Teaching self-care skills to children with special needs

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Independent living self care skills are the skills that a person needs on a daily basis to live independently. They include self care skills like eating, dressing, bathing, toileting and grooming.

Teaching independent living self care skills is a process that begins at birth and goes on into adulthood. Children with disabilities find these skills difficult to perform for various different reasons. However, they will need to acquire these skills as best they can to live as independently as possible. Even if they cannot live independently, being independent in self care will take a lot of burden off the caregivers. Thus, this is often the most important goal for a child with a disability. That is why it is so important to plan independent living skills lessons for students with disabilities. Here are some strategies you can use in your lessons to teach these skills.

Young children with disabilities often demonstrate delays in many areas of development. Because of these delays, they may need additional help. In order for children to receive acceptance and acquire as much independence as possible, it is important that self-care skills be a focus during the preschool years.

There are four main types of self-care skills:

Self-feeding. The best way to build independent feeding skills is to learn the normal developmental stages of self-feeding. Encourage children to practice feeding themselves from infancy on. Begin by offering older infants finger foods. Introduce a spoon and fork and give children plenty of time to practice. Let children be as independent as possible during mealtimes. Give them the tools they need to be successful. Consider bowls that attach to the table, child-sized utensils and small cups with handles and spouts (such as measuring cups) for pouring. Encourage children to try for themselves but provide help and encouragement when needed so they don't get frustrated.

Independent dressing and grooming. Encourage children to dress and groom by themselves; just provide minimal assistance. Begin with older infants and toddlers by encouraging them to help pull socks on and off, pull up pants after diapering and help put their arms through sleeves. As children get older, encourage them to dress themselves but help with challenging steps such as zipping and buttoning.

Hygiene and toileting. Look for signs of readiness for toileting. Encourage children learning to use the toilet to climb on and off the toilet seat, pull clothing up and down, and wash their hands independently. Also teach children how to brush their teeth after lunch and snacks. Be ready to provide support and help if they need it. Encouraging children to take care of everyday hygiene routines and to use the toilet independently helps them learn how to become more independent and self-sufficient, and frees up your time to help children with other activities.

Helping with daily chores like table setting and picking up toys. Encourage children to help with clean-up early on. Give toddlers responsibility for placing napkins or utensils on the table. Encourage children to begin clearing their own plates when they are old enough to carry them without dropping them. When children are involved in regular chores starting before the age of 4, they tend to be more independent in early adulthood than children without the experience of helping out.

Self-care skills are worth the time and effort in a child care program. The secret to success is to give children age-appropriate experiences and provide the appropriate supports to help children be successful. Child care providers can offer opportunities for children to develop self-care skills and give them ample time to work on these important tasks. Remember that adults are important role models. We model self-care skills; children learn a great deal from watching us.

Techniques to promote self-care skill acquisition:

Rewards: Give rewards to the child each time they perform a self care task, or a part of a task. Rewards can be edible, social rewards, activity rewards, material rewards or even privileges. Tokens are another way to teach and reinforce self care skills. Make a chart where you add a star everyday if the child has completed the task independently. At the end of the month, the child gets a reward based of the amount of stars they got. Different children benefit from different rewards depending on their level of understanding. Use appropriate rewards. Researched-based rewards are individualized, age-appropriate, and naturally occurring in the environment. A naturally occurring reward for drinking from a cup is relieving thirst. When the child first begins to learn to use a cup, say, “Look at you! You can drink from a cup!”

Forward Chaining: Forward chaining is the process where you break up a task into small steps, and teach the first step. Then you get the child to do the first step, and you complete the rest of the task. Then you teach the second step. After that, you make the child do the first two steps and you complete the rest of the activity. Forward chaining is usually used to teach tasks where the last step is very difficult.

Backward Chaining: Backward chaining is the opposite of forward chaining. Here you teach the last step first, then the second last step and so on. So, you do all the steps except for the last step and get the child to do the last step. Backward chaining is more fun for the child, because it helps them feel that they completed the activity. It is used quite often in training of self care skills.

Repetition: Repetition is one of the best ways to reinforce and learn a task. The best part about self care skills is that you need to do them every day, and often more than once in a day. Help the child practice his skills every single time he does that activity.

Shaping: Shaping is when you reward and appreciate the child when they are approximately able to do the task. It means that you don’t look for perfection. If a child takes the comb to his head n moves the comb, you reward him and appreciate him for it. It’s ok if he can’t completely comb his hair, or even if he ends up messing up his hair. Shaping is used in the earlier stages of training.

