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Q: My 5-year-old is quite high functioning and attends kindergarten with typical peers. He is independent in using the toilet to urinate, but holds his bowel movements until he gets home from school, and then requests a diaper to have a bowel movement. Help! What can I do to change this behavior?

A: Your child may be doing this for a number of reasons; this is when it is helpful to do some "detective" work to try and understand the reasons for his behavior. Your child may be very firmly established in a routine of having a BM in a diaper and not know how to get out of this pattern! One technique that has been very helpful, especially with individuals who are higher functioning, is to use "Power Cards.” This is a technique developed that used the individual's hero or special interest to come up with a solution to specific problems.

Remember, too, that individuals with ASD may not automatically understand some things that we think are obvious: For example, your son may need more specific training and visual cues to understand that he can have a bowel movement in the toilet. Prepare him ahead of time by showing him a set number of diapers (10, for example) and letting him know that when the diapers are gone, there are no more and he will have to go in the toilet. Also, review the toileting area at his school and provide visuals so that he knows that he can use any of the boys’ toilets at school to have a bowel movement. Sometimes anxiety can greatly affect the ability to use the toilet; your son may require a longer time and quieter environment in order to relax and have a bowel movements.

Q: My child, age 4-1/2, seemed to be doing quite well using the toilet after we followed a consistent schedule for toileting. However, she has started to have "accidents,” and to our dismay, she doesn't seem to care that she is wetting his pants. What can we do? Is she regressing in toileting?

A: First of all, look at when these accidents are happening. Sometimes individuals with ASD are so focused on a highly reinforcing activity (such as playing at the computer) that using the toilet takes a very low priority. Be sure to place visual reminders in areas where accidents might occur (computer, play area, TV). Be sure your child has a communication system that allows her to let someone know when she needs to go. Review your observations of your child's toileting behavior: What does she do just before she has an accident? Try to catch her at that point and get her to the toilet so she experiences more success. It also sounds like your child continues to need reinforcement for when she does use the toilet successfully. If she does not seem to care that her pants are wet, review your reactions to her wet pants. Be sure she is aware that they are wet and that she is responsible for changing them. Remember, the toilet training process is a long one and will include "ups" and "downs.” In addition, be sure that your child has not developed a urinary or bladder infection, which may also contribute to the occurrence of “accidents.”

Q: My child is so afraid of toilets flushing that he becomes panicky when brought into the bathroom and refuses to sit on the toilet. What can I do?

A: First of all, be sure no one is flushing the toilet when your child is in the bathroom. Bring your child into the bathroom and introduce the visuals for toileting, and be sure to include a visual for "no flushing" to begin to teach your child that the toilet won't be flushed. Introduce your child to sitting, with his clothes on, on a closed toilet lid. Again, be sure to use visuals, as you will soon ask your child to pull his pants down, then sit on the toilet. Be sure he has enough support to sit comfortably on a toilet. Use visual or auditory timing cues: counting to a certain number, singing a song, using an egg timer, whatever is convenient and effective. Start with very short periods of time and gradually increase he length of time. Outside of the bathroom time, introduce auditory listening games that are paired with photos. Be sure to include the sound of a toilet flushing along with the photo. When family members use the bathroom, have them give a warning to your child: “I'm going to flush the toilet!” or “Ready-set-flush!” Give him time to get used to the flushing and over time he will eventually flush the toilet himself!

Q: My child is 16 and is not toilet trained. I have tried over the years with no success, so he continues to wear diapers. I can put up with it, but it is almost impossible to find caretakers who are willing to change pants of someone so physically big. I worry about my son, especially as I get older and think about him moving into a group home. Is it too late to get him toilet trained?

A: First of all, good for you for recognizing that toilet training is a skill that will help your son! Keep in mind that over the years professionals in the field of autism have become better at recognizing the need to look at the autism learning style prior to starting a toileting program. It is highly likely that methods tried in the past were not successful because they did not address your son's unique needs. Get in touch with an individual who is knowledgeable about autism and experienced in toilet training individuals who are older. Your son will present extra challenges because of his age, but no one is too old to toilet train!

These are just a few of the many questions and concerns parents and educators present! Remember, all individuals with autism spectrum disorder are unique and all toileting issues must be considered within the picture of the whole individual.