​April is autism awareness month: Day 20 – ADLs/ Toileting

April is autism awareness month 

Day 20: ADLs/ Toileting

Activities of daily living (ADL) are routine activities that people tend do every day without needing assistance. There are six basic ADLs: eating, bathing, dressing, toileting, transferring or walking and personal care. 

A person’s ability to perform ADLs is important for determining what type of long-term care may be required.

Toilet training is one of life’s great milestones and it was one of Dylan achievements that he was fully toilet trained day and night by age 3. Dylan is able to recognise that he needs to go to the toilet and able to hold off until he gets there. 

As with most kids he has always come into the ladies with me and it’s never really been an issue. However now he is getting older going to the toilet alone is becoming a reality and a worrying one at that. 

I didn’t realise until recently that there is a whole etiquette of male toilet manners. There is a rule of which urinal to stand at. 

If there is someone already standing at the urinal then there is an unwritten social rule that you don’t stand next to them. 

That’s a no-no.

 Also you don’t look anywhere other than straight forward, you don’t look at the person next to you, either at their face or anywhere else.

Another no-no. 

It is not acceptable to pull your trousers down at the urinal but to expose as little as possible to pass water.

Bare bottoms at the urinal is a big no-no.

The rules are complex and confusing, even more so to a young autistic male like Dylan. These are not social rules that you would like to misinterpret or get wrong. 

Toilets are sensitive and vulnerable places.

However having frequented many a ladies toilets whilst growing up, Dylan is much more comfortable sitting on the toilet within the cubical. 

He still needs supervision with this as he can find the lack of space and coordination difficult and will hold onto the toilet whilst he sits; we strongly discourage this due to the cleanliness of most public toilets (Although Dad assures me that the cleanliness is considerably reduced in male toilets which pose even more of a hygiene risk.)

Dylan has purchased a radar key which can be used universally to unlock the doors in Disabled toilets. 

These toilets have more room and generally are well maintained. The only thing that we need to be aware of is the automatic hand dryer. Although these are hygienic due to the no touch technology, they are often too sensitive for a clumsy boy rushing to get to the toilet. Should he brush past it too closely and set it off absolute terror follows. 

Due to past experimce Dylan is painfully aware of how unpredictable these driers can be and a great deal of his independence is hampered by his need for reassurance whilst in the presence of hand dryers. 

I think it may be the pitch or volume of the noise, exacerbated by the wall and floor tiles within public toilets causing the sound to be intensified to a level where it appears that Dylan is frightened of the noise and it causes him intense discomfort. 

This sound coupled with the unpredictability of it starting, be it from an oversensitive sensor or the other people in the toilets who are drying their hands. Dylan has no control over the noise so we often wear ear defenders when going to the toilet in a public place. 

Although Dylan can still hear with these on any sound is dampened out enough for him not to feel so anxious.

All benefits assessments or health assessments will always ask questions such as; ‘is Dylan toilet trained?’ 

Looking positively on Dylan’s abilities and answering the question basically then – yes, Dylan doesn’t wear nappies anymore. 

However he does require supervision to clean himself afterwards, he needs assistance and support to follow social guidelines, constant reassurance because of the sensory overload and his coordination difficulties and then support to redress suitably afterwards. 

Continence and toileting is so much more than being out of nappies and going to the toilet.

** picture is of a request I made to Dylan to “put a new toilet roll on the holder please.” 

A picture speaks a thousand words. **


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