Autism and Toilet Training

I recently read an article about Toilet Training and ASD which contained a lot of misconceptions and “autistic untruths” about a very important developmental milestone.

It can be a tough gig parenting an autistic child and getting misinformation about such an emotive issue can really add to feeling “less” as a parent.

So, let’s try and deconstruct some of those myths. Using typical toilet training methods / ideas for autistic kids usually isn’t successful. Why? Simply because autistic children process their “world” totally differently to non-autistic kids.

We parents all understand the value of creating good routines and step-by-step instructions about toileting, we also know that for autistic children this isn’t the “full picture” of what needs to be considered.

Putting an autistic child on the toilet every 30 minutes is a waste of time if there’s no urgency to urinate / defecate and getting them to stay there for 10 minutes each time … impossible to achieve… like trying to stop the wind blowing! Your autistic child is very unlikely to make the connection between sitting on the toilet and having a bowel movement.

The most important consideration in toilet training your Autistic child needs to be their sensory issues surrounding the process. Yes, we have to become Sensory Detectives! Not just the sights, sounds, smells and tactile issues but also their individual vestibular and proprioceptive considerations need to be established and supported appropriately too. However, the most important sensory consideration, and one most often overlooked, should be your autistic child’s “interoceptive” issues i.e. not recognising the need to urinate or empty their bowels until it’s really urgent or too late.

In working with autistic children and families I’ve come to understand that there are many subtle nuances surrounding toileting that don’t need consideration in a neurotypical toddler but are vital for us. Autistic individuals feel very vulnerable about toileting and often need privacy before they can relax enough to actually “feel” that pressure in their bottom that signals a bowel motion.

Many of them also need to be standing up and “zoned out” to be “comfortable” or relaxed enough to have a bowel motion. This combination is why they are often perceived to “sneak” away to their bedroom to go to the toilet. Not bad behaviour, just an autistic child who intrinsically knows the combination of conditions needed to be able to evacuate their bowels. They are in fact “toilet trained” in recognising when they need to have a bowel movement, but this usually doesn’t fit with our picture of “toilet trained”. So, removing their nappy in an effort to “force” them to become toilet trained is just counter-productive.

“Holding” is a term I really dislike, as it implies the autistic child is consciously choosing to withhold bowel movements. It totally disregards the 3 truths of Autism: - 1. Autistic kids are rule oriented 2. Autistic kids like to please 3. Autistic kids are always doing their best. Again, this is linked to their interoceptive issues – not recognising that feeling of needing to evacuate the bowels, and in discussion with autistic adults’ lack of (muscle) tone in the Sigmoid colon often comes up.

We may see our autistic child “posturing” i.e. leaning on their stomachs across furniture in an unconscious effort to place pressure on their bowel. I’ve also known autistic kids who after 3 or 4 days of no bowel movement eat and eat and eat for a day, which usually results in a bowel movement.

So if your autistic child remains in nappies long after their toddler peers, don’t despair. Just enter their world and look beyond the behaviour to what could be really going on. #autistictoilettraining #theanswerisalwayssensory #nellefrances