Expert: Catherine Ridenour - 8/23/2008

Question
Catherine - - My son is 3 1/2 years old and was recently diagnosed with PDD/NOS.  He is high-functioning and verbal, although he does have a speech delay.  We started potty training him in January, and by May 1, he was in big boy underwear during the day and pull-ups at night.  For about 3 months, accidents were few and far between.  Now, within the past 3 weeks, there have been accidents daily, mostly with him passing stool, but also urine occasionally.  This is frustrating because he knows that poop and pee go in the toilet, and he even tells me "no poop in big boy underwear, poop in potty", so he knows where it is supposed to go.  When I ask him if he needs to potty, he tells me "no", then an accident usually happens a few minutes later.  Sometimes this happens when he is playing, and other times when he seems to be doing nothing.  He does not recognize facial expressions, so he usually smiles when I am telling him not to poop in his underwear.  I go so far as to exaggerate my facial expression and words to get across the point that it is not ok to poop in his underwear.  I do not scream at him or shame him.  Since he was recently diagnosed at the end of June, he is not in preschool yet (working w/school district), and speech and OT just started this week.  I mentioned the potty accidents to the OT and she suggested that I do not make a big deal out of this.  I have been told by many that to have my son be potty trainied to any extent with an autism diagnosis is great and that I am lucky.  I have also heard from another mom that her autistic son (same DX as mine), had similar potty training accidents after success.  Is this an autistic trait or is this just boys being boys?

Thank you.  Lena

Answer
Hi Lena,

There are a couple of possibilities.

One, he's doing something lots of 3 year olds do, he's asserting independence in one of the only ways he can. You can't make him go to sleep and you can't make him toilet if he does not want to. If he knows how to tell you he when he needs to go, I'd just stop asking and let him take the lead. He may be reacting to the push of "do you need to go potty?" with the "No, I'm in charge here."

Two, he's picked up on the anxiety of the family about his diagnosis. Kids have emotional radar even if they are autistic. He may be less able to cope with this than a "normal" child.

I do agree with the therapist that it is best not to make a big deal out of it. If he responds to rewards, you might try rewarding correct toileting. Keep it simple and low key like a sticker chart.

IF it bothers him to be wet or dirty and he asks you to clean him up when he uses his pants, another approach is "My, my, you need clean pants." Take him to the bathroom, give him the necessary supplies and let him work it out for himself. This only works if he likes to be clean. Some kids ignore the physical discomfort.

I think this will work itself out if you keep your cool. Many boys don't train until nearly four, I am told. I had three girls so I didn't have one to train.

Here is a link to a web site that discusses toilet training and autism.

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

Best wishes,
Catherine