Poor Personal Hygiene in Teens on the Autism Spectrum: 32 Tips for Parents

"I could use some tips on how to get my 16 y.o. teenager (high functioning autistic) to have better hygiene. His breath and arm pits stink most of the time. He hates to brush his teeth or take a shower. He doesn't even like to wear clothes (walks around the house in his boxer shorts most of the time)."

Sounds like you are going to have to assume the role of "personal hygiene coach."  Lucky you! Here are some of the main reasons teens on the autism spectrum seem to avoid practicing good personal hygiene:
  • Brushing hair or getting a haircut because they usually have very sensitive scalps.
  • Brushing teeth (e.g., not liking the taste of toothpaste, experiencing burning or stinging from it, having sensitive teeth and gums).
  • Getting dressed and feeling comfortable in clothing. Irritations can occur from loose fitting clothing touching the skin, tags or labels scratching, and clothes that are too stiff or too tight.
  • Poor vestibular system functioning means these young people often feel wobbly on their feet and suffer from gravitational insecurity (e.g., dislike of being upside-down, being suspended in mid-air or having their feet off the ground). Therefore, the simple act of bending forward or backward over a sink or in the shower can create dizziness, anxiety or mild panic.
  • Some teens on the spectrum fear falling over if they shut their eyes, thus you can imagine the potential anxiety experienced by simply washing their face in the shower.
  • Using deodorant. The shock of the cold spray on their warm armpit coupled with the quite high-powered aerosol delivery causes genuine alarm and discomfort. Most deodorants are strongly scented, which also bombards a sensory sensitive teenager.

While the typical youngster can usually master personal  hygiene skills by the time they are age 6, children with autism spectrum disorder often struggle with these tasks due to sensory issues (e.g., smells, sounds and textures) that are related to these skills. Fortunately, as they become more familiar with the tools used for personal hygiene, these tasks will be much easier.

Here are some tips to help with personal hygiene issues:

1. Brushing teeth is a task that can be difficult for children with ASD. The aversion problems have to do with a foreign object going in their mouth, the texture of the brush, and the taste of the toothpaste. What you may find helpful in introducing tooth brushing to your youngster is to use an electric toothbrush with a character on it that he enjoys. The vibration from the electric toothbrush and the familiar character will make this task more enjoyable. Once you overcome the aversion issues, all you have to do is demonstrate the process, have him copy you, and then narrate the steps as he tries to do it himself.

2. Have the same sex parent teach your son new hygiene practices. A man is better at teaching a boy to shave, for example, and a woman is better at helping a girl cope with her period.

3. Keep your grooming routine as stable as possible. Do everything in the same order and at the same time every day.

4. Look at a youth magazine with your son for ideas about hairstyles. Keep it simple, but not nerdy. Let him do it himself if at all possible.

5. Another challenge for teens on the spectrum is washing the underarms and using deodorant. Explain how it is done and why. Go slowly at first. You may want to let your son practice washing for a few days before adding the application of deodorant. Give him privacy if he is capable of washing himself. The simplest way to tell if he is doing it properly is the smell test. If body odor is still present, ask him to try again.

6. Repeat hygiene routines every day. Repetition is paramount. If there is not enough time in the morning, divide it between morning and evening.

7. Show your son how and where to shave with an electric razor. Autistic teens that need repetition to feel secure may want to repeat the process daily, even if it is not necessary.

8. Teach and reinforce the facts about sexual maturing to your son in a way he can understand. Start adding extra steps as body changes begin, one at a time, to his hygiene routine. When he is comfortable with one step add another. There are books and classes to help you, but learning and reassurance must continue at home.

9. Teach your son how to care for his hair. This will include learning how to brush, style, and wash it. You will want to start with basic brushing and styling. If he is resistant to hair brushing, it could just be the brush you are using. You can overcome this problem by letting him try a variety of brushes to find one he likes the feel of - or the look of. 

10. Washing hair is a big challenge also. The aversion that children with ASD have for hair washing has to do with several factors (e.g., water temperature, the feel of water on their head, soap getting in their eyes, the texture of the shampoo, etc.). A good way to overcome these problems is to adjust various aspects of the hair washing routine until you find the perfect combination that makes the task bearable. You will then walk your son through the hair washing process.

