Year: 2019

Toilet training children with autism

Communication
Children who are on the autistic spectrum often have difficulties with understanding words, with non-verbal communication and with expressing their needs. This means that they may struggle with:
• Understanding the words for toileting and so may not understand what is expected of them.
• They may not have or be able to say the words to let others know that they need to wee or poo.
• May interpret language literally and therefore be confused by some of the expressions we use to describe weeing or pooing. E.g. going to the toilet is literally about going to a place. It does not describe doing a wee or poo.
Using picture cue cards and social stories may help overcome some of these issues.
Social interaction
Children who are on the autistic spectrum may not understand expected behaviour and may have difficulties with relationships. Because of this they may:
• Not be interested in being the same as, or doing the same things as others
• They may not learn by imitating other people, in the way that many children do
• They may not be concerned about being wet or soiled
Using rewards to motivate may help, discuss appropriate rewards with your child’s healthcare professionals. These should be something small that your child is interested in and which can be provided as soon as they have done what is expected of them.

Imagination
Children who are on the autistic spectrum may not use imaginary or social play, they may be rigid in their thinking and struggle to understand what comes next, which means that they struggle if their familiar routines are changed. This means that they:
• May assume that you know when they need help and not realise that they need to tell you.
• Changes in their routines are very confusing for them and may make them fearful or anxious.
• They may struggle to transfer knowledge: if they learn to do something in one place they may not realise that they should do the same thing in other places. E.g. if they learn to use the toilet at home, they may not realise they should do so at school as well.
Making changes slowly and gradually, with the support of picture cues or social stories may help them to feel safe and accept the changes better.
Sensory differences
Many children who are on the autistic spectrum have sensory problems. They may:
• be more sensitive than other children, or be less sensitive. They may have a mixture of increased sensitivity in some areas and reduced sensitivity in others
• have difficulty filtering sensory information that occurs at the same time. Most of us can ‘switch off’ to some information that we don’t need e.g. if there are lots of background noises when we are having a conversation, we can concentrate on the words being said to us and ignore the other noises. Children who are not able to filter information cannot ignore all the other noises, but also sights, sounds, smells etc. that are going on at the same time.
Try to think about how the toilet environment affects your child with their sensory need and try to make adjustments to help them. Your child’s occupational therapist may be able to make some suggestions.
How do these affect toilet training?
To be able to use the toilet appropriately and successfully we need to learn a series of skills, but learning these can be more difficult if children are on the autistic spectrum. Causes of the difficulties will vary according to how the autism affects them. Success with toilet training involves working out what is causing issues for the child and making changes to reduce the effect of the issues.
What can help?
Starting work on the skills for toilet training early is often successful as there has been less time for rigid behaviours and thought processes to become established.
Try to ensure that your child is having fruit and vegetables every day and is drinking plenty of water-based fluids. Fruit and vegetables help prevent constipation, which can delay toilet training. Good intake of water based fluids (about 1 ¼ litres a day for children aged 2-4 years and about 1 ¼ – 1 ½ litres per day for children aged 5-11 years) helps develop a healthy bladder as well as prevent constipation.

Encourage children to drink more water

Many parents complain that their children are reluctant to drink their drinks & say they do not feel thirsty. Not drinking enough can cause or exacerbate continence problems, as well as being the reason for headaches, feeling tired & struggling to concentrate.
What should my child be drinking?
Water is the best drink, as it does not contain any sugar or other additives. However, some children refuse to drink water. If this is the case for your child, you could try the following:
• Offer water from the fridge or add ice cubes to it
• Use very dilute sugar-free fruit squashes as an alternative
• Avoid offering your child fizzy drinks, except as a rare treat.
• Avoid giving your child drinks with caffeine in them, as it can irritate the bladder.
• More than 500mls of milk per day can exacerbate or cause constipation& may contribute to excessive weight gain.

