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Pediatrics/Autism/Sensory Dysfunction & Potty Training


Hi, I'm writing as the girlfriend of a man who's 6.5 year old daughter has Autism and more specifically seriously interfering Sensory Integration Dysfunctions. She is on 0.5ml of Risperdal daily and has attended public prek/primary school full-time (special needs program in the public system) since age 3. She was completely non-verbal until approx 18-20 months ago when her doctor decided it was a good time to begin behavioral meds and prescribed the Ripserdal. Now she has probably 500 words at the most, is able to repeat words when she is asked or if she hears a word and decides to use it/attempt using it, and she does use consistent but an extremely limited number of words or 2-3 word phrases for functional purposes/needs based.
***She is not potty trained, has never been involved in any type of potty training, and the adults in her life have never made attempts thus far to apporach this task, and she gives absolutely no attention, curiosity, or notice to the toilet (I'm unsure if she even knows the purpose of a toilet). She's neither opposed nor interested in it and I'm wondering if you have any thoughts on the possibility of ever getting this little one trained...? I am beginning to wonder if its ever going to be an attainable goal for her, and I have many concerns including whether or not she is able to "feel" her body cues of needing to eliminate, whether or not she could communicate those feelings or cues when they occur in order to get to a toilet & use it with assistance or independently, and whether or not she will be able to tolerate the feeling of NOT urinating in a diaper. Can she actually move past the now conditioned need to feel the urine as it fills her diaper knowing it's safely contained?, can she move into toileting after 6.5 years of a developed comfort in her familiar functions of eliminating ON HERSELF which includes feeling the comfort from warmth of the fluid held close to her body along with knowing she will then being cared for (instead of independently caring for her needs) by another person as she's changed into a dry or unsoiled diaper with assistance from an adult?, and is it possible that this child would actually have the ability to "recognize" the advantages of using a toilet or compare toileting to diaper use as the preferred method 100% of the time?
Sorry for the multiple questions, it's just all my thoughts and concerns about this topic and common aspects of it that we are aware of in children with such profound impairments such as hers. If you have any advice or thoughts on this it would be greatly appreciated! My boyfriend is very removed from any of the planning or decisons regarding her toileting approach/or lack thereof and I have been in this relationship for over 3 years with him---3 years of us both wondering when the professionals working with her are going to approach this topic. As a very young child we didn't worry much about her being potty trained as other children were and assumed the transition from diapers to toilet would eventually begin (maybe at 4 yrs for her) and continue to be an area of consistent effort as she reached Kindergarten/Primary school, maybe by this time reaching a point of competence with using a toilet. But this is not the case and with her eliminating practices we are now actually quite shocked that starting this vital process of training (or even just attempting it) has now been delayed to this point in her development! It seems to have almost reached a detrimental point..... And elimination is a seriously unresolved issue for her, causing much distress and interference every single day with the changing and rashes and discomfort, etc etc. Ok that's it.
Thanks so much,
Chicago, IL

Hi, Gina,

Toilet training is a basic function that everyone can learn.  It can be taught with the simplest behavior modification approaches.  It is not a high level cortical function.

My suggestion is to discuss with the doctor who is prescribing her meds who she can see to develop a behavioral plan to help.  This is something her father, you and any other adults around her need to be integrated with.  

It would be worth spending a hour of time with a peds behavioral specialist to get this going and ultimately done.

Good luck, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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