Bedwetting and Autism
Most infants and young children are very social creatures who need and want contact with others to thrive and grow. They smile, cuddle, laugh and respond eagerly to games like peek-a-boo or hide-and-seek. Occasionally, however, a child does not interact in this expected manner. Instead, the child seems to exist in his own world, a place characterized by repetitive routines, odd behaviors, problems in communication and a lack of social awareness or interest in others. These are characteristics of a developmental disorder called autism.
Bedwetting is one of many issues autistic children face. In comparison, it is likely a less important problem, but a problem nonetheless. "Autistic children, in general, have trouble with bedwetting, because they have difficulty in toilet training," says Dr. Cynthia R. Johnson, director of the Autism Center at Children's Hospital in Pittsburgh, Penn.
Why do autistic children have trouble learning to use the toilet? "A number of factors are involved," says Dr. Johnson. "For one, autistic children are not good at imitation, which makes the process of potty training more difficult and that is only for the daytime training."
They are also hypotonic, says Dr. Johnson, which is a condition that includes a lax form of muscle control as well as a failure to respond or recognize stimuli such as the need to urinate. In some children, they do not even feel the wetness of the bed, which can complicate the training methods to help children overcome nighttime bedwetting. "They are not well regulated overall and need to learn these things," she says.
"My son, now 5 years old, who has mild autism, wasn't fully potty-trained until about 4 3/4 years old, but then again, boys often take longer," says Teresa, a mother in Indiana. "I have read that because it's difficult to get autistic children to fully understand their body signals, it can be hard for them to know when to use the toilet. And, of course, if they don't know or understand their body signals during the day, then they will wet their beds at night, because they will be even less tuned to body signals while asleep."
Jeanne Brohart, mother of 5-year-old Zachary, who is autistic, has her own idea of the link between autism and bedwetting. "In my opinion, the issue of bedwetting is related to damage in the area of the basal ganglia and the cerebellum," says Brohart, who created a Web site to help other parents of autistic children called Autismhelpforyou.com. "Both of these areas of the brain are known to be damaged in children with autism. If you look at the functions involved in the basal ganglia, they include matters relating to the movement control, cognition, learning and motivation."
There are many treatments available to help with enuresis, including limiting fluids and waking the child to use the bathroom. With special needs children, however, it's best to tailor their treatment to their condition.
According to Dr. Johnson, behavioral-based methods are best for children with autism. "It needs to be structured more toward the child and his or her individual needs," she says. "There are a lot of books on this type of training available. It requires a lot more effort and demands on the time of the parent. Once the child masters daytime control, the next step is nighttime control."
Teresa tried a number of methods to help her son with his bedwetting. "My son was using the potty pretty well during the day for several months before finally getting the hang of it at night," she says. "During that time, he would occasionally wet his bed. We tried several things, including reducing the amount of fluids he drinks before bedtime, putting a pad between his sheets and the mattress (so the mattress would not get soaked) and using disposable underpants for bedtime. We also talked with him a lot about how if he feels the need, he is to get up and use the toilet. "
Using disposable absorbent underpants can be a good solution for kids to help them feel dry at night while they're still developing control. And it saves wear and tear on parents, who may be changing and washing the sheets and pajamas every night.
Brohart found limiting fluids before bedtime helped her son, who has recently shown improvement. "I try not to give him too much to drink before bed," she says. "There have been a few nights recently when he awoke 'dry,' so I'm hoping by the end of summer the potty training will be a non-issue for us. If it continues to be, however, then all I can do is be understanding."
A treatment that seems to work well for children with autism is diet intervention. It often helps because autistic individuals are more apt to have allergies and food sensitivities, which many believe to be caused by their impaired immune system.
The most common food allergies tend to come from grains, dairy products, strawberries and citrus fruits. Grain products like wheat, oats, rye and barley cause allergies due to the gluten they contain, and the casein in dairy causes reactions to milk products. Consuming these foods can lead to bedwetting, plus a host of other symptoms such as headaches, nausea, stomachaches, stuttering, whining, crying, insomnia, hyperactivity, aggression, ear infections and possibly a seizure.
To test if your child is having a reaction to a certain type of food, remove the item from their diet for a week or two and then feed it to them on an empty stomach. If there is a reaction, it will take place in 15 to 60 minutes. You can also try giving them the food every so many days. If they have a reaction on those days, then there is an allergy to the item.
Of course, the best thing to do is to speak with your doctor before trying any treatment. He or she can help you tailor a program to fit your child's specific needs and encourage you that most children do grow out of bedwetting – autistic or not.