Activities of Daily Living

Interactive Autism Network at Kennedy Krieger Institute

Date Last Revised: December 5, 2013

Date Published: April 2, 2007

Learning to perform activities of daily living, like dressing, self-feeding, and toileting, is crucial to a person’s independence and their ability to take part in the larger world. Mastering such tasks can be especially challenging for those on the autism spectrum.¹ Motivations and skills that a child with a different impairment, such as Down Syndrome, might bring to bear when learning such skills are not necessarily present for individuals with autism spectrum disorders (ASDs), even those who do not have intellectual disability.

Writes one group of experts:

"Most children learn self-care skills by watching and imitating what they have seen with minimal teaching by parents or instructors. They are motivated to do things for themselves, to be like the “big kids,” and to imitate adults. They are aware of the social benefits and know how to imitate. In contrast, many people with autism need systematic, sometimes intensive teaching in the self-care area due to deficits in language and attention skills, interfering behaviors, and/or sensory impairments. People with autism don’t understand the social motivations of others." ²

In other words, all the other issues individuals with ASD face make the acquisition of daily living skills that much harder. Imagine learning to put a sweater on all by yourself. A person with autism may, first of all, not inherently value doing things “all by myself," or care about how they appear to their peers if they can’t perform a certain skill; they may have impaired fine motor skills that make buttoning the sweater a challenge; and they may not like the way the woolen garment feels. Social, motor, and sensory issues collide.

The tendency to insist on sameness can also make acquiring life skills difficult. For instance, issues around eating and self-feeding can be complicated by a child’s acceptance of only a limited number of foods – preferences that may also be connected to sensory issues surrounding taste, texture, or appearance.³

Behavioral techniques,⁴  which attempt to reward and encourage desirable behavior while eliminating and discouraging non-desirable behavior, are often used in the area of life skills. Which skills are targeted and what specific techniques are used will depend on the needs and developmental level of the person being helped. Toileting is one obvious building block skill that can be difficult to acquire for individuals with any developmental disability;⁵ mastering such a skill can make a huge difference in the day-to-day life of a person with an ASD, as well as in the life of their caregivers.

Acquiring life skills is an important focus of intervention for those with more severe autism spectrum disorder. Such skills, especially those surrounding grooming and dressing, should also be addressed for individuals with milder autism. Because of their inherent social deficits, they need help understanding not just what needs doing, but why – a grasp of the importance of self-care and how it will impact their success at work or school. Temple Grandin Ph.D., a well-known speaker, scientist and writer with autism, wrote of an employer who “plunked a jar of Arid deodorant on my desk and told me that my pits stank.”⁶  He also had his secretaries take her shopping for appropriate clothes and teach her proper grooming.

Few employers would so directly and kindly intervene. Even brilliance may not overcome body odor, unwashed hair, or food stained clothing once a person with an ASD is trying to make their way in the larger world.

References 

1. Gillham, J.E., Carter, A.S., Volkmar, F.R., & Sparrow, S.S. (2000). Toward a developmental operational definition of autism. Journal of Autism and Developmental Disorders, 30(4), 269-278.  Abstract
2. DePalma, V., & Wheeler, M. (1991). Functional programming for people with autism: A series…Learning self-care skills. Bloomington: Indiana Resource Center for Autism, Institute for the Study of Developmental Disabilities. Pg. 4.
3. Williams, P.G., Dalrymple, N., & Neal, J. (2000). Eating habits of children with autism. Pediatric Nursing, 26(3), 259-265.  Abstract
4. Bregman, J.D., Zager, D., & Gerdtz, J. (2005). Behavioral interventions. In F. Volkmar et al. (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp. 897-924). Hoboken, NJ: John Wiley & Sons.
5. Cicero, F.R., & Pfadt, A. (2002). Investigation of a reinforcement-based toilet training procedure for children with autism. Research in Developmental Disabilities, 23, 319-331.  Abstract
6. Grandin, T. (2006). Thinking in pictures: My life with autism. (Exp. ed.) New York: Vintage Books. (Page 113)