Hi Dianna, it is not unusual for children with additional support needs to take a little longer to attain both daytime and nighttime continence. As I’m sure you are aware, toilet training can be particularly challenging for children with autism due to their hypersensitivity to different sensory experiences, as well as difficulties with adjusting to changes in routine. Children with autism rely on both visual and verbal cues to learn so the fact that you are using pictorial cues is great way to start. When using pictorial cues it often helps to break the process down into simple step-by-step actions, so a series of drawing or photographs rather than just one image will provide a better overview of the process. Behavioural reinforcement is typically a good option in encouraging the use of a potty or toilet. When I’ve used behavioural training programs with children with autism I typically modify the incentives so that they take into account the likes and dislikes of the child. With one boy I used anything to do with Thomas the Tank Engine – with another it was lollies (not great for the teeth but it worked a treat!), another child I worked with loved books – so every time he collected 5 stickers he was allowed to cash these in and buy a small book. Many children find the toilet frightening so his behaviour is not particularly surprising. The key to success when toilet training children with autism is that they need to feel comfortable with their surroundings. I would begin again by encouraging him to sit on the potty or toilet when he is fully clothed so she doesn’t associate it with negative feelings. He could do this while watching a favourite program on TV (if using a potty) or while reading a book. While I understand your desire for him to become more independent in his toileting, if he is not showing signs that he is ready to be trained then the best thing to do is to just stop for a few weeks. When it is time to start again introduce everything slowly taking your cues from his behaviour. A ‘slowly slowly’ approach will be the key to success – if he feels forced he is likely to revert back to old habits. With respect to his nighttime wetting and drinking patterns, a child your son’s age should be drinking approximately 1 to 1.5 litres per day. Make sure this is evenly spaced throughout the day, tapering off in the evenings. Do not restrict fluid completely as this can lead to constipation, a known contributor to bedwetting. For some additional tips on toilet training try the following website: http://www.autism-help.org/behavior-toilet-training.htm. Good luck!

Regards,
Dr Cathrine

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