As we all know, it can take a little longer for children diagnosed with autism spectrum disorder to master many everyday skills. As a result, potty training with autism can take some extra time.
Multiple issues, including sensory overstimulation, can contribute to toilet training autism challenges. However, parents and caregivers of children on the autism spectrum shouldn’t stress too much over potty challenges. For every problem, there is always a solution!
With a lot of patience, structure, and reinforcement, toilet training can be accomplished. In this article, we offer easy ways to make using the toilet a positive experience for parents and kids with autism.
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Autism Potty Training
Autism and potty training: Is it possible?
Children with autism can be toilet trained as long as they don’t have any medical issues that prevent them from urinating or having a bowel movement.
Some signs that would indicate a child is having urological problems would be:
- Foul-smelling urine
- Too much or too little urination
- Inability to hold urine
- Observing discomfort when a child urinates or has a bowel movement
- Stools that are small, hard, dry, and painful to pass
- Having fewer than two bowel movements a week
Before beginning the autism toilet training process, it is recommended a pediatrician confirm with a physical exam there are no medical issues.
At what age can an autistic child be potty trained?
There is no specific age to begin toilet training children on the autism spectrum because every child has different needs and different skills. Instead of focusing on age, focus on the child’s skills.
Here are five questions that determine whether your autistic child is ready to start toilet training:
- Does the child have the fine and gross motor skills to carry out a toileting routine?
- Can the child pull down their pants and underwear and pull up pants and underwear with little to no assistance?
- Can the child imitate actions? (i.e., sitting on the toilet, wiping, etc.)
- Can the child identify where the bathroom is located in their house?
- Can the child sit on a toilet with a potty training seat or sit on a transitional potty without resistance?
Signs your autistic child is ready for potty training
When children with autism are ready for toilet training, they will begin to demonstrate these signs:
- They do not like the feeling of a wet or soiled diaper or pull-up and will show it by taking it off. They vocalize displeasure in being wet or soiled and want to be changed.
- They show interest in the toilet by sitting on it, flushing it, or watching an adult use it.
- They will take an adult to the bathroom to get a clean diaper or pull-up.
How to potty train autistic child
Successfully toilet training children with spectrum disorders takes a lot of thought and pre-planning. Being unprepared can lead to frustration for both parent and child.
Training can happen in three phases: the Planning Phase, the Setting Up Phase, and the Implementation Phase.
The Planning Phase
During the Planning Phase, it is essential to gather all the essential materials needed for a positive potty training experience.
Below is a list of the 10 items needed before beginning the potty training process:
- Potty seat with a stool or a transitional potty
- Lots of underwear (two weeks’ worth), preferably with your child’s favorite characters on them
- Timer
- Wipes
- Lots of liquids and salty foods (buy the child’s favorite ones)
- Visual supports: Create a step-by-step visual sequence of the toilet routine using actual pictures or the Picture Exchange System (PECS) icons.
- A bucket with fun activities that the child will like, such as toys, books, bubbles, etc. These activities can keep the child entertained while sitting on the toilet.
- A reinforcement bin filled with the child’s favorite candy, treats, toys, stickers, iPad, etc. The child should have access to these items only for successfully using the restroom.
- A data chart to track the time the child is taken to the bathroom and whether they are W = wet, D = dry, or have a BM = bowel movement.
- Toilet training books and/or a social story about ways to use the toilet. Many applications (APPs) featuring social stories and books are available online.
Setting Up Phase
Once the items from the Planning Phase are collected, it is time for Phase 2, the Setting Up Phase.
Pick one bathroom in the house that the child feels most comfortable using and designate it as the training bathroom.
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Here’s how to make your bathroom ready for potty training:
- Position the potty seat and stool on the toilet or the transitional potty in the bathroom.
- Put underwear, wipes, and a timer in the room.
- Place the activity basket within reach of the child so they can access it while sitting on the toilet.
- Hide the reinforcement bin in the room where the child does not have access to the reinforcing items.
