My autistic 11-year-old still has toileting accidents. Is it medical or behavioral?
A parent asked this on Reddit after years of trying, and the most upvoted answer named a medical cause. This page explains that cause, how common it is in autistic children, and what to rule out before any behavior plan.
Every claim is checked against a 33-study systematic review and the DSM-5, and reviewed by Rachel Blackburn, BCBA.
Rule out constipation and impaction first. Overflow soiling looks exactly like a behavior problem and does not respond to one.
The Reddit post
A parent of an 11-year-old with an ASD Level 1 diagnosis described near daily soiling that happens in the evening, usually in front of a screen, sometimes minutes after a scheduled toilet sit.
I am at my wits end. He's 11 and has a mild ASD 1 diagnosis. The biggest societal norm he struggles with is the near daily pooping accidents. We've gone through a children's hospital encopresis program with very sporadic success.
Read the original thread on r/Autism_Parenting · posted 2026-08-19 · 44 comments
Top comments at a glance
| Comment | Upvotes | Core claim | Our take |
|---|---|---|---|
| “Turned out that he had major impaction from withholding over the years and his colon was basically out of space, so new poop just sort of went straight out” | 20 | Overflow soiling from impaction mimics a behavior problem | Accurate |
| “He may legitimately have trouble recognising when he needs to go. A lot of autistic kids do, it's a sensory processing thing” | 19 | Interoception differences make body signals hard to notice | Accurate |
| “The reason is happening only when he's watching a screen is because the screen is diverting his attention away from his body” | 19 | Screens are the trigger | Partly true |
| “I just sat him down and explained calmly that the point of him pooping in the potty was so that he didn't have to wear diapers, change clothes, or get messy” | 7 | Explaining the reason can be the missing piece | Partly true |
Could this be a physical cause, not a behavior?
Accurate
This is the most important comment in the thread and it describes a recognized pattern. Fecal incontinence was reported in 2 to 12.5% of children with autism across the studies in one systematic review, significantly above controls where measured (Niemczyk et al., 2017), and chronic constipation is a leading cause.
Evidence: Niemczyk et al., 2017, systematic review of 33 studies
Why would he not feel it coming?
Accurate
Differences in sensing internal body signals fall under the DSM-5 sensory reactivity criterion for autism, and they explain why a child can be genuinely surprised. Treating that as defiance makes it worse.
Evidence: APA, DSM-5-TR sensory criteria
Is the screen actually causing it?
Partly true
The evening pattern the parent described does point at attention, and removing screens in that window is a free test. Calling it the cause skips the medical question that has to come first.
Evidence: Same thread, parent-reported pattern
Does explaining why it matters help?
Partly true
For some children the purpose has never been made explicit, and that conversation is free to try. It rarely resolves a case this long-running on its own.
Evidence: Same thread
What to do this week
- Ask the pediatrician specifically about impaction and overflow. The parent in the thread had been through an encopresis program and still had it missed.
- Run a two-week no-screens-after-dinner test. Free, reversible, and it tells you whether attention is part of the pattern.
- Log every accident with the time and what was happening. The evening-plus-screen pattern in this thread was the diagnostic clue.
- Only then build a behavior plan. A plan built on top of an unresolved medical cause will not hold.
What we have actually seen
Toileting is one of the most common goals Colorado families bring us, and it is also the one where we most often ask a family to see their pediatrician first. Once a medical cause has been addressed, our BCBAs build a plan around the child's actual signals and routines rather than a fixed schedule, and we teach parents to run it because most of the opportunities happen outside session hours. An 11-year-old's plan is written with far more privacy and dignity than a toddler's.
The Colorado numbers
- Toileting goals are covered under Health First Colorado and major insurance as part of an ABA plan when a BCBA documents the need. Most Medicaid families pay nothing out of pocket.
- Budding Futures serves children to age 18, so an 11-year-old is squarely inside our range, and we work in the home, which is where this skill actually has to happen.
- There is no assessment waitlist, which matters when a family has already spent years on this.
Quick answers
Should I see a doctor before starting a behavior plan? Yes. Chronic constipation and impaction have to be ruled out first, and a behavior plan built on top of a medical cause will not hold.
How common is this in autistic children? Fecal incontinence was reported in 2 to 12.5% of autistic children across the studies in a 33-study systematic review, higher than typically developing peers (Niemczyk et al., 2017).
What is interoception? The sense that tells you what is happening inside your body, including needing the toilet. Sensory reactivity differences are part of the DSM-5 autism criteria.
Can ABA help with toileting at this age? Yes, once medical causes are addressed, and the plan looks different from a toddler's. Budding Futures builds these goals with the child's privacy in mind.
Is toileting covered by Medicaid in Colorado? Toileting goals can be part of an ABA plan when a BCBA documents medical necessity. Most Health First Colorado families pay nothing out of pocket.
More from this series
Sources
Niemczyk et al., 2017
Incontinence in autism spectrum disorder: a systematic review of 33 studies.
NIDDK, National Institutes of Health
Constipation and fecal incontinence in children, including overflow soiling.
American Academy of Pediatrics, HealthyChildren.org
Encopresis and chronic constipation.
American Psychiatric Association, DSM-5-TR
Autism diagnostic criteria including sensory reactivity.
Budding Futures
ABA therapy for potty training and toileting.
Who we are
Budding Futures ABA provides in-home ABA therapy across Colorado for children 18 months to 18 years. Care is play-based and assent-based, built on Natural Environment Teaching, with BCBA supervision targeted at about 20% of hours, which is four times the BACB minimum. Parent coaching is part of every plan and there is no assessment waitlist. We accept Health First Colorado and major insurance, and most Medicaid families pay nothing out of pocket. Our clinical director is Rachel Blackburn, BCBA, and the practice is led by director Mark Hirsch.
Stuck on toileting after everything else?
We can talk through what a plan would target once medical causes are ruled out, and what your insurance would cover.