Saturday, January 2, 2010

Let's get Dressed


In this post, I am going to try and explain why some of our kids have trouble getting dressed in the morning and staying dressed all day - or adapting their clothes and shoes to suit the weather or the occasion.

This is not an issue that affects everyone with autism, like the big bugbears of Toileting and Sleep it can be a dividing line between those that do and those that don't have a problem.

But when it is an issue it can be incredibly stressful. Often it is one of the earliest signs of the sensory distortion of autism, and one of the first battles that parents get themselves into with their kids.

Like it or not we are judged by the way we look. We are also judged as parents by the way our children look.

We used to go to a community child care centre where a mix of kids would attend and the director had started a clothing bank.
As well as the usual back up for toileting accidents, she would collect jumpers for the cold days when some of the kids arrived in just t-shirts, and shoes for the kids who just needed a decent pair.

She also used to bath these kids and brush their teeth and hair. Seems whatever money there was in these kid's homes, it wasn't being spent on soap or toothpaste.

These kids seemed less loved, because they looked that way.

So dressing our children properly can really matter to us. We don't want to be seen as neglectful. We don't want our kids to look unloved.



The first issue is Sensory

Some of our kids just don't like clothes!

In the first few minutes after we get dressed in the morning we can feel our clothes.
Not in an irritating or scratchy way, but just a sensation of contact.

Imagine that sensation lasts all day.

For many of our kids this is so unpleasant that they simply cannot stand to have the clothing on in the first place. It feels like sandpaper or a hair shirt on their little body.

They might just be able to stand a nappy, but little else.

Getting them dressed to go out is a torment as they are genuinely distressed and will often undress again as soon as you turn your back. Not great if you are running late! And if you do manage to get them clothed and out of the house, first thing they do when they get in the door is take all their clothes off again.


I used to have to dress Boo and then bodily carry him to the car, strap him in to his seat belt and then go back for the Bratty. Shoes would go on at our destination.

But as far as fine motor development and milestones went, both Boo and Bratty were expert strippers of every item of clothing including shoes. Particularly shoes.


So what do you do?

Well, I suggest you observe your child to start getting a feel for what sensations they do like.

Some kids like clothes that are old and softened by multiple washes, the elastic a bit stretched out.
They may need anything they wear to be washed a few times, or they may even prefer hand-me downs. (ask around to see if someone has a child slightly older or bigger than yours and put your hand up for the stuff they grow out of - you can buy them a new outfit once in a while in exchange)

Some kids like clothes they have outgrown. They like the tight sensation, a sense of being squeezed. Just buy them new clothes in a smaller size than usual, and make sure it is well made and stretchy.

And some kids like some clothes which they associate with one activity, and hate those that they associate with something they don't like. But they can't tell you.

So the trick is to get the new item on to them and follow it up with a very reinforcing activity:

This is how we used to buy Bratty's shoes. I bring home 3 pairs in varying sizes; Mr Hammie and I flip them on and off her foot while holding her ankle and we choose the appropriate size and keep it.

I put the other 2 pairs aside to return to our friendly neighborhood kid's store;
while Mr Hammie puts the new pair on Bratty before hustling her out the door for a trip to McDonalds, a walk or a trip to the Supermarket to ride the "Scoop" toy and buy jellies.

By the time she gets home her old shoes are gone and the only way to go on the next reinforcing trip is to wear the new pair.

Clothes were a different story and the sensory defensiveness came to a head one winter when she would only wear a dress and knickers. The same dress and knickers. No other underclothes or trousers and no coat.

It took a Senior Tutor in The Good School who created a dressing Task.  I was asked to send in a lot of different clothes to be tried on and changed several times a day in the "Life Skills Room" - a little bedroom in the school.

Without time constraints or the animosity that had built up between Mummy and Bratty over the issue, she was able to learn to dress appropriately in a reinforcing environment in a range of outfits.

We still have to keep an eye on this and make adjustments for the seasons. Pairing each change with something familiar. In summer it means getting used to a sensation of exposed skin in t-shirts, shorts and dresses and maybe sandals without socks. (please do not make them wear socks with sandals, that is a crime against fashion).

In the winter it can mean getting used to tighter and cosier sweaters, long trousers, socks, tights and boots.

We stick to a theme, T-shirt style dress over long leggings. Long sleeved Tee underneath in the winter, Short leggings and a vest for the summer.

The school even support us with coats and shoe changes. Bratty now has several pairs of shoes that fit her at any one time. She can wear a variety of coats. And I maintain this by keeping a high rotation to stop those fixations......


