Triveni Goswami Vernal
Registered Special Educator (A64010)

The skill to independently dress oneself, is another Activity of Daily Living, that requires a lot of coordination between fine motor skills, gross motor skills and even balance. If there is a challenge with even one of these elements, it can create complicate the process of gaining independence in dressing oneself.

Occupational Therapy is one branch of therapeutic intervention that plays a very significant role in honing all the elements (fine motor skills, gross motor skills and balance) required for working on the skill of dressing independently.

The Pre-requisite skills required for Dressing independently, are as follows:
1) FINE MOTOR SKILLS: Finger strength, Hand strength, Ability to grasp and push, Reach out, Pincer Grasp, Eye-hand coordination etc. These skills play an important role in buttoning, zipping and even grasping the fabric.
2) GROSS MOTOR SKILLS: Ability to reach out with arms, Bend at the waist, Squat, Sit Independently, Move one’s limbs, Cross the midline, Bilateral Integration etc.
3) SENSE OF BALANCE: Ability to stand and hold one’s posture, Awareness of one’s body with respect to the surrounding environment etc.

According to the article, “Gross Motor Skills and Getting Dressed” (, “for complete independence with dressing skills, a task analysis of dressing indicates the child must be able to:
1. reach in all directions
2. rotate the trunk and cross midline
3. bend at the waist
4. maintain sufficient postural control to allow the extremities to complete the skill
5. squat and return to standing
6. maintain balance in sitting and standing while reaching
7. stand on one foot while the other half of the body is moving
8. be aware of where the body parts are in space (ie body awareness)
9. motor plan multiple steps
10. coordinate both sides of the body and the eyes/hands to work together.”

Source of Image:

One can do several activities at home and outdoors to work on strengthening the child’s fine motor and gross motor skills, through play.


1) Tearing and crumpling paper
2) Roll and pinch play dough
3) Insert coins/spoons into thin slots
4) Use tweezers to pick balls of cotton
5) Place clothes pegs on the raised sides of a box
6) Peeling stickers
7) Threading and Beading strings
8) Finger painting
9) Dip sponge in water and squeeze out water
10) Puzzles


1) Throw and catch balls
2) Dancing
3) Hop Scotch
4) Jumping
5) Obstacle course
6) Climbing a ladder
7) Pretend Play
8) Foot ball
9) Walking on a low plank /board for balance
10) Cycling

Thus, we see that Dressing Independently comprises of establishing a smooth coordination amongst several components and we must ensure that each of these components are individually worked upon, to help the child achieve a semblance of independence. Apart from this, several kinds of adaptations can also be made to the clothes, to help the individual dress independently. Adaptations may include using Velcro instead of buttons/zips, using a coloured, and raised piece of fabric attached to the inner side of a shirt/t shirt, such that the individual can make out the difference between the front and back of the clothing etc. The ultimate aim for us, is to create accessible and adaptive clothing for the child, so as to make the process of dressing, stress free and happy for them, thus providing them a sense of confidence and independence.


Author Triveni Goswami Vernal

Triveni Goswami Vernal is an Autism advocate, registered Special Educator (CRR A64010) and an Independent Researcher. Her areas of interest include Autism, Disability Rights, Gender, Art and Northeast studies. She is a mum to an 11 year old on the Autism Spectrum.

Creative representation for this blog is done by our extremely talented CreativeSaathi associate Kabir Vernal

“Flowers in a Purple Vase”
Acrylic Painting on canvas

Toilet training and Autism

Registered Special Educator (A64010)

Toilet Training is one of the most important Activities of Daily Living that all parents and caregivers, work towards. Neurotypical children, usually get toilet trained by 3- 4 years. It is an arduous process for all children, but the process becomes more complex for children on the Autism Spectrum, who may require a wide variety of visual supports to aid their learning process.

As with all other ADLs, Toilet Training also has to be broken down into small, doable components and a strict visual schedule has to be maintained and followed for atleast two months, till it becomes a habit for the child.