- Hang up the visual sequence of the bathroom routine where the child can see it.
- Tape the datasheet on the wall outside of the room.
The Implementation Phase
The Implementation Phase is the third phase of potty training. It is important to remember that this phase requires time, structure, consistency, and patience.
The more structure and consistency children with autism have, the more success they will have with potty training. To begin with, set a date when potty training will begin.
Make sure it is a time when the child does not have many activities planned or there are no travel plans in the near future. Suggested times to start potty training are during Spring Break or the beginning of the summer.
Once the start date is chosen, prepare your child a week before by creating a visual countdown calendar and beginning to read any potty training books and/or potty training social stories to the child.
Start the toilet training process first thing in the morning by having a “Potty Party.” At this party, say “bye-bye” to diapers or pull-ups and “hello” to underwear. Buy underwear with characters the child likes, point them out to the child, and have them feel it is dry.
Encourage the child to stay dry and tell them that the pee and poop go into the toilet. Use simple positive language like, “Good staying dry,” and “Pee in potty, poop in potty.”
Show the child the items in the reinforcement bin and explain that they get those items when they pee and poop in the toilet.
Side Note: Until children with autism are successfully potty trained, they can wear a diaper or pull-up for naps and bedtime.
Potty training for autism: Step-by-step guide
Once the child is in underwear, begin the step-by-step potty training process listed below.
Step 1: Encourage your child to drink more fluids
Encourage the child to eat salty foods that cause them to become thirsty, so they are likely to drink more fluids. Offer the child their favorite drinks throughout the day to increase their fluid intake. If the child likes fruits and veggies, encourage them to eat them throughout the day.
Step 2: Regularly check and reward
Many parents wonder how to get an autistic child to poop in the toilet. This can be a common hurdle. Consider using a timer to remind your child to try sitting on the toilet regularly.
Set a timer for 20 minutes and consistently take the child to sit on the toilet after the timer goes off. Mark on the datasheet the time the child is taken to the bathroom and whether they are W=wet, D=dry, or have a BM=bowel movement when taken to the bathroom.
If the underwear is wet or they have a BM in the underwear, it is important not to get upset. Stay calm and, in a neutral voice, point out that they had a pee or poop accident in the underwear and say, “Pee goes in potty.” or “Poop goes in potty.”
Have the child sit on the toilet and bring out a fresh pair of underwear. If the child is dry, verbally reinforce it by saying, “Good job staying dry.” Have the child feel their underwear and give them something from the reinforcement bin as a reward.
Step 3: Keep the child entertained
Set the timer for five minutes and have the child sit on the toilet. Keep the child entertained by reading to them or having them play with the toys in the activity basket.
If the child has a success, reinforce it by saying, “Good pee or poop in the potty,” and immediately reinforce them with something from the reinforcement bin. Then use wet wipes or toilet paper to wipe the child and finish the toileting routine.
If the child does not have success, have the child feel the underwear and remind them to stay dry. Write down on the datasheet if the child has (-) = No success or a (+P or +BM) = Pee success or Bowel Movement success in the toilet.
Step 4: Use a pull-up during bedtime
Repeat the process until bedtime and put the diaper or pull-up on the child. Transitioning the child into a pull-up or diaper helps avoid accidents while the child is sleeping and is less aware of their bodily needs.
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Overnight potty training can be challenging for many children, especially those with autism, so it’s often a later step in the process.
Step 5: Build independence with gradual timing
After a couple of days, a pattern will start to form. Children with autism will either pee or poop more in the morning or afternoon.
After two days of consistently having success in the toilet, start decreasing the child’s fluid intake. Increase the time the child is taken to the bathroom from every 20 minutes to 30 minutes, to 45 minutes, to an hour.
When your child has more successes than accidents, they are on their way to being potty trained.
Additional potty training tips to consider
Once children with autism are successfully peeing and pooping in the toilet for a week, begin working on additional steps to toilet training.
