Help & Advice Practical Advice Health & Hygiene Keeping on top of your health and hygiene when you are living with an autism spectrum condition is not always easy. Every individual has different issues in this area and many can manage their health and hygiene with little or no support, but in this section, we will go through some common difficulties that people with autism can have. Some people with autism might not have the communication skills, or an understanding of what is happening, to be able to tell you if they are in pain or discomfort. Often, in these cases, the only indicator that something is wrong is a change in their behaviour. If they have become unusually agitated or withdrawn, for example, it is probably worth investigating. This might be as simple as asking the individual if they are in pain or discomfort and telling them to point to where it hurts, or you might have to use other methods such as visual aids to find the cause of the problem. Seeing a Health Professional Seeing a doctor or dentist can be problematic for someone with autism. Although there is a routine involved with seeing a GP or dentist, especially if it is a regular check-up, there are lots of things that are unknown and out of their control which can cause anxiety. It might be a fear that the doctor or dentist will find something wrong or that they can’t be sure how long they will be waiting before they can be seen. There can also be sensory issues involved. Doctor and dentist surgeries often have bright strip lighting and strong medicinal smells. It is inevitable that the doctor or dentist is going to need to perform an examination and for someone with hypersensitivity, touch can be uncomfortable or even painful. This is especially true at the dentist as the mouth is a very sensitive area and there is the additional issue of personal space. Most people understand that the dentist has to get close to your face and put instruments and fingers in your mouth, even though it is uncomfortable. For someone with autism who perhaps doesn’t understand why they have to do this, it can be very distressing. In an emergency, there is not much preparation you can give the individual, but if it is a regular check-up or a hospital appointment for the future, there are ways to help prepare them for the visit and reduce their anxiety. Marking the appointment on a calendar as soon as you know about it allows them time to process the idea. Take him/her to see the doctor’s surgery, dentist’s or hospital before their appointment so they can familiarise themselves with the building and the route to get there. It might help to try and book an appointment for the start or the end of the day to reduce waiting time. Book a double appointment so that you don’t have to rush and there is time for them to process the information the doctor is giving them. Ask the doctor’s surgery/hospital if there is a quiet area they can sit while they are waiting. Demonstrate what might happen at the appointment using toy doctor/dentist equipment, visual aids (photographs of examinations) and explaining what might happen verbally. Take comforters or distractors to the appointment such as favourite toys or sensory aids. Royal College of General Practitioners Autism Toolkit. Mental Health Mental health problems can sometimes be missed in people with autism as the symptoms are often misinterpreted as being part of their behaviours. Anxiety disorders are common among people with autism affecting around 40% of people on the spectrum. A combination of factors is thought to contribute to anxiety in autistic people, including social difficulties which can lead to lower self-esteem and feel threatened by social situations or even just going out in public, and problems with adaptability. The best way to overcome anxious feelings about a certain situation is by doing it and finding that you didn’t come to any harm but for someone with an anxiety disorder, the prospect of doing the thing they are anxious about can be unthinkable. If you or someone you know is struggling with anxiety, it might be helpful to see a therapist that you can build a good, trustful relationship with. Therapy might involve slowly exposing you, step by step, to situations that provoke your anxiety but aren’t intolerable to help you gradually learn that you aren’t coming to any harm when you face these situations. Anxiety can often lead to depression which is another common complaint among people with autism. Depression is debilitating and difficult to cope with for anyone who experiences it but it can be especially hard for someone with autism. It might be that they struggle to identify what they are feeling and so can’t communicate to their family or carers what is going on. Depression can make people more withdrawn and introverted meaning that they are less likely to seek help. Look out for signs such as a change in behaviour, being unusually quiet or tearful and encourage the person to talk to you about how they are feeling. Eating Keeping to a good nutritional diet can be difficult for people with autism. There are many factors involved that can make meal times problematic such as: Sensory issues (e.g. texture, taste and smell of food, noisy and busy environment when eating at school or at a restaurant) Discomfort and illness (if the individual isn’t feeling well but can’t communicate this to you, a lack of appetite or over-eating can be a sign) Food presentation (some people don’t like the different foods on the plate to be touching or don’t like certain colours) Social considerations (Perhaps they are more comfortable eating with certain people they know and trust, or prefer to eat alone) Obsessions (Some people have an obsession or special interest in food or diets which can cause them to overeat or have a very rigid diet) Good communication is important when trying to overcome some of these issues. It might be helpful to produce daily or even weekly menus for meal times so that the individual has time to process what is coming or the idea of trying a new food. Providing visual tools such as hunger/fullness scales, happy/sad faces etc. can help to determine how the individual is feeling during the meal. Other visual tools such as a food chart with the different food groups can be beneficial by making it a bit of a game that you try to eat something from each food group every day. It is also good to be as specific as possible when talking about foods or using visual aids. For example someone might love green grapes but dislike red grapes and if you show them a picture of green grapes and they communicate that they would like some, but then bring them red grapes, that can be very confusing for someone with autism. If there is a problem with over-eating, there are various things you could try to keep it under control Give them verbal and visual confirmation that all the food is gone at the end of the meal i.e. show them the empty saucepan. Reducing food portions (this can be made easier by using a smaller plate) Limiting access to foods or not having unhealthy foods such as crisps and chocolate in the house. Create a food timetable to limit snacking to certain times and creating a routine around it. If there is an issue with under-eating you could try Giving bigger portion sizes (using bigger plates) Offer more interactive foods such as pizza, vegetable sticks with dip etc.Get the individual involved with making and preparing the food. Get the individual involved in making and preparing the food. Hygiene Maintaining personal hygiene can be problematic for someone with autism. It might simply be that they don’t understand the importance of personal hygiene or the social implications, and need reminding to have a shower, brush their teeth, wash their clothes etc. For some, there are also sensory issues to consider. Think about how much is going on when you take a bath or shower, brush your teeth, shave, put on deodorant etc. and how much sensory stimulation is involved. You have the feeling of warm water on your skin, strong smells of soap, shampoo and deodorant, the feeling and taste of brushing your teeth, the noises in an echoic bathroom. For most people it is a pleasant time having a bath or shower and feeling clean but for someone who is hyper-sensitive this can became overwhelming very quickly. Keeping a sensory record can help you to identify which parts of their personal care routine causes them discomfort. You might find that they don’t like showers because of the feeling of the water hitting their skin but they are happier having a bath, certain brands of soap and shampoo might aggravate them more than others or using a manual toothbrush rather than an electric one is easier for them. Each individual is unique and will have their own needs so it is important to get to know the person well and stay alert for signs of discomfort or enjoyment. Breaking the various activities involved with personal care down into small steps can help as it allows the individual time to process each bit separately. Having visual cues up in appropriate areas around the house can help to remind and motivate them to keep up with their personal hygiene.