How can I encourage my child to drink more?
Encouraging children to drink may be difficult, especially if they don’t feel thirsty. However, thirst is quite a late sign of needing fluids, so children should be drinking regularly – about six to eight drinks spread evenly throughout the day.
• Build drink times into your family’s routine.
• Make drink times fun: sitting together with a book or game & only read the next page or have your turn at the game when your child has had a few more sips. If your child won’t drink then put away the book or game until the next drink time.
• Let your child chose their glass, cup or straw, make it fun
• Start by expecting your child to drink only slightly more than they currently are & then gradually increase the amount you expect them to have until they are having about 1.5 litres per day.
• Some children manage better if given half a glass & told to drink it all; some do better if given a full glass & are asked to drink half of it.
• Measure out your child’s water in to a clean jug or plastic bottle each day, so they can see what they should be drinking. Pour all their drinks from that so they can see how well they are doing & offer them a small reward if they manage to drink it all.

How can I encourage my child to drink more when at school?
• Ensure your child always has a sports bottle of water for school each day. Make sure they bring the bottle home at the end of the day & offer them a small reward for drinking most or all of it.
• If your child enjoys cold drinks, fill the water bottle and put it in the freezer overnight. The water will stay cold as it melts at school the next day.
• Ask the teacher to build drink times into the day, or to allow the children to have their water bottles on their desks.
• Ask the teacher to allow the children to use the toilet when they need to. If your child thinks they will not be allowed to go to the toilet, they might not drink at school.
Other things to consider
Do not encourage your child to drink in the hour before they go to bed as this may cause bedwetting or make it worse. If your child has a bladder or bowel problem, making sure they drink well during the day can help.

Psychosocial disability, recovery & the NDIS

Psychosocial disability is the term used to describe disabilities that arise from mental health issues. Whilst not everyone who has a mental health issue will experience psychosocial disability, those that do can experience severe effects and social disadvantage. The NDIS will be supporting people with psychosocial disability that significantly impacts their life and is likely to be permanent.

The NDIS supports recovery and will tailor a support package to individual needs. If eligible for individualised NDIS support, it is anticipated that you will be provided with a commitment to lifetime support with your ongoing recovery journey. The NDIA defines recovery as “achieving an optimal state of personal, social and emotional wellbeing, as defined by each individual, whilst living with or recovering from mental health issues”. Sheehan Health work with a strengths & recovery model for all our Participants so you can live an optimal life.

Your NDIS Planning for Continence Management

You do not require a Continence Assessment if you are happy with your current products and management. If your goals have changed to your continence management this should be included in your plan and is best done in consultation with a Continence Specialist.

You need to specifically mention continence in your planning meeting or it will not be included.

Ask your NDIS planner or Local Area Co-ordinator to allow for a continence assessment and/or follow up review (approximately 4 hours therapy per annum) to be approved for you in your NDIS plan under the category Individual Assessment Therapy and /or Training (includes assistive technology)15_048_0128_1_3.

Continence aids and products you require will need to be included in your NDIS plan under Core Support: Consumables. The NDIS principles of ‘Reasonable and Necessary’ applies when it comes to a delegate approving prescription items.

Your NDIS plan is focused around you achieving your goals. You will need to express how your incontinence affects your goals as this is what the funding is related to. For example; if your goal is to return to employment, what continence requirements do you require to meet this goal?

A Continence Related Assistive Technology Assessment will document requirements in line with achieving your goals when conducted by an experienced Continence Specialist.

Finally, talk about incontinence at your planning meeting, if it is not part of your NDIS plan goal, it is not part of your plan.

What is a bladder diary, and should I keep one?

Everyone who experiences incontinence should try keeping a bladder or bowel diary for at least a couple of days. What you see may surprise you, or, at the very least, provide a roadmap of your concerns that you can share with your health practitioner.
A bladder diary is a great tool for those looking to treat their incontinence, and should be used as the first step in understanding your specific condition. A bladder diary will track the number of times you have gone to the toilet in a day, if you’ve had any leakage (and the amount), and also tracks your food and drink consumption. By recording all of this over a series of days (at least 2-3 but up to a week or two can be really helpful), you may be able to see trends over time. For instance, perhaps you always experience leakage at a certain time of day, or after you’ve had a certain food or drink. This tracking can help you adjust your routine (or your diet) to avoid leaking. This tool can be extremely helpful to your clinician, as it gives him/her a better picture of your situation and may help advise better treatment options that will work for you.