Difficulties with washing hands

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My son has had real problems with learning how to wash hands. It isn't that he does not know the "procedure", it is just that he seems to have a physical problem with bringing his hands together and rubbing them against each other.

He does have difficulty with motor planning (dyspraxia) but he does not have tactile defensiveness, so I don't know what else could be causing his refusal to rub his hands together.

Has anyone else encountered this with their kids ? If so, could you share advise on how you helped your child resolve this ?

Thanks !

Do his palms touch each other when he tries?

When I just mimicked the motion myself, the movement comes from my elbows. What is happening at his elbows when he tries?

How old is he?

As far as I can tell, boys simply don't WANT to wash their hands. We kind of had to force it, and I realized just how common that is one day when my son had a friend over, and I shouted out my automatic response to hearing the bathroom door, "wash your hands!" and the kid didn't even blink turning on his heel to do so.

Sorry, I know it is also possible much more is going on, but I eventually reached a point of deciding that my son was simply going to be an endless list of "reasons" on the concept (and he was), so it was best to simply get it down to a rule. If I had noticed real emotional distress when I ordered him to wash, I might have seen it differently, but that was not what I saw. Sure, he disliked it, but he was not being overly stressed from it, which was different than what I saw with some other self-care issues.

My daughter does. She is HFA but this has been an issue forever. She only sticks her finger tips in and only with extreme reminding... if she isn't reminded she won't even turn the water on. I asked her and the best I can get out of her is that it is "unpleasent". The only way I can get a proper hand wash is by taking away her nintendo until she does it the way I say it should be done. That's it. Unfortunately it doesn't get reinforced at school due to the bizarre lay out of the bathroom and all the rules about adults in them. I'm pretty sure her aid couldn't reinforce this unless she took her down to the kitchen or science room every time her hands needed washed.

He is 4, almost 5.

His palms touch each other, but when he rubs his hands, it is almost always the right hand rubbing the left. He keeps the left hand stationary and runs the right hand against it. Then, also he does not want the back of the palms, even after I had physically prompted him to wipe himself after a bowel movement. He is in session now, but when his toilet break comes, I will check what his elbows do when he is being prompted to wash.

He also did not clap his hands until age 3.75 years. When he claps now, it isn't a strong clap but it is enough of a gesture to pass for a clap.

Last edited by HisMom on 23 Apr 2014, 11:33 am, edited 1 time in total.

It is interesting you bring up the issue of distress. He used to get really upset last year when we first started the program but that has subsided over time and he is now "reluctant" but not distressed. He also likes playing with the water, so we use that as a reinforcer and left him play for several minutes at the sink after and if he has "properly" washed his hands. Although, to he honest, I have to physically wash them after a bowel movement for obvious reasons, and can't just rely on him to do so. He may go with the motions of running his right hand against the left but that is the end of that.

CWA, does your child not get a bathroom aide at school ? If she is given an aide, shouldn't that person be taking her to the bathroom and making sure she cleans up afterward ? I would complain about that as that would mean a violation of her IEP (at least in my book).

I think DW_A_Mom is right about this. Kids do not necessarily like to wash their hands. Kids on the spectrum can have other issues, with it of course. But it could just be the usual kid thing.

I know you said he has no sensory issues with it, but I am going to throw these out there anyway. I hope that is OK.

1) Even if he does not mind his hands touching, he may not like the texture of the soap or the wetness of the water. Have you tried wipes or moist towelettes? They may feel "dryer" if that makes sense.

2)He could have issues with the sounds of the faucet.

3)He could dislike the enclosed space of the bathroom.

4)He could not understand the necessity of it and just want to get back doing fun things. (This is really an "any kid" kind of thing but I am not sure being on the spectrum does not make it worse b/c the siren call of fun seems harder to resist.)

Edited: I wrote this while you posted he liked the water--so ignore that part.