Grading: Grading is when you give a simple activity to start with, and slowly increase the complexity of the task. Some ideas for grading are – using a large comb, teaching buttoning on large buttons, teaching dressing with over-sized clothes.

Adaptations: Sometimes planning lessons or an independent living skills curriculum is not enough. Some children with special needs, especially children with physical disabilities may need to be taught an adapted way of performing the task. They may also benefit from some adaptive equipment.

Adapting the environment: Some adaptations in the environment that can help are a wheelchair accessible toilet, a bath chair, a low sink. Keeping the clothes and other belongings of the child at an accessible height will promote independence.

Adapting the technique: Sometimes, adapting the technique can help the child to be independent. For example, stabilizing forearms on the table before eating, or sitting down on the bed and putting on pants. An occupational therapist will be able to advise you on techniques based on the child’s needs.

Adaptive equipment: There are a lot of different adaptive equipment that can help a child with special needs to be independent. Modified spoons, long handled reachers and modified clothing are some examples.

Select appropriate prompts. While teaching a child to eat with a spoon, for example, the teacher can move from full physical assistance to assisting the child only when moving the spoon directly into his mouth. You may need to use hand-over-hand assistance, but this support needs to be faded as the child becomes more independent.

Establish a routine. Routines pay a critical role in the formation of self-care skills. For example, putting on a jacket before going outside to play is a self-care skill that is routinely done prior to outdoor play. Brushing teeth after lunch is another self-care skill that is part of the daily schedule.

Learning, rather than time, should be the focus. It may take longer for a child with a disability to master these skills. Persistence and consistency are the keys to success.

Professionals: Get help from professionals as needed is important.

Expectations: Expect positive outcomes. Sometimes we do not attempt to teach self-care skills to children with cognitive disabilities because we have low expectations. If we expect children to succeed, there is a higher probability that they will.

Integrate: Integrate opportunities to promote self-care skills throughout the day and during play will provide needed practice for successful mastery of targeted skills. Having dress-up clothes in the housekeeping center, for example, provides an excellent opportunity to reinforce buttoning, zipping, snapping, and tying.

Responsibility: Child care providers can help young children become independent by allowing and encouraging them to take responsibility for themselves whenever possible. It can be faster and less messy to do things for children, but they learn so much more from doing things for themselves. When children practice self-care skills such as feeding and dressing themselves, they practice their large and small motor skills, gain confidence in their ability to try new things and build their self-esteem and pride in their independence.

Stories: Talk about various independent living skills through stories. Use stories also to talk about work, different jobs, and the value of money. All this will help the child be motivated to be independent, get a job and support themselves when they grow up.

An example of toilet training:

Children with mild disabilities are typically toilet trained using traditional methods. For students with mental or physical disabilities, it may take considerably longer for the child to become toilet trained. The prerequisites to begin toilet training are: 1) a stable pattern of elimination, 2) daily periods of one to two hours of dryness, and 3) a chronological age of two years or older. If toilet training is delayed until the child is older, it may result in placement in a more restrictive setting away from their peers and friends.

When beginning toilet training, it is important to consider clothing. Teachers should suggest to parents that children wear pants with elastic, rather than overalls with suspenders that are difficult to remove. Training pants, as opposed to diapers, make it easier for the child to be aware of wetness. When teaching the children to pull up their pants, it may be necessary to use hand-over-hand techniques; gradually fade the assistance as children begin to perform the task on their own.

In addition, it is very important for the child to be able to use a comfortable potty chair where her feet touch the floor. Occupational therapists may have additional recommendations such as seating the child on the toilet facing the tank. This position provides more stability and allows the child to see what happens when she urinates in the toilet. Teachers should be aware that toilet training takes time and the child may lose instructional time during toilet training. Toileting programs for children with disabilities often involve extra drinks of water before taking the child to the restroom. About five or ten minutes after the child drinks a glass of water, she is taken to the restroom to sit on the potty for ten minutes. This process is repeated several times each morning and afternoon. For children with seizure disorders, be sure to check with the child’s physician before giving extra water during the day since it may interfere with anticonvulsant medication.

Rewards should be used judiciously. When the child has toileting successes, affirm him by smiling, clapping, and telling him what a big boy he is. You also can provide treats that he really likes. For rewards to be effective in maintaining skills, the child must be weaned from treats and verbal affirmation gradually. The ultimate reward for the child is staying comfortable and dry, and avoiding embarrassment with classmates.

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