Six years ago, my then 6-year-old daughter sustained a severe TBI. In the past three months, bathing has become a nightmare for her … for all of us. She will hit herself, dig at her face, try to bite herself, pull her hair, and so on. She will start this behavior prior to taking a bath or a shower. Pulling the towel off the rack can set her off, so can pulling the shower curtain back. Do you have any advice to help to curb this behavior? Also, why would she be doing this now, so long after her injury? She is non-verbal, so we're constantly guessing.
Since the human brain develops through adulthood, it is not unusual to see changes in behavior or coping skills over time relative to brain injury. As we age, we experience more cognitive, behavioral, and emotional demands. A normally developing brain is usually able to manage this increase in demand. Individuals with brain injury, however, may experience challenges at different developmental levels, as tasks may pose a different set of demands for which they are unprepared. It seems that as your daughter is entering adolescence her bathing routine has become the source of anxiety for her. Has she experienced other sensory changes such as heightened reactions to touch or noise? If so, an occupational therapy evaluation may be helpful in understanding and treating her increased sensory reactions.
If her reactivity is specific to her bathing routine, it may be helpful to pair positive experiences with the bathing routine in gradual steps. The first step may be entering the bathroom without an expectation to bathe. Entering the bathroom can be paired with an activity that she enjoys. Once she is able to tolerate being in the bathroom, you can add another part of the routine such as removing the towel from the rack and so forth. This intervention is called systematic desensitization. A behavioral therapist would be able to assist you in developing a hierarchy of tasks as well as the positive experiences to desensitize your daughter to her bathing routine. This therapist can advise you on how and when to add more tasks to the routine so the routine remains pleasant. In the meantime, you may want to explore alternative methods of bathing such as sponge baths with the ultimate goal of having her return to the shower in a relaxed fashion.
Jacquelyn Borg, PhD is a clinical child psychologist and manager of the Department of Neuropsychology and Neurorehabilitation for Children's Specialized Hospital in New Jersey. She is an affiliate member of the medical staff at the Hospital.