1. Teaching a child to ask to use the bathroom
Whether children with autism are verbal or non-verbal, it is important to teach them how to communicate when they need to use the restroom. Before the child enters the bathroom, prompt them to communicate that they need to use the bathroom.
There are various ways to encourage this communication, both verbal and non-verbal, tailored to each child’s abilities.
Here are some ideas:
- Verbal: Prompt the child to say, “Potty,” or “I want potty.”
- Sign: Prompt the child to sign the word “Potty.”
- PECS: Use a Picture Exchange Communication System, have the potty icon readily available, and prompt the child to get the potty icon and give it to an adult.
If the child spontaneously communicates “Potty,” honor it and immediately take them to the bathroom. Reinforce the child for communicating the need to use the bathroom.
2. Encourage independence
Once children with autism are comfortable with using the toilet successfully, encourage them to complete the entire toileting routine by prompting them to wipe, flush, and pull up their pants on their own.
Present a visual sequence of the steps, gradually reducing physical and verbal prompts as they gain confidence. Shift reinforcement from simply using the toilet to completing the entire bathroom routine independently, rewarding their progress and independence.
3. Teaching an autistic child how to wash their hands
Once children with autism are potty trained, finish the routine by teaching them how to wash their hands after they use the bathroom.
Create a step-by-step visual sequence of the handwashing routine with actual pictures or by using the Picture Exchange System (PECS) icons. Place it in front of the bathroom sink.
The handwashing sequence is:
- Turn on water
- Put soap on hands
- Rub the soap into the hands
- Rinse hands
- Turn off water
- Dry hands
Do not teach potty training and hand washing at the same time. This would be overwhelming for both parents and children with autism.
You want to make potty training a positive experience. Teaching too many skills at once may be extremely overwhelming to the autistic child and set them up for failure.
Potty training is a step-by-step process. Once the child masters the first step, then additional steps can be added. This only adds to the child’s potty training success.
4. Expanding bathroom comfort beyond home
Children with autism often thrive on predictability and routine, so they may initially prefer using only the bathroom where they were potty trained. Once the child feels comfortable with the routine, gently encourage them to try other bathrooms in the house.
When visiting family or friends, support them in using unfamiliar bathrooms and provide positive reinforcement each time they do. Remember, potty training is a gradual, step-by-step process.
Common concerns around potty training an autistic child
Below are some of the common questions and concerns around potty training with children with autism and strategies to help.
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What if my child is afraid of the toilet and doesn’t want to go near it?
When children with autism are afraid of the toilet, use a transitional potty and encourage them to sit on that. You may need to have them sit on it outside the bathroom and slowly transition it into the bathroom.
Reinforce your child for sitting on the transitional potty for 10 seconds, 20 seconds, 30 seconds, etc. Once your child can sit on the transitional potty, encourage your child to sit on the “big potty.”
First, have them sit on the toilet with the seat down. Then, have the child sit on the toilet with the seat up on a potty seat. Start off by having the child sit for 10 seconds and then reinforce them.
Increase the time that your child sits on the toilet until they can sit comfortably. This process can take many weeks, so do not get discouraged. With consistency, your child will eventually feel more comfortable.
What if my autistic child is afraid of flushing the toilet?
Being afraid of flushing the toilet is very common for children with autism. The flushing sound can be loud and scary to children and can overwhelm their sensory system.
If your child is afraid of flushing, avoid doing it while they are in the room during potty training. Instead, wait until they are out of the bathroom. Once they are comfortable using the toilet, have them stand outside the bathroom when you flush.
Gradually, encourage them to be in the bathroom with earplugs or headphones while you flush. Finally, empower them to flush the toilet themselves. With time, your child will become accustomed to the flushing sound and feel less fearful of it.
What if my child likes to play with the toilet water?
When children with autism play with toilet water, it often indicates that they have unmet sensory needs. To address this, create designated areas in your home where your child can engage with water safely, such as the sink, bathtub, or a small outdoor pool.
To discourage toilet play, keep the bathroom door closed and place a visual stop sign on the toilet.
