July 02, 2015

Q: I have a 4 year old whose has not been officially diagnosed with autism but we have been told he is autistic. We are waiting for the official diagnoses but we have been told he is on the mild end of the spectrum. He refuses to have a bowel movement in the toilet. Do you have any recommendations on how I can get him to stop going in his pants?

A: Potty training is a difficult process that requires a lot of patience and creativity on the parent’s end! The literature shows that potty training a child on the autistic spectrum is especially challenging, so know that you are not alone in your experience.

You may want to begin by assessing your child’s level of readiness for using the toilet for pooping. If he showing interest in using the toilet to urinate, then you’re at a good starting point already! If you are doing so already, continue to have a potty or potty seat in to the bathroom and let him continue to sit on it and explore it.

You may want to take a ride to your local library and check out some books and videos about potty training. This may help him to validate his feelings about potty training, especially if he is able to relate to a character’s experience in the book. It may also help to give him the visualization of the process so that he can internalize it and carry it out himself.  Check out some of these titles:

Once Upon a Potty book (for boys) The Potty Book for boys  Potty Time (from Usborne Books)  Potty Time with Bear (in the big blue house) book  I Gotta Go! Music Video 

You can also create a social story for your son.  A social story is a brief, simple and personalized story that you create for your child with Autism in order to teach a skill or validate feelings. Begin by reading the story with your son multiple times each day and then less often once he begins to show an understanding of the process. The story you create should use simple language and picture symbols to help him to begin to associate the message with the picture.

Another strategy may be to offer him a role model. That is, you may need to use the “open door policy” in the bathroom and allow your son to watch you or other family members going through the motions. If you are not comfortable with him watching you or a family member, then pretend but make sure he is watching.

All of us seem to have a pattern or time(s) of the day when we have a bowel movement. Keep a log of when your son is pooping in his pants. Once you notice a pattern, take him to the bathroom at ‘the’ time. It may be harder to resist going in the toilet if the urge is there.

Reward, reward, reward! Provide lots of high affect and verbal praise when he even attempts to make a poop in the toilet. If he doesn’t, don’t get upset or frustrated (or at the very least, don’t let him see that you are!) and say, “Good try. Maybe next time” and move on to something else. Don’t dwell on it or discuss it. Find out what motivates your son and reward him with it. Perhaps he can watch a video after pooping in the toilet; this is his short-term reward. Then enact a long-term reward where if he goes in the toilet X number of times during the week (Sunday-Friday), he earns a bigger reward (e.g., a new toy).

Practice, practice, practice! The more he practices, the more the process becomes familiar, and the easier and less frightening it will be for your son to poop in the toilet!

Answered by Dr. Elizabeth Matheis