potty training with autism

Hi. I have a 4 year old son with Autism. He also has OCD with the Autism. We have been potty training for about a month now. He does very well, at home. Almost no accidents. My concern is that, he will only use ONE bathroom in our house. Only upstairs. Also will NOT use any other bathroom outside the house. Not public, not family houses, not school. This is making it very frustrating. I think it's a power struggle, and maybe some of his OCD. I just don't know how to help him. Has anyone else had this happen? And what did you do to help this situation? Any advice would help here.
Thank You

[MJIthewriter]

I'm no expert, but maybe offering rewards for going in another bathroom would be worth trying.

With me I had issues with public restrooms, not because of the location, but the awful loud booming flush sound the toilets made... It'd hurt my ears, spook me and prevent me from wanting to flush it another time. The automatic ones are worse... They just suddenly flush without warning... Over the years I've gotten better, but I still wait to flush until I've got the stall open and just about ready to leave.  I'm learning how to get automatic ones to wait until I'm just about out as well. My ears are still sensitive to that loud WOOSH...

That probably isn't the same problem your child is facing, but it may be something worth noting when going to public restrooms.

[lk131mom]

Thank You for your suggestion. We have tried that, but will keep doing so...
I have thought about the sensory part to the bathroom, like you said the noise hurts your ears. And that could be the reason in public.. I am very aware of his sensory issues, public restrooms may take alot of time. But I am just not sure why he won't go in our downstairs bathroom, or family houses.
Thank you so much!
Anyone else have any suggestions?

[pennst8r]

MJ is certainly correct about the noise factor. Also many many children with autism have great difficulty accepting changes in routine, as well as generalizing a skill learned in one place to a new place. This is quite common. Does your insurance cover behavioral therapy?

In my state, we have a service called wraparound which provides behavior shaping across home, school and community settings. Their job is to develop a plan, then work with the child and the family so that the family learns to use the plan on their own. Is your child enrolled in a supports coordination or similar unit?

Penn

[lk131mom]

Hi Penn
Yes my son has been in behavior therapy through his school district for almost a year now.. He is also in a intergrated pre-school 5 days a week, for 5 hours a day. So he is getting the therapies that he needs. But even his behavior therapist and teachers, just don't have any new suggestions. I am most likely going to have to just keep trying to get him to use other toliets, and it is just going to take alot of time, I think.
Also I think that you are right about generalizing a skill learned in one place to a new place, I knew that he has that problem with other things, I guess I just didn't think of this in that way.
I have never heard of that service called wraparound, it sounds similar to what we have. His behavior therapist comes to our home, and what ever we feel we really need to work on we will. Sometimes we are at the grocery store, or out to eat, or just at the park helping him to interact with other children. We do not go to his school, but he already has speech, OT, and music therapist in the school with him daily. Does that sound like the wraparound service that is in your state? By the way I am from NY, do you mind me asking what state you are in?

[MJIthewriter]

Along with the generalization problem, there could other reasons.  I'm not a parent, but I do have a cat.  Thankfully he doesn't seem to have litterbox issues. I mean he's not perfect, but he goes where he should 99% of the time.

If he were to stop going, as a pet owner, I'd have to look into why my cat would be rejecting the litter box.  In this case your child is going in one place but not in another.  When I was researching on ways to take care of my pet, I noticed litterbox issues come often.  Some of the suggestions are to look at the location. Is the cat comfortable with the location?  If the litterbox is near the food dish, too close to where the dog hangs out, or some other cat is guarding it, then the cat likely won't be motivated to go in that area.  Likewise if something traumatic occurred such as a child coming in and grabbing the cat...

Other possible reasons could be wrong type of litter, the smell being off, unclean conditions and so on...
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I know I'm talking about a completely different animal, but I would think in a basic level potty training a human would be similar to training a pet. If the pet won't go in a certain area, then the reason has to be addressed before the animal can be successfully trained.
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This may or may not work, but is worth a try. See if you can make notes about what things are different and what things are the same about both bathrooms.  If there's any single thing that bothers your child about the downstairs bathroom, then likely no behavior mod programs, incentives, etc will get that child to use that bathroom until something can be done to make the downstairs bathroom tolerable.

