Toileting Issues and Adult Assessment

Welcome to the November edition of Ask Dr. Emily! We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights here, on the last Friday of each month, in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month.

My 6-year old son is potty trained at home and at the homes of friends/family but he refuses to use the toilet outside of these familiar situations and subsequently has accidents at school. I am at a loss as to what strategies to suggest since we don’t have these issues at home. Do you have any recommendations for children with challenges successfully using toilets outside of their comfort zone?

It is not uncommon for children with autism spectrum disorder (ASD) to present with toileting issues. The cause could be medical, behavioral and/or environmental. With any toileting issue, the first step will be to check in with your pediatrician. They will be able to assess for potential medical causes, may have ideas about how to intervene, and/or may be able to provide recommendations and/or referrals for behavioral treatment providers and/or toileting experts in the community or through the school system. The other thing to do would be to consult with your child’s school regarding specialized services and/or behavioral assessment resources available.

As a LMHC I am working with an adult (30 years old) who has many characteristics of Aspergers. He believes he has Aspergers, but was never referred for such an assessment when he was growing up. This individual already receives Social Security Income (SSI). Is there a point where getting assessed is ever “too late?” What would be the benefit of getting evaluated as an adult?

As with any evaluation, the goal of an adult autism-specific evaluation would be to provide recommendations for treatment, services, and/or funding that can help make the individual’s life easier and more functional. Peace of mind related to “just knowing” is another benefit commonly endorsed, especially for adults. For adults, the decision to be assessed (or not) is a personal one. Weighing the pros (e.g., “I might finally know what’s been going on with me and I might be eligible for funding or services that I wasn’t before.”) and cons (e.g., “I might come away with a label that I’m not sure I need/want/am ready for.”) is an important part of this decision making.

Dr. Emily Rastall is a clinical psychologist at Seattle Children’s Autism Center, where she works to evaluate and treat children and families affected by autism spectrum disorder and related or co-morbid disorders. The information contained in this blog should not be used to replace the relationship that exists between you and your healthcare provider. Please contact your healthcare provider for specific medical advice and/or treatment recommendations.