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Refuses to poop on the toilet
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Refuses to poop on the toilet

I have a boy who has been toilet trained (pee) for about a year and a half.  He has always pooped in a pull-up.  He recently turned 5 and is independent enough that he will get himself set up (change out of his clothes and put on the pull up by himself) and go into the bathroom to poop.  He does have a diagnosis of Autism but I am fairly certain that this is not a comprehension or sensory issue.  At first he would only poop in a pull up, in his room alone playing with his toys.  We gradually (with some resistance at each step) got him to poop in the bathroom without toys.  He will stand next to the toilet.  We have tried to have him sit on the toilet with the pull up on, but he won't.  About a month ago we simply said, "no more pull-ups, big kids make poops on the toilet." and he held it in for nearly a week.  His teacher called to say that he was having difficulty sitting in a chair and was obviously uncomfortable.  We allowed him to go back to standing next to the toilet.  He is perfectly content to remain in a pull-up and is not showing any curiosity toward the toilet.  This seems to me to be an anxiety/control issue.  Any information you can provide will be appreciated.  Thank you!
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Many children show resistance to having bowel movements on the toilet. This experience appears pretty frightening for many of these children. And, as you identified, control seems to play a part in some cases as well. As children develop, they seem to figure out quickly that there are a small number of things that adults can’t control, and they struggle to maintain control of those things (e.g., eating, eliminating). I admire the approach that you have taken thus far. When children resist having bowel movements on the toilet it is often best to move them gradually from their current situation toward the ultimate goal of eliminating on the toilet. As you experienced, you are likely to encounter a great deal of resistance if you move too quickly. There are a few additional techniques that you might try.

First, to reduce the extent to which this is an anxiety provoking experience, be sure that your son is as comfortable as possible on the toilet. For example, there are child-sized seats that can be placed over the regular toilet seat that make children feel more secure. Some children also benefit from having a stool at their feet so that their legs don’t dangle. If he prefers, allow your son to remove his pants and underwear so that they are not at his ankles. Make sure that the bathroom is warm, and allow your son access to books or music if that helps.

Second, begin by having your son sit on the toilet when he is not ready for a bowel movement. This will allow him to get comfortable with sitting. I assume that your son stands to urinate. I also recommend that you provide some type of reward for sitting calmly on the toilet. Start with very small periods (e.g, a second or two) and allow your son access to some small reward (e.g., a piece of candy or access to a favorite toy or movie) for meeting this goal. Then, gradually extend the time requirement until he sits on the toilet for approximately 5 minutes. At this point, it may be possible to arrange the award only if he has a bowel movement on the toilet.

Third, attempt to give him as much control as appropriate during the toileting routine. You might ask him if he wants to sit on the toilet now or in 5 minutes. If you have more than one bathroom, you might allow him to choose the bathroom. If you allow him to look at a book, you might let him choose the book.

If he is only willing to sit on the toilet in a pull-up, allow him to do this at first. This is still progress.
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Jason C Bourret, Ph.D., BCBA-DBlank
The New England Center for Children
Southborough, MA
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