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.

Mind-blindness 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 are.

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 involve:

- 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..

practical strategies

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!

Desensitization

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 at www.autism-help.org

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.