Remember, children on the autism spectrum who engage with toilet water may not yet be ready for potty training. They need to learn appropriate water play locations before they can successfully transition to using the toilet.
What if my child is afraid to have a bowel movement in the toilet and becomes constipated?
If your child is fearful of having a bowel movement in the toilet and begins to hold it in, it’s important to address this gently and patiently. Many children with autism tend to wait until they have a diaper or pull-up at night to have a bowel movement.
If this happens, don’t feel discouraged, as potty training for urination and bowel movements can progress at different rates. The initial goal is to establish success with peeing in the toilet.
Once your child is consistently peeing in the toilet around 90 percent of the time, you can start focusing on bowel movements.
Follow the same training approach, but identify the time of day when your child typically has a bowel movement. Bring them to the bathroom around that time. Encourage them to sit and “poop in the toilet.”
To ease the process, ensure your child stays well-hydrated and eats fiber-rich foods to promote soft stools, making bowel movements easier. When they successfully use the toilet for a bowel movement, reward them with a special prize.
If constipation becomes a regular issue, consult a doctor for appropriate guidance.
Understand when it’s time to take a break from potty training
Potty training children with autism may take a long time. As long as the child is making progress and it is a positive experience, continue the process.
However, if the child becomes resistant to going to the bathroom or sitting on the toilet, or if they are having more accidents in their underwear than successes in the toilet for over a week, then stop toilet training.
These are signs that the child is not ready to be potty trained. At this time, take a break from potty training for at least three months and revisit it at another time.
Do not think of it as a failure, but think of it as both parent and child are not ready. Once everyone is ready, potty training will be an easy and positive experience.
FAQs
Q: At what age is an autistic child potty trained?
A: Many autistic children are potty trained between the ages of 3 and 5, similar to neurotypical peers. However, the timing can vary significantly based on the child’s individual development and comfort level.
Q: Does autism affect potty training?
A: Yes, autism can affect potty training, as many autistic children may have sensory sensitivities or difficulty with communication that complicate the process. Differences in cognitive and behavioral development can also influence readiness and motivation for toilet training.
Q: Do some autistic kids never get potty trained?
A: Some autistic children may struggle with potty training and may not become fully independent in this area. Factors such as cognitive abilities, sensory issues, and behavioral challenges can impact their ability to be toilet trained.
Q: What are the bathroom issues with autism?
A: Common bathroom issues for autistic children include sensory sensitivities to the bathroom environment, difficulties with transitions, and challenges in understanding social cues related to using the toilet. Anxiety or fear associated with using public restrooms can further complicate the experience.
References
Simon, M., Wilkes-Gillan, S., Chen, Y. W. R., Cordier, R., Cantrill, A., Parsons, L., & Phua, J. J. (2022). Toilet training interventions for children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 99, 102049. https://www.sciencedirect.com/science/article/pii/S1750946722001362
Bertolotto, M. G., Pfeifer, L. I., & Sposito, A. M. P. (2024). Toilet training for children with Autism Spectrum Disorder: experiences, difficulties and supporting strategies. Physis: Revista de Saúde Coletiva, 34, e34083. https://www.scielo.br/j/physis/a/NyL3WttdjmjYCHzcdX3wmKQ/?lang=en
Perez, B. C., Bacotti, J. K., Peters, K. P., & Vollmer, T. R. (2020). An extension of commonly used toilet‐training procedures to children with autism spectrum disorder. Journal of applied behavior analysis, 53(4), 2360-2375. https://onlinelibrary.wiley.com/doi/abs/10.1002/jaba.727
Baird, D. C., Bybel, M., & Kowalski, A. W. (2019). Toilet training: Common questions and answers. American family physician, 100(8), 468-474. https://www.aafp.org/pubs/afp/issues/2019/1015/p468.html
MRuzEk, D. W., HAnDEn, B. L., Aponte, C. A., Smith, T., & Foxx, R. M. (2019). Parent training for toileting in autism spectrum disorder. https://psycnet.apa.org/record/2018-48203-009
