Expert: Dr. Sharon A. Mitchell - 3/29/2007

Question
Hello,
I am an OT working in a special school. Whilst I have worked with children with special needs for many years, I have never had much success with toilet training. I find many of the children are just not sensorily aware of needing to go to the toilet, and have limited anticipation of their toileting needs. any ideas for how to progress with this.
many thanks
Susi

Answer
I agree with you. I've also found that kids kids autism or other sensory-involved special needs may not be aware of when they need to use the bathroom. It sometimes help if you think of autism as a processing disorder where it's hard for the person to process more than one piece of sensory information at a time. So, it they're playing with something, watching something or focussing on one thing, when their bowel or bladder gives indications of being full, those message can easily get lost in the midst of all their brains are trying to process simultaneously.

Apart from being unaware or insufficiently aware of their bodily processes, children with autism can have all kinds of fears wrapped up around bathrooms. For kids with auditory sensitivities, the porcelain and tile in washrooms can makes sounds more echoey or harsh. The whoosh of the toilet flushing can be equally startling. The lights are often bright or glare off the chrome and sinks and can bother children with visual sensitivities.

It's not unusual for people with autism to have vestibular and balance weaknesses. Many kids are nervous perched atop a toilet or commode but for an autistic child will vestibular issues, that fear would be pronounced. Toilet reducers to make the seat opening smaller may help a child less fearful or falling. Grab bars may give him something to cling to if he feels that he might fall off.

Another difficulty that may be interfering with independent toileting may be trouble your children have relating cause and effect. Understanding the possible reasons behind the problem though does not make toilet training any easier.

There's one advantage you can build on if your kids have autism - they love routine. Once you have a routine established, they will cling to it more firmly than sometime you would have even hoped. Therefore, if you can eventually "catch" them and train their body to void
at prescribed times, you may in essence have trained the caregivers rather than the child but still there will be less clean-up to deal with. And over time, the "habit" may become ingrained and independent.

If your students are higher functioning, social stories may be useful in getting your point across. Here's a simple example taken from the following website: http://www.polyxo.com/socialstories/ss0004.html

Sometimes I have to go to the bathroom.

Sometimes I have to go pee.

Sometimes I have to have a B.M.

After I have a B.M. I need to wipe myself. This is okay.

I will try to wipe myself until my bottom is clean.

Sometimes I might have to wipe myself 2 or 3 times. This is okay.

When I am done wiping I can flush the toilet.

Then I can wash my hands.


If you're unfamiliar with the concept of social stories, there are good explanations at the following sites:

http://www.polyxo.com/socialstories/introduction.html

http://www.autismnetwork.org/modules/social/sstory/index.html

Social stories need not be written in words, but pictures work just as well, if not better for some kids. A great free source for ready-made pictures (if you're not the artistic type) is www.dotolearn.com.

I'm afraid that I am no expert in the toilet training area. So, I'll refer you to a few resources that I'm
familiar with:

The autism section of About.com recently ran an article on toilet training kids with autism.

You can read it at:

http://autism.about.com/od/childrenandautism/ss/toilettrain.htm?terms=autism+++t...

Here's an article geared to training kids with special needs, but not children with autism in particular:

http://pediatrics.about.com/cs/parentingadvice/a/sp_needs_potty.htm?terms=autism...

Dr. N. Azrin has written an interesting little book that has lots of suggestions and readiness indicators. Although I'm not sure about the "in a day" bit, it's a worthwhile
read:

http://www.amazon.com/Toilet-Training-Less-Than-Day/dp/0671693808/ref=sr_1_4/102...

9332?ie=UTF8&s=books&qid=1175480397&sr=1-4

Maria Wheeler has written, Toilet Training for Individuals with Autism and Other Developmental Issues

(http://www.amazon.com/Toilet-Training-Individuals-Autism-Developmental/dp/193256...)

Lastly, here's a website where you might find some more suggestions:

http://www.bbbautism.com/toilet.htm

Sharon A. Mitchell
www.autismsite.ca