1) Enter the Bathroom
2) Pull down pant /pull up dress
3) Pull down underwear
4) Sit on the Toilet seat
5) Do the job
6) Use a Spray or Mug of water to clean themselves
7) Flush the Toilet
8) Pull up underwear
9) Pull up pant /Pull down dress
10) Open the tap of the sink.
11) Take soap from dispenser /bar of soap
12) Wash hands: Scrub hands with water and soap
13) Close the tap
14) Dry their hands with a towel

Source of image:

Please note: Instead of the visual of the use of Toilet Paper & Wipe, you can insert a clipart of a Mug or a Toilet spray, instead, depending on what the child uses.

One cannot teach all these steps at once. Initially the focus can only be on taking the child to the toilet every half an hour, like clockwork. Make the child drink enough water and take the child to the toilet. One can increase the time frame between toilet visits, incrementally over time.

There are a few important points to be remembered while Toilet Training. If the child is still wearing diapers, then training them while they have moved to wearing pull ups/diaper pants, is a good option, as they mimic, wearing an underwear. This case often arises, when the child is sent to a school or a day care, that refuses to take in a child, unless the child is toilet trained. The option, then, is to send the child in diapers and hope that the support staff in the school, would take the child to the toilet at regular intervals, even if the child is unable to express his/her need.

In case the child stays at home, and there is a caregiver/parent with the child at all times, then the child can be off diapers and made to wear an underwear and their regular clothing. It is important to teach the child to wear an underwear, beneath their regular clothing from their early days, because as they grow older, it becomes far more difficult to teach the children the importance of wearing an undergarment.

(One can make it as detailed, or with as little information, as feasible)

Every time the child goes to the Toilet and is able to use the Toilet for his toileting needs, his /her behaviour has to be Positively Reinforced (it may initially be a tangible reinforcer like a toy/food or something the child really likes and care has to be taken that the reinforcer is only limited for Toilet Training and not used elsewhere. But later on, one can switch to non-tangible reinforcers only, such as Praise, Hugs, Giving lots of Attention etc). The child can be taught to place a mark on the schedule, when the job is done in the toilet. That also provides a sense of achievement and ownership to the child.



Printable Resource:

With a First, Then & Next visual, a few steps can be taught at one go, to the child. For example, Feel Pee Pee/Potty, Sit on the Toilet & do the job, Get a Reward. Or one can also use it to teach the first few steps in the Task Analysis of Toilet Training. The possibilities are endless.


So, while the process of Toilet Training is quite arduous in itself, sometimes there are associated challenges that might make the process even more complex. Some of them are as follows:

a) Vestibular Sensory Issues: The Vestibular sensory system deals with our sense of balance and movement. It controls the working of our muscles and also our reflexes. An Over-Responsive Vestibular system or Vestibular Hypersensitivity can make a child fearful of sitting on the toilet. An over-responsive vestibular system can make a child fearful or anxious with uneven and unstable surfaces and the child can develop gravitational anxiety, a fear of their feet leaving the ground. The Middletown Centre for Autism, has listed down a variety of sensory strategies to work on a child’s fear of sitting on the toilet seat (

b) Constipation: A number of children on the Autism Spectrum also have digestive issues, like Constipation. Besides feeding them a fibre rich diet, a low foot stool can also be used at the base of the toilet, for their feet to be placed on and to help exert pressure.

c) Interoception: Interoception refers to a sensory system that provides an individual, the information about one’s internal bodily processes such as Hunger, Thirst, Awareness of when the Bladder is full, and when they need to use the toilet etc. So, even when a child may be completely toilet trained, they might still have accidents as they may be so engrossed in an activity of their choice, that they miss out on the signals provided by the body. The following website, , has a list of activities that can help improve the sense of Interoception in an individual. Teaching the child to be more aware of his/her bodily sensations, like tightening of the muscles in the stomach, or increasing pressure /pain in the stomach or the need to run to the toilet, are some important strategies.

The article, “Four Strategies to Improve Toileting through Interoception” on the website Fun and Function,, includes doable and easy strategies that can help the child understand his/her internal bodily processes, better.

