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9 Year Old Boy Won't Use Toilet
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9 Year Old Boy Won't Use Toilet

My Asperger son was 5 years old before he was completely potty trained.  He is now 9.  Since then he's gone back and forth using the toilet.  There are long periods of time (months -- sometimes a year) where he will have 'accidents' and hide his underwear and never get on the toilet, and then he'll go back to using the toilet.  When he does want to use the toilet he comes up to me and says "I love you" and this is my clue that I need to go in there wtih him and pick him up and set him on it.  We've tried breaking him of the need for my help and when we've done that he reverting to soiling in his pants instead.  Last summer he ended up in ER because he was impacted and in pain.  He is a very intelligent boy, with obsessions, and we are confused about his aversion to this situation!  We have consulted doctors, the internet, books, advice of others....   I'm not sure its encompresis because he said he can feel it when its coming out.  He is in Karate and doing great!  He wants to do leadership in Karate but I have been sort of holding this over his head!  I don't even know what the right thing to do is anymore!!  I am so frustrated and I don't know how to help him.  
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I'm not familiar with this being an aspergers trait. But then again I don’t fully understand aspergers either… It seems to me something more in the autism end of the spectrum, but then again I was classified PDD NOS (which has developmental delay). What I have is like aspergers in a lot of ways, but aspergers lacks the delay in speech and other things.

How long does it take for him to use the bathroom?  Does he view the process of going to the bathroom a big hassle and a disruption?  This is something I'd like to know for my own curiosity.

I'm trying to see if what you describe is a variant of what I go through when I am busy with something... I put off eating, sleeping, and using the bathroom until I REALLY need to go, then I'm practically running to the bathroom.

I remember several times as a kid I'd barely have time to sit down on the pot before I started peeing. Sitting down to do #2 was especially boring...  I found myself often thinking ahead to what other things I could be doing rather than sitting down waiting for the **** to drop....lol.

When I was outside and away from the house, I didn't want to come in to use the bathroom...so I'd find a place that seemed relatively private and like an animal, just got it done...  Thankfully I've grown quite a lot from those days. I make sure to relieve myself in the proper place, but I still feel it is a disruption and my mind wanders in 1000's of directions while I'm sitting atop my throne.
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Actually his diagosis was PDD-NOS.  I think he waits too long and then probably its too late.  I wonder if he's losing sensation to the point where he's not sure he has to go until its too late.  I worry that his friends will find out about these 'accidents' but he seems unconcerned!  
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That could be somewhat. I don't feel like I must go until I really feel it.

Then again I seem to be chronically constipated most of the time regardless of diet, which makes it hard to know if I will really go when I sit down or if I will have to wait it out...

I wish I knew what to advice. For me, it fell out of favor when I started feeling awkward going anywhere but the toilet. That awkwardness was a good motivator. It no longer felt natural to just relieve myself, outside the toilet, no matter how badly I needed to go.

And just a random side note: One time I felt like OMG I gotta pee, but I was sent to timeout for whatever reason... My parents made it clear you never leave your room during the timeout time (ever.)  Rather than break the rule and make an exception, I found a bucket to pee in and waited out my timeout time.

Perhaps if any parents of an autistic child are lurking and reading this, make sure to let your child know it is okay to break the timeout rule and go to the bathroom if they really need it.

We have a tendency to take rules literally and believe they are unbending under any circumstance as children. Although I'm probably contradicting myself because there were rules I deliberately broke... The paradox of being human I guess.
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So you think this is pretty much a control issue??  What would be the right approach in dealing with this?  Also, he sometimes blurts out the wrong answer although he knows the right answer.  Is this just him beilng silly or is this something he can't help?  I get so frustrated at time because I don't understand him.
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I doubt the toilet issue has anything to do with bad behavior, but it could have something to do with a breakdown in the process that you have set up. If he needs to come up to you to say "I love you" as a signal to help him go potty, that could cause a problem if you're not around for him to give that signal.

That was one possibility. Here's another. If he is getting older he may be dealing with embarrassment having to go up to you and have him help you make him go potty.

And yet another: He could be like me just get so wrapped up with whatever he is doing that he may have tuned out everything else or "put to the back burner" so to speak.

