STRATEGIES FOR DEALING
WITH SOILING (ENCOPRESIS)
Soiling (encopresis) occurs when a child does
not reliably use the toilet for a bowel motion. They may dirty their
pants, or go to the toilet in inappropriate places. It can be a
common problem in children with autism,
Aspergers syndrome and other developmental disorders.
Whereas children with ADHD
may soil themselves from simply ignoring their bodies, children
on the autism spectrum
are more likely to very aware of their bodily functions. Typical
reasons for soiling are:
- Rigid routines about when and where the child
will use a toilet
- May not be willing to defecate, leading to constipation
- Plays with poo or smears on surfaces
- Constipation from poor diet
- Refuses to sit on the toilet at all.
look for the underlying issues
It helps to understand the underlying reasons
before attempting to change soiling behavior. There may be a sensory
issue involved, whether it is the sight, sound, smell or feel
of the toilet, or actual poo. Understanding the sensory issues may
make it easier to encourage the appropriate behavior.
is the inability to know how other people think differently. A child
may simply not realize that other people find smearing poo on walls
to be unpleasant, or why it is important to use the toilet.
Children on the autism spectrum often experience
a lot of anxiety.
It is extremely important that managing any soiling is done in an
encouraging and positive way. Learning to use the toilet will only
become harder if the child becomes more anxious than they already
Children with autism or Aspergers find it difficult
to change existing routines. Learning to use the toilet instead
of diapers will usually take longer than with neurotypical children.
Communication issues exist as well. It will be
common for children to have trouble grasping a verbal message. It
can also help to use pictures, and also model the desired behavior.
A poor diet can lead to constipation. Severe constipation
causes the bowel to be blocked with hard poo. The child finds it
painful to pass this, and so becomes more constipated. Liquid faeces
then leak around the blockage, staining clothes. A good diet will
- reduction in the intake of constipating foods
such as dairy, peanuts, cooked carrots, and bananas
- increase in high-fibre foods such as bran, whole wheat products,
and fruits and vegetables
- higher intake of liquids, such as juices, but be aware of tooth
decay and potential diabetes..
Set rules and use contracts
Set plenty of rules, children on the autism spectrum
tend to love clear logical rules. These rules can set time limits
for routines, and the contexts they are allowed to happen. It can
help to even write these down in a contract.
Shaping the existing behavior
Look for ways to 'shape' the preoccupation into
something constructive i.e. a fascination with butterflies can lead
to discussions about biology and other insects. Children with autism
often don't see the 'big picture', so it always helps to try to
broaden the narrow interest into a wider one!
Where sensory problems are involved, desensitization
is a behavioral technique that can be useful when a child experiences
anxiety or fear over a cold toilet seat or being enclosed in a small
space. The child is gradually exposed to the object or event that
creates fear, but with plenty of positive
reinforcement. Examples of this include free time, verbal praise
or special food treats.
Reinforce desired behaviors
Reinforcement provides a response to a child's
behavior that will most likely increase that behavior. It is “differential”
because the level of reinforcement varies depending on the child's
response. Difficult tasks may be reinforced heavily whereas easy
tasks may be reinforced less heavily. We must systematically change
our reinforcement so that the child eventually will respond appropriately
under natural schedules of reinforcement (occasional) with natural
types of reinforcers (social).
Click here for the full
range of Asperger's and autism fact sheets and personal stories
Visit http://groups.msn.com/TheAutismHomePage/environmental.msnw which is the autism home page of Gary Heffner, the author of this
article. This fact sheet remains under his copyright and is used
with his permission. You are encouraged to visit his site as it
is one of the few autism websites offering free comprehensive information.