Reasonable adjustments are changes that your school or family makes to remove or reduce a disadvantage because of your neurodivergent needs around routine and change.  You can ask for reasonable adjustments to be made. 

Children with disabilities may experience the same bladder and/or bowel issues as their  typically developing peers. However, they are more likely to develop lower urinary tract symptoms and/or constipation. Furthermore, they may face additional obstacles to achieving and maintaining continence. Restricted mobility may make getting to the toilet more challenging; communication difficulties can hamper requests for help; reduced social awareness may impact on their desire to learn to use the toilet, sensory issues may make them unwilling to use school toilets.

Some children with disabilities will require adaptations to promote toileting. Liaising with their family and health care professionals is important to ensure that individual needs are understood and met. Some children with disabilities may already have a care plan in school.

If so, any continence needs should be included in these. Learners without a care plan may benefit from one.

Access to the toilet

Schools should be aware that some learners avoid eating and/or drinking in school so that they can avoid using the toilet. This is more likely if they feel that toilet access is restricted, or they feel the need for additional privacy, or school toilets are poorly maintained and stocked.

Learners should have open access to clean, safe, well-stocked toilets throughout their hours at school. This is particularly important for younger children, those who have difficulties with their bladder and/or bowel and for girls who are menstruating. Some learners will need prompting to use the toilet; it may be appropriate to do this after breaks, meals and snacks.

https://eric.org.uk/information/school-toilet-policy/ provides good advice for schools around child continence

Hygiene standards in school toilets

It is important that school toilets are cleaned and restocked as required during the day, so that learners have access to suitable facilities, appropriately heated, ventilated and lit, with toilet paper, soap and paper towels or hand driers. Floor to ceiling doors ensure privacy.

Movement sensors are not recommended for school toilet lighting as they may switch lights off while a learner is still using the toilet.

Waste bins should be provided in all cubicles for both sexes. The bins should have an attached lid, be lined with a disposable rubbish bag and have an opening of sufficient size to easily accept large pads, catheters etc, as well as sanitary protection. All learners using such equipment should have disposal bags provided by home for these items. This allows discrete and hygienic disposal and ensures double bagging.

Girls who have reached puberty require appropriate provision for sanitary wear, but any learner may need to dispose of catheters, stoma bags or continence containment products.

Waste bins should be emptied as required during the school day to ensure they are not overfilled.

Learners with additional needs or those with continence difficulties may require extra space and privacy than is afforded by most school toilets and provision should therefore be made for them to use the disabled toilet. Those with sensory issues may also need special provision, such as access to a toilet that does not have hand driers.

Consideration should be given to a discrete location for learners to store spare clothes or accessories required for toileting or changing, including items such as catheters and wipes. Soiled items to go home for laundering should be returned discreetly.

School toilets: Good practice guidance for schools in Wales (2012)
https://www.gov.wales/school-toilets-good-practice-guidance

School toilet provision

Schools must meet the minimum standards required by legislation. It is good practice for schools to consider:

• Provision of sufficient toilets to cover peak use in break times
• Whether toilets should be provided separately for girls and boys
• Whether there should be gender neutral toilets. If these are single cubicles, they should ensure the privacy of the occupant, by having full height walls and doors
• Gender neutral cubicles offer choice to learners, increase accessibility, meet legislative requirements for schools to provide for learners who are taking steps to live in the opposite gender and are what learners are used to using at home
• That single cubicles with washbasins provide privacy for learners who need to clean themselves after an episode of incontinence. They usually have bins and these should be provided for those who need to dispose of accessories, such as wipes or catheters
• Many learners do not like having toilets that open directly onto a school corridor, as they do not like feeling they are being observed going into the toilet
• That behaviour generally in the toileting area may improve when all learners are using enclosed toilet cubicles, in a single area
• Involving the learners in decisions about school toilet provision

Managing episodes of incontinence in school

Episodes of incontinence may occur for a variety of reasons. If it is known that a child may have bladder and/or bowel difficulties their parents should ensure that sufficient clothes/equipment for individual requirements are available in school at all times.

It is not acceptable for school to suggest that a learner goes back into disposable continence containment products (nappies or disposable pants) as a means of managing incontinence.

Washable ‘protective’ or ‘padded’ continence pants are acceptable. Disposable continence containment products reduce the sensation of wetting and soiling and may give the learner the impression that it does not matter where they pass urine or open their bowels.

Disposable continence containment products should only be used to manage incontinence in school if recommended by a healthcare professional who is involved in treating the learner’s bladder/bowel issue.

If a learner is incontinent frequently and this is causing concern either for the learner’s wellbeing or in terms of management, parents and an appropriate healthcare professional should be consulted. Parents may be asked to provide washable pants as an alternative to disposables, although each case should be assessed individually.

Schools should consider that time spent assisting a learner to change is an opportunity for a positive learning experience. It may take ten minutes or more to support an individual with changing, but this time should be used to assist them to become as independent as they are able and is not dissimilar to the time allocated to working with a learner towards an individual learning target.

Continence policies for schools

A clear intimate or personal care policy in schools will not only help to safeguard both learners and staff but will ensure that arrangements and expectations are clear. It will ensure that learners’ independence and welfare is promoted, their dignity and privacy is respected. It will also promote confidence in the child and family that school is supportive of their needs.

Learners with bladder and bowel issues who receive support from school are more likely to achieve their full potential28. Personal care is usually included in job descriptions for school support staff. Assisting a child in such a way that they learn the skills needed for independence with their personal care, as far as their medical condition and level of ability allows, may form part of their one-to-one education.

The policy should outline the circumstances when it is appropriate for a child to have a care plan.

Individual Health Care Plan for pupils with continence conditions

An Individual Health Care Plan (IHCP) is essential to ensure a child’s needs are sensitively and effectively met in education settings and that all people responsible for the child understand their needs.

ERIC has produced a template IHCP with input from Dr Eve Fleming, a community paediatrician and Brenda Cheer, a Paediatric Continence Specialist Nurse. The plan was reviewed by a school nurse, a paediatrician, and two families of school-age children with continence problems.

https://eric.org.uk/individual-healthcare-plan/

For parents

Allow plenty of time to talk about wees and poos. Using picture stories to help understanding.
https://autismlittlelearners.com/toileting-training-using-social-stories/

Routines will be important, needing consistent approaches and careful use of language.  For example, asking a child to sit on the toilet may not yield the best response, but asking the child to sit on the toilet to let the poo slip out into the toilet, is clearer and the instruction is unambiguous. 

The child may have difficulty reading between the lines of communication, so clarity and openness is important. 

Some of the causes of communication difficulties are explained further here:
https://www.autism.org.uk/advice-and-guidance/professional-practice/toileting

Although there may be challenges in toilet training, patience and sticking to a toileting regime will often bring success in the end; never say never!

Encouraging 5-10 minutes (maximum) on the toilet 20-30 minutes after meals, is when the child is most likely to pass a poo. This should be a relaxing time with something for the child to do.

A footstool enabling the child’s knees to be at hip height, will provide the best toileting position.