Toilet training can be a challenging process for any parent. It can be even more difficult for parents of children with autism spectrum disorder (ASD). Not only can potty training be difficult for the parent, but it can also be difficult for the child, as well. This guide will help you, as a parent of a child with ASD, to potty train your child in a way that will be less stressful and more successful for you and your child.
Difficulty with Toilet Training
Many children with autism take longer than other children to become fully toilet trained. There can be different reasons for this.
Some children with autism also have developmental delays. They may experience a global developmental delay which refers to having delayed skill development in multiple areas (such as in both fine motor skills, speech skills, and self-care skills) or they might have developmental delays in just one area, such as toilet training or social-emotional skills.
CHANGES IN ROUTINES AND EXPECTATIONS
Some children with autism struggle with changes in their routines. They might struggle to adjust to new expectations. For instance, they might have difficulty with trying to go potty on the toilet - and giving up their old way of going potty - in their diaper.
Although every child with autism experiences communication in their own way, some children with autism can understand verbal instructions while others may not be able to comprehend communication from others. No matter your child’s level of communication and comprehension abilities, their deficits or differences in communication skills may make it difficult for them to process information and expectations about toilet training as compared to how other children receive this information.
ANXIETY OR FEAR
Some children with autism may become anxious or fearful about going potty on the toilet or in a potty chair. This is one reason why it is important not to force a child to go potty on the toilet and to try to use several proactive strategies and reinforcement instead when it comes to encouraging them to become toilet trained. Punishment is almost never recommended for accidents or noncompliance surrounding toilet training-related behaviors.
Recognizing Signs for Needing to Go Potty
One thing to consider when potty training your child is whether they are currently able to recognize if they must go potty - if they actually have to go pee or poop. Some kids might easily be able to recognize the need to urinate and then urinate in the toilet but getting them to poop in the toilet could be much more difficult. Some kids might not notice or pay attention to their body enough to notice when they need to go potty. If this is something that needs to be improved, be sure to help your child work on this.
For any child with autism, identify a functional way that they can tell you or whoever is caring for them (such as a teacher or caregiver) that they need to go to the bathroom. If they can use verbal language, teach them what words to say if they need to ask permission to use the bathroom or if they need to tell someone they are going to the bathroom. If they do not use spoken language, give them a way of communicating to an adult that they need to go to the bathroom. This might be a picture icon card that they give to the adult or it might be by using a communication device.
Remember that typically developing children learn to use the bathroom, at least in their own home, without having to ask to go and without needing to tell their parent that they need to go, so make sure to help your child with autism transition to this level of independence.
Consider Medical Issues
Another important thing to consider is whether there are any medical issues with your child that could affect toilet training. You might want to consult with your child’s doctor to get their input on whether any medical issues could impact your child’s ability to become toilet trained. For instance, some children experience chronic constipation. Others might have what is called encopresis, which is when a child has bowel movement accidents, and they might not be able to sense when they are about to poop. So be sure to consider medical concerns when it comes to toilet training your child.
Even with a medical issue, it doesn’t mean your child can’t get toilet trained, but it does mean that the medical issue should be considered when helping your child to become potty trained.
Going Potty is a Multi-Step Activity
Toilet training isn’t just a one-step process. There are multiple steps for going to the bathroom to urinate or to have a bowel movement. The child needs to go into the bathroom, put up the toilet seat (if needed), pull down their pants and underwear, sit on the toilet (or stand up next to the toilet for boys learning to stand up to urinate), pee or poop in the toilet, wipe, pull up their underwear and pants, flush, close the toilet seat (if this is an expectation of parents), and wash their hands. Washing one’s hands also has multiple steps involved.
It is necessary to think about all the steps involved in going to the bathroom when toilet training your child so that you can provide prompting or help when needed and to support your child’s independence with each step as they can handle the process more and more on their own.
Creating a Potty Schedule
When beginning potty training, it is helpful to create a potty schedule. Decide what times your child should go to the bathroom. These times should be fairly close together and you should keep to your planned schedule to create the best chances of success for your child. If you already know about how often your child pees or poops, then you can use this information to create the potty schedule. Choose times that are a bit more frequent than the times you think your child already goes potty in their diaper.
Another option is to set a schedule to every 30-60 minutes depending on how intensive you want to approach toilet training with your child. You will also want to consider what you think your child can reasonably handle. If your child can go the duration you choose (such as 30 minutes) and stay dry without having accidents a few times (such as 3-5 times) in a row, you can increase the time in between having them go potty. For example, you could increase it from 30 to 40 minutes if your child can stay dry for 30 minutes 3 times in a row. They may or may not go potty on the toilet at the 30-minute mark.
