As a Pediatric Occupational Therapist in Mountain View, CA  I work with kids on toileting.  Toilet training is a thing.  For many parents it’s a badge of honor, “My kid was toilet trained at 18 months”.  

UGH.  

Developmental differences are…different

Children with developmental differences may have challenges with medically related reasons why they have trouble “going”.  Once those issues have been addressed and cleared, seeking the help of an occupational therapist can help.

Tuning in

An occupational therapist can help work on a child “tuning into” what is going on inside their body. An occupational therapist may look at it from a sensory perspective. For example, if a child is having trouble feeling that they are hungry or thirsty, they may be having trouble getting enough nutrition in order to effectively make good solid bowel movements or to urinate. 

What’s that?

Some children do not feel what it feels like when they are going to the bathroom. For example, they may not even know if they are urinating or having a bowel movement until they look in the toilet. They have trouble knowing if they need to pass gas or have a bowel movement.  

Sound differences

 Some children may not like the sounds of the bathroom.  Especially public or community restrooms.  For example, how the echoes in the bathroom sound when they are in the bathroom. The toilet flushing can be uncomfortable to their ears.  The automatic flush on the toilet can be scary.

Body Awareness challenges

For some children who struggle with body awareness, they may not want to sit on the toilet because they think they will fall into the hole. This is pretty typical for younger children but, when children above the age of 4 or 5, having this issue needs to be addressed.

Body perception concerns

Then there’s a perception of their own body. Many children who are autistic do not really even tune into the fact that other people may be bothered by them having accidents. They don’t see the social ramifications, they don’t realize that there is a smell related to it and that there is a sensory experience for other people related to it. They’re perfectly happy to have an accident in their pants rather than going on the toilet. This isn’t a problem when you’re talking about a two or three-year-old but, as children get older it can definitely cause social issues.

A conscious choice?

After interviewing and talking to several autistic adults about this problem, it has become clear that for autistics-they really need to make a conscious choice about how and IF they’re going to pay attention to what is going on in their body. This may mean coming up with some systems that work for them or it may mean that they just didn’t even think to think about this problem.

Great resources

Some kids benefit from reading books about how their body works. Here is one that I found kind of interesting and helpful for some of my kids. How do you know you need to go? By Wendy Hayden. I also really like Listening to My Body: A guide to helping kids understand the connection between their sensations (what the heck are those?) and feelings so that they can get better at figuring out what they need. By Gabi Garcia.

Individual Support

Others need individual support.  Contact an occupational therapist if you want to learn more about how to help with toileting.