Toilet training - autism

Autism and pooping in pants

Soiling or pooping in pants is a problem many families of autistic children face.  It happens most often when the child does not reliable use the toilet for a bowel movement.  But it can also happen when the child is fully toilet trained.  It is a very common problem in children with autism, Aspergers syndrome and other development disorders.

Children with an autism spectrum disorder struggle with bowel movements!  They can struggle with leaky-gut, constipation, and/or diarrhea.    Some struggle because of gastrointestinal issues – which form part of their diagnosis, whilst others struggle because of their diet or lack of a proper diet.

Further contributing factors to pooping in pants may include:

  • Transitioning difficulties which basically means the child struggles to stop what they are doing to go and do something ells.
  • Restrictive behaviors can also be to blame for the child not wanting to use the toilet for pooping.
  • Sensory challenges and the child’s refusal to sit on the toilet for periods long enough to allow for a complete bowel movement
  • Sometimes autistic children who are toileting can behave in challenging ways. They may want to play with the toilet water, or they may continually flush the toilet.  Some autistic children may want to smear poo on the wall. All these behaviors are ways in which the child gets to avoid doing poos on the toilet.  So, when they do need to go then they just go in their pants.
  • If a child struggles with change, then they may struggle with the use of a toilet when they are in different places.
  • Rigid routines can cause problems as the child may not understand that they can go to the toilet when they need to. They may only go to the toilet when their schedule allows for it.  This problem is particularly hard to overcome because on the one hand children with autism flourish when they have structure.  They flourish with visual schedules BUT visual schedules and too much structure will also mean toilet training difficulties could arise.
  • A fear of the toilet or bathroom or an association of something negative that happened e.g., if the child had bad constipation and went to the loo and it was painful then they may refuse to defecate in the toilet. They think that if they don’t go into the bathroom defecating will not be painful.  In this case the child associates the pain they felt with the bathroom – not with the actual act of pooping.
  • The time of day can be a reason for accidents. Nighttime accidents could mean that the child is not aware of their need to go to the toilet when they are sleeping, and you may need to implement a nighttime toilet training routing.  Many children have sleeping problems and medication can have side effects that make night time accidents a common problem.
  • Co-operative sitting can be another reason. The child is more than able to sit on the loo for a quick wee-wee but the time it takes to wait for their bowels to be empty is a whole different story.
  • Children on the spectrum often experience anxiety which can be another reason they do not want to go to the bathroom.

There are so many reasons why a child with autism poop in their pants rather than on a toilet.  The best advice we can give is to keep a record of your child’s toileting success and their mishaps.  It will help you to understand the underlying problem your child has.  Once we know what the reasons are we can start working on strategies to help your child overcome this behavior.

Ilse Kilian-Ross
ilse@amazingk.co.za

Ilse Kilian-Ross is the owner of Amazing K, a registered ECD and Partial Care Facility in Johannesburg. Amazing K is a private adhd school, autism school and therapy centre for children from age 2 years where learners receive the best of both the schooling and therapy world. The autism school offers Individualized Education Programs, ABA, Speech- and Augmentive Alternative Communication (AAC) therapy as well as a full and adapted Academic Curriculum.