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Brushing

I am in the stage of making my son independent in Brushing. But to reach this stage, I should say that I had to undergo lot of struggles (and still undergoing☺).

I think even struggle is a very simple word to explain the journey of brushing with my son.
My son was diagnosed with Autism only at the age of 3 years. When he was around 1.5 years, I had met a Doctor for some purpose. Just like that I asked the Doctor about brushing my son’s teeth. She said it is natural that some children to resist brushing and not to worry. She suggested to use soft white cloth to start with instead of a brush. And also she advised to give lot of crunchy vegetables like carrot and cucumber.

On seeing the vegetables my son ran away and I got a good “crunchy” biting when I put my finger into his mouth with soft white cloth for brushing.

Now he is going to be 9 years and today he can take the brush, put the paste and start brushing, though not very thoroughly, wash the brush, keep it back and rinse the mouth.  The journey has been so long and very exhausting and he is still in the processes of learning (i.e. to become completely independent).

Let me now explain some of the routines that helped my son to bring him to this stage.
First, I introduced brushing as a routine and did the brushing like ritual though I didn’t get much support from my son. I didn’t keep it as a first task in the morning since I know it will upset him in the morning itself. So I mostly waited till he got into a good mood in the morning. In the beginning stages, screaming was the usual first outcome on seeing the toothpaste and toothbrush. Sometimes he allowed for a single stroke, sometimes we came out of the bathroom without brushing at all. And a very important thing here is I always used the same brand of tooth paste so that any change in the colour/taste of the paste didn’t lead to more anxiety. I also used a soft brush which helped to handle his sensitivity (about which I will explain little further down).

Every day the brushing task will be in his daily schedule (Note: A visual schedule showing all the important tasks for the day) and by showing it, I took him into the bathroom daily. Slowly his anxiety about brushing reduced, but the sensitivity in the mouth stopped him to co-operate with me. I knew about this sensitivity which is typical for many kids with Autism after he was diagnosed at 3 years.
At this stage therapists helped me to reduce the sensitivity in the mouth.

One therapist taught me to use the soft baby brushes and also how to make simple strokes on the cheeks (inside the mouth). So focus is on the cheek than teeth in the initial stages.

Another occupational therapist taught to gently massage the cheek, chin, upper lips, lower lips (outside, not inside the mouth) i.e. around the mouth.

So these massages along with the routines helped my son to brush. Today he is able to adjust to different toothpastes and almost independent.

To make him independent I use a detailed visual schedule specially for brushing with all the actions required to do brushing(like take the brush, take the toothpaste, put toothpaste etc).  This Visual schedule help him to understand what to do next.  The picture shown below is the visual schedule that my son uses daily while brushing.



 
 Let me explain how I prepared the above Schedule.

First step is to prepare the below base sheet. Base sheet is used to stick the visual cards one after the another.
To prepare the base sheet I laminate a A4 size paper and cut it into 3 equal strips. And stick the laminated strips one below the another with transparent cellotape(to make it long enough for all the visual cards).

Now, the next step is to prepare the visual cards to stick on the above schedule, separately.
I prepared the above visual cards using word document, laminated and cut it into individual pieces. The visuals in the visual cards are from google images and I have added text to my son's understanding. Then put velcros on both the sides of the visual cards.

Now the Visual schedule is ready for the use.  For the daily use I hanged this visual schedule near the wash basin.


Whenever my son finishes one action as per the visual cards, I flip it to indicate that action is complete(that is why there is Velcro on the front as well as the back), like picture shown below




The reason why I do the flipping myself is that my son gets distracted from the actions for brushing into the flipping action. So I make him focused on the actions and I do the flipping on his behalf.

After following this visual schedule, my son has become almost indepent with ability to follow this sequence independently. But does the brushing for front teeth only as of now and also does not necessarily do it as a part of morning duties, but rather any time he wants to brush. These are the two areas now I am continuing to work with my son as the next steps.

Hope this experience helps you make your own action plan for your kids. All the best.

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Please click the following link for a comprehensive documentation of my journey with Aakash: Click Here
Here is the link to the playlist of Activities done with Aakash, in YouTube: Click Here