Hi Michelle, it is important first to separate her daytime toileting from nighttime wetting. The important distinction here is one she can consciously control (daytime) while the other (nighttime) is largely subconscious. It is not unusual for children with additional support needs to take a little longer to attain both daytime and nighttime continence. Children with autism often find the toilet frightening so her behaviour is not particularly surprising. 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. Behavioural reinforcement is typically a good option in encouraging the use of a 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 while another girl loved fairy stickers. 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 her to sit on the toilet when she is fully clothed so she doesn’t associate it with negative feelings. With respect to her nighttime wetting the first thing you need to determine is whether this is occurring while she is asleep and therefore may just be an indicator that her body is yet to mature to the point where it can hold the amount of urine her bladder produces overnight or her nighttime wetting is in direct response to her fear of the toilet. If it is the former then she should become dry at night as her body matures, having a diagnosis of ASD does not mean that she will never achieve nighttime continence. If it is fear – then the first thing you need to do is work on her daytime toileting. For some additional tips on toilet training try the following website: http://www.autism-help.org/behavior-toilet-training.htm.

Regards,
Dr Cathrine

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