E057 · Sensory experience, body & daily living
Difficulty carrying out personal care and everyday living routines
What might be happening when everyday personal-care activities require substantially more support, effort or organisation than expected for a young person in their own context?
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Overview
Everyday routines such as getting dressed, washing, brushing teeth, managing personal belongings and preparing for the day can appear simple because adults perform them automatically.
In reality, they can require many interacting abilities:
- recognising what needs to happen
- remembering and sequencing several steps
- coordinating movement
- tolerating sensory experiences
- organising materials
- estimating time
- noticing body signals
- initiating an activity
- maintaining attention until it is finished
- communicating when something is difficult.
A young person may therefore understand perfectly well why something needs to happen while still finding the process of doing it difficult.
Phoenix should also be careful about assumptions concerning independence.
Expectations around personal care, family support, privacy, routines and independence vary between families and cultures. The relevant question is not whether a young person performs daily activities according to one particular model of independence, but whether they can participate in personally relevant routines with a level of support that works for them and the people around them.
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What this might look like
A young person might:
- need repeated support to get dressed
- struggle with fastenings, shoes or clothing orientation
- find toothbrushing very difficult
- avoid washing, showering or hair washing
- become distressed during grooming activities
- forget stages within familiar routines
- need adults to initiate activities they can then complete
- take much longer than expected to get ready
- lose or misplace essential personal items
- struggle to organise belongings for school or activities
- manage a routine in one environment but not another
- become overwhelmed when several self-care tasks need doing close together
- resist routines involving uncomfortable sensory experiences
- appear more independent when a visual or established routine is available.
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Developmental expression
At this stage
Early childhood
Substantial adult involvement in personal care is expected. Differences may become apparent through the amount of support needed to learn and participate in emerging dressing, washing, feeding and toileting routines.
Early childhood
Substantial adult involvement in personal care is expected. Differences may become apparent through the amount of support needed to learn and participate in emerging dressing, washing, feeding and toileting routines.
Middle childhood
Expectations for independence usually increase, particularly around school preparation, dressing, hygiene and managing belongings. Differences between what a young person understands and what they can reliably carry out may become clearer.
Early adolescence
Puberty introduces new personal-care demands and can increase sensory, privacy and self-consciousness concerns. Adult support may need to become more discreet and collaborative.
Later adolescence
Preparation for greater independence can bring additional expectations around hygiene, clothing, food preparation, appointments, medication or health routines, travel and management of personal belongings.
Choose each stage to see how the presentation and surrounding expectations may change over time.
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Strengths and differences
Difficulty with personal-care routines does not indicate:
- low intelligence
- lack of maturity
- poor values
- laziness
- lack of awareness of social expectations.
A young person may be highly capable in complex academic, creative or practical areas while relying on substantial external support for everyday routines.
Independence should not automatically be defined as doing everything without assistance.
Knowing how to use routines, reminders, adaptations, technology or other people's support effectively can itself represent skilled independence.
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Top tips for support
- Work out which part of the routine is difficult.
- Break complex routines into visible steps.
- Keep frequently used items in predictable locations.
- Adapt sensory aspects where possible.
- Build sufficient time into routines.
- Avoid shame around hygiene or personal care.
- Practise skills within meaningful everyday routines rather than only as isolated exercises.
- Offer support discreetly as young people become more self-conscious.
- Respect privacy, dignity and cultural or family expectations.
- Focus on routines that matter to the young person and family.
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Things needing careful planning
Personal-care difficulty can arise through many different routes.
These may include:
- motor coordination
- executive functioning
- sensory differences
- communication
- fatigue
- pain
- learning
- anxiety
- difficulty recognising body signals
- lack of opportunity to learn or practise a routine.
A sudden loss of previously established self-care skills, marked deterioration or significant physical symptoms should prompt consideration of health and wellbeing rather than being assumed to represent behaviour or motivation.
Personal care also requires particular attention to dignity, consent, privacy and safeguarding.
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Practical support principles
Useful support may include:
- task analysis
- visual sequences
- laying out materials in order
- consistent routines
- environmental adaptations
- adapted clothing or equipment
- alarms and reminders
- sensory adjustments
- occupational-therapy input
- repeated practice within ordinary activities
- collaborative goal setting
- gradually changing support as skills develop.
Evidence from systematic reviews supports occupation- and activity-based approaches in which young people practise meaningful daily activities, with coaching, feedback and environmental support, rather than relying solely on decontextualised skill exercises. (1)
Activities of daily living are also recognised as important functional outcomes across childhood and adolescence, particularly as expectations and environments change with development. (1)
From understanding to support
Phoenix Atlas connections
Often useful
- occupational-therapy-informed approaches
- task analysis
- visual supports
- executive-function scaffolding
- environmental and sensory adaptation
Worth considering
- assistive technology
- motor-skill approaches
- interoception/body-awareness supports
- communication supports
- explicit teaching of functional routines.
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Evidence and cautions
Prototype placeholderPrototype placeholder. The current source does not yet include a separate evidence-and-cautions synthesis. Its public evidence sources are retained below for the next review pass.
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Public evidence sources
- Occupation- and activity-based interventions for children and young people — systematic review.
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Possible explanatory lenses
Relevant possibilities include:
- executive functioning
- motor coordination
- sensory processing
- internal body awareness
- communication and language
- learning
- anxiety
- fatigue
- pain or physical health
- developmental opportunity and experience
- environmental organisation.
About this entry’s source
Open Beta · read the evidence notes and limitations
Source status describes the underlying material. The current site edition is Open Beta; the evidence notes and limitations remain part of the entry.
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