This is very, very simple indeed:

• Ask a question with two possible answers.

• Take their hand to their right shoulder as you say the first answer.

• Take their hand to their left shoulder as you say the second answer.

• See which shoulder they want to take your hand back to.

• If there’s a yes/no question, always use the right shoulder for “yes”.

That’s it.

An example: “Is your belly hurting?”

• Say “yes” and take their hand to their right shoulder.

  • Remember: always use the right for an affirmative choice.

• Say “no” and take their hand to their left shoulder.

• Then say “yes or no?” and move their hand a little bit and see which shoulder they take your hand to.

A choice to remember: “Something Else”

Often there are many possible answers. You can work through them with “something else” as the second choice:

• Shall we go to the park or something else?

• Say “to the park” — hand to their right shoulder.

• Say “something else” — hand to their left shoulder.

• They indicate “something else”.

• Say “okay, shall we play on the swing in the garden or something else?”

Yes, it can become a game of “20 Questions”, but it’s surprising how often you can narrow things down once you have eliminated your earlier guesses.

This is obviously very, very simple to pick up for both parents and children.

No child is likely to get this on the very first go, so it will take some practice. Also, for many of our children, their body map is rather scrambled and their motor control might not let them point to what they want (at least, at first), but with your hand on theirs, you can steady them and you will feel which way they are indicating.

I didn’t invent this; it was taught to me by a good friend who has changed our lives with her wisdom.

Once you can ask questions and get immediate answers, this is truly life-changing, especially since you don’t need any tools or setup whatsoever. Once you’re both practised at it, it works even in very stressful situations, which resolve far quicker if you can figure out what they want!

Our son is severely autistic. Kids in his situation sometimes never learn to use the toilet and need nappies (diapers) their entire lives.

My wife’s approach to this was slow and gentle, and it worked. I’ve never come across any approach quite like it, which is why I’m sharing it — there is more than one way to do this.

In this post

• Toilet training can work with a slow, gentle, child-led approach.

• Use predictable moments, like before going out and after coming home.

• Phase out nappies in easier conditions, not all at once.

• Let them set the pace while gently encouraging toilet use.

• Remove nappies fully only once toilet use is already established.

• Progress does not have to be perfect to be life-changing.

Another way to toilet train

First she realised that he’d been dry overnight for some time, waking to squat and pee (incidentally, I’ve heard from other parents that electronic bedwetting alarms can be very helpful).

So she started leading him straight to the toilet when he leapt up to squat, and getting him to sit there, which he resisted for quite a while (some weeks, maybe — it’s hard to recall) but eventually he started to pee in the toilet.

From there she took the unusual step of putting him in boxer shorts overnight, and that worked fine! He seemed to like not having a nappy on overnight. Usually the overnight nappy is the last thing to go, as far as I can tell.

That went on for some months because the next step needed to wait for summer; accidents when wearing heavy winter clothes are obviously far harder to sort out.

In the meantime, she started taking him to the toilet and encouraging him to go before we went out and also straight after we came back, because he was naturally avoiding having a pee when he was out.

Then, when summer came, she gradually started introducing more and more time without nappies and offering him the toilet every now and then.

For the first couple of weeks or so he always had a nappy on when he went out but very rarely used it. So then she started choosing trips where an accident would be less inconvenient; an accident during a walk in the woods isn’t such a big deal as an accident during a visit to the shops.

He never attempted to poo in his pants, but would ask for a nappy by getting one out and bringing it to her. Eventually he started taking off his boxers and putting the nappy on for himself. If she caught him doing that, she’d ask him if he wanted to try in the toilet first.

Then we found that he was occasionally pooing independently in the toilet.

So at that point she took the nappies away completely… and that was it!

Amazingly successful

He almost never had an accident, the entire time. He had one pee during a very long boat ride and one poo when he was very, very excited and running about on a beach. It seems very unusual to have had so few accidents. I think it’s simply due to taking it very much at his pace, setting him up to succeed and getting him reasonably comfortable with using the toilet before taking nappies away completely.

Not quite done, but close enough

It’s not perfect yet; he’s still got to learn to wipe for himself. So we have that to get through, but it’s a massive improvement to our lives to escape the hell of endless (potentially, literally endless) nappy changes, resupplying nappies, washing and drying the wash cloths, etc.

The only thing which wasn’t gradual was using public toilets. It just wasn’t practical to get things working well at home first, as is often advised, since there’s only so much time during a school summer holiday and there are many places to visit. He generally is fine with them, mainly only objecting to long-drop, smelly toilets in forests. He can get pretty upset about using them but will eventually be persuaded and have a pee, which also lets him have the victory over his fear.

Now the skill that he needs to learn is having a pee in the woods!

