How do You Get a Child with ASD to Know When They Need to “GO”?

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.

Looking for more information on potty training an autistic child?

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The Practical Guide to Toilet Training the Autistic Child will guide you from diapers to using the toilet in a community setting!  I believe that understanding every part of toilet training is what is needed, not thinking of it as a “behavioral skill”.  Because the last time I used the facilities, it was a sensory-motor skills with some behavioral components!  And I think that is as true for kids with autism as it is for me and you.  So I go deep into all of the ways to make this sensory-motor skill easier and faster to learn.  You might need PECS and charts, but not always.  You do need to know how to create an environment that makes a child feel comfortable and how to pick clothing that doesn’t get in the way of their efforts.  Don’t miss any of the readiness strategies in my book, because they will inform you about where a child’s strengths and needs lie.  I have created 3 fictional families whose stories will help you imagine what this journey could look like.  You will see yourself in their challenges and victories.

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By Cathy Collyer

I am a licensed occupational therapist, licensed massage therapist, and certified CBT-i sleep coach in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment. It has been a joy to help people of all ages improve their ability to grow and thrive! Occupational therapists are focused on enhancing a client's functioning in everyday life. We are practical healthcare providers, interested in teaching, adapting actions and environments, and building a client's useful skills for living their best life, regardless of their challenges. I am the author of five books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training the Autistic Child". I lecture on many subjects, including sleep, trauma, and development. Contact me to learn more about how I can help you achieve YOUR goals!

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