Last edited by ASDMommyASDKid on 23 Apr 2014, 11:55 am, edited 1 time in total.

some users said it could be normal kid stuff. It could be, but also I am 19 yo and don't like washing my hands. That is because it makes them feel dry and very sensitive and the textures hurt more afterwards. It is probably sensory issues. You could try different kinds of soap that may minimize the problem

Just for reference, I usually washed my son's hands with him until he was 7 or 8. Seriously. It was just something that had to be done, so I did it. And he kind of liked the extra "mom" time; it seemed to help offset how much he didn't like the washing. Until he got old enough to feel embarrassed about it, and which point threatening to help him was enough to get him to do it himself.

Basically ... be prepared for a long, slow road. One of the many things that will just be "different" in your life than you expected.

I always put lotion on my hands right after washing. I keep the bottle right there by the sink. It helps with the dry feeling.

One of my kids has no aversion to being touched and he also loves playing in water... but he hates (and I do mean HATES) the feeling of water 'falling' on him. So showers are out of the question and hand-washing too is upsetting for him. So we put the plug in the sink and fill it with a little 'bath' so he can wash his hands in the still water. I also still stand over him and watch him do it though.

ASDMommyASDKid

My son is 4.5 and isn't great on that part of his hand washing. I think it is more #4, he likes the water and really doesn't see any reason not to half ass the rubbing together to get back to the water part and he likes turning water off and on. The visual schedule helped, so at least he attempts it. We just do the washing ourselves when it counts, for BM and when he hands are really dirty. The other times we just let him do it and push to make it better slowly. He went from putting soap on one hand and rinsing to touching them together and now is at an almost rub on the palms only. Water is big draw for a lot of our kids so it might just be the water. If it is really important you could try some reinforcers if he does that part well.

If you think it is physical(not getting his hands together) you might check w/ OT.

One thing I notice is that he does not rub his hands together at all ! What he does is to kind of bring them together, then squeals and starts splashing the flowing water in the sink. I realize that I have been partially physically prompting to wash his hands all along !

Holland, interesting thing about not liking showers ! As soon as he gets in the bathtub, he turns off the shower "setting" and will sit under the faucet and enjoy the water running over his shoulders and down the rest of his body. He also swims in the bathtub. If someone changes it back to shower, he will just turn it back off. It is quite hard to get him to take a shower, as he seems to think that the tub is some sort of a swimming pool ! !

Spend two minutes waiting for a stall in the men's room at a sporting event and you'll see that this is true for adult men too...makes you think twice about sharing popcorn.


Regarding the presenting issue, it may be possible to think of a functional way for him to get his hands disinfected without needing to go through the same steps that we usually use, as a stop-gap. I'm thinking one solution could be to use a wash cloth. Another option would be to just use Purel.
It may also be possible to get him to mimic some of those muscle movements by playing with play-dough, and trying to get him to make a pancake shape between his hands.

This is interesting, Emile, because he struggles to make a flat pancake ! ! This is why he is diagnosed as having quite severe dyspraxia. I think that planning & executing actions involved are problematic for him, rather than the act itself. For example, we have been trying to teach him to wipe his face with a warm wash cloth. He struggles to do this, although he does not complain or protest when we wipe his face for him.

Do you have any suggestions on how to help him learn to do these actions ? We don't get OT anymore, so we need to figure this out for ourselves.

I don't know if this will be helpful to you or not, but it caused a strong memory of my daughter trying to learn to wash herself with a washcloth. She had a really hard time crossing the midline. Her OT did exercises with her to help strengthen this ability, and now (at she is able to do it "correctly" though she still has to be supervised in the shower. You could ask his OT to evaluate his ability to cross the midline and see if they can recommend activities you can do with him to help if that is the issue.

Edit: I just saw you don't get OT anymore. I should clarify that the reason I thought of crossing the midline issues was because of your description of his motions when he does try to wash. It reminded me of my daughter. There are a variety of websites that have activities to improve the ability to cross the midline since you don't have an OT anymore.