Teaching Handwashing to Children With a Developmental Disability

Given the importance of maintaining good hygiene because of the spread of the coronavirus, parents and caregivers should ensure that children are washing their hands more frequently. For some parents, just giving a simple reminder may be enough to increase your child’s handwashing. However, for some children with a developmental disability such as autism, handwashing may be a skill that is still being learned. For these children, providing a simple reminder may not be enough.

The purpose of this article to give parents and caregivers a brief overview of how you can teach your child handwashing. If your child is still learning handwashing and is receiving special education or applied behavior analysis services, we encourage you to consult with these providers for specifics of how to teach handwashing to your child.

Break down handwashing into sequential, smaller steps that can be taught individually. Focusing on learning small steps may be easier for your child than learning everything all at once. For example, handwashing can be broken down like this:

• Turn on faucet
• Wet hands
• Put soap on hands
• Scrub hands, front and back, together
• Rinse hands
• Turn off faucet
• Dry hands

Once you have broken down handwashing into smaller steps, consider making a visual schedule that includes a picture for each step. Put this schedule by the sink so that your child can view it while practicing handwashing. Here are two links to visual schedule examples for handwashing:

• From the National Autism Association
• From the Scott Center

Before practicing handwashing, make sure that you have all the materials that you will need. This might include hand soap, a step stool (if necessary), hand towel and a visual schedule. Place these items in the same location each time you practice, so that your child can focus on learning each step instead of trying to find everything. They will be more motivated to practice and may learn more quickly if you provide reinforcers. Reinforcers differ for each child, but these might include labeled praise and access to a preferred toy or snack. Be sure to have your reinforcers readily available before practicing.

Start by giving a clear, concise directive to wash hands. Teach your child the steps by using prompts. A prompt is any assistance that you give your child to help them complete a step. The types of prompts are:

• Verbal prompt: Telling your child what they specifically should do. For example, reminding your child to turn on the faucet by saying, “Turn on the faucet.”
• Model prompt: Showing your child how to complete a step. For example, demonstrating how to scrub hands by scrubbing your hands together in your child’s line of vision while saying, “Scrub your hands.”
• Gestural prompt: Gesturing to help your child seethe relevant materials needed to complete a step. For example, you might point to the soap while saying, “Put soap on your hands.”
• Physical prompt: Helping your child do a step. Full physical prompting involves using gentle “hand-over-hand” guidance to have your child complete a step (such as guiding your child’s hand to turn off the faucet). Partial physical prompting involves guiding your child to complete part of a step (such as moving your child’s arm toward the water, but not guiding your child to rinse their hands).

When practicing handwashing, you should focus on teaching one step at a time (a target step). Immediately prompt your child to complete all other not-yet-targeted steps. This typically involves using full physical prompts for those steps. For target steps, you’ll want to gradually decrease the amount of prompting you provide. This might involve physically prompting your child to complete a target step, then moving to a model prompt the next time you practice, and so on until they can complete the step with only a verbal prompt or no prompt at all. This might also involve giving your child a brief period (such as five seconds) to independently complete a target step before providing a prompt. When practicing, be sure to check the water temperature before your child wets their hands.

Once your child can independently complete a target step, move to teaching the next step. You can teach handwashing either by targeting the first step and then moving forward through the task or targeting the last step and working backwards. For example, if targeting the first step, you will teach your child to turn on the faucet and then physically guide your child to complete the remaining steps. Once they have learned to turn on the faucet, let them do this step independently, teach your child to wet hands, and then prompt through all other steps. Repeat this process until your child learns all the steps.

To help your child learn faster and to support their cooperation during practice, use reinforcers. Throughout practice, praise your child for being cooperative and successfully completing a target step. Provide a toy or snack reinforcer after your child independently completes a target step (for example give one fruit gummy for turning on the faucet) or after the practice for being cooperative.

By breaking down handwashing into simple steps, providing effective prompts and using reinforcers, you are doing a lot to decrease the chance that challenging behavior will occur while practicing. Nonetheless, it may still happen. If you notice your child becoming agitated while practicing, give your child a moment to calm down before continuing. This way, your child has the option to practice and earn a reinforcer or not practice and miss out on the reinforcer. If your child does not calm down, discontinue practicing and consult with a behavioral health service provider, such as a licensed psychologist or licensed behavior analyst who specializes in skill acquisition or behavioral concerns in children with a developmental disability.