Expert: Dr. Sharon A. Mitchell - 2/25/2009

Question
My Autistic son is twelve years old. He is fully potty trained; however, every winter Jan/Feb he wets his pants at school several times a day while sitting in the classroom.. He loves his teachers and enjoys being at school.  We cannot figure out why he does this. I reiterate, he does this for about two months every winter.  Why at school and not at home? He even does not mind sitting in his urine  Is he bored?  Is he tired of winter? He plays outside for hours without wetting himself.  My son does not talk so I cannot ask him.  Can you help us understand?

Answer
Yes, I'm sure he is tired of winter, just as we all are. But I'm not sure that accounts for his incontinence problems in January and February. Unless of course, he finds the additional winter clothing he wears in this season difficult to get off in time to make it to the bathroom.

Sometimes, mothering a child with autism feels like detective work, doesn't it? It's especially hard when your child does not talk.

It's great that your son loves his teachers and being at school. It's also a plus that he's fully potty trained. Now the detective work begins.

The first place I'd look is to the medical department, with a physical check up. Kids who have even a mild bladder or kidney infection may have more difficulty making it to the washroom on time or even feeling that they need to go. This is an especially hard area for kids with autism.

It can help to think of autism as a processing disorder where the child finds it hard to process more than one piece of incoming information at a time. If he's absorbed in or enjoying what he's doing, the sensations that he needs to go to the bathroom may be lost on him. If he's used to being in control of his urine and an infection interferes by making him continually uncomfortable or by producing spasms that push out small amounts of urine, he may be unaware of the signs he'd normally respond to.

Is he sensitive to the cold? Is he allergic to anything? Some kids are more prone to allergic reactions during the winter when we're more closed in.

Does your son find it hard to readjust to the routine of school after being away during the Christmas/New Year's vacation? Does he show the same incontinence problems when school starts in the fall?

If your doctor can't find any medical reason, next consider sensory issues. Do you have access to an Occupational Therapist? They can often play detective quite successfully, determining what things in the environment may be interfering with the child's progress and in figuring out strategies to help overcome the difficulty.

At home, do you remind your son to go use the washroom? Could that account for why he is not having these accidents at home? Or at home, is he used to visiting the washroom at set intervals?

If you cannot find a cause for this incontinence, then your next resort might be to work on managing it. Even though your young man is successfully potty trained, you and the school may need to go back to the steps you used when he was just in the process of being trained. By that I mean take him to the bathroom at regular, frequent intervals. Give him frequent reminders. Employ the First_____, Then______ tactic where he first uses the washroom then he gets to do his preferred activity. I realize that this is not getting at the cause of the problem but it might help manage things until you get this figured out. And of course, you'd keep several changes of clothes at the school, just in case.

There are now a number of companies who make incontinence products for older children and adults. If your son will wear them, again this might buy you time while you get to the bottom of his winter wetting.

If none of this helps and you are really desperate, you could talk to your doctor about medication. I know that is a last resort.

You might be interested in reading more on urinary incontinence in children at websites such as:

http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/

http://www.medicinenet.com/urinary_incontinence_in_children/article.htm

Sharon A. Mitchell, B.A., B.Ed., M.A., Ph.D. Candidate
www.autismsite.ca