My son has anxiety attacks when he needs to use the toilet.

Our son is mildly autistic. Toilet training as you know is all the more challenging with a child who is autistic.  He is now 5 years old.

Two years ago he had a very severe yeast infection. Since then he has a lot of anxiety when he needs to have a bowel movement.  There is no blockage that we know of.  He is not constipated or prone to diarrhea.  These anxiety type attacks lately have been occurring more often with him.  I have asked our family doctor to refer us to a GI clinic. He is looking into this for us.

What I want to know is if we should have him see a neurologist about these attacks?  He is not verbal yet so he can’t tell us if he is in pain or what the trouble is that is causing these attacks.

There is little research on pain in children with autism.  However, the limited evidence suggests that their reaction is very varied. Some children with autism may feel strong pain when other children feel no pain. Conversely, some children with autism have little response to what might be painful in others.

I cannot answer your question about whether you should seek a neurologist. Take the advice of your family doctor on this.

It would be a good idea, if possible, for his doctor to carefully and gently examine his rectum to insure there are no obvious sources of pain.

It is not unusual for a child who has had a painful experience to develop anxiety about the situation. Anxiety then continues even when the experience is no longer painful.  Many children with autism have fears of the toilet. It may be the sound of the toilet flushing or the sight of the water disappearing that is causing fear. You may have to experiment to figure this out.

If it is anxiety, the best strategy is to make his time on the toilet positive.  You could start by having some toys that he likes available to him only when he is in the bathroom. Use a gradual approach. Then when he gets used to being in the bathroom,  try the same with him on the toilet.  Perhaps you can sing his favourite song with him as he is put on the toilet. The more often he has positive experiences near or on the toilet, the more likely anxiety will be reduced.

If your efforts are not successful referral to a psychologist who is experienced in autism would be my suggestion.

Thanks to Dr. Tony Otley, a pediatric gastroenterologist, and Dr. Isabel Smith, a psychologist specializing in autism, for helping with this question.

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