First of all, knowing when you need to use the toilet is different from acting on what you know. Many autistic kids have the sense of elimination urgency. But not all. This is the feeling of heaviness/pressure in their lower abdomen or rectum. How do we know that they know? Because we see them crouch behind the couch or cross their legs. We don’t see that AFTER they have peed or pooped. We see it BEFORE. They knew they were about to eliminate, or they had started to eliminate.
Sensing elimination urgency in time to get to a toilet is something any mom in Spanx at a wedding reception knows a lot about. Because if you don’t respond in time to get to the front of the line in the ladies room and get those elastic drawers down (in my mother’s words!) you are going to be in trouble. And a lot of ASD kids aren’t good at sensing urgency in time to avoid an accident. Good news: this is true for their younger typically-developing counterparts. And it can be learned if they have to cognitive capacity and the motivation plus adult support to value it and practice it. That means that ignoring urgency messages from their body will come with consequences. They can include having to clean up in the bath, missing something fun because of being in the bath, and having to redress themselves. No shame, but lots of inconvenience. The next time they are visibly showing urgency signs and refuse to act, they need to be reminded of the cost. It can take more than one event to send the message home.
ASD kids with low muscle tone may need to stand up to get gravity to help them sense that they need to go to the toilet. Read for more on this: Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty .
Kids with ASD that have no awareness of urgency need help to heighten the sensation. That is where drinking more comes in. Children urinate more often in the day than they defecate, so this is why you focus your “urgency awareness training” on peeing. Get them to drink larger quantities of a desired drink in a short period of time. Kidneys do their job in about 30-45 minutes on a fairly empty stomach, so you can time this out as long as you aren’t in a terrible rush. (HINT: toilet training isn’t successful if your life or your child’s life is crazy chaos!) Be descriptive about what it should feel like, and any words they use are now YOUR words for discussing urgency.
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