Emotional aspects surrounding encopresis and autism - היבטים רגשיים סביב אנקופרזיס באוטיזם

היבטים רגשיים סביב אנקופרזיס באוטיזם - למאמר בעברית

This week a conference was held on emotional aspects surrounding encopresis, organized by the Emotional Developmental Clinic at the Child Development Institute at Sheba Medical Center, Tel Hashomer.

Toilet training challenges may present as constipation, encopresis, toilet refusal, and more.

Toilet training challenges in autistic children can be particularly complex.

We chose to share with you 15 key points that emerged from the conference regarding your child’s toilet training process.

1. The diaper-to-toilet transition is a family project. Challenges may arise along the way and there are ways to address them and help children move to using the toilet but the most important message the child receives from their parents is we are in this together!

2. The process can be challenging demanding and intensive and may bring up many family difficulties.

   You are already carrying a lot so it is important to seek support for yourselves.

   Guidance from a professional whether from the educational setting or your broader therapeutic circle is extremely important.

   You need containment and support in this process in order to help your child get through this stage which has a significant impact on your family’s quality of life.

3. Disruptions in the diaper-to-toilet transition are a complex issue.

   They can be understood as psychological physiological and behavioral in nature. Treatment should be creative and include attention to all of these areas at minimum.

4. A child going through the diaper-to-toilet transition is moving from the world of little children to the world of big children.

   This is a meaningful developmental process that supports growth and the ability to gain control over important aspects of life.

   Parental guidance that is both firm and nurturing is essential for the success of the process.

   Parental fear of frustrating the child or entering the process can have a negative impact.

   Once the decision is made parents should support the child with determination and sensitivity. You are in this together. 

5. Recently there has been a significant increase in Israel in cases where children urinate independently in the toilet but pass stool in their clothes or require a diaper.

   Data show that nearly one in four children behaves this way. You are not alone and there are ways to help.

6. When there are no medical causes, and sometimes alongside them, a link is found between toileting difficulties and children who experience separation difficulties in general children who "punish" parents following prolonged military service parental absence or a move.

   In autistic children it is very common that even a single experience such as a painful bowel movement due to constipation or very hard stool or an incident in which a child was sitting on the toilet and was interrupted for example by other children entering from the kindergarten can disrupt or delay the toileting process.

   At times a connection is also found between sexual trauma experienced by one of the parents and toileting difficulties in their children.

7. It is important to try to identify the cause of the toileting difficulty but once this is done the event itself is no longer relevant to the toileting process.

8. Encopresis and autism. Some characteristics of autism such as difficulties with cognitive flexibility difficulty with change and strong attachment to familiar routines and rituals absence of speech and high or low sensory sensitivity to smells noises and bodily sensations can make the toileting process more difficult particularly in relation to constipation and the transition from stooling in a diaper to stooling in the toilet.

   These factors should be taken into account when building an individualized toileting plan for the child.

   In addition because there are difficulties in identifying internal bodily sensations and because internal sensations are often experienced differently than they are by neurotypical individuals behavioral expressions of constipation pain gas abdominal bloating or the need to have a bowel movement may appear in an autistic child as increased vocalizations more bouncing movements or stretching the body in different ways.

   These expressions are often not understood by the environment in the appropriate context and therefore important signals in the process may be missed.

   In addition research shows that the problem does not resolve with age. Toileting difficulties require intervention. The recommendation is to address the issue as early as possible with the understanding that the process does not follow a typical intuitive path.

9. You can play with poop! There are dedicated games available on the market and it is possible and even recommended to lighten the process through playful and humorous games such as fishing for poop aiming poop into the toilet or driving poop and stopping it like a remote control car.

10. Constipation not just what you thought. Even a child who has a bowel movement every day can suffer from constipation. Even a child who soils their underwear several times a day can suffer from constipation. Even a child with diarrhea can suffer from constipation. Constipation is one of the central factors in toileting difficulties and there is a lot that can be done. It is important to identify what exactly is happening for each child.

11. There is a poop scale! The Bristol Stool Scale is a professional medical tool that helps assess the situation and tailor the appropriate solution. It is important to look at the stool and yes sometimes we will ask you to photograph it.

12. Medications such as Normlax and others do not cause dependence. Their use supports the process is not addictive and is not dangerous. It helps.

    It is true that if the underlying problem is not resolved and the medication is stopped the constipation may return but this is not bodily dependence.

    Medication should be adjusted and prescribed by a professional.

13. Here’s an interesting nutritional fact.

    Take a very green banana. With the peel. Boil it in water for about 10 minutes until it is very soft. Peel off the skin, and grind it in a blender.

    The resulting mass is tasteless and odorless.

    Cool it down completely, it can be frozen in an ice tray in a small amount of a teaspoon. Once cold or frozen, you can add a teaspoon to a shake, a snack, yogurt, or pasta sauce.

    Do not reheat. This is Type 3 resistant starch which was found in research to be a powerful prebiotic, and it can literally cause a laxative effect, it is worth trying for the treatment of constipation.

    Gradually if there is a need, you can increase up to a tablespoon.

    Also 2 kiwis a day is considered to have an effect on bowel movements.

    It is important to note that these additions are not suitable for use during the first stage of treatment; the gut must be acclimated to changes rather than overloaded. Additions should be made gradually and in consultation with a professional.

14. Visual supports: such as symbols a personalized social story tracking charts and various reinforcers greatly help illustrate and support the process.

    Different physical exercises motor games yoga poses and the use of supportive tools can also promote progress.

    Each tool supports a different area providing emotional visual or bodily support. For a psychological physiological or behavioral difficulty we offer a creative and dynamic solution.

15. The pediatrician is the first stop. If there was constipation in the first two weeks of life or difficulty passing meconium this should be reported. If needed there are gastroenterologists who specialize in gut motility and there are important tests that can be done to rule out certain conditions.

    If you are told that your child has functional constipation this does not mean there is nothing to do. There is a lot that can be done!

    
    

    היבטים רגשיים סביב אנקופרזיס באוטיזם - למאמר בעברית

    In summary

    Toileting independence is one of the factors that most strongly affects the quality of life of a child an adult and the entire family. Autistic children who require different levels of support can transition out of diapers.

    From our experience many children are capable of far more than we assume and more than they are able to initiate on their own at this moment. When we start from an assumption of capability and show them the way success can follow.

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