Due to several disruptions earlier, my son was completely toilet trained only when he turned 8. It took strict scheduling for atleast two months, till he became habituated to using the toilet independently, without the need of a reinforcer. Although it has been three years since he has become independent in his toileting skills, accidents do occur, although rarely. Last year, after a series of accidents, I began to explore and look up articles on Interoception and Toileting. The more I read about it, the more I realized how important it is to keep working on this sense, to improve upon the child’s bodily awareness.

Being able to independently use the toilet, is one of the most important life skills, a child can ever have. But one must not lose heart, if the process takes longer than usual. One must always remember, that a child on the Autism spectrum, is battling with his or her own battles, that may not be visible to others, and that may complicate the process of Toilet Training, further. As a caregiver or parent, our aim should be to be aware of various associated factors that may be impacting the child’s toilet training and work on those aspects, diligently, till a pattern can be established for the child.

Printable Resources on Toilet Training:,-Visual%20cues%20and&text=Stick%20the%20schedule%20on%20a,way%2C%20training%20will%20be%20consistent.


Author Triveni Goswami Vernal

Triveni Goswami Vernal is an Autism advocate, registered Special Educator (CRR A64010) and an Independent Researcher. Her areas of interest include Autism, Disability Rights, Gender, Art and Northeast studies. She is a mum to an 11 year old on the Autism Spectrum.

“Aquarium”, Acrylic Painting

Creative representation for this blog is done by our extremely talented CreativeSaathi associate Kabir Vernal



-Triveni Goswami Vernal
Registered Special Educator (A64010)

Activities of Daily Living or Life Skills are activities that are routinely followed by individuals, that help them be independent in life. For an individual with various challenges, these daily activities can prove to be cumbersome. And hence, they need to be broken down into small components that can be taught individually till it is mastered, before the entire activity is taught and becomes second nature to them.

Activities of Daily Living include:

1) Self-care and Hygiene: Bathing and drying themselves after a bath, Brushing Teeth, Clipping Nails, Getting dressed etc
2) Sleeping: Sleeping on their own
3) Toileting: Using the Toilet independently and cleaning up after themselves
4) Meal Times: Preparing a meal, eating independently, washing dishes etc

Mastering the various ADLs, is the end goal for almost everyone on the Autism Spectrum. The core idea is to keep working on these skills across the years, such that the individual can become independent in those skills, and not be forever dependent on caregivers, all their lives.

According to the website, Daily Living activities are important for the following reasons:

• “Independence: if you are able to look after yourself by undertaking these key activities of living you are more likely to be able to live safely and independently as an adult.
Self-esteem: self-reliance helps with self-esteem, it feels good to be able to look after yourself without needing help.
Less reliant on others: as with the above two points, it’s an excellent goal to be able to function on your own without needing assistance from other people if possible.
Skills for life: these daily living skills are tasks that everyone needs to undertake every day throughout their life. If you can learn to undertake them yourself early, it will make life a lot easier and improve your quality of life.”

Each activity that we perform on a daily basis, is often taken for granted by us, because it takes place so naturally that we do not spend time analysing how many small components make up one particular task. For example, the activity of Brushing Teeth might seem a simple task, but when you break down the steps, you realize how complex the activity is, in reality.

In Special Education, a strategy to break down the activity into the small steps, is called Task Analysis. So, a Task Analysis of Brushing Teeth brings up the following steps:
1) Take the Toothbrush and keep it down on a surface.
2) Take the Toothpaste tube with one hand.
3) Twist the cap of the Toothpaste tube with the other hand and open it.
4) Remove the cap and keep it on a surface.
5) Squeeze the toothpaste tube, just enough to place a small amount of toothpaste on to the toothbrush.
6) Place the toothbrush on a surface.
7) Twist the cap and close the toothpaste tube. Put it back to its place.
8) Pick up the Toothbrush with the paste on its bristles.
9) Open the tap in the sink and wet the toothbrush bristles.
10) Close the tap in the sink and brush the teeth, in various motions.
11) Once done, open the tap, and clean the bristles.
12) Replace the brush back to its place.
Visual for Brushing Teeth

A Printable Visual for Brushing Teeth:
One can choose to be as detailed or keep the steps short and concise, depending on the ability of the individual. The idea is to break the activity into small steps that are doable and can be taught in a simple and stress-free manner.
Another strategy of Special Education that can be applied while teaching the steps in a Task Analysis are BACKWARD CHAINING or FORWARD CHAINING.

