Navigating hygiene can be challenging for any young person. For PDAers, these self-care tasks can feel especially overwhelming. Traditional approaches to personal care often rely on routines, authority and compliance—none of which work well for PDAers, who can experience anxiety around demands. Instead, a flexible, collaborative and autonomy-respecting approach is key.
PDA stands for Pathological Demand Avoidance or Persistent Drive for Autonomy
Image from Canva, by Hilda Weges | INTREEGUE Photography
You may also be interested in my other blogs on PDAers such as ‘Getting to Know More About PDAers: The Less Discussed Characteristics‘ and ‘Distress Language: How to Tune into What Your Child Can’t Say’
Understanding the Challenges
PDAers often have a great need for autonomy and can experience a distress response to perceived demands. Hygiene tasks—such as showering, brushing teeth, or using deodorant—can feel like overwhelming demands rather than self-care. Add in sensory sensitivities, body changes and social pressures, and the experience can become even more difficult.
Common challenges include:
- Sensory difficulties: ie., water temperature, texture of soap, strong smells of hygiene products, bright lights in bathrooms
- Loss of autonomy: feeling like hygiene is being imposed rather than chosen
- Anxiety around body changes: which can feel unpredictable and out of control
- Executive functioning difficulties: struggling to start or sequence tasks
- Social pressure and masking: which can lead to exhaustion and shutdowns
Strategies for Supporting Hygiene
The overall aim is to work with the PDAer’s need for felt safety and autonomy around hygiene tasks in order to find what works for them. Here are some strategies that can help:
1. Reduce the Demand
By reducing the demand, hygiene tasks can feel less like an obligation and more like an opportunity for comfort, choice and personal care.
Here are some ways to do that:
- Make it Playful – Turning hygiene into a game or a playful time together can remove the pressure. For example, using fantasy like pretending to be a spa owner giving themselves a treatment, or brushing teeth alongside a favourite toy can make tasks feel more inviting.
- Use Indirect Language – Instead of direct instructions like “Go brush your teeth,” try more open-ended phrasing such as “Your toothpaste is on the sink if you want it” or “I’m going to brush my teeth now—want to join me?”
- Make It a Background Activity – Sometimes, shifting the focus away from hygiene itself helps. For example, brushing teeth while watching a video, listening to music in the shower, or using a foot spa while reading can make hygiene tasks feel more natural and less forced.
- Create Easy Access to Hygiene – Create an environment where hygiene naturally happens. For example, leaving a face wipe station near the bed rather than insisting on a full skincare routine.
- Adjust Timing and Flexibility – Strict schedules can feel demanding. If possible, support hygiene routines to happen at a time that feels right.
2. Address Sensory Needs
For PDAers, sensory sensitivities can play a big role in hygiene challenges. Certain textures, temperatures, sounds, or smells can feel overwhelming and trigger a strong avoidance response. Identifying and addressing these sensory needs can make hygiene tasks more manageable.
Here are some ways to support sensory comfort:
- Temperature Adjustments – Lukewarm water might feel better than very hot or very cold water. Offering control over the temperature of showers, baths, or handwashing can help.
- Texture Sensitivities – Some soaps, shampoos, or lotions may feel unpleasant. Trying different brands or textures (foam, gel, bar soap) can make a difference.
- Clothing Comfort – Scratchy fabrics, tight seams, or labels can cause distress. Opt for soft, tag-free clothing that feels comfortable after hygiene routines.
- Noise Levels – The sound of electric toothbrushes, running water, or hairdryers can be overwhelming. Using quieter alternatives, incorporating ear defenders or playing music can help.
- Smells and Tastes – Strong scents in hygiene products can be aversive. Opting for unscented or mild-smelling options can be a good alternative. Some toothpaste flavours may be too strong—trying different ones or using water-only brushing can be useful.
- Lighting – Bathrooms tend to have bright lights. Consider fairy lights, night lights and glows from salt rock lamps instead.
- Gentle Touch – Some people find certain sensations uncomfortable, such as the pressure of a toothbrush or the feeling of a towel. Using soft-bristled brushes or patting dry instead of rubbing can reduce discomfort.
Giving PDAers as much control and choice over their hygiene products and routines can help reduce sensory overwhelm and encourage participation in a way that feels safe and manageable.
3. Incorporating Passionate Interests
If your PDAer has a passionate interest, they may enjoy linking it to hygiene. For example:
- A science-loving child might enjoy learning about how soap removes bacteria or pretending to be like ‘astronaut handwashing’ with foamy soap.
- A music fan might enjoy a ‘shower playlist’ to make the experience more enjoyable.
- A fashion enthusiast might feel more comfortable to engage with skincare or hair care as a form of self-expression.
Practicing Hygiene with Plushies, Dolls and Figurines
Sometimes, a hygiene task can feel unfamiliar or even a little overwhelming. Practicing on a plushie, doll or figurine first can make it feel more comfortable and maybe even fun! This can help build confidence before trying it on ourselves.
Here are some ways to use plushies and dolls to practice hygiene:
- Brushing Hair – Use a brush to “style” your plushie’s or doll’s hair before doing your own.
- Brushing Teeth – Pretend to brush their teeth while talking about why it’s important.
- Washing Hands – Guide their paws or hands through the steps of washing.
- Using Wipes – Gently wipe their face or hands with a tissue or baby wipe.
- Changing Clothes – Practice changing their toy’s outfit to get used to dressing and undressing.
This playful approach can help make hygiene routines feel more manageable. At the same time, please respect if your young person wants to keep their interests out of hygiene. Interests are so important to us and our mental health and so it’s a priority to ensure that they always feel comfortable when they engage with their passions.
4. Respect the Learning Curve of Puberty and Changing Bodies
Puberty can be unpredictable and distressing. Provide factual, neutral information in a low-pressure way:
- Use books, videos, or social stories tailored to their level of understanding.
- Normalise changes without over-explaining
- “Everyone’s body changes at its own pace. It’s okay to ask questions when you’re ready.”
- Offer solutions to discomfort, like cooling pads for menstrual cramps or breathable clothing for sweat management.
Some recommended reading:
- The Everybody Book of Consent
- Growing Up, An Inclusive Guide to Puberty and Your Changing Body
- Making A Baby: An Inclusive Guide to How Every Family
- The Autism Friendly Guide to Periods
- The Autistic Guide to Puberty: A Practical Survival Handbook
5. Make Adjustments Based on Energy Levels & Capacity
PDAers often experience burnout from socialising and masking. At these times, it can be helpful to offer a simplified version:
- “Feeling low on energy? Maybe just a quick wipe-down and fresh socks today.”
- “Washing hair sounds exhausting, maybe just a body rinse while you have an ice lolly.”
- “Here’s the mouthwash if brushing feels too much today.”
6. Encouraging a Positive Relationship with Self-Care
Rather than framing hygiene as a set of rules to follow, emphasise that self-care is about health and feeling comfortable.
Avoid shaming or using social expectations as motivation such as “People will think you’re dirty if you don’t shower”. Instead, focus on intrinsic motivation:
- “Wiping your face with a damp cloth might help you feel refreshed.”
- “Fresh clothes can make you feel more comfortable.”
- “Brushing your teeth can help avoid pain and discomfort.”
By approaching hygiene with flexibility, understanding and a deep respect for autonomy, we can create an environment where PDAers feel safe to learn skills for taking care of themselves – in their own way and at their own pace.
Have you found any strategies that work well for supporting PDAers with hygiene? Share your experiences in the comments below!
Thank you for reading,
Laura Hellfeld
RN, MSN, PHN, CNL
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References and Resources
Last modified: 5 March 2025