I don't know from your post if your son goes into the downstairs bathroom for any other purposes or not. Some things I can think off the bat that may cause problems:

- Lighting: too bright, dark, buzzing (florescent lights), burning out and flickering (florescent lights).
- Noise: street traffic, noise in the house, anything
- the toilet itself: too high, too big, the seat being different, uncomfortable, the flush being too loud... risk of toilet overflowing... My mom warned me that can happen. My mental image was of a geyser like Old Faithful coming up... No wonder I felt intimidated to flush... Not to mention it didn't help when my mom used to treat every case like it was a 911 emergency. "Get the plunger! Hurry! Help!" LOL.
- smell.  Pretty self explanatory. It could also include air fresheners.
- Appearance.  Patterns on the walls, color, etc...
- anything else that may be overlooked.

Autistic people can be very sensitive to the slightest things.  With encouragement, self will and determination, I believe people like me can come to overcome and put up with minor to moderate discomfort. I will flush the toilet in the public restroom, even if it sounds like it could blast apart a rock if someone threw one in...  I just learn to modify my behavior. If I know it's going to hurt my ears, I will put off flushing until I am ready to make a quick get-away. Yes I do wash my hands.  I make sure to get that necessesary behavior taken care of...

[lk131mom]

MJ
You did bring up some good things that I did not think of before... The downstairs bathroom is right next to the dinning area...
(strange but thats how the apartment is set up)
So maybe being so close to where he eats. There is nothing I can do about that, and also the toliet is different then the one upstairs, but also nothing I can do about that.
I will however take the plug in air freshener out ;O)
and I can try to put in his favorite color for the rugs maybe..
Thank you so much... alot to think about and try now.

[MJIthewriter]

It'll be interesting to see if it does apply for people.  It was something that popped on my mind when I read about litterbox problems and then read about potty training problems. My mind tends to put things together in odd ways.

I can't remember who said it, but someone in one of the autism groups my dad and I went to claimed all cats are autistic. Maybe that person's right. I know our cats stiffen up, stretch out, and give me a WTH look when being held and cuddled.

Good luck and hopefully something can be done.  I remember going to an autism convention and one of the people wanted me to lead her to another area. At the time I was a young pre-teen-teenager and the person was an adult also a form of PDD.  I lead her through a corridor in a hallway, but it turned out to be a different route than she always went.  She was happy I varied her route a little. She enjoyed the change.

I think sometimes with routine/ issues getting locked in a routine can be too easy. As a result sometimes we can become blind to better options out there, but when shown a better way, have a choice to either reject the option or eagerly take it on.

I try to take on new things if I do clearly see they are better than what I am doing.  This can apply to anything, I'm sure. That's something to keep in mind when working with autistic children and adults.

Sometimes resistance to change may not be because of the change itself, but a failure for the person to see that the change is in fact necessary and beneficial.

One recent quote I came up with to describe this: "If you're going to change my world, give me a reason. If you explain your reason well enough, maybe I'll agree with you or maybe I won't. It's worth a try and thanks for letting me know."

[888mom]

Something really really gross... my grandmother hated public  restrooms so much that she used to wear Depends underwear on long outings.  She's since died, but when she was around,  it was seriously her preference to wear a grown up diaper than go in a public  toilet.  

I would rather  use the public toilet and just suck it up and try to get through the ordeal.  And although I will use a public restroom, I do try not to by limiting what  I drink while out and about, and going before I leave the house.  The smell is the worst thing that gets to me.  The bright lights  is  another.  And the flushing is loud.  I have coping mechanisms to get me through the public bathroom... I count.  Keeps my mind distracted i suppose.  I don't know.  I tend to count or do math in  my head when I'm  scared or have to deal with something I don't want to.  My daughter also hates public restrooms.  She's only 2 1/2 and still in a diaper, and  I imagine I can put her in a pull  up  until she's like 4 or so when we go out in public.  I am starting to potty train her, but I imagine she will have difficulty with the public restroom as well.  Certain toilets are nicer than others. Some restaurants keep a really clean bathroom and they clean every 30 minutes or so.  And they don't use cleaners that smell too intensely.   Some  places use cleaners that smell bad to cover up the bad odor.  Some places just don't clean enough.  

I have learned over the years to know which places have acceptable bathrooms and which don't.  You could ask your son why he is having the aversion, and see if you can  find places he will tolerate and which he won't.  Will he wear a pullup in the meantime?  He's only 4.

[27yroldmomof3]

my daughter has ocd and adhd we have a lot of problems with any type of change what so ever. she will not take a bath where others have bathed but will stand for a shower. also wont sleep or sit on certain types of furniture.  my suggestion is to make everything look the same as upstairs as you possibly can to help make him think its the same. If that works then try slowing changing one item at a time to see how he reacts to it then. it could be as simple as a color he is attached to or a certain towel hanging that can be brought from one bathroom to your purse for trips in public.