Oh and another yet: Is there any thing he is adverse to? Possibly an uncomfortable toilet seat?  Lack of things to stem on when having to do a BM?  For me I found the waiting process annoying. Sometimes the peeing process didn't start right away either. I remember either dad telling me, a book, or someone saying to think of a stream of water as I sit there. I don't know if it helped or not, but at least got my mind active on something beside sitting rather uncomfortably on a toilet seat... I found throughout my childhood imagining I'm driving a stick-shift truck or car (using the toilet plunger as the stick) gave me enough distraction to make the process a little less boring and ease anxiety.
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I can't speak for him. It could be any one of what I mentioned or a completely unrelated thing. That's something you'll need to coax out of him yourself, but in a non confrontational manner.  

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As far as giving wrong answers, could you give some more specific examples? What is he like when he does that? Is he excited? Slap happy?  (that's how my parents described me... I'd go off on OMG I'm HYPER!!! And everything is so FUNNY!" and the more I tried to stop laughing and the more my parents got grumpy, the funnier it got...  I took to trying to bite my lip or my arm in attempt to try to stop the extreme hyper laughing spell and become more serious. Sometimes I'd try to think of a sad thought to counter it.

Usually it would have to work itself out. This could have been something done in timeout or if I could run off into the field across the street (at the time) and find something else to do.

Sometimes just a silly mental image would trigger a silly outbreak... I sometimes used that to my advantage if I was put in a situation and in an uncontrolled crying spell. Sometimes it helped cheer me up and sometimes not.
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On a more serious note, sometimes I blurted out the opposite or something different than what I was trying to say… I would not be so giggly and hyper when that happens. Next time I experience a moment like that, I’ll see if I can put it into words what comes up, whether it is something like “slip of the tongue” or something else.
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An example of him blurting out the wrong thing -- He doesn't seem to pay attention when I'm talking to him and we were actually discussing him 'not paying attention' and something about 'reading' and when I asked him "So what was I talking about" to test whether he was paying attention (the answer was "reading") he blurted out "laptop".  His teacher told me he does that in class where he'll blurt out the wrong answer though he knows the right answer.  She thought he was doing it to be silly and make the kids laugh.  I'm not sure now if its more a communication problem.  When he was 4 he failed the 'Comprehension" part of a test -- and therefore was put in a special ed program.  He no longer needs special ed.  I want to understand my son so bad and I feel like I'm failing.
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Hmm interesting. I wonder why he's thinking about laptops (in that example). Perhaps ask him about laptops? (or whatever else)  I wish I could meet him, but oh well.

This is just a thought... If he gives out the wrong answer, maybe discuss with him what he IS talking about. Perhaps he doesn't realize a laptop is different than a book?  Then again isn't there a laptop called an ibook? Could he be confused there?
Or maybe what he was reading was talking about laptops (which I doubt, but since I'm recreating this scene in my head, I can't rule out that possiblity.)
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I'm generating this scene in my head:

Your son is reading a book about cars.
You come in, "Hey son, whatcha doing? What are we talking about?"
Your son may be thinking, looks at his book, sees a picture of a car and blurts out, "car."
You may or may not be aware that he is reading a car book. In fact he may have been absorbed in his book, he probably wasn't paying much attention to you.  Since he is thinking about cars he may assume you are too.  In his mind he was talking about cars.
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It didn't dawn on me that people around me may be thinking of other things than what I was thinking about until probably around age 11 or 12. For a while I just couldn't understand why people didn't have the same enthusiasm about my obession (insects) that I did.

This probably lead to some unusual answers.  I wish I could remember my hand raising days. I just know in 4th grade when we got to study insects. My had was constantly in the air. I think I even blurted out some answers freely without waiting for the teacher to call on me.  I think in retrospect I must had annoyed that teacher. At one point she said, "Okay anyone but [insert my name] have an answer?" The teacher was trying her best to get the entire class to participate, but I failed to realize that. To me teacher asked a question. I had an answer.
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As far as giving out the wrong answer, on some occasions it was because I only heard part of the question. If someone is saying, "I was out to the park and I saw a beautiful yellow butterfly with black stripes. I wonder what kind of butterfly it is Have you seen one at the park too? Oh by the way how was your date with Fred at the park?" This person isn't looking at me, they are looking at their friend and wanting their friend to talk about an experiance in the park.

