Dressing skills for children with special needs: Personal hygiene and activities of daily living

The presentation above is an information guide on dressing skills for children with special needs.

Dressing is an important self-care skill to be acquired by children, as they grow. Introducing self-care skills early will along with ample support and guidance will ensure independence and self-sufficiency. 

Address sensory sensitivities

• Children with autism are often prone to increased sensitivity to sensory stimuli. This might include hypo or hyper sensitivity to the texture of the fabric, the fit of the clothes and or sensitivity to the seams or tags of certain dresses.
• It is therefore important to identify what is bothersome to the child and to choose their clothing based on their preference.
• Soft, breathable fabrics can be selected. Dresses without tags and protruding seams make for a better choice. Loose-fitting dresses may also offer greater comfort to children.

Teaching requisite motor skills

Before teaching the child self-care activities like dressing, it is essential that we teach the required motor skills (both gross and fine motor skills).

Children with autism have concerns in motor planning and therefore might find the steps involved in activities like dressing difficult to comprehend and plan. This might lead to the child feeling overwhelmed and avoiding the task altogether.

It is therefore important to teach the child some important motor skills before introducing ADLs like dressing.

These include a range of activities in both gross and fine motor skills:

Gross Motor Skills:

• Balancing, bending at the waist are requisites for pulling up or removing pants. 
• Reaching overhead is needed to pull out or wear a top. Midline crossing, trunk rotation are some of the important gross motor skills that are essential for putting on or removing socks or shoes, putting on and removing pants. 
• Hand eye and body coordination are needed for putting on and removing front open shirts and zipping or unzipping.

There are a variety of activities that can help improve gross motor skills. 

• Balancing activities and midline crossing through play and games such as kicking the ball, playing with hula hoops. 
• To achieve trunk rotation and reaching hands above their heads, games like passing or rolling objects to each other, throwing and catching ball can be introduced to the children. 
• Body awareness can be developed by playing games such as ‘Simon Says’ which can help identify different body parts and also differentiate between right and left.

Fine motor skills: 

Skills important for dressing skills are buttoning and unbuttoning, grasping for pulling zips up and down, tying laces to be able to wear shoes.

Significant concerns in these areas can make the task of dressing up independently rather difficult and overwhelming for the child. To help with development of these motor skills, many activities can be incorporated in the day to day activities of the child. 

• Teach the child to thread beads or lace boards to develop eye hand coordination and better grip. 
• The child can improve his pincer grip by putting cloth clips on boards or using clips to put coins in a piggy bank.
• Practice buttoning or unbuttoning on boards or using large buttons

Teaching motor skills will go a long way in helping the child gradually learn the different steps in dressing. Over time, the child can slowly gain confidence and independence in this area of self-care.

Step-by-Step learning

Break the process into manageable steps and teach gradually for better understanding and retention. It is easier to follow and prepares the child to expect what comes next in the activity.

An example of a step by step guide to help with dressing skills is as follows: 

• Undressing: 

It is important to first teach undressing and then move on to dressing since it is easier to follow and achieve.

1. It can be taught by first teaching the child to unbutton any buttons on the pants. They can then sit or stand, and pull the pants down their legs one after the other.
2. The second step can be to teach them to remove a shirt similarly by first removing buttons on them and then to pull their hand off the sleeves one by one. 
3. Tops or pull-overs can be taken off by holding the garment at the bottom with both arms crossing each other and pulling it up to the chest and then taking it off the head.
4. Socks can be taken off by making the child sit and hold the top edge of the sock. The child should then insert their thumb into the sock, hold it firmly and pull it down to the heel.
5. Similarly, footwear can be taught to be removed by first sitting and then removing any buckles, straps or laces. Holding one leg up, holding the heel, the child can slowly pull the footwear off.

• Dressing:

As with undressing, start by physically guiding the child, gradually assisting them only with verbal prompts. Finally the child should be able to dress independently. Remind the child to dress only in privacy.

1. Undergarments and pants can be taught to be worn, by instructing to hold the pants in the front of their legs, putting in each leg and pulling them up.
2. Remind to button up or pull the zip on the pants.
3. Putting on a shirt may need assistance to put each arm into the shirt and pulling it in the front.
4. Button up the shirt
5. While putting on a dress or a T-shirt, show them to roll it up, such that the back of the dress faces the child. Place it over the head and bring it over the shoulders. Find the sleeves, then put one hand after the other.
6. Similarly, guide them to put on the socks by folding the socks, put the feet in -toe-first and pull it up to their heel. Finally pull it above the ankle.
7. Finally, while putting on the shoes, teach the child to decide which shoe belongs to which foot. Teach them to insert the heel first and then to push the foot forward. If the shoes have laces, teach this skill independently first and then apply it here.

Along with dressing skills, it is important that the child understands the importance of cleanliness too. Help them identify if their clothes are clean before they go out. Teach them to store their clean clothes at the correct place.

 Be consistent

• Consistency is the key. Maintain the same sequence each time. 
• This helps the child to understand what is expected in the task and motivates them to participate. 
• The caregiver can also simplify the task by placing the clothes out for the child. This should also be in a particular order, for example undergarments, vests, shirt, pants, socks etc. 
• By simplifying the task, it makes it easier for the child to plan and understand the activity.

Provide support

Offer guidance, make necessary adaptations, and assist. When it is noticed that the child is overwhelmed with carrying out the different tasks involved in the activities, certain changes can be made to make the child comfortable and help them perform the task without frustration.

• Larger buttons or press buttons can be placed instead of small buttons on dresses. Shoes with velcro straps can be used instead of shoes with laces. Slip-ons can be another alternative. Elastic pants can be used instead of pants with buttons or zips.
• Using visual aids such as a chart explaining the step by step sequence for dressing will be helpful to guide the child perform the task with little or no help from the adult. This can help motivate the child to participate and carry out the task, increasing their confidence and fostering independence.

Positive encouragement

• Praise and encourage the child to boost their confidence and willingness to learn. 
• Each child learns at their own pace and it is important to have patience as the child progresses through each step. 
• Too many instructions or corrections might make the child overwhelmed, leading to the child being reluctant in engaging in the activity.
• A key point to remember always is that once the child starts dressing themselves up, help from caregivers should be slowly weaned off. 
• It is also important to teach the child to undress and dress up in privacy. They should be instructed to learn to find privacy and dress once they are independent.

Dressing independently is an important skill that should be introduced and taught early to children. By being consistent and providing ample support, parents can instill confidence and self-sufficiency in self-care skills such as dressing.

You may also seek tips from Ms. Snehal Vaidya, Occupational Therapist about activities of daily living.

The Jai Vakeel Foundation has helped us in compiling a step-by-step process for dressing skills in children with special needs and to walk your child through the act of dressing-up/undressing shirts, pants, socks and shoes.

Do you want to teach your child bathing skills as well? Refer to the link here to learn.

If you have questions about Autism, Down Syndrome, ADHD, or other Intellectual Disabilities, or have concerns about developmental delays in a child, the Nayi Disha team is here to help. For any questions or queries, please contact our FREE Helpline at 844-844-8996. You can call or what’s app us.

DISCLAIMER: Please note that this guide is for information purposes only. Please consult a qualified health practitioner for proper guidance.