Toilet training Dilemma - please lend me your wisdom

[nikos]

Ds is 4.5 and has HFA. We have tried at various times to toilet train him with not much success.
Just after the Easter holidays, we kept him off school for a week and my mum came to help (as I have 2 other children it is really hard to focus on this). We tried an intense week of toilet training and had quite a lot of success. So much so that on the Sunday we took him into town and he requested and successfully went to the toilet in a shop.
The positives were that he has no fear of the toilet and that he went without any complaint from nappies to pants. He also seemed to be recognising the signals that he needed to go.
So we sent him to school the following week in pants and he had no accidents at school (he goes for half days) but also didn't use the toilet either (possibly holding it in). But at home he started weeing and pooing in his pants. Just using them like a nappy. So that now we are at the stage that it is just like when he was in nappies except we have to change his pants. He doesn't notice that he is wet and is quite happy to sit in pants that are wet or filled with poo.

I'm at a bit of a loss now what to do. Don't want to go back to pull ups, but we are not making any real progress. This morning I was talking to his TA at drop off and out of the corner of my eye noticed a commotion at the table he was at. He was sitting doing a wee in his chair and wasn't in the slightest bothered that anyone was noticing.

This all seems slightly at odds with his level of functioning. He is verbal and in mainstream school. Can follow requests and make his feelings known 'I'm angry', 'I'm hungry'. That sort of thing. He had no resistance to toilet training.
Thanks anyone who has read this far and would really appreciate any words of wisdom/experience you might have.

DS didn't get the hang of pants initially, for a fair while I would put him in little summer shorts under his trousers instead of pants, possibly that might help?

DS is 7, with Asperger's, and although is MUCH MUCH better, still has occasional bouts of wetting (very occasional pooing).

What was he doing when he was weeing in his chair - was he totally absorbed in something? Concentration levels can be so high that its easy to ignore other signals (I need a wee, I'm hungry/hot/thirsty/cold etc).

It is also a change in routine, so his stress levels may be slightly higher. My son has problems when things have changed, a supply teacher/different TA, just back from school holidays, etc etc. Anything like this which disrupts his routine can trigger an accident. This past week, its been SATs for the first time - so we've had a few accidents. Then its just a question of settling back into a routine again.

With my son we just got into the habit of accepting that he is slightly different, and take him regularly to the toilet whether he needs to go or not.

Bowel control can also be an issue with Asperger's/HFA. The signal "to go" might not come until its almost too late. That is something that hopefully will improve with time. I have Asperger's too, and I can get so wrapped up in something that I forget to eat, and although I don't have accidents, I sometimes am "suddenly" aware I need the loo.

(feel free to ignore anything you read, this is just my personal experience)

Mine have both gone through this. Both are now generally dry at school but still often do this at home.

Sometimes it can be because they are so busy concentrating on whatever they are doing that they block out everything else. Both boys seem very genuinely surprised when I tell them that they are wet.

Telling them to go to the toilet can help. I avoid asking if they need to go as they will invariably say no and then promptly wet themselves.

There was also a big improvement when they started taking lactulose. The Paed said that often if there are bowel problems it can effect the sensation in the bladder. Their constipation showed itself in different ways. One always had to go at least 3 times a day while the other one had very hard poo (sorry if TMI). The lactulose sorted the problem out and I don't know if it was a coincidence or not but the accidents decreased too.

Thanks for your replies. When he did a wee this morning, he actually paused and was leaning forward as if he was doing a poo. That's what alerted me as the other children were looking too. So he wasn't in deep concentration. It's as if he is incontinent. Do you think there might be anything else wrong, not just down to asd?

Its difficult to say this early, I was told by the HV re: my DS that they wouldn't investigate till he was 7. You could try speaking to your HV.

What was he doing immediately before? He still may have been concentrating on something. Just because he paused, doesn't mean his brain wasn't still working on something (knowing how my brain works...).

Do rewards work with him? Maybe have a reward chart? (didn't work for my son, but you never know...)

He is not motivated at all by stickers. And only for a short time by charts. I don't know how to help him now really.

I think your best bet is to keep taking him regularly to the toilet, tell, don't ask, and praising him when he goes. Tell the school to do the same. He needs consistency.

could you ask for this maybe to be put on a now and next chart so its structured that they take him in the day instead of waiting for a verbal ask

my ds is verbal but has speech delay and has HFA he will just hold it and hold it pre school are good as they recognise the signs and take him

but he is prompt dependent he doesn't communicate his needs at all so will need to be structured at school that they just take him as if they ask he'll just say no but will go if taken

i would take him as soon as you get to school and then get ta to take maybe every hour with praise and eventually he may get used to this and be able to control or maybe even ask

i would just get school to take regular
at home ds is so Independence he'll just go on his own not poos though he will not poo on a toilet but outside of the home he will not talk or ask at all so needs the structure as he'll wee and wont say anything

You could possibly try training pants which are more absorbent so give more sensation - Eric sell some I think.

i have to say i bought ds some of them pants and he just kept weeing himself as he thought was a nappy we had better luck with the just taking him regularly

I think I will ask school to add a visual prompt into his visual timetable - thanks for that idea. At home I will take him regularly. I think he will try and fight this though, as he is happy to go to the toilet but only on his own terms. Should I just be really firm do you think and just ignore a possible tantrum? The preschool advisor said to try and avoid it becoming a battle so it is a fine line to tread here.
I could imagine school being nervous in the same way.

i think with my ds they have now and next he does something he doesnt want to and he can choose the reward activity so here you will go to toilet and when we come back you can do and he gets to choose and a timer is set for 5 mins so he can do activity of his choice for 5 mins then back to the structure again its his reward

he then feels in control and is happy and has got used to this

same at home get him to do something he doesnt like with a reward of 5 mins of something he does like

i dont need to do this with ds now as his ok and has now learnt but i did when first trying new things

I've had some good advice but just bumping in case the evening crowd have any experience/ideas.

My son wouldn't poo on a potty at all until he was 5. He was still in nappies at night as he still wet the bed and he'd always wait until he had a nappy on and then he'd do a poo.

I tried all sorts of things with him, one of the things was having a tub filled with cheap toys/sweets and he was told "POOS MEAN PRIZES!!". Now I can't remember if it was this that prompted him to use the loo or if it was his 5th birthday when he exclaimed that he was not a baby and did not need to wear a nappy. It's all a bit of a blur now tbh ... I reckon i blanked it out lol. Anyway, he just stopped like that! No waiting for nappies to poo in, no more pooing in his pants, wich he did sometimes if it was daytime and he needed a poo, he just started using the loo, AND became dry at nights all in one go.

Sory, that was rather a long post. Anyway, POO MEANS PRIZES might be an idea you could try? Good luck.

Thanks for that. We have a system going which is one piece of chocolate for having a try, two for a wee and three for a poo!! I'mtaking him about every half hour and while he will protest a bit will generally go. The problem is that his grandparents and school are not having much success and he won't go for them (think they might notbe as forceful about it as me but them I have more of a vested interest in getting this to work).

sorry for the highjack but POOS MEAN PRIZES! has given me the giggles. I'm imagining some kind of tasteless game show!

PS we also had to resort to bribery at one point when we were getting desperate... for us it was 'if you do a plop, you get a lollipop!' (another game show type slogan) when we had a big sack of mini chupachups left over from a light trick or treating year in our neighbourhood at halloween. wouldn't necessarily recommend it though... took us a long time to get rid of the association between poos and lollipops.!