I didn't hear that last sentence at all.... I heard, "I wonder what kind of butterfly that is?"
Thinking they honestly wanted to know what kind of butterfly they were talking about I answer, "Tiger swallowtail."

I'm either ignored or given a really wierd look from one or both people engaged in the conversation. First off she wasn't talking to me. She was talking to her friend. She wasn't even asking about butterflies. The real question was to see how her friend's date with Fred went. Likely she expected to hear some jusy answers about if they kissed or not. For someone to blurt out, "Tiger swallowtail" seemed totally out of place. In fact she may have even forgot she asked about a butterfly.
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That's one possability. If that is what is going on with your son, that would be something I can relate to.
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While I was waiting for his answer which shoudl have been the word "READING" he looked up and saw his laptop so he blurted that out.  It could be that he tunes me out and doesn't hear half of what I say -- kids are like that!  But my first thought is that he is being a smart aleck.  And maybe thats not really what he's doing.  I wish I had more patience.  I really enjoy your posts because after reading them I feel I understand my son more. Thanks so much for replying!
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You're welcome. The best I can do is try to imagine myself in a person's situation and go back and see if I have any memory to match that up. The more I reflect on myself and observe people, the more I wonder in some cases Is there really that much difference between an non-autistic and an autistic person, besides a few obvious differences. One of them being that the part of the brain responsible for recognizing faces and dealing with social interactions is not the right size (so to speak) As a result the brain uses the area for recognizing objects and cognitive thinking for the social interactions.

For most people facial expressions, etc come naturally, but for the autistic, these have to be learned. For instance if I want to frown I have to choose to frown. After enough practice I can do it more easily. I don't have to put as much thought into it. But if I am in observation mode or jsut most of the time, I don't bother because it may take some of my concentration away. Same with eye contact, etc. It causes anxiety to look into people's eyes, but if I look off to the side I can listen to them better. Sometimes just doing something while talking works (as long as it isn't reading or writing.)

Some people more on the aspergers end can learn to do eye contact better than others. For me it is a bit much. For someone else, they can overcome it. I get a kick (sarcastically speaking) when people think that in order for me to pay attention, I must look at them as close to their eyes. It seems to work the opposite. I do have to find an angle I can look or listen best. Most of the time I'm looking downward. Perhaps that shuts out some of the visual distraction, I don't know. That I need to observe more, but then again I'm trying to listen to the person, so I guess that doesn't really matter, lol.
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Also see if you can encourage him to ask questions if he missed part of the conversation. This is something I have to do often when listening to people. The challenge becomes how much do I ask for repeats, and how much  do I just let go. Then I also have to control the mind wander factor... Obviously if I hear any kind of insect mentioned (along with african violets, alcoholism, etc) My mind tends to pick up on that right away.  
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Mind wander factor in action:
Someone is talking about a drunk guy that confronted them... Anything related to alcohol I am prone to imagining the character in my story that isrecovering. A scene from my imagination plays. If I don't catch myself I'm too busy watching a movie for those few seconds... My ability to concentrate is a little less.  I try to tune out of my mental movie. The conversation has moved on. Suddenly one of the things they say makes my mind think of light sabers...then onto star wars (I watched the series an likely can remember quit  bit in great detail) Then from star wars I may be thinking about good/bad force...Gets me thinking about religion. God vs. Devil...Then I may wander and start thinking about how Some Christians view it their calling in life to stread the Word. Then my mind wanders to midieval times when Catholics were crusading... Then I think about the witch trials...  Then I start wondering were tey really following God or their own agenda and saying they were called by God... Then I think about Columus and contrast what I learned in history vs a book my 8th grade history teacher read where it portrayed Columus in a more realistic light. (it was aweful!)  Then I think back to how the Catholics thought he was being a missonary. I question and wonder, Did they know what he was doing? Could they have been misguided? Then I start wondering what times have I been mislead into things.....................

If you were every going to ask me "penny for your thoughts?" you may as well pay me collect, lol...

