9 yr old boy w/ ASD is TERRIFIED of "monsters" in the toilet


Question: I work at a school and one of the students (9 year old boy with Asperger's syndrome) refuses to use the toilet. He pees and poops in his pants on a daily basis because he says his brother told him there are monsters in the toilet.

When we try to get him to sit on the toilet he throws a tremendous fit: screaming, crying, flailing, hitting himself, and yelling ideations about killing and harming himself and others. He will not sit on the toilet for more than a few seconds at a time, and he uses his arms to prop himself up and hover over it when we try to make him sit.

We have tried various methods of positive reinforcement, as well as explaining to him over and over again that it is physically impossible for anything to come up through the pipes.
Can you suggest anything for us? Are there any videos or books for children with similar phobias about how the toilet/sewer system works?
Thanks for your help,
-Clueless in California

Answer: It sounds like you will probably need to do some desensitization training. Start by just getting him to at least stand in the bathroom when he does go in his pants. Then perhaps standing closer and closer to the toilet and eventually briefly sitting on the toilet.

For each step you will give reinforcement, but you don't want to move on to the next step until he shows no fear or anxiety during the previous step. If he is afraid of flushing then simply do not do this until you are able to successfully get him to sit for a few seconds without any signs of fear.

Unfortunately, it is something that will just take time. Forcing him to sit on the toilet while he is afraid, may make him regress even further. Talk to him about each step in a calm and soothing voice about how there is nothing to be afraid of and give praise for "standing in the bathroom" and then praise for taking a step closer to the toilet.

If he starts to show signs of fear/anxiety, you will want to move back to the previous step for a few days. You may also find some of the recommendations in the following book specifically for individuals with asperger's or autism to be helpful.

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