11. Watch for early signs of adolescent changes. Do not wait until they are full blown to begin to teach good hygiene.

12. Using visual reminders/timetables to encourage the completion of daily grooming tasks can be helpful in establishing good routines.

13. Use simple clothing. Look for things like elastic waists, pullover shirts, Velcro fastenings and slip-on shoes.

14. Use a 2-in-1 shampoo and conditioner to reduce time spent in the shower.

15. Try to keep your son’s hair and clothing fashionable (even if he doesn’t care, his peers do).

16. Teach your son to wash his hands, especially after coming home from school or playing outside and before eating. Hand washing is, without a doubt, one of the best ways to prevent the spread of germs and illnesses.

17. Teach your son to cover sneezes and coughs. Germs can travel far and wide on a sneeze or a cough. Get him into the habit of covering his mouth and nose with a tissue (or his arm if he can’t reach a tissue fast enough) when he sneezes or coughs.

18. Set up regular bath times. Many moms and dads find that evening baths are a nice way to relax their teenager before bed. And bathing the night before can help ease the morning rush. Some teens prefer showers, which can also save a lot of time on a busy school night or morning. Showers can also save water.

19. Remind him to wash his hair if it looks oily, and teach him how to clean his face and under his nails.

20. Remind him not to touch his eyes or mouth or to pick his nose. Germs can easily enter the body through the mucous membranes of the eyes and through the nose and mouth.

21. Provide a soft bristled electric toothbrush and bland tasting toothpaste.

22. Minimize temperature variations when bathing.
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

23. If your son has balance problems, consider a shower chair for use while washing hair.

24. If your son finds a shirt that he is comfortable in, buy a couple in bigger sizes and put them away.

25. Goggles protect eyes from shampoo and water.

26. Get him into the habit of flossing, and if he has bad breath, have him gently scrape the back of his tongue with his toothbrush. Get a fun timer to help him brush longer, like a cool little hourglass filled with blue sand.

27. Experiment with unscented roll-on deodorants or natural crystal antiperspirant.

28. Cut out tags and buy seamless socks and garments if your son is sensitive to seams.

29. Being empathetic and talking with your son about his discomfort in the grooming process will help him develop better personal hygiene habits.

30. Be sure to put down a secure bath mat to prevent any slips on the wet floor when he’s done.

31. Allow your son to try several brands of toothpaste until he finds one he is comfortable with.

32. Lastly, have plenty of patience for your son's sensory sensitivities!


Resources for parents of children and teens on the autism spectrum:

==> Videos for Parents of Children and Teens with ASD
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•    Anonymous said... Also natural deodorant crystals don't stink the place out. you use them on wet armpits so they're a good reason to have a shower first. They're surprisingly effective and last a long time.

•    Anonymous said... I posted a list on the bathroom mirror (very detailed) and insisted that he follow it every day. ie: shower, wash your hair and your private areas, put on deodorant, comb your hair, brush you teeth for 2 minutes (set a timer), clean underwear every day, etc... I also purchased clinical strength deodorant that is applied before bed and that helped A LOT!! He is now 19 and usually remembers it on his own but before he walks out the door I always say "did you brush you teeth and put on deodorant?" I am fortunate that he is not offended by these reminders. I also told him that taking a shower is a daily activity and he would just have to get used to it so that he could fit into society. Everyone takes a shower every day- no questions asked!!!

•    Anonymous said... I recently took my Aspie nephew to the store and let him choose his own deoderant. He is very proud of it and pretty much puts it on every day without being asked. He also likes for us to smell him and tell him how good he smells. Maybe letting him make a choice and making a bit of a deal out of it helped. Who knows, I just hope it lasts.

•    Anonymous said... I wish choices worked for my son I even bring up going to choose one he likes or try to pass them in the store isle and he flips out. bought the natural no smell ones and he throws them away. We have him shower every other day. One day I did laundry and only found one pair of underwear. So I confronted him about this and he padded the laundry for the next week with 7 pairs of clean underwear. Consistency is key.

•    Anonymous said... Lots of good ideas here for you. I tie some of the hygiene items to rewards. My son loves to play games and if he gets the hygiene done without too much repetition he gets extra play time.

•    Anonymous said... My aspie son, 16, loves Axe because its cool and girls like it. I got him the soap/shampoo mixed one, the deodorant, and the body spray. I stopped buying the body spray when he was using a can a week.

