I have a new 9-year-old client that does not like to wear clothes. She now wears one pair of pants and one long sleeve jacket. (In the winter she is reported to have worn shorts and a shirt.) She does not wear underwear or socks. She walks to the car in a towel and then gets dressed in the back seat. She does have other sensory issues. I have suggested the Wilbarger Brushing Protocol and will also suggest a behavior plan and implement a sensory diet. Do you have any other suggestions?
Sounds like a tough case! I agree that she needs to wear underwear. She also needs to wear a variety of clothing and get dressed in her room rather than the car. Sounds like you’re on the right track with the
Wilbarger protocol, behavior plan and sensory diet.
Here is what I would do:
* Get parents on board with her needing to dress in the house and insist on at least 3 different outfits initially, working up to 7 (one per day each week) by the end of the summer. Explain that it’s necessary for cleanliness as well as to prevent teasing and to expand her ability to cope with a variety of clothing. Ideally, she should be allowed to choose her own 3 outfits but make sure she understands that whatever she picks, she will have to wear. If money is short, encourage parents to take her to Goodwill to choose 3 outfits. No matter where the clothing is from, choice is important.
* The girls clothing store, Justice, sells a type of underwear most kids with sensory issues love. I think it’s called “Super Soft.” It fits snugly and is basically seam free. Again, it would be best if she were allowed to choose the underwear. Try to steer parents away from cheap underwear sold in bags—usually has seams, wrinkles, and itchy elastic.
* Make a schedule strip for dressing with about 6 spots on it. She probably needs red and yellow arrow activities during this part of her routine. Here is what could be on each spot:
1. Wilbarger protocol (BrainWorks has a card with a scrub brush on it. This would work.)
2. Her choice red or yellow arrow activity
3. Her choice again
4. Get Dressed
5. Her choice red activity
6. Highly preferred reward activity (could be TV time, piece of candy, etc.)
The reward activity should only be given when she is calm and in control, not if she is screaming or having a fit. If she has a meltdown, it could be handled a couple of ways:
1. Parents could ignore it and proceed with getting her ready for school. Parents should be all business, not engaging in a debate or showing much emotion at all. They can repeat one phrase like “People wear clothes. You’ll get used to it.” This will be a tough transition for everyone because this child has learned to get her way. It’s going to be hard for parents to stop giving in. Prepare them ahead of time to stand their
ground and remember they are doing what’s best for her in the long run. She WILL survive.
2. Parents could hold her tightly on their laps and wait out the meltdown. During this time, they should say nothing more than “I’ll talk to you/let you go when you are calm.” When she calms down, they can say “Good for you. I knew you would get used to the clothes. Now you can (reward activity).” Again, parents need to beware that the meltdowns could last a LONG time initially, but the child will catch on if them remain firm. Their resolve will let her know that they truly believe she can cope. If they become emotional and cave in, she will conclude that they don’t think it’s possible for her either. Require her to wear one outfit each day, not repeating an outfit until all 3 outfits have been worn. Once she can handle 3 outfits, add in another to the rotation. For some kids, getting to go shopping for a new outfit will be motivating in and of itself. If not, reward her in another way for being able to add in another outfit.
I hope this helps! Please keep me posted on her progress.