Toilet Training and Autism

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Every parent faces the chore of imparting proper potty skills. Then, there is toilet training toddlers affected with autism.

I was recently interviewed about the special challenges that face parents as their affected offspring embark upon this important developmental milestone. Here are the questions and answers:

What challenges do children with autism have, either mental, social, or physical that would make learning a skill like potty training difficult?

Many children who are affected with autism have other medical conditions – known as comorbidities – that affect their health, especially in the gastro-intestinal tract. Poor G-I function can lead to diarrhea, constipation, GERD, and inflammation. Sometimes it can occur following the overuse of PPIs, antibiotics, or Miralax™.

Multiple sensory issues, accompanied by increased pain tolerance (or decreased perception) need to mature, so that traditional techniques are more likely to be successful.

Decreased energy production leading to decreased abdominal and rectal muscular function presents physical challenges for affected patients.

As these issues are successfully addressed, parents see improved toileting abilities.

Toilet Electric

Patent US 4162490 A 1978 Fang-Cheng Fu, Chien-Hung Fu A battery-powered toilet training device… to provide improved training of toddlers… A non-contact electronic sensor is used to detect the presence of urine and stool in the receptacle. A battery-powered toy is used to produce an audible signal and a mechanical motion to reward the toddler and to signal the trainer when the toddler’s elimination begins.

What effect does parental support or having a parent who is educated on autism have on the development of a child with autism?

Understanding that schedules are important to many children with ASD can be a key feature for achieving success. I usually ask parents to try to put the child on the potty one or two more times than the number of stools per day. That way, the child has more chance for success. Some schools will take children frequently.

Knowledgeable parents pay attention to the signs that the child wants to/ needs to/ is going to… “do number 2”. Sometimes, they are lucky, and catch it early enough. Literally.

Assistance is provided by achieving G-I health with non-inflammatory, non-processed, lower sugar, better digested foods.

There are even special sensory challenges, such as the noise from a bathroom hand dryer, that make facilitating acceptable auditory functioning paramount for success in that venue.

Have you ever had parents come to you needing support or information in the area of potty training?

This is a common problem that becomes increasingly noticeable as children enter preschool years. General-education staff are usually resistant to students who have not acquired this skill. There are lots of websites, but most parents have explored that route.

Behavioral, occupational, physical and neurodevelopment interventions by professionals can be quite helpful, especially when referred by previous successful families.

Do you have any research or stats on the relationship of potty training and autism, or on the topic of potty training as it pertains to autism?

The earliest work on this actually appeared when Dr. Leo Kanner first described Autistic Disturbances of Affective Contact 75 years ago. A majority of the children displayed gastrointestinal signs and symptoms that were overlooked at the time (by the father of modern child psychiatry).

Another unfortunate reality is that, medical evaluation has been slowed by the inclusion of all ‘retarded’ children in many of the early studies about this problem. A 1970’s article entitled, Toilet Training of Normal and Retarded Children, appeared in the Journal of Applied Behavioral Analysis.

In the 90’s, Additive Benefits of Laxative, Toilet Training, and Biofeedback Therapies in the Treatment of Pediatric Encopresis represented the state of the art. Comorbidities were not recorded, and autism was not an outcome measure.

At last, in this century, research documenting ‘normal‘ acquisition of bathroom skills appeared in a respected pediatric journal. A review entitled, Toilet training individuals with autism and other developmental disabilities concluded, “Shortcomings to currently available programs are highlighted and future areas of study are suggested.”

A ‘model for treatment‘ has been offered in a respected research journal. It was based on two patients.

There is plenty of room for improvement in our understanding and treatment of this difficult problem.

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