Expert: Catherine Ridenour - 6/2/2008

Question
QUESTION: My grandson who is 6 is high function autistic. He can speak well, but is behind on cognative speech. He has only started to talk about events in his day since he was mainstreamed in kindergarten in February. He still gets stuck when we ask a "why" question. He can read (first grade level) and is starting to do math. He is normally a friendly child and only gets upset when he is in major sensory overload - overtired, large crowd for a long time, too many loud noises. About 2 weeks ago he started hitting his friends for no apparent reason. The teacher said it ususally happens in the morning, and the afternoon is better. Today at respite care, they had to separate him because he was hitting. He had occasional problems with this in the past when he got too excited but was hitting out at whatever was handy, not deliberately walking over to hit someone. He is usually a sweet loving boy and I don't want to see him loose his friends. The autism coach tried social stories, and we tried taking away his legos but it hasn't worked. I hope you have some ideas.
Thanks,
Jennifer

ANSWER: Hi Jennifer,

The one thing that comes to mind is that autistic children are usually way behind emotionally as well as verbally. This may be his version of the "terrible twos." I doubt he really has any concept of the feelings of others.

If you have not heard of "theory of mind", you might want to read up on it. Basically, it is thought that autistic children have no instinctive understanding that others have thoughts and feelings like their own. People are objects, just like toys and furniture, to them. His formerly friendly behavior may have stemmed more from lack of irritation than from true good feelings toward others. Now that he is beginning to deal with social issues, he needs to learn new coping mechanisms.

My daughter tells me, and other autistic people confirm, that their own emotions tend to be very basic: happy, mad, and sad. The intensity varies but they don't usually recognize anger until it is overwhelming. The ability to restrain an outburst comes only with much practice. Over time, they DO learn others think, feel and have needs, too.

As he gains the ability to express himself in words, he will be more able to interact appropriately when his emotions are in play. In the meantime, he needs to be reminded to use his words not his fists. Over and over. Prevention goes a long way. Whenever possible, someone should be nearby to catch the hand in mid-air. I know this is asking a lot of the school system, but he may need a personal aide until this phase passes.

Families are usually willing to accommodate for the child's needs to keep peace and we tend to prevent or sidestep problems without knowing we've done it once we learn how. He is now in a world of people his own size who have their own agendas. This takes some getting used to. Hopefully, his teachers and therapists will continue to help him grow rather than label him as violent and isolate him. Brief time-outs are appropriate, long isolation is not. He can't learn social skills when he's by himself.

Hopefully, this won't last long.

Best wishes,
Catherine

---------- FOLLOW-UP ----------

QUESTION: Thank you for your answer. Summer is coming and he will not have much chance for peer interaction. Most of the mothers of his friends work, and the camps and programs often exclude children who hit or are not toilet trained. He still will not do a bm on the toilet. Do you have any ideas on working with him at home on this. (also, do you have any hints on getting him to poop on the toilet? We have tried sitting with him and reading when we know he's ready. He just waits until he's off the toilet. IF he poops accidentally on the toilet we praise and reward him and tell him how proud we are etc. but this doesn't work.
We also tried taking away lego sets if he made a "mistake", but this didn't help either. He almost seems afraid to poop on the toilet, but has no problem peeing and flushing.
Again, thank you for your help.
Jennifer

Answer
Hi Jennifer,

If he responds well to rewards, using them is good. NEVER punish for toileting mistakes.

Clearly, he has control over when he defecates. So, he must have some "reason" why going on the toilet is not his preference. Since he does not handle "why" questions well, getting him to tell you may not work.

If he has had problems with constipation, he may have had pain while defecating on the toilet. If so, he may have associated the toilet with this pain. Make sure his diet contains enough fruit and vegetables to prevent this problem.

Like many things we try to teach our children, he has to want to do it. You can't make them go to sleep and you can't make the go to the bathroom on cue. Only he controls his bodily functions.

My only suggestion is to set up a camping potty that is the right size for him. It has no water so it does not splash. Maybe, don't even put it in the bathroom, at first. If he accepts it, then begin moving it closer to the toilet. If it has a removable seat that can be placed on top to the toilet, it could help him transition to using the toilet.

I have a link here for you. This man has worked with developmentally disabled people so he address it from that perspective.

Try his suggestions first. He's trained more kids than I.

http://groups.msn.com/TheAutismHomePage/toilettraining.msnw (toilet training)

Best wishes,
Catherine