Tooth Brushing - Teaching the Functional Skill

A Free Printable Task Analysis Supports Functional Skill Success

Tooth brushing is an importan functional skill. Chris Bernard Photography/Getty Images

Tooth brushing is both an important functional life skill and an appropriate skill for school intervention.  Other functional life skills like showering may be appropriate in residential setting, but we need to remember that only a small minority of our students are in residential placements.  In that way, tooth brushing is in a way a pivotal skill, (see Pivotal Response Training) that will lead to success in other task analysis based skill programs.

   Once a student understands how completing one step leads to the next, they will more quickly acquire new skills. 

A Task Analysis

First, you need to start with a task analysis, which lats out the discrete steps that a child must complete in order to complete the entire task.  These need to be operationalized, or described in a clear way that any two observers would see the behavior and identify it in the same way. 

I created this task analysis, which your will find on the data sheet.

Tooth Brushing Task Analysis

  1. Remove toothpaste and toothbrush from drawer.
  2. Turn on cold water.       
  3. Wet toothbrush       
  4. Remove cap from toothpaste     
  5. Squeeze 3/4 in. toothpaste on bristles      
  6. Place brush with toothpaste into top right side of mouth. 
  7. Brush up and down.      
  8. Plate brush into left top side.    
  9. Brush up and down.        
  10. Repeat on right bottom.      
  11. Repeat on left bottom.      
  12. Brush front top and bottom teeth.       
  1. Rinse mouth with water from water glass.      
  2. Rinse your brush in the sink.      
  3. Replace brush and toothpaste.     
  4. Turn off water.

Instructional Strategy

Once you have a task analysis that fits your students need, you have to choose how you will teach it.  Students with a significantly disabling disability may need either forward or backward chaining, teaching one or two steps at a time, mastering each before moving on, or .

. . your student may be able to learn the "whole task," using visual prompts, or even a list, for students with strong language skills.

Forward Chaining:  I would recommend forward chaining for a student who is capable of learning multiple steps quickly, over a short span of time.  A student with good receptive language may respond quickly to modeling and some verbal prompting. You will want to be sure that the student exhibits mastery of the first two or three steps without prompting before moving on, but  you will be able to expand the steps quickly.   

Backward Chaining:  I recommend backward chaining for students who do not have strong language.  By performing the early steps hand over hand while naming them, you will be giving your student repeated practice in the steps for tooth brushing while building receptive vocabulary, and as you get closer to the end, you will withdraw prompting for the last steps,while keeping the reinforcement for completion closest to successful completion of the the task. 

Complete Task: This is the most successful with children with high functional skills.  They may even be able to complete the task with a written checklist. 

Visual Schedule

In each of these strategies a visual schedule would be helpful.

  I have found that creating a picture schedule with the student completing each step (heavily edited, of course,) is a very effective way to support student success. The visual schedule can be reviewed before you brush teeth, or can be placed on the counter.  I like to use laminated pictures with a hole punched in the corner, bound with a binder ring.  You could also make a "flip book" using two rings at the top of the pictures, having the students lift and flip each page. 

Evaluating Success

You will want to use the data sheet I have created to measure student success.  You may want to use every other column to make notations on prompting.  You want to be sure you are not "over prompting" which may easily lead to prompt dependence.