•    Anonymous said... My son is all about rules and lists so I had to make hygiene a 'Rule'. I use a wax pen to write his list of hygiene tasks on the bathroom mirror. He gets fined $1 if they don't happen. He has a strong aversion to anything not natural and chemical and for awhile wouldn't use products. I had him research natural products that worked. So now the entire family uses them thanks to him educating us all lol! It took awhile but now its almost a non-issue.

•    Anonymous said... My son walks round in his boxers. ALL the time! He's 20! (So does my little boy age 1 0 and nt)...my aspie son had problems with his teeth and needed a brace and when the orthodontist saw him she almost refused to put him into braces because of poor dental hygiene..he was so mortified he went completely the other way, brushed his teeth from then on perfectly and now has a dream smile...he works out a lot and can get v sweaty and be unaware of his own body smell (so I make him use a roll on deoderant and then a spray one on top!) X

•    Anonymous said... stick reminder notes up in the bathroom? Brush teeth. Wash under arms. Use deodorant etc...

•    Anonymous said... We had the same problem with our daughter, we got help from our local autism outreach worker who came out and had a personal talk with her and touch wood so far it's worked, the only problem my daughter had was with spray deodorants where she would spray but it wasn't going under the arm so I got her a roll on and she now smells sweet

•    Anonymous said... we had this issue in working with our behaviour therapist we chose the most important task to challenge first and focus on then listed the others below. My son was on a token program where he got tokens of different colors each day to trade in for something he liked then at the end of the month we tallied them all and if he was in the big range he got a bigger treat. Predetermined in the planning phase. It takes a while but it did work. We are still working on brushing teeth it is coming. We go to the dentist every 6 to months for a cleaning to ensure we are OK. Hope this helps.

•    Anonymous said... also glad it's not just mine, I did get him a onsie which he likes enough to wear all the time instead of walking round in boxers (with a fleece blanket tied over one shoulder like some sort of roman toga when it's cold) but I have to kidnap it when he's sleeping to wash it, again, it's that old chestnut of 'no honey, you can't go on playstation til you've had a shower/brushed teeth etc'

•    Anonymous said... OMG..I thought it was just me! He was diagnosed 6mths ago...now 20yrs old...now showers 5 out of 7 days a week. But through his teen years...geez!

•    Anonymous said... Your not alone, I'm in the same boat but that's what's so funny. When you hear someone going through the same thing you gotta laugh and have a sigh of relief your not insane. I do have to check with my son every morning and tell him to shower, lucky for me he does not give me a hard time but if I forgot you can Smell him as he goes by and basically I have him stop what he's doing and take a shower right then and there. How about good old fashioned bribery. My son loves his Star Wars tee shirts and such. Maybe if you cant find stuff like that he would love to wear, especially when they think its funny ,he'll take a shower to wear one. The teeth...that's a tough one. I have three other grown NT children and everyone of them gave me a hard time about that, it's a Teenage thing. They all out grew it.

•    Anonymous said… We have a laminated list in the Bathroom and Kitchen because we felt we were always nagging..".have you cleaned your teeth, have you washed your hair and had a shower today"!! Now we just say have you checked your list today hun and she goes off and does it...seems to be working so far!!

•    Anonymous said… That's my son! Lists work great. If its not on his list it won't get done. I write with a wax pencil his hygiene tasks on his side of the kids bathroom mirror but in questions. 'Did you brush your teeth?' 'Did you use Deodorant?'. Not to single him out I do the same for his sister on her side. It helps. I just wonder when he grows up will he still need a list?

•    Anonymous said… That's my son too! Holy cow. I thought he was just being lazy. He refuses to take more than one bath/shower per week, so I let him get away with that one AS LONG AS, he washes at the sink every day - and yes I have to stand there and watch. Also have to check on him when he's brushing his teeth, otherwise he'll do a quick "brushover" and say he brushed his teeth. ugh. We started with the deodorant almost 1 year ago (he's 12), still have to remind him every day.

•    Anonymous said… I just took my Aspie nephew to the store and allowed him to choose his own deoderant. He is so proud of his choice, pretty much puts it on by himself every day and loves for us to smell him after he does. Maybe making it his choice was the key. I'm not sure.

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