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OH NO, HE WON’T GO  Help for toilet training the child with autism who refuses to go.

OH NO, HE WON’T GO Help for toilet training the child with autism who refuses to go.

Posted by Dr. Fredric Daum, Professor of Pediatrics and Clinical Scholar School of Medicine, SUNY, Stony Brook, New York on May 25th 2020

Unwillingness to toilet train is very common among children with autism. The primary cause of delayed training is often stool withholding. A child who stool withholds is physically able to defecate, but delays defecation either due to:

  1. fear of pain on passing a stool
  2. desire for behavioral control

Stool withholding results in the build up of stool in the rectum with the eventual passage of a large stool. This is a behavior, not a disease or medical problem. It is not related to dietary or fluid intake.

A child who stool withholds creates significant turmoil and frustration within the household. Toilet training a child on the spectrum poses a unique set of challenge as certain traits such as obsessive compulsiveness, perseveration,  and defiance may be exaggerated. These traits, if present, make training more difficult.

Despite the difficulty, toilet training is important because:

  • it permits children to have a better self image.
  • it improves the ability to concentrate in school. Your child will be placed in an appropriate learning setting based on learning potential rather than his/her being in pull-ups/diapers.
  • it allows children to concentrate in OT, PT, speech therapy.
  • it eliminates rashes, discomfort from being wet or dirty, and the unpleasant odor of stool/urine.
  • it makes family vacations fun and allows children to go to camp, swim in pools and socialize.

Your Ultimate Training Goal: To eliminate stool withholding and keep your child dry and clean 24 hours a day.

I have found training children with autism who stool withholds requires a combination of safe laxatives and behavioral interventions supervised by a knowledgeable physician. Please note:

  • The judicious use of laxatives is the standard of care for children who stool withhold.
  • Dosage is critical and must be tailored to your child.
  • Use of laxatives should be supervised by an experienced physician.
  • As all children differ, a behavioral plan needs to be tailored to meet the individual needs for your child.
  • Training should take 3-7 days, depending on how resistant your child may be. It is best achieved over a long weekend or during vacation

Keys to Successful Training Program

Teamwork: Parents, schools and your your doctor should work together as a team.

Consultation: Daily, personalized coaching over the telephone is vital. Your specialist will make adjustments to the dosage of laxatives and changes in specific behavioral strategies based on your daily feedback. Children who stool withhold find surprisingly creative ways to avoid toilet training…your feedback will help your doctor adjust each approach as needed.

Follow-up: Regular follow-up with schools and programs to implement the correct dosage and behavioral approach is important to assure continuity of treatment and continued success.

Support: It is important to have ongoing consultation and support available to families for as long as needed as set backs in toileting sometimes occur, especially during times of transition or changes of schedule.

Doctor Daum believes that any child who can respond to simple commands can be toilet trained. If you have questions or seek more information, feel free to contact DoctorDaum.com