Expert: Trey McGowan - 3/28/2009

Question
QUESTION: Hi Trey, I have asked you a couple of questions before about my 5 year old daughter with p.d.d and found your answers very helpful.I hope its o.k to ask you another one! She is going well,but we have hit a brick wall with toileting.She does wee fine in our toilet and school's ( will not go in ANY other toilet) but I can't seem to toilet train her for no 2.She will just do it in her pants every night and as this makes such a big mess, I have to sit in the room with her every night.I have tried a social story, picture symbols,read website information,etc.She seems to understand perfectly through the stories and symbols,because she says 'Oh no' when she does it in her pants and points correctly to the right pictures. She also did a poo in the toilet a couple of days after first training, but has done nothing since(2 months later).We thought the 'splash' may of scared her and reintroduced an old potty,which she now uses a lot for wee but no poo.Do you have any ideas on how we can get her to poo in the toilet or potty?It has been suggested to us by the autism adviser who helps us out to maybe put her back in nappies but I am concerned that she will get so used to them and I will never be able to toilet train her!Any advise you have would be most welcome. She is also mostly non verbal, although is slowly saying more single words.Thanks vey much for your time.Julie.

ANSWER: Hi there, Julie!

Actually, while I am not a doctor and can't make a medical diagnosis, there is a fairly common issue with autistic children where they either cannot as easily control their bowel, or lose 'sensation' in the last bit. They may not notice that they are in need of defecating .... er, pooping... until it is 'too late'. Also, one issue you may be having is that while she knows what is *wrong* (pooping herself), she hasn't drawn the lines for what is *right* (pooping in the toilet instead). You may wish to ask her doctor to give her a medical checkup to rule out the former; even if it's not the issue, it's best to make sure. After all, once you've ruled out medical, you can focus more on the behavioural.

You mention that your child soils herself every night. Is it at a particular time? Say, after supper, or on just coming home? If so, one of the things you can do is to make it a part of her schedule: around the time that she'd soil herself, bring her to the toilet and let her know it is time to poop. When she does (I am going by 'when' rather than 'if' here for positive thinking), make sure that you give her praise for doing it right. In that way, it will start to become a habit, as well as being solid in her mind that, yes. This is the appropriate place (and time) to be emptying her bowels, rather than in her pants!

If this fails, then you may indeed need to consider putting her back into nappies for a time. As she develops, teaching can hopefully be done, but sometimes there are 'blocks' which you simply have to work around, rather than try to bull through. I am in agreement with your concern, that she may get used to them, but even with autistic children, many of them dislike 'wearing' their own poop and will learn to toilet train themselves. Not all of them by any means, but a majority tend to.

Here's a few sites that may be a bit of help for you as well:
http://www.articlesphere.com/Article/Toilet-Training-the-Autistic-Child/159630
Exactly what it says on the tin.

http://www.youtube.com/watch?v=GYmBPfnSeMM
A YouTube video for the 'how-to' on toilet training an autistic child. A good listen if you learn better through listening than reading.

http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1071&a=3366
A toilet training tutorial from the National Autistic Society.

I am glad to hear that things have been going well for you, and that your daughter's language skills are coming along (if slowly). :) I hope that this suggestion will help out some as well! And as always, more questions, comments, feedback, follow-ups, are welcome!

Trey

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

QUESTION: Hi Trey, thanks very much for the practical advice. One interesting and important fact I forgot to mention was that my daughter was fully potty trained at the age of 2( for both No 1 and 2).She still wore a night time nappy.The potty( same one that I have reintroduced) was in the living room but when I moved it to the toilet( BIG mistake) she wouldn't use it again. It then took a year or more to get her to wee in the toilet(with a toilet seat)and No 2 was never done again!In the potty,that is.Do you have any thoughts on this?I have tried to sit her on the toilet at night when she is due to go,but no luck.I find it all very interesting as she is generally so quick to pick up new things.A couple of months ago, she was also going to the toilet,signing 'toilet' and saying 'toilet'when I was taking off the soiled nappy and putting the contents in the toilet.Truly ,the more I learn about autism,the more complex it becomes! Thanks for your time again Trey and I will try to relax about this rather messy issue.Rome wasn't built in a day. Julie

Answer
Hi there, Julie!

Neophobia, the fear of new experiences, is definitely a characterization of autism. While I won't say for sure this is what caused the recurrence of problems, it's very possible that the movement of the potty is indeed what triggered some of the problems. I'm not saying you shouldn't have, obviously; children need to learn to use their toilet in the proper place, and not the middle of the living room! After all, while in some cases you can indeed 'work around' autism, carrying a potty with oneself is neither hygienic nor exactly convenient. :)

If it makes you feel any better, many neurotypical children will have regression during potty training, as well. Bowel movements, in particular, seem to be a sticking point for many.

Here's some suggestions for what to do with regression. Although 'patience' seems to be the big thing here. Basically starting from where you'd had the catching point and working your way back up, or helping the child through a time of stress:

http://pediatrics.about.com/od/weeklyquestion/a/04_potty_pblms.htm
http://babyparenting.about.com/cs/pottytraining/f/ptregression.htm
http://pottytrainingsolutions.com/article_info.php?articles_id=8

As a secondary and more mention, I see your child is apparently progressing with her communication skills. I hope my suggestions on the matter were a help, and I'm glad you're sticking with it!

Questions, comments, feedback, follow-ups, are definitely welcome as always! And I wish you luck with this stinky problem!

Trey