I don't know if this is specifically an autistic trait, but it could be... I just know that's one of the things that make paying attention and following conversation a little more difficult for me. If you can imagine, these mind wanders often are some kind of image or movie clip like detail… Some more than others…  For me in order to pay attention, It seems to work a little better if I try to concentrate my mental imaging ability to portray what someone is talking about.
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I didn't run the post through the spell check to catch typos... I'm a little bit peeved about my computer stalling.
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Don't worry about the typos!  How long have you known you were Asperger?  Do you have obsessions?  Right now Jordan is obsessed with being left-handed and right-handed.  He will ask a complete stranger walking by which hand they write with, which hand they catch the ball with, etc.  I don't understand why he needs to know this.  When he was 5 he had to count the pedals on the floor of every car that he could look into.  If there were 2 pedals (gas and break) he knew it was an automatic.  If it had 3, he knew it was a clutch.  At that time he was also obsessed with campers.  So at the age of 5 he started saving his money for a clutch-camper!!  
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Oh, and good new!  About the bathroom issue - he has had bowel movements 3 days in a row!!   This has been a roller coaster ride all his life.  Sometimes he goes regularly, and then sometimes he decides he doesn't have the time for it.  
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I've been suspected to be different ever since age 2. My grandma thinks possibly earlier.  When I got the PDD NOS diagnosis was age 6 in Wisconsin.

Obsessions- I have a few main ones like insects and plants and then offshoots such as psychology, disorders and drug addictions; specifically alcoholism...  Other current obsessions: Autism (no surprise there) and the Myers-Briggs Type Indicator. (Personality profiles.  It seems though I can only focus on one obsession at a given time.

Some of the obsessions I don't know. I got obsessed with the alcoholism ever since I created a character for one of my story series. With my psychology obsession or perhaps just my obsession in creating things...I like to make my characters as believable as possible.

I'm sure I kind of puzzled my grandma a couple nights ago when I came down and wanted to pinpoint what each of her friends were on the Myers-Briggs personality test...

We guessed one person was an ENFJ and another person as an ENFP. As far as my grandma goes, I still haven't figured out. We came up with either ENTJ or INTJ, but then again I wasn’t satisfied with either... Perhaps she's something else on there...  The closest I can find to myself is probably an INFP, but sometimes I find myself more a logical thinker than a feeler... Perhaps I switch off?  Then again I don't believe people can be set to any given, but it does give me a good framework in attempt to understand people and their personalities.

Perhaps your son is conducting some sort of mental research, keeping tabs on how many people are right handed and how many are left-handed.  Some sites seem to think there are more learning disorders associated with left-handed people. I've also read something about them being better with language, but I could have forgotten a lot. A good google may solve that...

If he's curious to know about me, I can't really say. I write with my right hand and have my computer mouse set on the right side but I tend to use my left hand for most other activities such as opening doors and puling down string light switches in the basement. When I was into 3-D art, it wasn't uncommon for me to switch off between hands if one got tired.

Perhaps it helps him understand the person, just like me trying to understand personality types.

I remember an interesting story: One of my parents read off a news article about a "bee" getting into someone's car and triggering an accident...

I insisted to ask "What color was the bee?" That really bothered me because they failed to mention that detail. Why I wanted to know: For one thing it is uncommon for any sort of bee to just fly into a car unless it isn't a bee. Yellowjackets on the other hand are very prone to flying into buildings and cars. They are wasps but people confuse them with bees. They also like to land on people to lap up sweat or bite with their mandibles? I wanted to know if my mental image of it being a yellowjacket wasp was correct. To me that was important. I would have also liked to know what color the car was... If I was really into trying to create the scene it would have been nice to know exactly what the car looked like and the people involved...

That way rather than just getting my own interpretation which is flawed at best, ideally I wanted to see things EXACTLY as they were...

There was also an occasion when someone talked about a butterfly flying up against his chest as part of a story about God calling him. (Church thing) I wanted to know exactly what that butterfly looked like to see if I could calibrate my mental image accordingly

I'm also selective at what details I'd like verbatim and what ones I can just generate in my head.  Over the years I've learned that there is no way I can see the situation exactly as you did, so I've just sort of let my own creative thinking do the rest. That also saves on a lot of annoyance from the other party. Sometimes I still ask for a few details if I feel compelled to.
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Your son sounds alot like my son.  Ryan is 5 years old and has Asperger Syndrome.  He had been toilet trained since he was 3 but recently he has stopped using the toilet.  He pees and poos in his pants, or if he is wearing a pull up in that.  He has made attempts albeit poor ones to cover it up but that only makes matters worse.  For my son, what concerns me the most is that he will sit in it and not tell me about it and seems content to sit in it.  I have found him reading quietly to himself in his room and the horrible smell is overpoweringly strong.  He will also get it on his hands and not go wash it off, opting instead to wipe it on whatever, he has even smeared it on my walls.  Ryan is an extremely intelligent and usally very high-functioing.  Lately, however in conjunction with the toileting issues, other strange and obsessive-compulsive behaviours have increased.  I am scared at how much he seems to be regressing and am puzzled and bewildered as to why.

