The skin of an adolescent covers approximately 5 ½ square metres (18 square feet) and is our boundary between self and the world. It comprises about 5 million nerve endings (or touch receptors) and is extremely sensitive. In other words, our skin is our external nervous system. Touch receptors communicate information about pain, pressure, heat and cold, vibration and texture.
This may clarify the difficulty children with Aspergers Syndrome seem to have with showering. Our AS son will take a bath quite happily (for the most part!) but rarely showers, explaining to us that taking a shower “is a nightmare”, likening the feeling of the water spray against his skin as “tiny daggers stabbing me”. When he was aged about 9-13 he would often go into the bathroom and “pretend” to shower, by running the water for a reasonable amount of time, and then changing into his pyjamas. Taking a bath can present problems too, with Asperger children not liking the noticeable change in temperature and how that feels on their body, from warm bath to cool air.
The nervous system of children with Aspergers Syndrome is always on high alert, and their brains interpret touch in unexpected ways e.g. instead of being calmed by a gentle hug, they may become agitated or tense. Sometimes even anticipating being touched can trigger a fight or flight response in an AS child.
Additionally, poor vestibular system functioning means Aspergers Syndrome children often feel unsteady on their feet, and usually suffer from gravitational insecurity e.g. dislike of being upside-down, being suspended in mid-air or having their feet off the ground. This can mean that the simple act of bending forward or backward over a sink to have their hair washed can create dizziness, anxiety or mild panic.
Some Aspergers children fear falling over if they shut their eyes. Imagine then the distress experienced by simply washing their face in the shower. (Perhaps this is why our son always seemed to have soap in his eyes – he may have kept them open when washing his face and hair!) This fear of falling comes from a proprioceptive (bodily sense of self) imbalance – a common trait in those with Aspergers Syndrome.
Getting dressed and feeling comfortable in clothing is another area of distress for AS children. Irritations can occur from loose fitting clothing touching the skin, and tags or labels scratching. Clothes that are too stiff or too tight also cause problems. Clothing is usually chosen for comfort – for this reason our son insisted on wearing the same clothes each day, and it was our job to ensure they were clean and ready to be worn! This seemingly obsessional preference extended to his school uniform. Even though he had 3 sets of uniform (shorts and shirts) only 1 set was deemed comfortable enough to tolerate. He could distinguish his favourites by the length of the shorts and the sleeves of his shirt. Incredulously these only differed in length from the other sets by as little as 3mm (1/8 inch).
Cleaning teeth may also present challenges for children with Aspergers Syndrome. Problems in this area of grooming can be for a variety of reasons, from not liking the taste of toothpaste or experiencing burning or stinging from it, to having sensitive teeth and gums (their gums may become tender, bruised or actually bleed from brushing). I recommend trying a variety of toothpaste flavours and also using an electric toothbrush. Be sure to model the correct procedure for brushing teeth to your Asperger child. Our son brushes his teeth much the same way he brushes his hair (the word ‘brush’ is the same, so the procedure must be the same!). Your AS child may never brush his/her teeth for the recommended 2-3 minutes each time, however it’s important to focus on establishing the twice a day routine.
Dislike or distress at brushing their hair or having a haircut seems to be a common obstacle with Aspergers children. AS children usually have very sensitive scalps and skulls (our son would become hysterical when he bumped his head, and would tell me he could feel his brain ‘rattle’ or move). We were never able to go to a Salon to have his hair cut, and I had to add Hairdresser to my list of talents! He would refer to the process as a “Hairs Cut”, because he could feel each of his hairs being cut. He recently explained that the change in the weight of the hair produced by the haircut was what caused him so much distress, as well as feeling exposed and vulnerable by losing the ‘protective’ barrier his hair created between him and the world.
Using deodorant or anti-perspirant sprays is another area of discomfort for children with Aspergers Syndrome. 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 Asperger child.
So whether your Asperger child is 4 or 24, personal hygiene and grooming may continue to cause distress through their sensory sensitivities. Using visual reminders/timetables to encourage the completion of daily grooming tasks can be helpful in establishing good routines. Being mindful of their sensitivities and being prepared to compromise helps too.
Look for ways to minimize their distress while completing their grooming e.g. suggest a bath instead of a shower, minimize temperature variations when bathing, use a 2-in-1 shampoo and conditioner to reduce time spent in the shower, provide a soft bristled electric toothbrush and bland tasting toothpaste, and experiment with unscented roll-on deodorants or natural crystal anti-perspirants. Being empathetic and talking with your Asperger child about their discomfort in the grooming process will help them develop better personal hygiene habits.
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Article Added on Saturday, August 9, 2008
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