Think your child could never do this? How often have they swallowed great lumps of food (or non-food!) without chewing and you've seen it come out whole in their poo? Do you think they can’t swallow a sugar pearl (in the picture!)?

In this post

• Start with tiny “sugar pearls”, then move gradually to small capsules.

• Swallowing capsules unlocks options that hiding supplements in food can’t.

• If your child is fussy with drinks, being able to use prescribed medications as capsules could be vital.

• Even severely disabled kids can learn this!

• Keep practice low-pressure, brief but consistent rather than forcing it.

• Swallow a capsule yourself, each time.

• Reward any attempt, no matter how bad with lots of praise and a treat.

• Make sure they take enough water to properly wash it down.

• Make sure to choose capsules without any smell at first.

• Tell them what good things it can do (happier belly!), even if you think they don’t understand (they probably do…).

I would do this as an absolute priority for any autistic child. Once you are not limited to what can be hidden in food you have the potential to make huge changes in their health. Also, if your child is fussy with drinks, remember that doctors usually prescribe liquid formulations for children. Being able to take capsules has been vital for our son when needing to take medications.

I wish we had done this years earlier. It was an absolute game-changer in terms of what we can consistently get our son to take and therefore the results we are now able to achieve with those things.

He has made huge, huge progress since learning this. It has entirely changed the trajectory of his life — and ours!

Hiding supplements and medications in food is simply not feasible, even if it works at first. There are numerous stories of children suddenly refusing to eat anything that tastes bad after years of accepting awful flavours from “hidden” supplements, and their health and behaviour falling apart as a result.

At the time we did this, he was not a compliant child. He has a diagnosis of low-functioning autism with severe learning difficulties. I think we could have got a diagnosis of Oppositional Defiant Disorder (ODD) if we’d pushed for it.

But swallowing capsules allowed us to get the right things into him and he’s transformed into a far happier and more cooperative child. He’s simply unrecognisable from how he was.

Frankly, we didn't think this would be possible for him, but with persistence across weeks and months, it was.

The parent who originally told me about this got it done in four weeks, but another parent I know managed it in a single weekend.

How you can do this:

Simply buy:

• Small “sugar pearls” (the things in the picture at the top of this!)

• A supplement that comes in very small capsules

  • Make sure it doesn’t smell bad — that could be off-putting (e.g. not TTFD form B1)

• A slightly larger capsule to move on to

Then just try it, as often as you think your child will tolerate, without forcing the issue.

Take the pearl yourself, show it’s gone, then offer it to them. Have a treat ready as a reward for trying.

There’s no more of a trick to it than that.

Once it’s working, it’s likely you’ll find that taking two capsules in one mouthful is no more trouble than taking one, and taking multiple separate mouthfuls of capsules should follow relatively easily.

I find it easier to eat a little food between every few capsules, and so does my son.

How did we do it?

We started out with very small “sugar pearls” that were only about 2–3 mm in diameter. We managed to find organic ones without scary colouring.

Honestly though, I wouldn’t hesitate to use scary coloured ones if that’s all I could find. This is so, so important.

No, it does not matter that they are sugar, for three reasons:

• They are tiny! The amount just isn't worth considering.

• You're using them to teach what might be the most valuable skill they could acquire: the ability to take things that can change their life..

• They will only ever eat a dozen or fewer because as soon as they can swallow them consistently, you'll swap to a (tiny) capsule of some supplement.

We only did it once per day to avoid it turning into a battle of wills and we’d always “take” a pearl first ourselves; we'd each put it on our tongue and then swallow the water before showing our empty tongue. Then we would eat a piece of the treat we were offering him.

In our case, the treat was dried fruit. It was the same dried fruit he got anyway, but we couldn’t think of any other option that didn’t also cause his gut to flare.

He fairly quickly tried putting the pearl in his mouth, but always spat it out again.

After some weeks of that he got the idea of holding it in his mouth and taking a sip of water, but he always cunningly spat it into the water glass. Again, that went on for weeks.

Then, one day, he just swallowed the pearl.

I did make sure he took a big enough swig of water: I raised the glass he was drinking from a little so he extended his neck and had to take in more of the water.

We gave him lots and lots of praise and lots of treats. And the next day… he didn’t do it, and it was hit-and-miss like that for about two weeks.

Then it stopped being hit and miss, and he started swallowing the pearl every day.

We carried on with the pearls for a few days because we were afraid to change anything and mess up the whole process.

Eventually I got a tiny Jarrow Pterostilbene capsule (size 5 maybe?) instead of the sugar pearl… and as I was trying to put it into his mouth, I dropped it and it rolled into the hallway.

To my astonishment, he went and picked it up and handed it back to me, waited for me to put it into his mouth, then swallowed it without blinking.

And that was that.

