It's time to try a new phase of the toileting plan for Alex. Now that he is reliably telling us when he has soiled himself and tends to have a single go-time during weekdays, we're going to try pairing screentime and toileting.
This is not something which our behavioural therapist recommends in most cases because it usually causes more complications than it helps. Kids can become reflexively triggered to go to the bathroom during any screentime and it's not always an option.
In this case, we're trying it because Alex already has a tendency to go when he's got screentime, so we're going to try and transfer it to the toilet.
We also have concerns that we're still missing something. We've offered lots of rewards and incentives and in other areas of his life, that's been enough to change his behaviour. In this case, it isn't, so there's something we're missing.
I'm thinking that if this doesn't work, it's time to abandon the idea that he will learn to use the toilet in a predictable way. We'll have to consider other strategies like part-time diaper usage and teaching him to clean himself up. Or figure out how to build a standing support so that he can stand and use the toilet.
It's frustrating. We've been trying to solve this problem for almost seven years now. We've tried everything we could think of that had the remotest possibility of success. And no luck.
A small percentage of kids with autism are never toilet trained. Even if they are very intelligent and socially high-functioning, it limits what they are able to do in life and the supports they can be offered. Most day programs will not accept someone who is not toilet trained and the same for most residential programs. The ones that do tend to have residents who are much lower functioning than average, so they're not great places to be.