Expert: Trey McGowan - 4/3/2009

Question
My (almost) 12 y.o. son has began falling back into old patterns of having accidents at school & I am against the wall as to what to do & how to help him overcome this hurdle.  His background: early dx (age 3) has been ranging from Au/PDD-nos, mild MR & Global Developmental Delay, back to Au/PDD (higher functioning). He was late to potty train (age 4) and we still haven't gotten night bedwetting issues resolved. He's a deep sleeper combined with fact that I was also a bedwetter until about his age; I'm not overly concerned with this just yet and am hoping that our strategies will eventually work. (ie: restricting liquids after 6 pm & waking him up 2 x's during night)  However, he is in the 5th grade and has again started having accidents during school. Unfortunately, most likely due to his age or out of shame/embarrassment he is trying to hide it and has began to try to go the entire school day without notifying his teachers. Usually he only wets himself, but today he soiled himself and went for the last 3 hours with a very noticeable stain on his pants.  
Let me back track again briefly: he has always had the tendency to wait until he is about to explode before he'll go to the bathroom; sometimes he won't make it in time.  We've tried talking to him about trying to 'tune' into his body; at times, we lovingly just offer encouragement and reward him for going regularly, but too, I'm ashamed to admit that we've scolded him occasionally when he's had accidents...out of frustration.  I'm not at all proud of that & after a teary-eyed episode I vow to never do that again. However, I'm so perplexed by this because externally it seems like he's 'plugged in':to his surroundings & other basic personal needs, but it 'appears' that he's not putting this basic need higher on his priority list.  Or so it seems, I think, I guess, I don't know?  I've asked him repeatedly if he realizes that he needs to go or is he just too busy playing, watching TV, etc. that he doesn't want to break away from his activities so that he can relieve himself.  His answer always is, "I don't know", or "I can't help it".  And after today's accident, I'm starting to believe it.  My amateur hunch is that he simply cannot mentally multi-task or take a time out to do it.
But, if this is the case, where do we go from here?  He is such an amazing kid and very NON-TYPICAL of Au/PDD traits with regards to inability to understand feelings & emotions and being able to give & receive love and affection.  He's very loving, sensitive and empathetic to those around him. I know he's hurt and embarrassed by this.  
Sorry for the lengthy post but can you please offer any advice?  Thanks for letting me vent.

Answer
Hi there, Shawn!

I was just answering another mother with 'toilet training regression' questions as well. :) Seems that they come in waves. Maybe it's the phases of the moon!

For an autistic child, sometimes there are indeed times when the child is just plain unable to tell when they have to go. However, more often, your hypothesis is the case: the child is fixated on whatever it is that he's doing, and unimportant things are ignored in favor of whatever that activity is. Unfortunately, to the autistic mind, 'unimportant' can be defined as 'anything that is not what I'm doing'. This includes, as I'm sure you've noticed, going to the bathroom on time. Holding it back until it's too late is a very common problem in cases like this.

To help with the 'waiting' issue, you may have to introduce some discipline. This should not be mistaken for punishment. Rather than praising and reassuring, make it matter-of-fact; this neither reinforces that having an accident is something he shouldn't worry about, nor punishes him for a situation that can happen to even the normal person. Casually tell the child that because he made the mess, he has to stop whatever he is doing at that point in time and help you clean it up. This may mean that you turn off his favorite TV show, or move him away from something else, in order to go and take a shower, clean the wet spot, rinse his clothes out (if it was a bowel movement), and change. Reinforce to him that by stopping briefly and going to the bathroom, he will find his pattern a lot less interrupted than if he waited too long and had an accident. If he is stopping what he is doing immediately and 'fixing' the problem, this might not be a help, but I'm not sure if he is or not.

If school is the only place that he is having issues with bathroom accidents, then the likely problem is that your child is simply too shy or uncomfortable to ask whether he can go to the bathroom, and at recess is simply too busy playing to want to stop. It is difficult to be singled out, and in the classroom atmosphere, the act of putting one's hand up and asking 'May I go to the bathroom?' is singling one out. If your child is already having bullying or teasing issues at school, this would be perceived as a way to make things worse. The fact he is too embarrassed to say something even more strongly suggests that this could be part of the issue: not wanting to stand out.

I would suggest that you try and find out whether there are school issues for your child, involving things such as bullying, shyness, or feelings of inadequacy. Talk to him as well as the teachers; this is one thing where two sides of the story are definitely going to give you more information than one! After all, a teacher will not know if your child is being bullied if he doesn't tell her, but she would be able to admit he has a lot of shyness issues even if he can't vocalize the emotion.

Hopefully those snippets will help out! Questions, comments, feedback, follow-ups, are always welcome here!

Trey