Expert: Dr. Sharon A. Mitchell - 1/12/2010

Question
I have a 7 yr old nephew who was recently diagnosed w Aspergers. This past weekend my nephew and his family came over for dinner. We had an incident where I had found him  hiding in the corner of a room away from everyone clearly having to go to the bathroom. I told him he should go or I would not let him to continue to play with his toys. He responded by getting mad at me,saying he did not like me telling him that and started to cry. I started to tell him again and at this point my brother stepped in and said he would take care of it. Let me just say that this is a reoccurring problem, it's been going on 8 months! My brother has brought my nephew to a specialist and there is no physical problem,the Dr said children have a bad experience ie constipation and gave him some suggestion. My brother's way of taking care of this is bringing extra underwear where ever they go and having him sitting on the toilet for 5 mins while playing with toys.Half the time I see my nephew up off the toilet playing. Since his diagnoses of Aspergers my brother seems to use this as an excuse for allowing my nephew to continue with his lack of being "potty trained". My question is should I have done something differently, both his parents were not around so I thought this needed immediate attention. Also if you have any other suggestions you could give me on discipline since twice a month I watch my nephew for a few hours.
Thank You

Answer
Discipline is a tough thing and I quite agree with you that having Asperger's is not an excuse for poor behavior. The trick though is determining if this is a "can't" or "won't" behavior on the part of the child.

Any child (or adult for that matter) likes to have his own way. Sometimes kids being kids are choosing not to comply and would rather do what they wish.

It is hard to make an accurate guess without being there and observing this little boy, but if he was hiding in a corner, that does not sound like brazen, defiant behavior. If he became upset and cried, that also does not sound like willful defiance. He did not sound happy or satisfied with the way things were going.

It's distressing that this is a recurring problem that has happened for months - distressing for you and for this child and his parents. It's good that your brother took him to first see if there is a medical basis for this behavior. The explanation of past constipation creating fear and avoidance could account for what is happening. I would assume that the suggestions the physician gave involve dietary changes, likely to add more fiber to soften stools, making them easier to pass. Increased water intake could help as well.

I appreciate that you did not hesitate to step in when his parents weren't around and you saw that the situation required adult attention. Your nephew is lucky to have you involved in his life. Perhaps you will be a significant person in this child's life and a real support to his parents.

If his diagnosis of Asperger's was fairly recent, his parents may still be reeling from the news. While having Asperger's is not all bad, it can be a shock initially. Often parents feel sorrow and guilt (even though Asperger's is most definitely not something they caused). You may need to be patient with your brother and his wife as they work through this.

It might help for them to understand that Asperger's, a form of autism, is a neurobiological disorder and because of neurological differences in the brain, people with autism spectrum disorders process and respond to information differently than other people. Here's a short article that explains some of these differences: http://autism.about.com/od/causesofautism/a/AutismBrain.htm?nl=1

Because of the neurological differences, people with autism spectrum disorders have trouble making sense of the world. They do not readily make connections and a skill learned well in one instance or place will not easily carry over to another, similar situation. To your nephew, it could be like a whole new ballgame.

You may notice that he is much more comfortable in his own home and has more difficulties when visiting, even if it's to the home of a much-loved aunt. When it's hard to make sense of the world, predicting what's going to happen and what will be expected of you is difficult. You can help your nephew by making things as routine as possible. Even if your routine differs from that in his home, that's fine as long as the child understands the routine in your house.

Since you watch him several times a month, develop a pattern for what you expect and what you do together. Let him clearly know what will be happening. Ideally, don't just tell him, but write it down. If he can read, printed words are fine. Or you can use pictures. A good example of who to do this is at the following website, along with free pictures: www.do2learn.com.

A book you might want to look at is found here:  http://tinyurl.com/ybzwfub

Another good way of getting across what is expected is through social stories. An example is here: http://tinyurl.com/yztl7wa Social stories about toileting may be useful.

This next book may help more specifically with the toileting issues: http://tinyurl.com/yapt8uf

There is a free toileting video: http://card.ufl.edu/video.htm

Kids with Asperger's and autism frequently have sensory sensitivities. These may include auditory sensitivities and some kids get quite spooked by the echoing sounds in bathrooms, by the flush of the toilet, etc. Others have vestibular (balance) problems and perching on a toilet is unsettling and they avoid that if possible. If this might be the case for your nephew, place a stool or box under his feet to help him feel more secure. Place grab rails around the toilet. Try a smaller toilet ring you insert on your toilet seat to make the opening smaller so that he may not fear falling in. These things are all readily available at stores such as Walmart.

Since you say that this particular problem has gone on for eight months, I presume that prior to this toileting was not an issue for this child. With the love and support and patience of his family, this skill will once again fall into place.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD candidate
www.autismsite.ca