hot hands under a cold tap to cool them there was no harm done but it demonstrates perfectly the difficulty in generalising skills.
Looking reflectively at what happened I realise that us having recently moved home that the taps here in the new house are different. Previously we had mixer taps throughout and Dylan now needs to be shown how to mix the correct temperature with the separate taps.
Bathing is one of Dylan’s joys and he will spend many an hour in the tub just about any time of day. He likes a full bath so he can full submerge himself in water, plunging himself under and holding his breath until the last minute before whooshing up out, gasping for air while chuckling and screeching with pleasure.
It makes my stomach turn, all he has to do is misjudge his grip on the side of the bath or slip his foot slightly and he will not be out of the water in time before taking in a big lungful of bathwater.
Needless to say that bath time is not unsupervised, not even at 13 years old, his lack of privacy is a necessity to keeping him safe. Not that Dylan minds, he is oblivious to any company, consumed by his enjoyment of the bath.
Dylan will use a whole bottle of shampoo making endless lather and often requires assistance to rinse his hair free from the thick slick of never-ending bubbles. Without help Dylan will always get out of the bath with suds in his hair which if he isn’t led back and rinsed properly will result in a big itchy knotty mess once dry.
The supervision continues when getting out of the bath, due to the excitement of the activity the floor will be flooded and slipping is another risk.
For Dylan there are no careful steps out the bath but more excited leaps, despite the fitting of handrails Dylan will happily attempt to leap out of the bath and so risk slipping or injuring himself. He needs constant verbal reminders to get out carefully and watch where he is going.
We have tried using pictures as prompts to increase independence but this has proved unsuccessful, Dylan is simply too excited to take heed of the written warnings; verbal support is much more effective!
Drying post bath is another area requiring extra support. Dylan struggles to coordinate the towel to dry himself effectively and so needs reminders and often physical support to be able to manipulate the towel to be able to dry himself.
Despite the whole bathing activity being motivating and enjoyable there is still so many different areas which require support, and that may require long term support to ensure that Dylan remains safe.
That’s fine – we just need to work on getting him practiced at tidying up his mess afterwards!