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Autism/Sleep and Toilet Training

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Question
My 3 and 1/2 wakes up between 1 and 3 and is wide awake until morning.  Also, he refuses to try using the toilet. Fights toilet training no matter what the "reward".  Any help or suggestions would be much apprepriated.

Answer
Hi Raymondo,

How exhausting for you.

I presume that your son has autism. There are a few that contribute to the lack of interest some kids have in toilet training. One is interoception. This is an awareness or sensitivity to stimuli originating inside of the body. Many kids on the autism spectrum have sensory sensitivities and weaknesses in interoception. They have difficulty reading the messages their body sends them, such as when they are tired, hungry, thirsty or need to use the bathroom. That could be one factor complicating your son's toilet training progress.

Another has to do with other sensory sensitivities. In our homes, the bathroom is probably the room with the most echoes and unusual noises. The porcelain and tiles reflect back the noises. Toilets flush with a noisy whoosh. These things might make the bathroom an unappealing or scary place to be.

Many ASD kids also have weak vestibular systems and poor balance. Perching on a toilet, with legs dangling can be frightening, as can the worry about falling through that big hole. Some kids feel better using a foot rest, a plastic ring that reduces the size of the hole in the toilet seat or using a low potty chair that sits on the floor.

Still other kids are too absorbed in their own play or agenda to want to be bothered with trips to the bathroom. While this is true of many kids, it happens even more so with those who have an autism spectrum disorder (ASD).

It is not only kids with ASD who don't take readily to toilet training. Both kids with autism and without autism may have an intellectual disability. Kids with this type of developmental delay frequently come to toileting later in their lives; some not at all.

Some of the disposable diapers we use these days keep a child so dry that he feels no discomfort from wetness, lessening the desire to cooperate with toilet training.

Since rewards have not worked for you, you might want to consider another approach since you may be unable to up the ante enough to interest your boy. Some parents and teachers instead work bathroom trips into a schedule, without waiting for the child to indicate that he needs to go. Schedule bathroom breaks could be shortly after he eats a meal or snack or drink. Kids with ASD generally respond better to visuals rather than listening. And, they appreciate knowing what is expected of them and what will be happening in their day. Make a visual schedule of the day's events, and include regular bathroom visits. You can use pictures to represent the activities of the day, such as breakfast, toileting, play time, etc. A nice website that give suggestions on making such a visual schedule is www.do2learn.com. Don't worry about the rewards. Be calm. The visits need not be long, but he must accompany you to the bathroom or potty and sit for a couple minutes. Hopefully, over time, he will make the connections you're hoping for. But even if he doesn't, he'll be trained to a schedule. Actually, more accurately, YOU'LL be trained to a schedule, getting better and better at catching him at the right time.

Sleep issues plague many people who are on the autism spectrum. There can be a problem falling asleep and also with remaining asleep. For some, this is a lifelong problem.

What does your son do before bed? Does he watch television, use a computer or tablet, watch a DVD, etc? Screen time does not promote sleep. The type of light given off by these pieces of technology does not allow the body to secrete melatonin, our body's natural sleep-inducing hormone. Our bodies respond to the lack of light at day's end and release melatonin. Is your son's room darkened? For some sensitive kids, even a night light is too much to allow him to sleep well. Some kids even need black-out drapes covering the windows.

Making life as routine and scheduled as possible might help. Develop a bedtime routine that you stick to as much as possible. It could be something like a bath at 7:30, followed by a snack, then a bedtime story and cuddle, then lights out. Again, use a visual schedule to show your son the steps in the routine. You could take pictures of him doing each one and tape them to a strip of paper. Point to each one as you do it, explaining as you point.

If his sleep difficulties are extreme and persistent, talk to a doctor. There might be something underlying the difficulty. Even things as common as a bladder or ear infection may affect a child's behavior, especially a child who cannot tell you how he is feeling.

Hopefully, this is just a temporary, albeit thoroughly unpleasant phase your little boy is in and he will revert back to more appropriate night time behavior.

Best wishes,

Autism

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Dr. Sharon A. Mitchell

Expertise

Sharon can help with parenting and educational concerns. She has worked in teaching, special education, counseling and consulting for over thirty years and gives workshops to educators and parents on working with kids with autism spectrum disorders. Sharon speaks from both the education and parent points of view, having an adult son with Asperger's.

Experience

Sharon has spent decades as a special education consultant with a school district and autism consult for the province's Department of Education, giving workshops and individual consults. Currently she works as regional autism consultant for a health district in between teaching university classes. She is an Amazon bestselling author or a series of novels, each depicting a child who has an autism spectrum disorder. Sharon's Master's thesis looked at the long-term outlook for persons with high functioning autism and Asperger's. Her Doctorate focused on strategies to help those with autism spectrum disorders.

Organizations
Website at http://www.drsharonmitchell.org and sits on Autism Today's Panel of Experts (www.autismtoday.com)

Publications
Author of "Autism Goes to School" - a novel about autism that that became an Amazon bestseller. Get this Amazon bestseller free at http://www.drsharonmitchell.org. In the next book, Autism Runs Away, Ethan is only in grade one and already has been kicked out of one school due to his tantrums and pattern of running away when in a panic. Now in a new school his mom remains glued to her phone, waiting for the call to tell her that they don’t know what to do with a child who has autism. Sara is about to learn if this new school is up to the challenge. (https://www.amazon.ca/Autism-Runs-Away-Book-School-ebook/dp/B01FCYQ7DC). Autism Belongs is the 3rd book. Manny's life has shrank to the confines of their house. His parents are desperate not to rock his world because the aggression has gotten to much worse. Where will this lead? Is there a chance that Manny could actually belong out in the world? You bet! Get a free sample at https://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6. Book four, Autism Talks and Talks, is about a 12 year old girl who has Asperger's. She's bright, inquisitive, highly verbal, but lacks social skills. Try a free sample at https://www.amazon.ca/Autism-Talks-Book-School-Daze-ebook/dp/B01IIUZH3S Book five, Autism Grows Up features Suzie, a bright, twenty-one year old whose life collapsed after she finished high school. Now, she lives in her mother's basement, spending nights on her computer, afraid to broach the world outside their door. Autism Grows Up is found at https://www.amazon.com/Autism-Grows-School-Daze-Book-ebook/dp/B01JB8QW3U. Prefer a boxed set? Get the first 3 books bundled together at https://www.amazon.com/Autism-Box-Set-School-Books-ebook/dp/B01KBEHJ08. Co-author of Amazon.com bestseller, The Official Autism 101 Manual (http://autism101manual.com/).

Education/Credentials
B.A. in Psychology, B.Ed. in Special Education, M.A. in Educational Leadership PhD. in Psychology Management, specializing in autism.

Awards and Honors
B.R.A.G. Medallion for the novel Autism Goes to School - Book 1 in the School Daze Series. (http://www.bragmedallion.com/medallion-honorees/2013/school-daze-autism-goes-to-school). Like Autism Goes to School, the third book in the series, Autism Belongs, also ranked #1 on Amazon (http://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6). Manny is not like other children. He doesn’t talk. He doesn’t leave the house. His parents desperately try to arrange their world so that Manny does not get upset. Because, when he does, well, the aggression was getting worse. At ten, Manny was becoming difficult to handle.

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