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My son was toilet trained at approx the 'normal' age of 3+.  Then he did revert back to nappies for a time.  He cannot urinate standing up.  I know he has problems with feeling internal body systems eg. he may not feel hungry/thirty/need the toilet or may frequently feel hungry/thirty/always need the toilet.
I have got him into a routine for doing #2, but am having difficulty moving him on from there.  At present he goes to the loo and shouts me to come upstairs.  Then he wipes himself 3 times and then I do a final wipe to check all is well!  But now I have to get him to move to the next step of doing it on his own (without having to call me or for me to check).  But he is finding that really difficult.  He seems to need me to be there to remember what he needs to do.  But it is common for them to have sequencing and planning difficulties.
Giving the wrong answer to questions.  I think that might be a communication problem.  My son does the same thing.  It could be as MJ said earlier, you are asking him about something, but as he is looking at something else he blurts out what is gaining 'his attention' at that moment.  The other thing my son does is if I ask him a question and he cannot get his answer ready in the time allocated (ie. he cannot retrieve the words, put them in order and say them), he may say a phrase from TV or a DVD or a TV commercial.  He is doing that to 'take his turn' in the conversation, but he uses inapproprate/irrelevant words because he cannot put the right answer together quick enough.  You can help with that by giving at least 10 seconds after asking a question before you ask it again.  If he does give you a 'strange' answer repeat the question and answer back to him.  Usually my son will laugh at his answer and will then be able to give me the correct one.
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I too have a 6 yr old son who will not do no2s in the toilet. He will wee only in toilet, and I haven't found a solution either. He was diagnosed aspie only 6 months ago but this issue has bothered me for the last 3-4 years now.I wish someone had an answer for it but I'm not sure there ever will be.I have tried the goody approach(didn't work) and the baddy (withholding his favourite things) I'm at a loss of what to try next.We've also tried timing but who's ever in the same place at the same time everyday(impractable)?I have however been able to get him to sit on the dunny & wipe his bum by using a mirror on the floor so he can see what he's doing & also by refusing to help him with the task.This has been great for both of us.Just hoping I can be ceative & think of something to get him to do it in the dunny.Best of luck ladies ,if I have any more success I'll let you know asap renna3265
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I tried everything too.  Then when he realized it made me upset, he started hiding dirty underwear.  Someone told me told me that in their chaotic world they feel its the only thing they can 'control'.  So I believe Jordan tried to 'control' it by not going at all and ended up in Emergency with severe pain.  He was impacted!  We had to give him a lot of stool softeners and keep an eye on him.  We've made an appointment for him to see another child psychologist -- she deals with Asperger children.
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It could be a 'control' thing or it could be that he doesn't feel his internal body sensations ie. he doesn't feel he needs the toilet.  Is your son aware of when he is thirsty or hungery, does he request these things or can he go for hours without eating or drinking and seem unaware of that fact.  This is also a sensory problem along with other signs of high pain threshold (or low pain threshold), aversion to sudden/loud/unpredictable noises, sunlight, touch, taste, smell etc.  There can also be problems in the vestibular (balance) sense and proprioceptive sense (knowing where your body parts are in space).  So if you child is showing any sensory problems it could all be linked to the toilet problem.  If it is any consolation I do know alot of other children still in nappies but they do grow out of it, but just at a much older age.
All you can do is get them into a routine.  Envourage them as much as possible.  Praise any attempt they make (even if they sit on the toilet).  You can also use Social Stories to talk about toileting issues so that they understand exactly what they should be doing and why.  
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I think you're right!!  I think with him it might be 50/50 about sensory issues. He doesn't ever seem to be hungry much.  We make him sit down and eat.   Sometimes he's hungry - most of the time he's not!  Sometimes he makes it on the toilet - sometimes he doesn't.  This Monday we have an appointment with a child psychologist who deals with Asperger children.  BTW, what are Social Stories??
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I'm going to thow this out as another possibity. I highly doubt that an autistic person has a higher pain threshold than the average person.  It could be more what to do with the pain?  I find it difficult to approach people when I am hurting, especially my grandma. In fact I got this really painful thing going on above my right eye...I went up to grandma only to get grumbled at...