Backward Chaining refers to a technique where the last step of the task is taught first, and once that is mastered, one can teach the earlier steps. So, for example, for Brushing Teeth, the individual will be first taught to do the last step, that is washing the bristles of the brush under the tap water and keeping it back in its place, while the rest of the steps will be done by the caregiver. Once that is mastered and can be done independently, the step next to last, that is brushing the teeth, will be taught.
In contrast, in Forward Chaining, the first step of the task is taught first, till it is mastered, and then one moves on to the next step. For example, in Brushing Teeth, the first step of taking the toothbrush from its place and then opening the cap of the toothpaste tube will be taught first, while the rest of the steps will be done by the caregiver, till the time the first step is mastered and then they will move on to the next step.
The strategy of Chaining (whether Forward or Backward) is adopted so that it does not overwhelm the individual who is being taught. The idea is to provide handholding and scaffolding for the individual to learn the task, at his or her own pace, without being rushed.
This was just a small example, but the idea of breaking down a task into smaller components and providing a visual for it, is very significant. Visuals help the individual remember the steps pictorially. Most individuals on the Autism Spectrum are visual learners and often struggle with Executive Function and Self- Regulation.
According to the Centre on the Developing Child, Harvard University, “Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses” (
By breaking down the task into doable, small components and representing those tasks, visually, the individual is helped in planning, remembering the various steps involved, paying attention to the task at hand and implementing the various steps, to fruition.
As a caregiver, our aim is to make the process of learning more accessible and stress-free for the individual with challenges, with a final goal, towards their independence. Only if we create the right environment to facilitate their learning and engage them proactively in the learning process, can they progress towards the final goal.
Free resources on Visual schedules for various ADLs:

Author Triveni Goswami Vernal

Triveni Goswami Vernal is an Autism advocate, registered Special Educator (CRR A64010) and an Independent Researcher. Her areas of interest include Autism, Disability Rights, Gender, Art and Northeast studies. She is a mum to an 11 year old on the Autism Spectrum.

Acrylic paints and Texture paste on canvas

Creative representation for this blog is done by our extremely talented CreativeSaathi associate Kabir Vernal


Teaching Cooking activities for kids with Autism

A video blog by Pinki Kumar on Teaching Cooking activities for kids with Autism.

Author Pinki Kumar

Pinki is a special educator, play therapist and a mother of a neurodivergent kid. She has a YouTube channel Play and learn to teach different methods and strategies. These videos are a great resource for the parents to help their child learn various skills.


Bathing and brushing teeth: Personal hygiene ADL skills

Bathing and brushing teeth: Personal hygiene ADL skills- Activities of daily living- part 2

Teaching Personal hygiene skills

Personal hygiene and grooming skills are essential for all children and are an important ADL that all children need to learn, regardless of their disabilities. However, for children with multiple disabilities and visual impairment, learning these skills can be challenging. They may need more help with this than others. This can include assistance with brushing teeth, bathing, toileting, and getting dressed. As a parent or caregiver of a child with disabilities, it is important to teach them the necessary hygiene and grooming skills so that they can maintain their health and hygiene.

Teaching personal hygiene skills to children with disabilities requires careful planning and patience. These skills are essential for their physical health, emotional well-being, and social interactions. With the right strategies and support, children can learn these skills and become more independent in their daily routines.

I have already discussed toileting in my previous blog on ADL skills. Read my blog on Toileting ADL skills 1 here.

In this blog, I will discuss some strategies and techniques for teaching personal hygiene skills of Bathing and brushing teeth, to children with disabilities.

So lets begin with understanding the basic that it is important to establish a consistent routine for personal hygiene and to work with the child’s parents or caregivers to ensure that they are receiving the help they need. Here are some noteworthy points to begin in establishing a consistent routine.

