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Interoception and Autism: Why is Potty Training so Hard?

interoception and potty training kids with autism

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Interoception is commonly called the 8th sense. Joining the ranks of hearing, sight, touch, taste, smell, vestibular, and proprioceptive, interoception is a very key sense that many of us forget to appreciate.

Interoception is our sense of what’s happening within our bodies. This sense keeps track of the internal cues that we need in order to take care of ourselves. Here are some examples of interoception in action:

  • the urge to go potty
  • feeling too hot
  • feeling too cold
  • thirst
  • hunger
  • satiation
  • nausea
  • feeling your heartbeat
  • feeling your breathing

With the examples of feeling too hot or cold, keep in mind that this refers to the body feeling too hot or cold. This is not the experience of touching a stove or an ice cube and having a momentary temperature change.

Why Does Interoception Matter?

As the examples demonstrate, interoception gives us really important cues. If we’re getting a signal that we’re thirty, we know that we need to grab some water. If we feel the urge

 to go to the bathroom, we pull the car over and find a gas station. In most cases, interoception sounds the alarm when we need to take care of a basic human need—eating, drinking, eliminating, etc.

Interoception is also crucial for cluing us in when something is a miss internally. Whenever we’re feeling sick, we can thank interoception for telling us that it’s time to take a nap or see a doctor. Think of interoception as your internal alarm system saying, “hey, something isn’t right here and I think you should do something about it!”

How do Kiddos with Autism Experience Interoception?

For kiddos with autism, it’s challenging for them to integrate their interoceptive signals. Let’s dive into this because it’s an important distinction. It’s not that kiddos with autism aren’t getting the sensory signals that they need to understand that it’s time to go to the bathroom or that they’re hungry or thirsty. Instead, they struggle to integrate them.

What is sensory integration exactly?

Whenever we get a sensory signal, it goes to the brain where it gets processed and integrated. Our brains

get a chance to evaluate the signal that came in and trigger an appropriate response. If it received a thirst signal, we’re prompted to get a glass of water. If it received a cold signal, we feel the urge to grab a jacket.

When kiddos with autism get an interoceptive signal, it doesn’t always get integrated by the brain properly or fast enough. This means that it’s very easy for it to go unnoticed. It’s like getting hit with a fly ball. You could have caught it if you knew it were coming, but it’s nearly impossible to put your arm out in time when you’re caught off guard.

Why Does Interoception Make Potty Training So Hard?

Many parents of kiddos with autism will tell stories of how challenging it is to get through potty training. No matter how much they practice, these kiddos can really struggle with making it to the potty in time. In fact, some won’t know a bathroom break is needed until they’re going in their diapers.

The urge to go to the bathroom is very dependent on interoception. Whenever we feel a bathroom urge, we not only get a cue that it’s time to make a pit stop, we also get really good at sensing how much time we have before the situation gets urgent. Thank you, interoception!

When we get an urge to go to the bathroom, an internal signal is sent to the brain. From there, the brain must integrate that signal, which means that it takes the signal in, processes it, and activates the proper response. In this case, we realize that we need to look out for a bathroom.

For kiddos with autism, bathroom signals may be triggered in the body, but they may never get fully processed and integrated by the brain until it’s too late.

How Can I Help My Kiddo with Potty Training?

As with everything, it’s important that you work 1-on-1 with an occupational therapist or other medical professional that can help your kiddo in alignment with their specific needs and challenges. What I’m offering here is general advice but is by no means medical treatment that you should implement without further evaluation.

When helping your kiddo with potty training, understand that they will need a lot more help than their peers. Without relying on interoception’s cues, kiddos need other cues as a way to know it’s time to go to the bathroom.

Here are some ways to make potty training a bit easier. Talk them over with your occupational therapist and see what they would adjust or add.

1) Get a Sensory Plan in Place

When kiddos with autism or sensory challenges struggle with potty training because of interoception deficits, we’re talking about a sensory issue. While some of the following techniques may help, the most important thing is to work with your occupational therapist to establish a great plan of action to address your kiddo’s sensory needs. There isn’t currently a lot of research about how to specifically improve interoception skills, but your occupational therapist will be able to guide you with tools and techniques that can help.

2) Recognize the Signs

Start to pay attention to how your kiddo behaves right before they go to the bathroom. Are there any patterns you notice?

Are there certain times in the day that your kiddo goes to the bathroom? How long after a meal are they eliminating?

The more you know about your kiddo’s pre-bathroom behaviors, the easier it will be to prompt a bathroom break right in the nick of time. If your kiddo’s interoception skills make it hard to know that a bathroom break is needed, you can help by recognizing the cues that indicate it’s time to go.

3) Use a Potty Schedule

If the body can’t offer an internal schedule, implement an external schedule. While your kiddo may not need to go to the bathroom at the exact moment the schedule asks, it’s a great way to practice the bathroom routine. Talk about how to use the potty and wash hands! Every once in a while, you’ll be lucky, and your kiddo will actually need to go during a scheduled potty break.

This can be a great chance to not only familiarize kiddos with the bathroom routine, but also help them practice the skills involved. If your kiddo struggles to wash their hands, try using forward and backward chaining and use the bathroom as a chance to develop this skill.

Use a simple visual schedule that you post on the wall or try out a potty-training wrist band that alerts your kiddo that it’s time for a bathroom break.

4) Stay Positive

Kiddos who struggle with interoception can find potty training really frustrating. Many times, they want to use the potty appropriately and independently, but they don’t understand why their bodies aren’t giving them the right cues. They can also feel insecure about potty training as they get older, especially given that they’re seeing their friends leave the diapers behind.

Studies have found that stress and adverse events can actually hinder interoception skills. If language around potty training becomes negative, it may do more harm than good.

As much as possible, make potty training a positive experience. Try using reward charts and words of encouragement to remind your kiddo that they’re successful and making good progress.

5) Make the Potty Fun

Even if they aren’t getting the right bodily cues to use the bathroom, what kiddo can avoid a fun activity? While potty time will likely never be the most fun activity of the day, try to liven up the experience with songs, games, and activities.

It’s also fun to spruce up your kiddo’s bathroom with some of their favorite décor. Look into fun toilet seats, soap dispensers, and towels. The more enjoyable you can make the bathroom experience, the more your kiddo will be willing to participate in it.

Here are some ideas if you’re looking for inspiration!

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