Autistic child won't wear anything other than a nappy.

[JLou08]

My DS will not wear underpants, he won't wear trousers without a nappy. He will happily go naked on the bottom half and takes himself to the toilet when needed but if wearing a pull up he will just go in the pull up. Does anyone have advice on how we get past this? He is in school and we are out and about a lot, places where going naked is obviously not an option. We've tried him choosing his own pants, pants with a pull up and bribery but he will kick and scream and remove the clothing.

have you tried different tightness of trousers or seam free underwear?

Have you tried no pants. Just trousers or shorts?

Have you tried trunks or boxer shorts rather than underpants? What about training pants?

Does DS have other sensory difficulties? What is he like with T-shirts, jumpers, etc? Has he had a sensory OT assessment?

I've tried different trousers, I can't even get them over the ankle. I will look in to seamless underwear though, thank you.

No issues with other clothing. We've tried trousers without pants and pyjama bottoms with no pants, tried training pants but he will just wet in them whereas with nothing on he has no accidents.

If you can’t get trousers over the ankle, have you tried trousers with a zip up the side?

Some DC find the addition of clothing means they don’t recognise the signs they need to go to the toilet. For some, it is easier for them to know they need to go without clothing on. It can be a stage of toilet training for some that needs perseverance. Will DS go to the toilet if prompted/taken? Has DS had an OT assessment?

He used to go when prompted and he was in a routine of going at certain times during the day and usually doing a wee but he started refusing once he started school.
He hasn't had an OT assessment, I asked the educational psychologist about one in the summer when he was being assessed and was told it wouldn't be of much use and even if it was getting one is really difficult.
The continence team are involved but the advice they give is all things that we've already been doing for 2 years.

An OT assessment can help. Not just with this issue, but more generally too.

Not all ICBs commission sensory OT the NHS. If your area does, it is worth a referral. In some areas, you can self refer. Although NHS provision can be quite limited even when the ICB does commission provision.

Does DS have an EHCP? If so, an OT assessment could have been part of the EHCNA even if your ICB doesn’t normally fund SIOT. If the EP assessment was part of the EHCNA, they misled you by saying it was difficult and wouldn’t help. As part of the next AR process, you can request OT advice and information is sought. If DS doesn’t have an EHCNA, you can request one. On their website, IPSEA has a model letter you can use.