What is the recommended approach for assessing and managing continence issues in teenagers with Autism Spectrum Disorder (ASD)?

From the Guidelines

The recommended approach for assessing and managing continence issues in teenagers with Autism Spectrum Disorder (ASD) involves a comprehensive, individualized assessment followed by targeted interventions, prioritizing a multimodal approach that addresses physiological, sensory, communication, and behavioral factors. When assessing continence issues in teenagers with ASD, it is crucial to begin with a thorough medical evaluation to rule out physical causes such as urinary tract infections, constipation, or neurological issues 1. Functional assessment should document patterns of incontinence, including timing, frequency, and potential triggers, while considering sensory sensitivities and communication challenges common in ASD. Behavioral interventions form the cornerstone of management, including:

• Scheduled toileting routines (typically every 2-3 hours)
• Positive reinforcement systems with immediate rewards for successful toileting
• Visual supports such as picture schedules or social stories
• Environmental modifications to address sensory concerns in bathrooms. Medical interventions may include treating underlying constipation with dietary changes, increased fluid intake, and occasionally medications like polyethylene glycol (Miralax, 17g daily) 1. For urinary issues, desmopressin (DDAVP) may be prescribed for nocturnal enuresis at 0.2-0.4mg at bedtime. Parent/caregiver training is essential, focusing on consistency across environments and adapting strategies to the teenager's specific needs and developmental level. This approach is supported by the understanding that children with ASD need a structured approach with explicit teaching, and that long-term treatment planning and family support are crucial 1. By prioritizing a comprehensive and individualized assessment and intervention plan, clinicians can effectively address continence issues in teenagers with ASD, improving their quality of life and reducing morbidity and mortality associated with untreated incontinence.

From the Research

Continence Assessments on ASD in Teenagers

• Continence issues are common among teenagers with Autism Spectrum Disorder (ASD), with studies showing increased rates of nocturnal enuresis, daytime urinary incontinence, and fecal incontinence compared to typically developing teenagers 2.
• A multidisciplinary approach is recommended for assessing and managing continence issues in teenagers with ASD, taking into account the individual's unique needs and circumstances 3, 4.
• The International Children's Continence Society (ICCS) consensus document highlights the importance of adapting treatment approaches to the specific needs of patients with neurodevelopmental disorders, including ASD 4.

Assessment and Management Strategies

• A comprehensive assessment of the individual's continence issues, including medical, behavioral, and psychological factors, is essential for developing an effective management plan 2, 4.
• Behavioral interventions, such as toilet training and bowel management programs, may be effective in improving continence outcomes for teenagers with ASD 5.
• Collaboration between healthcare professionals, caregivers, and the individual with ASD is crucial for ensuring a coordinated and supportive approach to managing continence issues 3, 4.

Considerations for Teenagers with ASD

• Teenagers with ASD may experience delays in achieving bowel and bladder control, highlighting the need for ongoing assessment and support 2.
• Co-occurring psychological symptoms and disorders, such as anxiety and mood disorders, may impact continence outcomes and require concurrent management 2, 6.
• A holistic approach to care, addressing the individual's physical, emotional, and social needs, is essential for promoting optimal continence outcomes and quality of life for teenagers with ASD 3, 4.