Eve Fleming - Toilet Training and the Autism Spectrum (ASD): A Guide for Professionals

This is a comprehensive and extremely useful book about the toileting difficulties associated with Autism Spectrum Disorders. From developing basic toilet training and independence skills to discussing more complex issues like sensory differences, constipation, smearing and avoidant behaviour the book clearly demonstrates the importance of understanding how autism impacts on these difficulties. It offers practical, tried and tested suggestions and includes useful resources and links. This is going to be an invaluable book that has successfully drawn together, for the first time, everything you need to know about this subject.

Suzie Franklin, Author, Personalisation in Practice , and Family Liaison, Inscape House School

I was delighted to be asked to review this excellent book which gives a common sense and practical approach to toilet training children with ASD. By debunking the myth that toilet training should be delayed until the child is ready it ensures that all children with ASD are given the same opportunities as their peers. I would suggest that this book should be essential reading for all those involved with the care of such children.

June Rogers MBE, PromoCon Paediatric Continence Specialist

This is a must-have book. A comprehensive, informative and easy-to-read guide through the difficulties of toilet training individuals with ASD, this book is helpful for professionals and parents alike. It is thorough and full of practical, tried and tested ideas. The use of parent views makes this an excellent resource.

Lizi Snushall, Senior Teacher at Uffculme School (ASD specific), Birmingham

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Toilet Training

and the Autism Spectrum (ASD)

A Guide for Professionals

Dr Eve Fleming MB ChB BA MRCPCH
and Lorraine MacAlister PGC Autism, BSc Psychology

Foreword by Dr Penny Dobson MBE

Jessica Kingsley Publishers
London and Philadelphia

Bristol Stool Chart on p.112 is reproduced with kind permission from Dr KW Heaton, formerly Reader in Medicine at the University of Bristol. 2000 produced by Norgine Pharmaceuticals Limited.

First published in 2016

by Jessica Kingsley Publishers

73 Collier Street

London N1 9BE, UK

and

400 Market Street, Suite 400

Philadelphia, PA 19106, USA

www.jkp.com

Copyright Eve Fleming and Lorraine MacAlister 2016

Foreword copyright Penny Dobson 2016

All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 610 Kirby Street, London EC1N 8TS. Applications for the copyright owners written permission to reproduce any part of this publication should be addressed to the publisher.

All pages marked can be downloaded at www.jkp.com/catalogue/book/9781849056038/resources for personal use with this program, but may not be reproduced for any other purposes without the permission of the publisher.

Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution.

Library of Congress Cataloging in Publication Data

A CIP catalog record for this book is available from the Library of Congress

British Library Cataloguing in Publication Data

A CIP catalogue record for this book is available from the British Library

ISBN 978 1 84905 603 8

eISBN 978 1 78450 070 2

We would like to dedicate this book to all the children with autism and their parents from whom we have learned so much about learning to use the toilet. We have enjoyed their challenges and individuality.

CONTENTS

Perspectives on supporting children with autism and their families

Why toilet training is an essential skill for children with autism. The problems linked to difficulties in learning to use the toilet

The factors that interact to make these skills hard to learn for children with autism. The interaction of physical factors, maturity and specific autism characteristics

The importance of deciding the best time to start to help children with autism begin toilet training, and when to intervene for later difficulties

First Steps: Prepartion for Toilet Training

The importance of preparation and planning before starting toilet training. How to prepare effectively and develop good communication in order to help children understand the different aspects of toilet training

How to evaluate a childs readiness to begin toilet training, and the assessment of bladder and bowel maturity

The steps for learning toileting skills, target setting, strategies, rewards and motivators

Bladder capacity and fluid intake

Specific bladder difficulties: immature bladder, irritable bladder, infection; their investigation and treatments

Intervention, treatment and support

The factors affecting bowel function and regularity

Constipation and withholding help and treatment options

How these affect toilet training. The assessment of increased and reduced sensory input and how these factors may impact on toilet training. How sensory differences can be addressed

Some specific problems with toileting for children with autism: pooing in the wrong place, difficulty of transferring skills

Smearing: Causes and Solutions

Some useful strategies

The needs of older children and teenagers. Reassessment of continence problems and new approaches

Approaches to the development of joint working, good communication and inter-agency planning

FOREWORD

Children with autism spectrum disorders often find toilet training a challenge as do their parents and carers. Yet, for the vast majority, continence can be achieved. Health and allied professionals including health visitors, school and nursery nurses, as well as members of the more specialist paediatric continence team play an important role in advising and supporting parents in their journey towards their child becoming fully toilet trained. The good news is that this new publication equips the professional to take on this task with confidence. Not only does it provide up-to-date information, but it has plenty of practical suggestions to engage the families concerned.

My pleasure at being asked to write this foreword is personal as well as professional, as my parents were among a small group of founder members of the National Autistic Society and my father, Geoffrey Dobson OBE, was the Societys second chairman. I, on the other hand, was the founder director of the national charity ERIC (Education and Resources for Improving Childhood Continence), which I set up 1987 until handing it over as an established organisation to a new director twenty-one years later.