For fear of being called hypochondric, old lady, overly sensitive and so on... I just don't bother to talk about any pain I feel unless it gets to the point I can no longer ignore it. At that point it's either I tell about it or meltdown...  As a kid I felt somewhat embarrassed or ashamed when I got hurt... I think it was because I didn't really like getting attention. I may have learned to cry if it was a really bad pain such as a scraped knee. Who knows... I think I just wanted to find a quiet location and deal with it myself.

Plus it seems I deal with several small aches and pains in my body... I don't know which are worth talking about and which are best just ignored...If I talk about them all then I get a negative response. Most of the time pain comes and goes so ignoring it works. It doesn't mean I don't feel the pain or even have a higher threshold... It just means I'm not vocalizing the pain.  Could that be why I don't feel hungry until it's omg?  I wonder... I'm sure if I paid attention maybe I'd recognize the "indigestion" I feel to be leading up to hunger pains...sometimes I feel the opposite of hungry if the pains are bad enough.  Lately I've been doing pretty well.

There used to be a time, even when I first moved here, that I'd wait until I'd be practically faint and just lay on the floor...  Now I try to heat something up before it gets to that point. I think honestly the hassle I have with the cooking process is it takes so darn long and too many steps...  It could be laziness, but I believe it's a deeper issue. One thing it means distracting me from whatever I am doing and I have a hard time dealing with the waiting. I'f I'm not careful, I'll find myself wandering off getting involved with another task while waiting... I'm fully capeable of doing some of these things, but I have to be forced to in order for it to come to mind I must do it...

Also the oven needs to be manually lit which adds another step.  I could get tongs and hold the match that way, but since I haven't used the oven on my own, I don't know if I am allowed to...

Okay this is a bunch of random ramble....

Perhaps the #2 process to many children is like my cooking aversion...  I do admit #2 is considerably harder than #1 and takes like 2-3x as long... Last thing I like is getting on too early and not have anything come out...  Also I wonder if children who come to expect their mother around creates even more added hassle. To the kid, having the mother ready becomes a requirement. If she's not available then the kid must wait...

