Since toilet training involves a number of social and sensory components, and autism can involve a variety of social and sensory challenges, it is no surprise that toileting issues with autism are quite common. The usual motivations for accomplishing the task of toilet training may not apply to a child who has autism, making it necessary to find an entirely different approach. Toileting issues can be further complicated by physical problems, such as the gastrointestinal problems that often accompany autism spectrum disorders.
Common Toileting Issues with Autism
Social Aspects
Social rewards, such as peer acceptance and parent approval, are among the factors that motivate most children to become accomplished at toileting. As social cues are often difficult to grasp for children with autism, many are not swayed by such motivations. In fact, the social interaction that comes with parents attempting to teach an intimate life skill like toileting may cause anxiety in some children. Since social rewards are quite often ineffective in reinforcing the desired behavior, offering more tangible ones may be the key. Rewarding with a favorite snack after a successful toilet training session or a dry day can be helpful. For children who are resistant to spending time on the toilet, a selection of special toys that can be used only during time spent in the bathroom can be good motivation.
Communication Issues
Communication deficits can be an impediment to toilet training. Children with autism can have difficulty understanding words or associating them with actions, making it difficult to understand exactly what is expected of them when new words and skills are introduced. Expressive language can also be a problem, making it difficult for an autistic child to communicate the need to eliminate. If your child is having difficulty understanding what you want from him, when you are teaching toileting, visual reinforcement can help. Pictures illustrating the steps of the toileting process, even if just simple stick figure drawings, can help your child learn. Demonstrating the process as you explain it can be helpful as well.
On the other hand, if the communication issue is expressive, meaning that your child is unable to tell you she needs to use the bathroom, learning to recognize when she needs to go is often the best bet. Often, body language and facial expressions can be an indication of discomfort due to a full bladder. Teaching an alternative to verbal expression, such as simple sign language or a specific signal can help her express the need to toilet as well.
Sensory Issues
People with autism can be hypersensitive to sensory input, reacting strongly to sights, smells, or sounds that the average person may not even notice. Hyposensitivity can also be an issue, with many autistic individuals unable to process stimuli like pain or physical discomfort.
Sensory issues can present quite a challenge for the child with autism who is trying to learn toileting. The process can overwhelm those who are hypersensitive to sensory input, with things like the sound of a flushing toilet or the shine of the faucets causing stress. Hyposensitive children may not notice the body's signals that are meant to alert them to the need to eliminate or the discomfort of wet or soiled clothing. Some may recognize them only sporadically, responding appropriately one day but overlooking those cues the next.
Making some changes in the bathroom environment can help the hypersensitive child learn to toilet. Watch for reactions as your child enters the bathroom to see which items may be the source of stress. Remove perfumes, air fresheners, or scented soaps that cause discomfort or air out the room to eliminate general bathroom odors. If the bathroom is warmer or colder than the rest of the house, addressing that issue can help. Using slippers or socks to insulate the feet against the cold from tile floors can help make your child more comfortable, as can explaining noises that cause anxiety, such as toilet flushing or noisy pipes.
Scheduled toileting may be the best way to address hyposensitivity. If your child has difficulty knowing when he needs to eliminate, taking notes on his body's regular routines can give an idea of the best times to intercept and accident. Regular visits to the bathroom at one or two hour intervals can be effective as well.
Resistance to Change
Children with autism can be very resistant to changes in routine, making the introduction of new skills very stressful and difficult to handle. Such inflexibility can certainly make toilet training a challenge in the early stages, but adhering to a consistent routine can help. Scheduled toileting and a structured routine during every bathroom visit can turn this insistence on routine to your advantage during the toilet training process.
Medical problems
Gastrointestinal problems occur more frequently in autistic individuals than in the general population. Constipation or loose stools are common problems, and both can present an obstacle to successful toilet training. Constipation can make elimination uncomfortable or even painful, while loose stools can be the cause of frustrating accidents. Consulting your doctor about such issues is wise, and changes in diet, such as adding fiber and fluids, can be of assistance in easing constipation.
Remain Positive
Among the most important things to remember during the process is that your child is doing his best against more difficult circumstances than the average child. While toilet training takes hard work and patience with any child, addressing toileting issues with autism can be much more of a challenge. The process can be much longer and more frustrating for both child and the parent. Do your best to be patient and reassuring, and never punish mistakes, as this can create negative associations in the mind of your child that will impede progress with toilet training.
