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Why is toilet training difficult in children with autism?

William Stillman
Health Education
Toilet training can be a complex issue for those children who may have acute sensory sensitivities or sensory-processing issues. There may be any number of reasons. Here are a few:
  • For some, it may be one of the only ways they can exert any kind of control in their lives if many other aspects of their day -- and how their time is spent -- are micro-managed by adults. This may be especially true of those children who are not properly diagnosed and supported, and, instead, are labeled as impulsive, defiant, or aggressive.
  • Others may experience a physical “disconnect” from their bodies because they are so immersed in high thought and aesthetics. Their bodies may not be properly receiving “signals” the brain is sending in time to make it to the toilet (if at all).
  • Explore a thorough diet review -- are there certain foods that are problematic, creating gastrointestinal issues? There’s lots of literature, in print and online, about gluten-free and casein-free diets. Proper nutrition absent many preservatives, dyes, and chemicals -- all culprits that threaten to wreak havoc on an autistic child’s delicate system -- is essential to healthy digestion.
  • Ever flush a toilet and have it sound like you’re going to get sucked down with it because it’s got such a roar? Now, magnify that with the intensity of the child with acute sensory sensitivity for noise, and you’ve got a terrifying ritual to be avoided at all costs. Automatic-flush toilets are notorious for this especially because they are unpredictable.
  • Unless it’s been explained to them, some kids may panic when moving their bowels, believing that they are shedding a piece of their insides that’s not supposed to come out!
  • Similarly, some autistic children may be in perfectionism mode, and not wish to “get dirty” or become involved in the process of caring for oneself before, during, and after toileting.
  • Finally, in some children, defecating or smearing feces in places other than the toilet and the child ordinarily knows to use the toilet (and has been successful doing so) may point to an emotional or mental health issue that needs to be monitored and addressed with a professional attuned to the needs of autistic kids. Other associated indicators may include spikes in irritable, aggressive or out-of-character behavior.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.