​April is autism awareness month: Day 22 -ADLs/ Personal Care

April is autism awareness month 

Day 22 ADLs/ Personal Care

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.

A lot of personal care has been covered in previous awareness posts including haircuts, toileting and bathing. But personal care also covers teeth brushing, washing clothes, shaving, cutting fingernails and toenails and blowing your nose. 


I went to a training session in the week about the Mental Capacity Act. There were professionals there talking about young people with learning disabilities being held down by three people so that they could have their teeth brushed. 

My heart sank and my soul wept. 

The thing is, as outrageous as it is that this occurs, once the young person turns 18 it will not be legal to force them to have their teeth brushed in this way. 

Since the teeth brushing process is so negative and traumatic it would be understandable for that young person to never allow a toothbrush pass their lips again. It would not be surprising then in a few years that they would suffer toothache and probably need extractions or further invasive treatment. 

A life time of unpleasant dental treatments or suffer agonising toothache, this is awful and so avoidable.

Dylan’s teeth have always been an obsession of mine. I have been terribly paranoid that he will need a filling or suffer bad teeth. 

Over time we have worked on Dylan being desensitised to having his teeth and mouth touched. Dylan has abnormally strong check muscles and we must keep reminding him to relax them so that we can edge the toothbrush through to properly clean the back of his gums and mouth. 

Dylan has all his adult teeth cut through and his mouth is crowded with teeth now. He could probably use a brace but the dentist doesn’t feel that he would tolerate it. 

Dylan attends the dentist for a check-up himself every 6 months but we stagger everyone else’s visits in the family so that Dylan can come with every one of us to give him as much exposure as possible. 

Dylan will open his mouth for the dentist to look at his teeth but is clearly very anxious and will pant and whimper throughout. He won’t sit on the chair even though she promises him a little ride each time – in fact I think it may be the movement of the chair which worries him. Instead he has his consultation on a small stool in the corner of the office. 

The dentist crouches down and I use the light on my mobile phone to shine into his mouth. 

It’s a team effort but we manage it 😊

There are a range of tooth pastes to help with the compliance of brushing – tasteless, foamless and kiddie training toothpaste with funky flavours. I think Dylan likes the strong taste and smell of normal toothpaste, it goes with his sensory seeking tastes. 

When brushing, we have taught him to spit out the foam at the right force, for a while it would dribble down his chin or be thrust all over the sink and windows. Finally we got the balance right – it’s the little things! 😊


Dylan will always put his clothes in the wash at the end of the day. Most of them are dirty but this is a coincidence rather than having had Dylan check them.

 We have plans to break down instructions enough for Dylan to be able to independently set up a load of washing in the machine. He is very confident to unload a washed machine and will proficiently hang the clothes on the line. 

We had an ABA programme to build up enough strength in Dylan’s fingers and to teach him to be able to use clothes pegs. Before he simply couldn’t work them – Now, he’s a whizz!


Shaving is a task that Dylan does not yet require but I’m sure it won’t be far off so we need to prepare for this. Dylan will need to be able to work a razor and work on his mirroring skills with his reflection. Oh, and we are going to have to monitor the use of the shaving foam – Dylan will have a sensory party with all those bubbles!


Despite being able to use scissors to cut card and paper Dylan can’t cut his fingernails or toenails due to the technical precision required, he is fine having them cut for him though.

 He did have a stage when he was about 8 when he would hate to have his feet touched, at the time we were seeking advice from a sensory Occupational Therapist who advised us on some hands-on techniques and exercises to help relieve Dylan of his sensitivities with his feet. 

Touch wood since then, all’s been well.


Dylan can blow his nose with prompting but prefers to produce a tic like snorting, throat hacking that dominates day and night.

Prior to the snorting, Dylan had other stimmy behaviours which were less than desirable. I checked the snorting with his paediatrician who felt that it was a tic rather than a physical nasal problem.

I had suspected for months that the nasal snorting was a nervous tic as well as a self-stimulatory behaviour. It’s something which worsens in quiet public situations you certainly don’t want to draw attention. You know the ones; in libraries, school presentation assemblies, the quiet important bits of wedding ceremonies. 😦

But then it occurred to me, maybe it’s not comfortable? Maybe he feels congested. So, what do you do?  YOU GOOGLE!!

Well when Googling I stumbled across nasal douching or ‘saline sniffing’. Basically, it is pouring, dripping or snorting salt water up your nose and then blowing it all out along with whatever is up there. I checked the evidence base and couldn’t find any contraindications or injuries reported. 

Apparently non-infective rhinitis is recognised as improving with regular douching soooo… we gave it a go. 

I’m not usually squeamish but I cannot bear water up my nose so I sat out of this one and Mark kindly gave the demo and modelled to Dylan what he needed to do. Dylan was like a pro and picked up the syringe of warm salty water and whooshed it up his nose. He even made the ‘ahhh’ sound so as he didn’t swallow any. 

He did this for a couple of times a day for a few days and there was a definite improvement. Still snorting but not as violently and certainly not as frequently as before.

For social situations, we’ll definitely continue with encouraging the nose blowing though. 🙂

** Picture is of Dylans only ‘toothfairy’ baby tooth. He has swallowed or disposed off all the other ones when they fell out, never to be found. He brought this to me randomly one evening when it had just fallen out. I was chuffed to bits 🙂 **

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