Important Points to remember before you start-

1. Use tactile and sensory materials:
For children with disability specially visual impairment, tactile and sensory materials are crucial in helping them learn new skills. For example: You can use materials such as textured brushes, sponges, and tactile soap to teach children how to wash their hands, face, and body. These materials can help children with sensory issues understand the concept of hygiene and grooming.

2. Break down skills into smaller steps:
Teaching personal hygiene and grooming skills can be overwhelming for our children. To make it easier, you can break down each skill into smaller steps. For example, if you are teaching your child how to brush their teeth, you can break it down into steps such as wetting the toothbrush, putting toothpaste on the brush, brushing the teeth, and rinsing the mouth.

3. Use visual aids:
Although your child may have visual impairments, visual aids can still be helpful. You can use picture cards, diagrams, and videos to demonstrate how to perform each task. You can also use tactile diagrams or 3D models to demonstrate how to brush teeth or wash hands.

4. Use positive reinforcement:
Positive reinforcement is an effective way to encourage your child to learn new skills. Praise your child for their efforts and progress, no matter how small. You can also use rewards such as stickers, treats, or extra playtime, motivators to motivate your child to practice their hygiene and grooming skills.

5. Practice regularly:
Practice is key when it comes to learning new skills. Make sure to set aside time each day to practice hygiene and grooming skills with your child regularly. Consistent practice will help your child become more independent in performing these tasks.

6. Seek assistance from healthcare providers or Special educators :
If your child has multiple disabilities or complex medical needs, you may want to seek assistance from healthcare providers such as occupational therapists or physical therapists. These professionals can assess and can provide guidance on how to adapt hygiene and grooming techniques to your child’s specific needs.

Now let’s move to the first personal hygiene skill which is Bathing.

Bathing skills

Bathing is a crucial daily activity that helps individuals maintain good hygiene and overall health. However, for children with disabilities, learning bathing skills can be challenging. As a caregiver or parent, it is essential to provide a safe and comfortable environment for your child while teaching them bathing skills.

Here are some tips on how to teach bathing skills to our children.

1. Create a Safe Environment :

Before teaching your child bathing skills, ensure that the bathroom is safe and comfortable for them. Install grab bars, non-slip mats, and a shower chair, stool or bench to prevent falls and accidents. Adjust the water temperature to a safe and comfortable level to prevent burns. Ensure that the bathroom is well-lit to aid their visual impairment. Check for child’s proper safety and any loose wiring, open drainage etc should be totally fixed.

2. Use Visual Aids :

Visual aids are quite essential for our children’s learning. Use pictures, diagrams, and tactile models to help your child understand the steps involved in bathing. For example, you can use a tactile model of a soap bar or shampoo bottle to help them understand how to use them. Use braille labels to identify the different bathing products to help them become more independent.

3. Use Simple Language :

When teaching your child bathing skills, use simple and very short and clear language for giving any instructions. Avoid using complex sentences or jargon that can be confusing. Use short phrases and repeat them only few times to reinforce the steps involved in bathing. For example: , you can say, “Use soap to wash your hands” or “Rinse your hair with water” to help them understand the steps involved.

4. Provide Hands-on Assistance :

Children with multiple disabilities may need hands-on assistance when learning bathing skills. You can guide them through the steps involved in bathing, such as applying soap, washing, and rinsing. Provide gentle prompts to help them understand when to move on to the next step. Allow your child to touch and feel the bathing products to understand how to use them.

5. Use Positive Reinforcement :

Praise and positive reinforcement can go a long way in helping your child learn bathing skills. Acknowledge their efforts and progress, and celebrate their achievements. Use incentives such as stickers or small eatable treats to encourage them to learn and practice bathing skills.

Next is the skill of brushing teeth

Brushing teeth

Good oral hygiene is essential for overall health, and it’s especially important for children. However, teaching children with disabilities how to brush their teeth can be a challenging task for their parents.

So, here we will explore some effective teaching methods that can help parents and caregivers teach their children how to brush their teeth.

