Toilet training children is not an easy task for any parent. Every child is different and may require a variety of techniques and supports. We encourage a child – oriented approach that uses positive reinforcement. We want children to have the physical abilities to get to the bathroom, remove clothes, dress and wash hands. We also look for children to have the self esteem and motivation to develop the independence for this skill.
Children with autism may require alterations in the techniques to develop the skills for toileting. Children with autism may have difficulties with sensitivity to their environment, changes in the environment, social motivation to use a toilet, transitions, and communication skills that interfere with instructions and requests.
Considerations to be Aware of for Children with Autism:
Sensitivity to their environment – sounds, lights, smells, physical sensations, and flushing may be difficult. They may not like the change in temperature of taking off clothes or toilet seat.
Changes to the environment – differences in bathrooms – may want to use one specific bathroom.
Social Motivation – Social rewards and praise or just being dry may not provide reinforcement. They may not understand an explanation of the need to use a toilet.
Transition – Children with autism like routines and are resistant to changes. Loss of the diaper may in itself be difficult.
Communication – Children with autism may be better able to communicate with visuals rather than verbal skills.
Gastrointestinal Issues – Many children with autism have concerns of diarrhea or constipation.
How to Train Ourselves and Our Child
Preparations for Parents Ahead of Training
- Start by recording or charting your child for 2 to 3 days.
- Have 30 minute spot checks to note if they are wet or dry.
- Chart both bowel movements and urination.
- We need to train ourselves to be aware before children can be trained.
- Learn to read the bodily cues of your child.
- Prepare visual icons or pictures of the toilet ahead of time.
- Plan your routine and have needed materials in the bathroom.
First Training Days
- Set aside a weekend or several days for intensive training (no other activities for those days).
- Tell your child ahead of time we are going to have a potty day.
- Hydrate your child with lots of juice, water and milk.
- Set a timer for every 30 minutes and practice the entire potty routine. Do not ask your child if they need to go to the bathroom. Timer goes off and everyone follows routine. Say, “Time to go to the bathroom.” It does not have to be for a long period of time on the potty. Complete the whole routine with or without the urination. Show the child strong encouragement and praise. Celebrate small successes. Even when you have a success, continue this same procedure throughout the day with frequent opportunities to practice. Positive reinforcement can be given for successfully going in the toilet or for having dry pants.
- The following day continue to have frequent opportunities to practice. With success you can lengthen the time and gradually eliminate the use of the timer. Continue to say, “Time to go to the bathroom.” Do not expect the child to tell you when they need to go to the bathroom. This is a completely different task and requires additional skills. This can be taught with a bathroom icon or symbol.
- If children have difficulty with bowel movements there are some procedures for a gradual transition. First allow the child to poop in a diaper with clothes on while sitting on the toilet. Then allow them to poop in the diaper with pants down and sitting on the toilet. The final step would be to pull down pants and diaper to poop on the potty. This may have to be gradual and over time. For a sense of stability children need to have their feet on a step stool or floor in order to relax. Balance is important.
- If a child has an accident, have them help be responsible for their own care. It may be helpful to spread newspapers on the bathroom floor but have them remove their own clothing, help with self cleanup, put on fresh clothes, take soiled clothing to the laundry to be washed. Then practice from the location of the accident through the whole bathroom routine. This should not be done in a punishing manner but practice for improved skills. No scolding but as a support to know what to do next time.
Tips for Consideration
- Do not begin training at a stressful time. Examples – Moving or new baby.
- Determine the right schedule for your child.
- Use language of wet/dry and not clean/dirty.
- Turning on the faucet and the sound of running water may facilitate some children.
- Have favorite books and music available in the bathroom. Make it comfortable.
- Feet should touch the floor or a step stool for a sensation of security and balance.
- A good time to schedule a trip to the bathroom is within a few minutes after meal times or snacks.
- Some children may need a visual icon to follow instructions. Hand them the icon and say, “Time to go to the bathroom” Have a location to place the icon in the bathroom.
- Have motivators that work for your child. They should be immediate. For some children the opportunity to flush is a motivator. Pair it with praise and encouragement. A parent may need to start with stickers or snack treats.
- Having a family member model may help some children.
- To reduce distractions a small half bathroom might be a better place to train.
- A potty chair with arm rest or trays to help with a comfortable place for sitting and playing is useful for some children. However, some programs do not suggest potty chairs if your child has difficulty with transition. This just requires an additional transition.
- Include hand washing as part of the toileting routine from the start.
- Treat accidents lightly.
- Regression and relapses are common.