Bowel control is usually learnt after bladder control - although all individuals are different and learn at their own rate and pattern. Some children with autism can find bowel movements very frightening and not understand what is happening, perhaps thinking that their insides are coming out. It can help to get a book with pictures from the library to explain the digestion process.
For others the feel of a full nappy can be comforting, the weight of the nappy can squeeze them or they may enjoy the sensory feeling. You could replace these feelings in other ways instead of withdrawing them completely with toilet training. Those that enjoy a feeling of a full nappy may like to be tightly wrapped in a heavy blanket, this can be timetabled in to their daily routine and they can be given a means of communication to request this activity.
When teaching bowel control, sit your child on the toilet, keep the nappy on but with a hole cut in the bottom, slowly cut away the nappy each time until they are able to go without the nappy at all. To start with they will still have the feeling of a security around their waist which in turn will enable them to feel relaxed enough to poo on the toilet. Those that enjoy the sensory feeling can be provided with messy play activities such as gloop (cornflour and water mix), playdough or other messy play activities.
While sitting on the toilet it is very important your child feels relaxed enough to open their bladder/bowels. Having the tap running in the background can help enable your child to wee and blowing bubbles or blowing up a balloon can help your child to open their bowel. Sometimes having a toy to handle - not one which causes excitement - can be useful to both keep your child on the toilet and relax them. Keep certain toys/books for just when they are sitting on the toilet.
Allow your child to see you using the toilet so that they learn that it is a normal process and can see how you clean yourself. Children learn best by watching others.
If your child can't tolerate sitting on the toilet, try to make it as safe a place as possible:
- Make the hole smaller with an infant toilet seat.
- Put a stool under your childs feet
- Try having your child wear a weighted vest to encourage sitting for longer periods (available from www.sensorydirect.com)
- Try a handrail for them to hang on to.
- Use distractions like books, songs, music, and pictures on the wall.
- Try a padded toilet seat because it is softer and warmer.
Encourage your child to go to the bathroom to defecate initially even if he won't sit on the toilet so that he starts to develop a routine of going there for this purpose.
To help your child to independently manage their own toileting routine when they are older, you can buy watches which you can set to vibrate at certain times throughout the day. You can then teach your child when the watch vibrates they are to go to the toilet.
When teaching them to wipe themselves after defecating, wrap their hand completely in toilet paper so that they are less likely to get messy. Allow them to use wet-wipes to clean themselves as this is easier. If this is successful, give them a small pack to take to school to use there.
National Autistic Society (www.autism.org.uk)
Building Bridges Through Sensory Integration (Yack, E, Aquilla, P and Sutton, S)