Lilia is 7 years old and has a diagnosis of autism and learning disability. She is non-verbal but seems to understand much of what is said to her. She also understands Makaton sign language. Although Lilia is toilet-trained and continent, she takes every opportunity to smear her own faeces. Her mother reports that she opens her bowels many times a day and her movements are generally very loose. If she is not monitored very closely she will collect her faeces and attempt to store these in her pocket or hand. She has a favourite doll and she likes to smear it with her faeces.

Strategies

• In order to establish any potential reactions to specific foods or drinks, a food diary should be kept by home and school, detailing Lilia’s bowel habits as well as her food and drink intake. This should be examined to ascertain whether there is an underlying cause of Lilia’s frequent and loose stools, such as food sensitivities or poor diet. More settled bowel habits could result in a natural decrease in the difficult behaviour.
• Lilia’s smearing habit may be linked to a sensory preference and it might be possible to provide an alternative that provides a similar tactile experience. Certain toys such as ‘gunge’ have similar qualities and if Lilia is allowed to carry these around with her, she can be encouraged to play with them instead.
• When Lilia uses the toilet, an enjoyable distraction should be offered immediately in order to avert the possibility of faeces storing or smearing.
• A simple teaching programme should be introduced to help Lilia understand the role and importance of toilet hygiene. This should be built around Lilia’s preferences. For instance, she may enjoy the tactile experience of liquid soap and using this to clean her doll could become an effective replacement.