The goals of most young people during the teen years consist of getting an A on the next math exam, scoring an after-school job, getting their driver's license or going to the winter formal. The goals for teens with physical and/or mental disabilities or special needs are far different, but no less important. They may be working toward reading, riding public transportation, counting change or getting along in a group. And many are still working on keeping their bed dry at night.

Dealing with the problem of wetting the bed, or nocturnal enuresis, for the special needs teen would be no more difficult than it would be for their counterpart without special needs.

Preserving Self-esteem
Maria Wheeler, educator and author of the book, Toilet Training for Individuals With Autism and Related Disorders, believes that preserving the young person's self-esteem is key. "As a child becomes older, toilet-training problems can significantly interfere with self-esteem, acceptance and social success," says Wheeler.

Wheeler is passionate in her efforts to guide families, educators, therapists, medical professionals and caretakers in teaching techniques that treat special needs children, adolescents and adults with dignity and respect.

The causes of nocturnal enuresis in special needs adolescents cross the spectrum of both physical and mental disorders. Autism, pervasive developmental disorders (PDD), Asperger's syndrome and various physical conditions such as seizure disorders or cerebral palsy may influence physical awareness or bladder/bowel control. Teens who have various emotional disorders may be challenged by issues related to toilet training due to unusual fears, excessive anxiety or excessive fear.

Being sensitive to your teen's feelings is crucial for their sense of self-concept and their confidence in eventually controlling this behavior. "We must be very sensitive to, and understanding of, the degree of embarrassment and anxiety associated with bedwetting issues," says Wheeler. "The more anxiety, pressure or embarrassment that surrounds the issue of bedwetting, the greater the risk of continued bedwetting and possible psychological harm."

Wheeler suggests that in addition to providing the supports your teen needs to awaken at night and access the toilet, be sure to minimize related embarrassment by providing whatever your teen needs to be clean and by disposing of any soiled linens and clothing as privately and discretely as possible. "Avoid scolding or discussing your teen's toileting issues in front of others, including family members," she says.

Dealing With Friends
One of the most sensitive issues that arises concerning a teen's inability to control their bladder at night is social. Teens with special needs have social needs as well, and meeting those needs with sensitivity and understanding takes some thoughtful consideration.

"Many special needs teens who have bedwetting concerns find using adult protective underwear under their bed clothing a discrete approach for avoiding embarrassing bedwetting accidents when spending the night with friends," says Wheeler. "One girl who had a bedwetting problem brought her sleeping bag to sleepovers, keeping her protective underwear in the sleeping bag, and discretely put the protective underwear under her bedclothes after her friends went to bed. Using a sleeping bag with special absorbent padding discretely placed inside is another option."

Helping Your Teen Stay Dry
To help your special needs teen remain dry at night, Dr. Henry Roane, of the Marcus Institute in Atlanta, believes that there are a number of interventions useful in treating nocturnal enuresis, though these interventions tend to vary in terms of their long-term effectiveness and intensity.

Dr. Roane works in the Marcus Institute's outpatient program which deals with special needs children and adolescents with problematic behavior, such as noncompliance, sleep problems or toileting problems. He has found that though antidepressants such as Imipramine are the most commonly used medications for the treatment of bedwetting, they are sometimes associated with behavioral side effects. "More importantly, although medications may decrease bedwetting, they do not teach the child appropriate toileting skills," says Dr. Roane.

He has found that behavioral interventions are as effective as medication though usually more time consuming for caregivers. "A common behavioral intervention for bedwetting is the use of a urine alarm," says Dr. Roane. "A urine alarm is a pad covered by two sheets. The presence of urine on the pad activates an electrical current, which causes an alarm to sound. Over time, the child begins to urinate less and learns to get out of bed with a more full bladder."

Wheeler believes that carefully controlling the amount, type and timing of fluid intake is also critical for success in eliminating bedwetting. She suggests having the teen avoid drinking fluids after 6 p.m. and avoid caffeinated beverages after 4 p.m. "When limiting fluid intake, be sure to consume an adequate amount of fluids earlier in the day to make up for stopping fluid intake later in the day," says Wheeler. "Be sure the person uses the toilet immediately before going to bed."

Innovative Approaches
If the above solutions don't work, sometimes you have to get creative. For example, if teens require an adult to prompt them to use the toilet, caregivers and parents can try visual prompts such as pictures or printed words to replace the verbal prompts.

"For example, one young man with autism with whom I worked would subtly stand next to the bathroom door when he needed to eliminate," says Wheeler. "He would wait for his mother to walk by and tell him to use the bathroom."

This became a problem because the young man would wander the house at night disturbing other family members. Oftentimes he would wet his bedclothes before someone would get up to tell him to go to the bathroom. Although this wasn't a huge problem for the family, they felt that it would help him to be more self reliant if he used pictures instead.

"We posted the picture cue for 'use the toilet' on his bedroom door such that he could see it easily when he started to leave his bedroom at night," says Wheeler. "We posted the picture cue for 'go to sleep' on the wall where he could easily see the picture cue when he finished using the toilet."

They left nightlights on so he could see the pictures easily. When he awakened the first night, his mother prompted him to use the toilet and go to sleep by pointing out the picture cues. She did not talk to him. "Beginning the next night, he stopped wandering about the house and used the toilet at night instead of wetting his pajamas," says Wheeler.

Having problems with wetting the bed needn't be and shouldn't be a traumatic, shameful and embarrassing problem for your special needs teen. With support, caring and sensitive handling of the problem you can help your teen deal with the problem with their self-esteem intact.

Want to see more?

• Beating Bedwetting: Stories of Special Needs Children With Enuresis
• Dry Days Ahead Helping Special Needs Children Learn to Use the Toilet
• Bedwetting and Special Needs Kids
• Absorbent Undergarments and Special Needs Children
• Words That Heal: Incontinence Solutions for Special Needs Kids
• Bedwetting and Summer Camp: Does Your Special Needs Child Have to Miss Out on All the Fun?
• Under Special Circumstances: Sleep Disorders and Bedwetting in Special Needs Children
• Bedwetting and Special Needs Children: How Treatment Varies With Age
• Bedwetting and Your Special Needs Child: Finding the Right Approach
• Talk About It!
  

About the Author: Teri Brown is a Portland-based freelance writer and the author of Day Tripping: Engaging Your Child's Mind and Imagination Though Family Field Trips.