All individuals with autism are unique and so are their reasons for toileting problems. While a typically developing child usually learns to regulate this basic function, an individual with autism may find it harder to get in sync.
- Often, a very common reason for toileting problems is difficulty in processing sensory messages. An individual may be under responsive to sensation and lack the body awareness to know that they need to eliminate. They may not notice their pants are wet and soiled or that they smell bad.
- An individual may be over responsive to sensation. They may not be comfortable with the noise made by flushing the toilet or the feel of the toilet seat or they may have gravitational insecurity and are not comfortable on the toilet seat with their feet off the ground.
- An individual may be a sensory seeker and may find it comfortable to sit on warm squishy fecal matter or to play with it. This kind of stimulation may not be socially acceptable.
- An individual may have difficulty in discriminating between ‘empty’ and ‘almost empty’ and may jump off the toilet before completing a bowel movement.
- An individual may have difficulty in getting into and maintaining a stable position.
- An individual may have dyspraxia, which makes it difficult for them to come up with the idea of unbuttoning and unzipping their pants, motor plan these tasks, and how to carry out these plans.
- Wetting and soiling clothing results in significant amount of time, energy and resources being spent on an individual’s personal care needs. Soiled clothing and poor toilet hygiene also significantly interferes with social acceptance. Some behaviors of these individuals may also prove a health risk to the individual.
- Though it is generally believed that autistic individuals are the most difficult to toilet train, different strategies and techniques can be used to make this task effective. To achieve success in this task, it is essential that the needs and characteristics unique to an individual be considered while planning intervention. Following are some of the pointers which may help ease this difficult task of toilet training an autistic individual:
- For typical days, document the autistic individual’s routine. Track how long it takes between when the individuals eats or drinks and when he or she is wet. Check their diaper frequently for wetness (every 15min), this helps to decide when to schedule toilet trips.
- Consider the individuals diet. Dietary changes, such as increasing the fluids and fibers in their intake helps the individual feel the urge to use the toilet.
- Make small changes in daily habits. Dress the individual in easy to remove clothing. Change as soon as he or she becomes wet. Change diapers in or near the bathroom.
- Make the individual flush the toilet and wash hands after each diaper change.
- Make sure toilet trips are comfortable. The individual should be comfortable while sitting on the toilet. Provide a footstool. If the individual will not sit on the toilet, work on sitting before beginning a toilet training program.
- Improve body awareness related to elimination and improve sensitivity to tactile stimulation from clothing.
- Work on effective communication signaling that the individual needs to go to the bathroom and how to use systemic communication tools such as objects, pictures and words to communicate in different settings.
- Imitation is a powerful strategy which can be used for toilet training individual with autism.
- Developing routines and rituals is very important. This helps the individual to adjust to new situation such as using different toilet and serves as a bridge between old routine and new situation. Also these rituals and routines can be used to present toileting skills as a sequence of steps to provide the necessary sequential learning.
In conclusion, teaching the basic toileting & hygiene skills is essential for social acceptance. It is an integral part of social skills training & becomes a higher priority with each passing year.