To be tearing my hair out at autistic DS's refusal to wash his hands?

[HalebiHabibti]

DS is 11yo and autistic. He manages ok in mainstream secondary school but it is safe to say he doesn't mask particularly well. I am autistic too (recent diagnosis) so have some sympathy with this, but do think a baseline level of rote politeness and cleanliness makes everyone's lives much nicer and so have encouraged him to learn these skills. It has been (and continues to be) a struggle.

The most recent battle is over handwashing, which he avoids whenever possible. I know this because if he gets close enough I can smell his hands (although tbf I am hypersensitive to smells). I've tried explaining about bacteria, I've tried explaining that people will recoil from him, I've tried explaining that job recruiters tend to prefer people whose hands are clean - none of it works as he doesn't think there is a point. We have similar battles over clothing presentation, hair brushing, washing ketchup off your face, etc.

I don't want him to be dirty. I don't want him to be teased/made fun of. I don't want him to be embarrassed.

What on earth do I do please?!

Does he willingly have a bath or shower? Will he use wipes and hand sanitizer? What is his reason for not washing?

Will he use a hand gel or a mousse textured dry hand wash?

Have you tried to break down what the issue is? Is this everywhere or just at home/ just when out and about?

If you can figure out what part of it he can't tolerate there might be a solution. It is likely to be sensory in nature.

I'd try to lay off the impact on others (with exception of health) because this is something he is not doing on purpose. How old is he?

Does he see an OT ? This is something they may be able to support.

Sympathies, OP, there aren’t any easy answers (bribery?) but while some things just can’t be helped, your reactions to them also can’t be helped

This isn't entirely true. We shouldn't shame autistic children and young people.

The issues are genuine. It is far better to try to work together to find out what it is that is causing the difficulty to resolve it.

Starting by shaming is not going to help resolve.

Sensory assessment would be a good place to start. He may have significant issues with touch, water and textures and may actually find these experiences painful.

I was also going to say you need tobfind out the reason for not washing. Is it sensory and can that be tackled.
Not knowing anything about your son, my next step would be to build a routine supported with a timetable, ( once i knew the sensory side). But you will know if thats the type of thing he responds to.

That must be hard. One of my older family members has the exact same issue and he's worse than ever in his 60s. He just doesn't see the need and doesn't care about the impact on his loved ones.

If your son won't respond with reasoning, would he respond in rewards? A chart where if he evidences he's cleaned each day (or whatever frequency you need) then he can collect marbles etc and 50 marbles equals a cinema trip or something that would motivate him?

You need to tap into what motivates him, even though cleanliness isn't it.

I think he thinks it is a stupid pointless rule and therefore he can ignore it, which is very much #classicalautism thinking based on everything I've read. I have a bit of that attitude myself, but have managed to skirt it on occasion by considering the social oppobrium which will follow if I don't Do The Thing, whatever it is. He does not share my fear of social consequences as he says people are stupid :/

It is part sensory issue, part I can't see the point (he has explained at length that he sits down to pee and so doesn't need to wash hands afterwards as he hasn't touched any bits), and part 'don't you tell me what to do'. So it is complicated.... he does take showers occasionally as he likes them, which is great. But it does make eating with him a bit bleurgh as you can't ask him to pass anyone anything and certainly wouldn't want to share.

Need to do some work now but I will be back!

You need to figure out what he doesn't like about it. Would running a basin of water instead of using running water help? Is it the smell of the soap, or the sensation of foam? Foaminess can be a big trigger.

It could also be not really about the washing but a sign that he is struggling more generally. When mine couldn't manage to brush his teeth the fix was (1) non foaming toothpaste and (2) new school.

Social consequences arent always great motivator for someone with a social communication difference.

Humour any use? David attenborough style commentary of the habitat growing on his hand.

Have a look at pathological demand avoidance, it can go hand in hand with autism . While it doesn't seem like a demand to you , certain things, like hand washing , can be a demand to him and can set off his fight or flight. There could also be an element of sensory issues, executive function issues and of course that he just doesn't see the point.

What is he doing that his hands smell?

Much to MN chagrin, I very rarely wash my hands. I’m talking once a day, or I will rinse them after using a public toilet.

I’ve got quite a strong immune system and people at rarely ill in our house.

But my hands are visibly clean and absolutely do not smell (I’ve just checked with the friends that I’m with!).

Can you relax the rule to “dirty/smelly hands should be washed” as that is at least logical (to me) and I maintain is the only time you really need to wash your hands.

If he likes showers, can you get a routine that includes a shower everyday? That would get one guaranteed clean a day.

He might sit down to pee, but he also touches the toilet seat/lid and flush. I'd say hand wash after toilet, (gardening and touching raw meat) is the bare minimium. Can you work towards that?

If you have recently been diagnosed then I’m guessing that you have had a lifetime of masking. You’ve tried to fit in in a non autistic world in order to please others.
Your son doesn’t need bribes to fit in, he needs understanding and support. Find out why and ask him what he can do instead.
My asd dc says that washing physically hurts and the sound of running water distresses him. He instead uses a damp flannel.

Some great insights here, thank you. PDA had definitely crossed my mind too....

he has explained at length that he sits down to pee and so doesn't need to wash hands afterwards as he hasn't touched any bits

Can you find some data to show him about the bacteria on doorhandles, keyboards, phones etc. Way more than on his bits probably! Would he respond better to doing his own research on bacteria/handwashing rather than listening to you - esp if PDA is a possibility?

Hygiene is one of those things that is non negotiable in my house. Same as teeth brushing. They do it willingly or I pin them down and do it for them. They quickly learnt that it gets done either way but doing it themselves is a lot more pleasant.

I assume, hope, that you don't have a child who is neurodiverse?

I also assume your children are young. Ever tried pinning down an autistic teenage boy to brush his teeth?

This is too simplistic. It might work in young children but is not the approach to take with an ND 11 year old. It also won't resolve the underlying sensory issue and is likely to make the situation far, far worse.

Bribery for me.

Yes he may have sensory problems, see it as pointless, find it distressing BUT it's in his best interests.

I'd have the 'once your hands are clean, teeth brushed and you are tidy for school then you can.....' (usually technology in my house - have your phone, play on the PlayStation etc).

Tbf to Ballonhearts, when the kids were smaller I did indeed pin them down and wash them as needed. My (also probably autistic) mother did the same to me :/ I'd like to take a different approach with my own kids though.

The frustrating thing about information is that he's very interested in biology/the natural world, inhales books on medical/scientific info, and so already knows what I am going to say (I used to be a microbiologist for goodness sakes)!!

I think a different tack is needed - we need to calm the rhetoric and find another way of acheiving an outcome which works for all.

There are some good YouTube videos that show handles etc in green. But at the same time if he showers every day and just doesn't wash his hands I really doubt you can smell them, what could he be doing with them? Will he wash them if he really needs to look if they got oil or raw meat on? I think you might need to pick your battles. Plus I doubt all the other teenage boys at school wash their hands before they eat etc

Is it the washing experience specifically?

Would he use wipes or antibac gel rather than soap and water?