After a week on those, I started making up a size 2 capsule (I'd bought empty ones from iHerb) and filling it with some of the nasty things we were getting him to lick from a spoon each morning (the only way we could get the things into him that were needed to avoid our lives falling apart).

Then, after a week, I moved up to a size 1 capsule, which held all the nasty things from the spoon!

The first day I made up a capsule, I also made up the ”nasty spoon”. As usual when he saw the spoon he got a bit upset but when I told him he didn’t have to take it because he was going to take the capsule he was so happy!

He didn’t stop running and hooting for fifteen minutes! A few minutes later, he ran over to the plate with the nasty spoon on it, pushed it across the table and shouted “No! No!” — remember, he’s non-verbal!

I still made up the “nasty spoon” for another few days but each day I showed it to him and told him he didn’t have to take it because he was taking the capsule and each time he was clearly very happy about it.

He has gone through periods where he’s really not wanted to take them but we try to keep it light and just insist it’s next on the agenda, no more food, treats or activities until it’s done. It’s non-negotiable.

One important point: we had to try to encourage him to drink enough water when swallowing the capsules. Otherwise he seemed to treat the water as just a part of the ritual, not realising that taking a tiny sip of water might not be enough to wash the capsule down.

Don’t forget to explain why they might want to take them!

We had no idea how much our son understood of what we said. Now we realise he’s understood for years.

We’re sure it has really helped to explain to him why we take the capsules, and to keep reminding him. We tell him they help him to sleep, to think more clearly, to stop his skin itching, to keep his belly happy and to speak! All of which they are actually doing!

I’d always frame it as things to gain: “This will help your belly feel happy” rather than things that will be avoided: “You need to take this or your belly will hurt”.

Once he was taking them, I told him that he’d learned to do something that very few kids can do, and even many adults can’t do. He seemed very pleased about that indeed!

Some answers to common questions

Once they are taking their first tiny capsule, how soon do I move on?

Soon! A very few days at most.

And soon on to an even larger capsule (preferably containing something with a lot of value to your child); after that, two at a time before introducing multiple separate mouthfuls.

Do I have to fill my own capsules?

Certainly not! I think most people don’t.

One parent I know has their child swallow literally dozens of capsules every day and her progress has been simply stunning.

My son absolutely would not take too many capsules in one sitting, so I encapsulate exactly what he needs every morning by opening up other, smaller capsules and emptying them into larger ones. I'd rather not have to, but we do what we must.

If you do buy empty capsules, nothing smaller than a size 2 is very practical (so, not size 3s). Empty ones can be bought easily on iHerb, for example.

What do the size numbers for capsules mean?

First of all, it doesn’t really matter. You don’t need to know anything about capsule sizes to do this.

Confusingly, the numbers go the wrong way around. The smaller the capsule, the larger the number.

Size 5 is absolutely tiny. Size-00 is the largest capsule that you’ll find supplements come in (a Jarrow Colostrum or a Microbiome Labs MegaSporeBiotic).

Size-000 is absolutely huge — but I know of an 11-year-old who swallows them without any trouble (I don't recall ever seeing a supplement in a size-000 capsule — the largest I've ever seen is size-00).

How do I learn the capsule size numbers?

You don't need to learn them!

I'm just talking about them here because there's no practical way of describing them.

Just start really small and work up, in large steps.

Should I build up from size 5 to 4 to 3 etc?

The short answer is, no. It's just not necessary. I really don't think anyone can notice the difference between swallowing a size-2 and a size-0 (the latter is larger).

My son developed what’s now being termed “level three autism”, meaning he is about as severely disabled as you can get with this diagnosis, needing constant care. He is non-verbal and has difficulty consistently controlling his body in terms of basic movement and general behaviour.

But the changes we have seen, using things as simple as supplements, are astonishing. I would never have known about any of them were it not for other parents, and some enlightened doctors, putting their knowledge online.

Some of the things which have been game changers for us have also been game changers for other parents. So, on the one hand, I feel something of a duty to pass on what I have found, and on the other it’s obviously very gratifying to hear back from a parent that their child’s life has radically improved because of something I passed on.

My personal bias is very much towards biomedical interventions, but there are definitely behavioural things that should not be overlooked. However, I think it’s undeniable that it’s extremely difficult to change your behaviour if you’re feeling ill. So, using biomedical interventions as the basis gives behavioural changes the very best chance.

I also have a separate Substack where I post more generally applicable health-related pieces, aimed at people outside the autism world. But many of those pieces are relevant here too, so I repost them on this Substack. Hopefully that’s not too confusing.

I’m not selling anything, nor do I plan to. I’m just trying to pass on the things I know, to help others. Will they help your child? I don’t know. Most of the time the only way to know is to try. Will things I write about help every child? Certainly not. Everyone is different and has different needs and underlying problems.

But I hope you find something that makes the life of your child a little better. Actually, I hope it makes it a lot better.