Dear Meghan: Our 11-year-old daughter is not motivated by personal hygiene. She will shower when reminded to, but she does not wash her hair effectively (I still have to wash it for her sometimes to make sure it gets clean). She is in puberty and is starting to get pimples on her face, but she will not wash her face at night unless I basically walk her into the bathroom and do it with her. When she brushes her teeth in the morning, she still has morning breath afterward, so clearly is not doing an effective job.

I am at a loss. We have worked with her and, frankly, nagged her for years, and I’m just tired of it. Is this developmentally appropriate? We do not believe she is neurodivergent, and she’s a great kid — smart, social and involved in a lot of activities. I don’t understand this refusal to do the basics of effective personal hygiene. The approach we’ve been taking is clearly not working, so I would love some advice. Thank you!

— Nagging Not Working

Nagging Not Working: Personal hygiene is a sticky issue in these in-between years. Your daughter is no longer a young girl, but she’s not quite a teen yet. Hormones, changes in her body and social pressures all take center stage at this age, and three things come to mind when I read this letter. First, parents need to understand the development stage of their child. Second, I am not sure that neurodivergence is off the table. And third, you need to find a new style of communication with her, stat.

Developmentally, your daughter is experiencing puberty in her body, but her mind may still be immature. In her book, “The Crucial Years,” psychologist Sheryl Gonzalez Ziegler says: “Children in the earlier years of middle school aren’t equipped for puberty. Their bodies may be maturing faster, but their brains are not. … This means that kids under the age of twelve aren’t ready to understand or process many of the feelings and situations their changing bodies might lead to.”

Essentially I am wondering, despite the nagging and helping, does your daughter actually understand what is happening in her body? She needs guidance and support, beginning with flipping through a book (choose one that matches your family’s values) with her, detailing what puberty is and isn’t. This isn’t a moment of shame, “See, this is why you have more zits and your hair is oily!” Rather, it’s a moment to say: “Hey, everyone goes through this, and here are some ideas for how to take care of your body. Let’s figure it out so it works for you.”

I know that there is much talk about the autism spectrum these days, but it is worth mentioning that girls go un- and underdiagnosed, often well into adulthood, because of how well they mask (which is the term used for coping to look “neurotypical” in social settings and even with family). It isn’t that people with autism don’t “care” about hygiene, it’s that their sensory system is sometimes overwhelmed, clouding how well a task has been completed or even completed at all. Some people hate the feeling of sudsy hair, or the toothpaste is too minty. And some people simply get stuck in their own minds and don’t attend to needs right in front of them — which is maddening until you understand that this is not a willpower issue.

Finally, I don’t know whether your standards of cleanliness are, in fact, appropriate for your daughter. Check with your pediatrician to see whether your expectations are in line with typical hygiene behavior in an 11-year-old. If your expectations are reasonable, use the Ross Greene Collaborative and Proactive Solutions problem-solving method to find solutions that work for both parties (there are books, a website and trained facilitators). Hygiene is important, but your daughter’s voice must be centered here, and the Greene model allows for both parent and child to voice their point of view. When the parent is controlling a child’s body as much as you are, this problem-solving model may feel slow and frustrating at first, but there’s a bigger goal: We want our children to find reliance on and independence with their own bodies. You may have a vision of cleaner hair and fresh breath (understandably), but let’s instead focus on helping your daughter grow skills to care for her own body. There are numerous resources available in the Greene approach, and don’t be afraid to hire someone trained in the framework to help you.

In the meantime, immediately find and praise what your daughter is doing well. She may feel quite ashamed by your fussing over her body, so establish a deeper connection by creating situations where your daughter shines (especially when it comes to self-care). Whether it is her outfit or hair style, find what is working and truly see her, while ignoring the bad breath and skin (for now). Get the support you need, start with her doctor and stay loving. Good luck.

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