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    Toilet training kids with ASD: Part 2

    This second of 2 articles presents a practical, step-by-step guide for providers to use to help parents toilet train their children with autism or other developmental disorders.


    Like typical children, children with intellectual disabilities or autism will toilet train at different rates and with different strategies. For some families, this can be a frustrating and depressing time. Discussing the use of positive rewards and avoiding punishment will help these parents slowly make progress. Here is a detailed program to help patients like D.J. achieve continence.

    Provider guide

    STEP 1. COMMUNITY SUPPORT

    First, offer compassion for all of D.J.’s parents’ efforts at trying. Reassure them that you know this is challenging and offer them the space to vent their sadness and frustration. Remind them that you can help them work on this goal.

    Confirm that the parents have a covered prescription for Pull-ups or diapers with D.J.’s Medicaid coverage. They will need these while he works on this goal. Many families may struggle financially with larger and more expensive Pull-ups or diapers. (In my state, Medicaid will cover generic Pull-ups if I submit 2 diagnoses: autism, and urinary incontinence without sensory awareness. See "ICD-10 codes for urinary incontinence," for more information.)

    Related: Toilet training kids with ASD, part 1

    Assess D.J. for constipation and treat that appropriately. Children with constipation are prone to difficulty with toilet training, and children with autism may have higher rates of constipation.1,2 A recently published guideline recommends the use of MiraLAX or lactulose for constipation in children.3 (See “MiraLAX for children? What NASPGHAN guidelines recommend”) These 2 medications can be expected to take more than 24 hours to have an effect. (I often prefer senna or milk of magnesia because these are documented to work more quickly [up to 6 hours after administration] and can help a busy family plan for a potential mess.)

    These parents may need community-level support to train their child. Ask them what in-home support they have. Is D.J. getting applied behavioral analysis (ABA) or behavioral therapy in the home that can offer help? Can his daycare, preschool, or school help?

    Encourage the parents to advocate for individualized education program (IEP) goals in regard to D.J.’s toilet training. His IEP might state:

    ·      D.J. will be taken to the bathroom every 30 to 60 minutes and will sit for at least 1 to 2 minutes while shown a timer. When he achieves urinating in the toilet and his underpants or Pullups are dry between scheduled voiding times, the time between voids can be slowly lengthened to every 2 hours.

    ·      Progress will be documented with a chart that rates D.J.’s Pull-up dryness before bathroom times, and his willingness to sit and ability to urinate with each trial.

    ·      Parents will be offered times to learn how to do this at home.

    RESULTS: Parents agree to work on many of the above steps and will return in 2 weeks. It may take that long or longer for them to start receiving the prescribed diapers and longer to see IEP changes.

    NEXT: Getting started at home

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