Beige coat with Bear




Red coat in the Forest



 Blue coat with the Bear


Our kids are never going to naturally look for the most appropriate clothing for a situation, so you and other significant carers are always going to have to monitor how cold or hot they are, much like a baby.
This can be a real challenge with husbands (sorry guys) and professional carers who are used to kids who tell them when they are hot or cold.

It is very very very difficult to introduce these changes. Look out for puzzles and games to do with weather and "dress up" toys and use them to tell a social story around the issue. The children's show "Balamory" has a character called "Miss Hoolie" who uses a weather wheel and puts on a hat or coat according to the weather that day. Make something similar yourself and get a few accessories to match each day.





Make sure that the clothes are kept as close to the door as possible to naturally prompt the wearing and removal as they come in and out of the house. That way you can refer to the weather as you are preparing them. "It's a snowy day, lets get your boots" or "The sun is shining, so choose a hat."

A shoe rack is a good idea. At home we all remove our shoes as we come in. They could do the same at school, just send in a pair of "inside shoes" or slippers so they don't get cold.

The second issue is Rigidity.

Some kids in the autistic spectrum can seem to be getting along fine with changes and then suddenly develop an obsession for keeping some aspect of their environment exactly the same.

Huge behaviours can occur around this and like the iceberg the reason and therefore the solution lies under the surface.
I found that Boo was reasonably tolerant of changes in his environment until he changed school, one year into arriving here in Ireland.

At the time I had just purchased a new "Bob the Builder" Tracksuit and matching "Builders" hiking boots.
He would become violently distressed if I tried to dress him in anything else. And Boo self harms.



Fortunately he had two of these tracksuits. I contacted the retailer and found six more of them in a city branch to which I dispatched my helfpul Father in law to collect, bless him!



I had a short reprieve and he kept wearing them. With every wash they got smaller, and the boots which were not a good make to begin with, started to fall apart.

I got a replacement pair. Slowly we crept towards summer and the fleecy sweatshirt and long pants were getting to be too warm.

I paid a dress maker to make the pants into shorts, moving the little logo myself.

Then we made the jackets into body warmers, and vest tops. Thread by thread I was fading the clothes out.

Summer arrived and we were going on holiday to Spain. I bought a Bob the Builder swimming costume, hat and towel. And a pair of sandals that he could barely tolerate for long enough to get the size right. I actually sat on him in the shoe store while we measured them against his foot.  He was 4.

We arrived in Spain with the Boo in his fleece shorts, sleeveless hoodie and hiking boots. I got the sandals out hopefully.

His Dad asked him if he wanted to go to the swimming pool so he tolerated putting the swimsuit on and getting his towel ready but when he went for the boots, Daddy offered him an ultimatum.

Sandals or no pool? the Sandals went on and we broke the bond. I pushed the last fragments of the boots under a bed and left them for the cleaners to find.  He kept wearing the shorts all summer, by mid summer he was completely comfortable with short sleeves and sandals until one day we had a stand off about a raincoat on a very rainy day.

Slowly we introduced some other clothes, but always with either the top or the shorts from the original tracksuit and eventually just the logo badges which were moved from garment to garment.
And from then on I got a lot smarter about dressing.

I learned to buy the very best shoes I can afford in their size. One new pair per season.

That way if they become obsessed with them they won't be falling apart.

On a given day I would switch from the summer to winter shoe and that was usually it for the next six months.
The first day can be tricky, particularly when they are used to a tight fitting winter shoe, but they get used to it if you pair it with a rewarding activity.
No shoes = no fun kind of deal.

I have also begun to introduce different kinds of shoes for different activities, a social story that you wear. Jelly shoes or crocs for swimming, (Crocs should never be worn more than 10 metres from a swimming pool)
Ugg boots for going out in the car (no socks for Daddy to fuss with) and sturdy boots for winter.


I learned that his anxiety over wearing certain shoes could indicate anxiety about the expectations of that day. Which he would never be able to tell me.

At the beginning of summer we dress them and take them to the airport for our holiday in their new sandals and they wear them happily for the next six months.
So, when the clocks go forward, the trees are in bloom, the swallows arrive and the Hammie family all start wearing sandies; you know summer is here.

I continue to stick to a theme. As a frustrated stage mom/ex fashionista I would love to dress Bratty like a Mediterranean princess in frills but it just does not suit her personality. She is prone to a flat on the floor legs in the air tantrum, hence the leggings under her dress.