Brushing teeth is an important part of daily hygiene, and it is crucial for children to learn how to do it properly from an early age.

Let’s learn various steps involved in it-

1. Use Multi-Sensory Materials:

Children with multiple disabilities and visual impairment often rely on their other senses, such as touch and hearing, to learn. Using multi-sensory materials can help these children learn how to brush their teeth effectively. For example, you can use a toothbrush with a textured handle, so the child can feel the difference between the handle and the brush. You can also use a musical toothbrush that plays a song for two minutes to encourage the child to brush for the recommended amount of time. Moreover finger brush can also be incorporated while teaching brushing skill initially.

2. Use tactile cues:

For children with visual impairment, it is essential to use tactile cues to teach them how to brush their teeth. You can use your fingers to guide their hand to the right spot in their mouth, or you can use a textured toothbrush to help them feel where to brush. Make sure to explain to them what you are doing and why so they can understand the process.

3. Use Visual aids:

Even though the child may have visual impairment, it can be helpful to use visual aids such as pictures, diagrams, or videos to help them understand the process of brushing teeth. You can also use different colors to highlight the areas of the mouth that need to be brushed, such as red for the gums and green for the teeth. Using visual cues such as pictures, diagrams, or videos can help children understand how to brush their teeth. You can use a picture book that shows the steps of brushing teeth or a video that demonstrates the brushing technique.

4. Use Modeling and Prompts

Modeling and prompts are effective teaching methods for children with multiple disabilities and visual impairment. You can model the brushing technique for the child and then have them try it themselves. You can also use prompts to remind the child when to move on to the next section of their mouth or to remind them to spit out the toothpaste.

5. Make it Fun:

Making toothbrushing fun can encourage children to brush their teeth regularly. You can play a game with the child while they brush their teeth or sing a song together. You can also use flavored toothpaste to make the experience more enjoyable.

6. Use a mirror:

Using a mirror can be an excellent way for children with visual impairment to learn how to brush their teeth. Place a small mirror in front of them while they brush so they can see what they are doing. This will help them to understand where to brush and how much pressure to apply.

7. Teaching through pretend-play

Let the children learn by play- way methods as well, by making them brush their dolls or soft toys teeth

8. Break down the task:

Brushing teeth can be a complex task for children with multiple disabilities, so it is important to break down the process into smaller, more manageable steps. For example, you can start by teaching them how to wet the toothbrush, then how to apply toothpaste, and so on.

9. Use positive reinforcement:

Positive reinforcement is an effective way to encourage children to learn new skills.Positive reinforcement can motivate children to brush their teeth regularly. You can use a reward system where the child earns a small reward, such as a sticker or a favorite toy, for brushing their teeth twice a day. Positive reinforcement can also include praise and encouragement for the child’s efforts. Praise them for their efforts, and reward them with something they enjoy, such as a favorite snack or activity. This will help to motivate them to continue practicing their toothbrushing skills.

Teaching children how to brush their teeth can be challenging, but it is essential for their overall health. Using multi-sensory materials, visual cues, modeling and prompts, pretend play makes it fun, and using positive reinforcement can make the learning experience more effective and enjoyable for the child. With patience, consistency, and creativity, parents and caregivers can help children develop good oral hygiene habits that will benefit them for a lifetime.

So, with patience, practice, and encouragement, your child can become more independent and confident in their bathing and brushing abilities.

Teaching personal hygiene and grooming skills to children with disabilities requires patience, creativity, and consistency. By using above methods, practicing these skills regularly, and seeking assistance from healthcare providers, you can help your child become more independent in performing these essential life skills. Remember, every small step forward is progress, and with time and practice, your child will become more confident and capable in their hygiene and grooming routine.

Hope my blog will provide you some help in teaching your child in essential ADL skills of bathing and brushing teeth. If you like my blog then do share it with others and provide your valuable feedback. I will be happy to hear from you.

Author Shilpi Mayank Awasthi

Creative representation for this blog is done by our extremely talented CreativeSaathi associates Dhrov Tikoo, Vinayak Raj, Nikhil Thotam and Shubh Pathak