Why won’t my child with autism brush their teeth?
While teeth-brushing is a part of adults’ daily routines that we don’t think much about, it can be a source of intense stress for children with sensory sensitivities or autism. This may be due to hyposensitivity or hypersensitivity in the mouth. Here, we outline some ideas to support the transition from uncomfortable and stress-inducing to exciting and rewarding.
First Steps: Exploring the Supplies
Right now, your child may have a negative association with brushing teeth due to past sensory experiences with a toothbrush or memories of a past experience. You and your child can try to reset this experience and start the routine over by getting comfortable with the supplies. You can head to the grocery store and have your child pick out a soft-bristled or silicone toothbrush to play with. Allow your child to explore the toothbrush in their hands, on their arms, on their face, and even in their mouth. Provide some positive reinforcement in a calm, joyful tone when you see them interacting with the toothbrush.
As for toothpaste, try having your child smell a few different ones other than regular mint. Mint can cause a stinging sensation in the mouth. There are many child-centered flavors of toothpaste out there to try like bubblegum and grape. The child can explore the toothpaste using their senses leading up to taste. They can try to squeeze the toothpaste out of the bottle, smell it, smear it on the toothbrush or in the sink, and even do a “taste test”.
For floss, the same kind of set of steps goes for floss. You can have your child explore plain waxy floss, floss picks, or even water picks at their own pace.
Next Steps: Chaining and Reinforcement
If you really think about all the steps of brushing your teeth, there are quite a few. When we break down tasks to their many little steps, we call that a task analysis. When completing a longer task, we start with the first steps and “chain” them together over time as a person gains more confidence and independence.
The first two steps of brushing teeth are going to the bathroom and getting the necessary supplies. This can be the first thing you work on with your child. Once doing this is a breeze, you can add another step.
As a general note, after each step is completed, you provide some kind of little reinforcement (like verbal praise or a token on their token board). Once they are done with all their steps for that day, you can provide a bigger reward. To learn more about reinforcement, please check the articles about cleaning up and token boards on our website.
Here is an example of how this might look:
- “Russell, let’s go in the bathroom.”
- “Nice work coming in!” Parent initiates a high-five or gives a token on the token board
- “Okay, now let’s take out the toothbrush. Can you find it?”
- “Nice work finding your toothbrush!” Parent gives another high-five or token on the board
- “What’s next? Let’s find the toothpaste!”
- “Thanks buddy! Next time maybe we can wet the toothbrush. I am so proud of you for coming into the bathroom to work on toothbrush stuff today.” Parents can give the child a hug, double high-five, treat, or complete the token board so the child gets a reward
While the example above is a starting point, your child will become more and more independent and you can continue to add more steps as a part of their daily routine. Here is an example of the full task analysis of brushing teeth that you will run though, step-by-step, to work up to teeth brushing with your child:
- Come into bathroom
- Take out toothbrush
- Take out toothpaste
- Turn on the water
- Put bristles of toothbrush under the water
- Turn off the water
- Wet toothbrush in mouth (no toothpaste)
- Moving the wet toothbrush across teeth in mouth (no toothpaste)
- Put toothpaste on toothbrush
- Put toothbrush with toothpaste in mouth (then spit/wipe face)
- Move toothbrush with toothpaste across teeth (then spit/wipe face)
- Full-on brushing with toothpaste for increasing amounts of time each time (and spit)
- Rinse the toothbrush
- Put toothbrush away
- Wipe face clean
Please start with steps a and b (simplified steps of teeth brushing) and eliminate them as your child is able to manage taking on the authentic step (with toothpaste).
Final Steps: Keep the Routine and Reinforcement Going
If you’ve read our other articles, we regularly emphasize that predictability and routine is key in shaping the behaviors you want to see. Whether it be using a token board or just verbal praise/high-fives with a little treat at the end, just keep it going. This is a long process but we hope this way of working up to the full brushing routine will help you bond with your child and make a difference in their independence.
Occupational Therapists, Child Psychologists, and BCBAs are here to help you on your journey in teeth brushing. If you are looking for support from any of these clinicians in the Chicago area, reach out to Chicago OT for occupational therapy, The Goldman Center for child psychology, and Chicago ABA Therapy for BCBA support.