Using Clear Language
When talking to your child about going potty, use clear and simple language. For instance, if you want them to try to go potty or to sit on the toilet, don’t ask them, “Do you think it’s time to go potty now?”, instead, say, “Time to go potty.” or “Go sit on the potty.” Using simple and clear directions is more effective than giving vague and unclear statements or questions.
Using Visual Supports
You might also consider providing a visual prompt if your child might benefit from visual cues. You can do this while also giving the direction “Time to go potty.” You could also add a visual icon in a daily schedule that your child follows so they can see when it’s time to go potty. Visuals can also be helpful for supporting your child in becoming more independent with the entire toilet training routine from entering the bathroom to sitting on the toilet to wiping and washing their hands. You might also consider posting images for the various steps required for washing one’s hands somewhere near the sink for your child to follow while washing their hands.
Although it can be somewhat stressful to transition from diapers to underwear for both you and your child, in the bigger picture, it is often helpful for successful potty training for a child to wear underwear instead of diapers or pull-ups. Since diapers and pull-ups absorb urine and underwear does not, children can more quickly sense that they have started urinating in underwear and they can learn that it is more pleasant to go pee in a toilet rather than in their underwear.
Avoid Using Punishment
As mentioned above, punishment is not recommended when your child has an accident. And accidents will happen! That is part of the learning process. When an accident happens, there isn’t really a need to discuss it too much. You might remind your child to go pee or poop in the potty but expressing anger or frustration isn’t necessary and punishing their behavior by taking something away or scolding them is not helpful in most cases.
Use Positive Reinforcement
Using positive reinforcement is the most effective as well as most compassionate way of toilet training a child. Positive reinforcement is when you provide your child with an item or an opportunity to engage in a specific activity after they go potty and then they eventually go potty more often because of this experience. The reinforcing item or activity should be given right after going potty. You could also create a sticker or token system that allows your child to earn certain things after they start going potty on the toilet more often.
Be sure to not overwhelm your child but gently challenge them and remain aware of how they are experiencing the toilet training process. Also, try to make the process somewhat fun and enjoyable in an appropriate way for your child if you can. You can play songs your child enjoys when they are trying to go potty. You can let them watch videos while they sit on the potty seat or the toilet. You can give them things they enjoy or a small treat if you would like to reinforce sitting on the toilet or going pee or poop on the toilet.
If your child doesn’t even like to sit on the potty, you might reward (or reinforce) them for just sitting on the potty. You could set a timer for them to sit on the toilet for 30 seconds and then gradually increase this time to one minute and then two minutes and then up to five minutes or ten minutes at the most.
Intensive Potty Training
There is a more intensive approach to potty training which involves having your child sit on the toilet for an extended period while providing them with preferred items and activities and encouraging lots of drinking fluids. This approach aims to create success by making your child need to go potty more quickly and more often and since they are already on the toilet, they are very likely to go potty on the toilet. Once they go potty on the toilet, they are then given the chance to get off the toilet for increasing amounts of time. This approach should be used cautiously and carefully and should be discontinued if your child does not seem willing to follow this procedure.
Every child is unique. Going to the bathroom is a private activity and every child deserves to be treated with dignity and respect. It’s important to remember that you will likely approach toilet training differently with a two-year-old than you would with a 15-year-old. Toddlers and preschoolers, even without ASD, typically have more adult involvement in the toilet training process. Adults might go into the bathroom with them. They might sing songs and be silly when it comes to encouraging their child to go potty. On the other hand, teenagers have a much greater need for privacy. Consider this as well as your child’s individual needs when creating a toilet training plan.
Taking data can be extremely valuable in successfully toilet training your child. By documenting when your child has pee or poop accidents, when they sit on the toilet, when they successfully void in the toilet, and any other relevant information, you can monitor their progress and you can also notice any patterns that might arise. You might also document when your child drinks fluids and has meals or snacks to see if this impacts when they go potty.
Behavior analysts at BI can also help you with developing a data system to help your child become potty trained. They can also help you analyze the data.
Potty Training a Child with ASD
We have given you many helpful tips, but there isn’t a one-size-fits-all approach to toilet training a child with autism spectrum disorder. Because of this, we’d love to help you and your child through this process. Contact us, we can help!
Autism Speaks. Seven Toilet Training Tips that Help Nonverbal Kids with Autism. Retrieved October 2, 2021 from https://www.autismspeaks.org/expert-opinion/seven-toilet-training-tips-help-nonverbal-kids-autism.