I was a teacher's aid for a summer job.. They hired high school students with 'special needs' as assistant student teachers for a summer school project. There was a boy who needed me to lead him to the bathroom. He wouldn't go in on his own. I went into the boys room with him. He found a stall. So far so good... Then he needed help wiping his butt. Being in no position to help him I tried to tell him what to do, but I was not about to enter the stall.  Just to my luck the class let out and boys flooded in looking at me like...their jaws dropped... Quite an embarrassing moment...
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The little boy was one of the 1st graders and kind of small. I don't want to cause confusion.
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I started my son in counseling last week and already he's receptive to the idea of 'change'.  We're going to an ABA (Applied Behavioral Analysis) clinic.  They're whole approach to all our children's problem is to break the problem down into smaller steps.  My son needs me to lift him up and put him on the toilet.  This is purely a routine issue with him - he can get up on the toilet by himself.  When he needs me to do this, he comes up to me and says "I love you."  He's been doing this for years.  I could never get him to change the the wording of his 'request'.  So he will be earning tokens, and after so many he cashes them in for dollars that he'll be saving for a Wii.  Once he has mastered saying something like "I need help in the bathroom" instead of "I love you" then we move to another task that is part of the bathroom issue.   He will eventually master all the small tasks that add up to going to the bathroom by himself!  AND.... he's very receptive to the idea.  In fact, we weren't supposed to start the program til Wednesday because the counselor was going to have our chart made up and explain more to me, but since he wanted to jump right in -- I will too!!   If you live in the Detroit area, check out the HOPE Center in Royal Oak.  They offered a FREE 2-day workshop on ABA that I went to.  What an eye-opening experience!!  
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I think the thing that most parents find is that their children are capable of learning and expressing themselves, but they tend to learn differently and need different systems to help them achieve it.  That is why the appropriate support/strategy/approach is so important and that is why parents of children on the spectrum are usually the most pro-active/vocal.  Because we 'know' our children are capable of more but the 'way' everyone else does it/learns is not relevant to them.
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His therapist is awesome.  Her method of breaking it down into very small steps is working.  He really likes her and I'm shocked to see him opening up to her -- but very excited with his progress.  According to her, he might have this problem with the toilet overcome in 9 weeks!!  With the progress I've already seen I think so too!!  
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That is wonderful. Breaking things down into smaller pieces can be really useful.  It can also helps with problems they sometimes have of having to complete something before they move onto the next thing.  If a task is broken into smaller pieces they can learn to leave the task when they have completed the next piece rather than having to go on to the end of the whole thing.
If, as you say, he has problems 'feeling' hungry/thirsty etc then it understandable that he is having some problems with toileting.  Another famous autistic is Donna Williams.  She has the same problem.  Her website is www. donnawilliams. net (but without the spaces).  But, again, you can talk to him about it and explain to him that maybe he doesn't always 'feel' when he needs the loo.  He will tell you if that's not right.  And it will also explain it better to him, because he must understand on some level that he's different.  If you don't explain why he will come to the conclusion that the is 'bad'.
Social Stores are a way of giving information in story form to autistic children.  So, for example, if my son found it hard to lose at games I would write or tell him a story about a boy (with the same name as him) who didn't like to lose and I would explain that everybody can't be a winner all the time and that when one person wins the rest lose and when you lose you should behave like this ie. congratulate the winner, never mind that you didn't win this time etc.  If you google Social Stories it might bring up some better examples!
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Breaking tasks into smaller pieces is something I deal with... Also learning not to start certain tasks at times I know I won't be able to finish or get to a decent stopping point. That means no starting a painting when about to go somewhere.... Of course I'll be interrupted...  With writing, I may have to stop at chapters, sometimes even at the end of a swntence. I try not to leave things in mid sentence...  Chances are I'll come back confused...trying to pick up where I left off... I get that quite a lot when I leave a task unfinished. Chances are I'll probably not return to the same task if I can't pick up where I left off.

I'll need to learn to write brief summeries and outlines... Otherwise I repeat the scene(s) in my head until I have time to write it (them) out. It's like keeping a mental PDA divice or ipod...

I still have issues with the hunger, tiredness... I forget to sleep...  I may feel the initial tired or hungry feeling, but if I ignore it, it goes away...  I'm training myself if I don't feel hungry by 8pm, I better go down and eat dinner anyway.  I'll have to do the same with lunch and move it from 3pm to about 1pm...

Going to bed: One of my goals is to try to sleep when I feel that initial tired feeling, which is surprisingly at a more reasonable time...but it only works if I catch it and not determined enough to override anything... I may have to skip eating chocolate around dinner time. Bummer... Maybe if there are foods that conk me out, that'd be the time to eat them. ;) I did that last night and it worked.  I went to bed some time between 9 pm and midnight after eating a microwaveable banquit Mexican enchillata (sp?) combo meal.
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I perceive such determination and focus to be a strength. It's good to be able to zero in on a task and get it done with minimal interruption. That I would expect to be an admirable trait in a job situation.

But like any good thing, done too the extreme it becomes a major problem. The goal is to have more control on that issue... Be able to use that determination when it is an advantage, but not use it all the time and not when it's going to be a liability.
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I know believe this has nothing to do with control -- more like having to get out of a rut.  Sometimes its too hard to leave behind what we're familiar with.  I recently mentioned to Jordan as I lifted him on the toilet, "You know I can't be doing this all your life!"  And he smiled and said "How about til I'm 13!!"  With this therapy, he should be on his own in about 9-10 weeks!!  That doesn't seem very long to me, after these long 6 (potty training) years!!  LOL
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I think what we call a 'rut' is that they have learnt to do something in a particular way and because of their rigid way of thinking they just continue wanting to do it the same way.  Lack of imagination means they cannot predict or forsee that they need to gain their independence in this task and they resist any change or independence we try to force on them.
My son is semi-independent but he needs someone there to prompt him verbally to do the tasks he can do otherwise he will just sit there.
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my nephew is 14years old and has asperger and my 4 year old daughter has suspected asperger can i ask if anyone with experience with asperger has noticed any problems with toenails not growing normally!
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