She likes to wear her pants on her hips, hence the long t-shirt style dresses that hide her builders bum.

I tried to put her in jeans but she pulled them so low on her hips she got sent out of assembly for showing her lovely bottom. Dress over pants it is!

With Boo I have learned to take him clothes shopping after a rewarding activity, like going to the The Gap after a movie at Dundrum.

I hold up several items and give him "choices" about which ones he likes and stock up in quantity.  That way he doesn't object to them when we get them home.
He also dresses himself now so I try to keep things simple and easy. He may not care about which brand he is wearing, but at least everything is on the right way 'round.


I think things could be worse.
You choose your battles and you adapt.
xx

14 comments:

Looking for Blue Sky said...

Another very informative post, relate to the too-small clothing - my son is 8 and won't wear any of the new school shirts I've got for him in the past couple of years so he now looks silly and neglected! Thanks for the insights Hammie

K.Line said...

I cannot even imagine how stressful this is. I am very inflexible in a lot of ways, as we know, and I am extremely hard line (dare I say it) with M about wearing "appropriate" clothes for the weather. I give her a lot of flexibility to express herself with clothing, but the thought of her being cold is too much. If I had to fight for every slip on of shoes, I can imagine someone would be calling child services on me :-)

You know that M is very willful, and was even more so as a young kid. We had so many screaming matches and tantrums about not wearing sandals in January. I would often say "I don't want your teacher to think you're neglected." - so I can relate to that issue. But she's become more compliant with age. I'm grateful - as is my blood pressure

Jean said...

Your info is like diamonds hun...seriously, a book... xxx

Taz said...

i second what Jean says! A book, please!!!! The complete idiots giude to raising children on the spectrum!! Button recently decided that he doesn't like jeans, tracksuits are next to impossible to get for him because he's so skinny, so these days he looks very preppy in his chinos!!! xx

Autimom said...

you are such an insperation, i loved reading this blog as im having an issue with clothes at the moment, its not the wanting to be nude, its the not wanting her clothes off at all, its started all of a sudden at xmass and she isnt really verbal, i get around it by getting her into clean clothes if i tell her we are going somewhere i know she likes.
And i have giving up on pj`s, im happy as long as she wears clean clothes.

Hammie said...

Autiemom: we had that at one stage too. Try working in t-shirt type dresses and loose knickerbockers or leggings. Change the dresses several times each day in return for a reward. At the end of the day do the last chane and see if you can phase out the pants part. Then look for nighties thatl look similar to the tee dresses. H&M are really good for this as they take a theme like Hello Kitty or Sesame street and do a number of outfits including nightwear and underpants. Good luck xx

Petunia said...

Super super post! You always have the best advice :) Will try out a few of your ideas with my little streaker and see how we do. Am taking note of the times and circumstances in which she strips in playzone and trying to figure out why. It seems to happen most when a group of kids come in for a party or the place is busy making me think its sensory overload as she gets very excited to run around squeeling while the older kids are there. Have bought dungarees for our next trip lol xx

popsie said...

our little guy used to strip off the minute you dressed him which was really a pain if you were due to be somewhere and you would get him ready, then trot upstairs to brush your teeth and return to find him starkers again. we have come a long way since then! he dresses himself now and keeps clothes on in public but still likes to be in as little as possible at home, shorts and never wears footwear indoors, i can live with that. brilliant post and advice x

Lora said...

Griffin used to have terrible issues with clothing and now has no problems but you do make some very valid points that in the day would have been super valuable. There is one problem though and that is that he cannot wear jeans because of his fine motor skills delay, he cannot snap the metal snap or zip the metal zipper. So there is still a bit of an issue. Great post. Thanks!!!

jazzygal said...

Excellent post Hammie.

While we don't suffer this issue to extreme it is still an issue. The famous school woolly jumper is one (That he's tolerating)socks with seams and cheap school shirts are another. Like the Dunnes or M&S ones....again it's the seams. I have 1 good one from the (expensive ) school shop that I use. He doesn't wear it that often as I get away with Favourite Uniform (trackkie) 3 days a week;))

We don't do jeans and shirts....he's a shiny tracksuit kinda kid who likes crocs. Wonder how neglected looking that makes him ??!!

Wonderful, informative post;)) xx Jazzy

IrishMammy said...

Great post and some great insights, you are amazingly patient and understanding :-)

Mhark said...

Wow, you have a great blog here, I definitely want to bookmark you. Thanks

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