Troubleshooting video transcript

If you have watched the videos higher up this page, you will have considered how to get going with toileting, thought about the environment, your child’s developmental skills and their motivators and you will have thought about some common strategies to put in place. Even having done all this, there may still be some difficulties which need extra support.

 

In this video, we will talk about some common challenges that can come up during toilet training and some ideas for how to address these.

 

Over the next few slides we will address these common issues that autistic children can have with toileting.

 

We will think about what to do if your child shows no signs to let you know when they need the toilet… …we will discuss what to do if your child is having accidents.

 

We will think about how to address fear of the toilet itself and what to do if your child is smearing poo.

 

So what can you do if your child is not showing you any signs of needing the toilet? Signs they might show you could be telling you, but also any physical signs, like fidgeting, or pulling on their nappy. It could be anything which shows you they are noticing something in their body is about to happen. This can be linked back to their interoception, which, as we have discussed before, is our internal sense and our sense of knowing what our body needs, such as feeling hungry or needing the toilet.

 

If your child is showing no signs that they are noticing these sensations, habit training can be a really useful tool.

 

We talked in an earlier video about using a toileting diary to help spot patterns in when your child does their wees and poos.

 

To do this, you can create a routine based around your child’s toileting habits and their body clock. You can use a toileting diary to look for a pattern and specific times that they need to go, as we discussed earlier.

 

You would need to think about taking your child at a specific time, so consider how best to plan this in and how you will remember to stick to it. You could schedule it 20 minutes before they’re likely to go to the toilet, or a certain amount of time after they have eaten.

 

It’s important to try and make this as natural as possible, so fitting it around a schedule for them that feels natural, like going to the toilet before you’re going out, or just after you’ve finished a meal.

 

Try not to schedule it in too often. It has to be a manageable routine, not only for yourself, but for nursery or school as well. Think about what will be practical to stick to when you’re out in the community as well as at home.

 

Remember, you will still need to use the other methods described in earlier videos, such as a visual timetable, and motivators, because this helps to support autism and toilet training.

 

Another concern could be frequent accidents. It’s worth saying that all children will have accidents at times. Nighttime bed wetting is linked to the development of hormones. Even if a child is toilet trained in the day, they may still have accidents at night, and this is normal. If bed wetting is occurring after the child is toilet trained there are certain items you can get which may be helpful, such as special mattresses or absorbent underwear. Daytime accidents on the other hand are more likely due to a child not being toilet trained or other emotional or behavioural factors.

 

So what should you do if your child is having frequent daytime accidents?

 

When accidents happen, it is essential to remain calm and neutral in your reactions. If your child feels a sense of anxiety or panic from adults, it may contribute to them feeling anxiety around toileting. Also, if your response is animated or dramatic, your child may think it is a game or be interested in the reaction, which could encourage further accidents, as they explore how you respond.

 

When they do have an accident and you are changing them or helping clean them up, it’s important not to focus too much on the fact they have had an accident. Having a calm and positive approach will help reduce any anxiety for the child. Make toilet training a positive experience for your child, which will make them more likely to want to try again.

 

Once they are clean again, support them to return to the activity they were doing before and then take them to the toilet as normal, according to your toileting schedule or plan, and don’t return to talking about or dwelling on the accident.

 

Just to note here, if your child is experiencing constipation, this could be due to anxiety around going to the toilet, or their diet, fluid intake, or certain medications. Constipation can lead to further anxiety about going to the toilet as it can be quite painful. This might cause children to avoid toileting or toilet training. If you think your child could be constipated it’s therefore important to speak to your GP about this as soon as possible as they may suggest a supplement to address the problem.

 

All children can experience anxiety and fear around the toilet at times.

 

For example, pain from constipation may make them anxious about going. Autistic children may be more likely to have specific fears about toileting due to characteristics of autism.

 

Sensory differences in autism can mean that if there’s sensory input in the bathroom or the toilet that they don’t like then they won’t want to use the toilet. Adaptations or changes to the sensory environment may need to be considered in order to support them.

 

The tendency to show a preference for familiarity and sameness can mean autistic children experience fear or anxiety in response to changes in routine.

 

As well as developing new skills and routines, they are also letting go of something familiar and comforting, which is using their nappy. They may be adapting to changing happening in a different room if previously they were changed in the living room for example, then suddenly they’re having to go to a cold bathroom. So you can see how all of these are linking together.

 

And finally, if they have all these concerns with the sensory environment, not feeling comfortable changing their routine, or not understanding what the toilet is for, it links to their communication.

 

Even children with good language may find it difficult to fully express their worries to you, or to let you know what support they need. All of this together can form a general anxiety around the whole situation.

 

So what can you do?

 

If your child seems very fearful of using the toilet, you may need to work on the fear before you work on the toileting. You can do this through gradual desensitisation to the environment, and the routine. This means getting them used to it gradually, in very small steps. For example, as we have mentioned before, you could get them to sit on the toilet first. So you could get them to sit for just 2 seconds and then slowly increase it to ten seconds and fifteen, and then working on it being up to a few minutes. You will need to follow your child’s lead about the pace to take this, but it may need to be very gradual over a number of days or weeks. If they get anxious about undressing or removing their nappy, you could also reduce their clothing using a similar gradual approach. For example, you could loosen their nappy step by step over time. This means they are getting used to it being a different routine, and to any potential new sensations.

 

Another difficulty faced by some parents or carers in relation to toileting, is smearing. This is where children spread poo on themselves or on walls or furniture. It can obviously be a really difficult experience for the whole family. An autistic child may not be able to understand the social rationale as to why they can’t smear, and it may be very difficult to explain this to them.

 

Smearing is primarily a sensory activity.

 

One way to prevent smearing is by putting your child in clothing that stops them accessing their nappy. For example, using dungarees.

 

As this behaviour is often driven by a sensory need, your child will still need the sensory input of smearing. It can therefore be helpful to offer an alternative activity which replaces this while meeting the same need. Schedule similar activities into their routine using substitutes such as messy play, playdough, or slime, where they can smear it onto a surface.

 

Just as we discussed earlier, it’s really important to have a neutral reaction when your child smears, as far as is possible. You could redirect them to something else. For example, use your visual timetable to help them to wash their hands and them give them some playdoough or slime to use instead.

 

Thank you so much for taking the time to watch this video from the social communication team. We hope you have found it useful.

 

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