Hygiene in ADHD Kids:
How to Teach Your Child to Be Independent in Good Hygiene Practice
Middle school is brutal. I remember kids calling one of our classmates who had dandruff a “dirt ball” when we were in middle school. Dandruff. Like, ya know, the thing that happens when you’re scalp is dry from the soap you use? Horrible human beings. This was twentysomething years ago, and it’s gotten worse from what my sixth-grader tells me. Because of this (amongst other reasons), mastering the practice of good hygiene by middle school is of utmost importance.
Children with ADHD often have a more difficult time with hygiene due to their increased distractibility and the fact that brushing their teeth isn’t really fun. In his mind, my son is already playing out how he’s going to score at least three shots on his friend down the street when they play basketball. When showering, he often forgets whether or not he actually used soap. Now, I can totally relate to this, and maybe you can too. Have you ever shaved one leg but forgotten to shave the other? Or you after shaving your legs forgot if you shampooed your hair already or not? I cannot be the only adult this happens to. It happens a little more frequently to my child than it does to me—like, every day.
At first, we just trusted him to brush his teeth thoroughly but then they started to yellow, and I freaked. So, as any concerned mother would, I began brushing his teeth for him at least once per day. This definitely helped. Eventually we would fall off the wagon and his teeth would get worse, and the cycle continued over and over again. Finally, I decided to stop doing it for him and implement some new strategies and see if anything stuck.
The Magic Toothbrush
My sister is a dental hygienist, so she was full of information for us on how to get him to be more conscious about his teeth. She even gifted him an AMAZING toothbrush (pictured below) that has a corresponding app! You download the app and put your phone in the little holder thingy that comes with the toothbrush. The holder sticks to the mirror via suction cup at his eye level. When he’s brushing his teeth, the app tracks how long he’s brushed, which areas he’s done well, and which areas he’s missed. It also alerts him when he’s pushing too hard. Technology never ceases to amaze me!
2. Gestural Prompts
Sometimes, he’ll need to brush with a regular toothbrush. Mainly because I’m not sending the expensive magical one with him on overnights or week-long trips. In order to teach him to brush with a standard toothbrush, I started by modeling how and where he needed to brush. One thing I’ve learned in my job as a behavior therapist is that gestural prompts are easier to fade than verbal prompts or hand-over-hand guidance; so, I would watch as he brushed and then just point to any spots he still needed to brush. Eventually I was able to fade back to just being in the room with him. We’re still there right now. He’s not completely independent on brushing thoroughly, and I know that’s true in large part because of the fact that his meds aren’t actively in his system during toothbrushing. He’ll get there though!! Repetition breeds habit.
1. Visual Schedules
Visual schedules are just simply a way of life in our home. In this case, they’re a visual reminder of all of the places my kids need to be sure to wash. With a pre-teen, you can’t really stand in the bathroom and gesturally prompt them through a shower routing. I mean, you can. I just don’t know how comfortable you or your child will be in the process. The visual schedule I used is no longer available online, but here’s another great one:
I actually laminated his schedule and hung it on a suction cup hook in the shower. It helped my youngest to learn the steps as well. Visual schedules only work if they’re visible when and where the behavior is meant to take place.
2. Backward Chaining
This is a FANTASTIC tool for teaching routines. Basically, backward chaining is a principle that teaches all steps in a sequence, and then fades from the back end. I know that may sound super confusing so here is my example.
If you’re teaching a child to wash his hands, you would teach these steps:
- Turn on water
- Wet hands
- Pump soap into hands
- Rub hands together for 15 seconds
- Rinse hands thoroughly
- Turn off water
- Get paper towel
- Dry front and back of hands
- Throw paper towel in trash
Initially, you might teach him by hand-over-hand guidance, prompting him through each step. After a while, you would fade the last step, using hand-over-hand for steps 1-8, and then letting him do step nine independently. (You may use gestural prompting if needed, but the goal is fading back prompts to foster independence.) Once he’s mastered throwing the paper towel away, you would hand-over-hand steps 1-7, and then let him do steps eight and nine independently, and so on.
I realize this may seem tedious, but I think we tend to underestimate the things we need to be intentional about teaching our kids. Teaching things this way from infancy is really effective in getting those skills mastered from early on.
Here is my advice on implementing visual schedules in the context of backward chaining:
- Cut out the schedule and laminate it.
- Then cut out each of the pictures and laminate them.
- Use velcro dots, loop side on the schedule, and hook side on the back of the pictures.
- Set the schedule the way you want your child to learn it.
- After a while, remove the last picture. (She’ll have to complete the last step from memory.)
- Once she’s mastered independently completing that last step, remove the next picture. Keep going until they’ve mastered the entire schedule completely independently. And reinforce the heck out of it!
We always use the sniff test to make sure our guy used soap and really washed. If his hair smells like a wet dog, he has to go back in and try again. (FYI, going back in and trying again actually prevents him from getting to do what he was in such a rush to do. This is effective punishment! Forgetting to use soap has drastically decreased.)
These are just some of the different methods we’ve used to grow our ADHD kiddo’s hygiene skills. The hardest part as a parent is being motivated enough to stay on top of our kiddos: being sure to supervise every time until a habit forms. That’s probably been our biggest challenge. There are so many nights that we’re tired from a long day of work and we would just rather sit on the couch and veg while the kids do everything themselves. All that does is enable them to slide back into their old ways.
Stay strong! We’ve got this! Our kids will get this!
What have you tried that’s helped teach your kids how to practice good hygiene or form good habits?