Here is a report that we hear frequently from families:"Toilet training is going awesome! My child is staying dry for long periods of time and is initiating when he has to pee BUT he is still struggling with having successful bowel movements on the toilet. I know he has to go because he gets really quiet and hides behind the couch but he just can’t seem to figure this out!”
Before starting to talk about working on bowel movements in potty training for kids with autism, it is important to say that you should get your child examined by a pediatrician to rule out common GI issues in kids that may contribute to difficulties having bowel movements. Medical conditions, like Cerebral Palsy or Hirschsprung’s Disease, may impact a child’s ability to have a bowel movement. If your child has a history of constipation, including impaction and encopresis, it is very important to resolve those issues before starting any type of program. Constipation is common in many children, but children with autism might have a higher likelihood of struggling with constipation than other children. If it hurts or is difficult to go, toilet training with bowel movements is going to be more difficult.
Toilet training with bowel movements often takes longer than achieving success with urine continence. The fact of the matter is, there really aren’t as many opportunities to practice! It is relatively common for a child to start holding their bowel movements when starting a toilet training program, which can make it even more stressful for families.
Start with some antecedent strategies. These are simple modifications to add to your schedule to set your child up for success.
- If your child happens to have a bowel movement success on the toilet, reinforce that success with a huge party with lots of your child’s favorite things! If you have already been reinforcing urine successes, a bowel movement success should be twice as big! Withholding access to a highly preferred toy or snack and saving it only for bowel movement successes may make it a bit more motivating.
- If you are toilet training a boy, make sure he sits on the toilet when starting a toilet training program, even for urinations! It will be much more difficult to catch a success if they are standing.
- Try to find out if your child is going at a regular time by keeping a log of when they are having bowel movement accidents. Look for signs that indicate it might be time to go. This may include standing or squatting quietly in a private or quiet location, straining or grunting, or making special faces.
- Once you find out their schedule, schedule toileting sits at times they are likely to go. Start with shorter sits and gradually increase the time they are sitting, up to around 10 minutes. If they are having accidents every day after school at 3:00 p.m., schedule a time to sit on the toilet at 2:55 p.m. to try to capture a success. After snacks or meals may be good times to try!
- Make sure that your child can relax while sitting on the toilet. Giving them a stool to rest their feet on and a access to a relaxing activity, like a preferred book or YouTube video, may help. Some children may feel more secure with a toilet seat insert, if the toilet seat is too large.
- If you catch your child in the middle of having a bowel movement, have them sit on the toilet to finish and reinforce their success with their favorite toy or snack!
- Don’t punish or scold when a bowel movement accident occurs; just clean up, dispose of it in the toilet if possible, and move on without providing additional attention or talking too much about it. It is important to make sure we aren’t creating any additional anxiety during this process; it could lead to holding and make the process more difficult for everyone. It is also important that they aren’t getting more attention and reinforcement for having an accident than they are for sitting on the toilet appropriately and trying to be successful!
If you have tried all of these strategies with your child, have talked to you pediatrician, and are continuing to struggle with achieving success with bowel movements in potty training with autism, it may be time to seek some additional assistance from a Board Certified Behavior Analyst (BCBA) for some individualized recommendations. You may also benefit from the assistance of a BCBA if your child is waiting for you to put a pull-up or diaper on them before having a bowel movement, is afraid or refusing to sit on the toilet, or if having challenging behavior during bowel movements.
For additional information:
Autism Speaks. ATN/AIR-P Guide for Managing Constipation in Children.