Training a child to use the potty can be hard—and teaching a child with autism to use the potty can be even harder. As we all know, it can take a little longer for children diagnosed with autism spectrum disorder (ASD) 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 challenges. Sometimes children don’t have the motor skills to carry out a bathroom routine, while others are not cognitively able to recognize when to use the bathroom. And some children with autism may not know how to communicate (verbally or non-verbally) to someone when they need to go to the toilet. It is important to consider these factors before deciding whether or not children are ready for toilet training.
Parents and caregivers of children on the autism spectrum shouldn’t stress too much over potty challenges because, as they say, 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.
In this article, we offer possible ways to make using the toilet easier and a positive experience for both parents and kids with autism.
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 toilet training process with children with autism, it is recommended a pediatrician confirm with a physical exam there are no medical issues.
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. Below is a list of five questions that determine whether children with autism ready to start toilet training.
1. Does the child have the fine and gross motor skills to carry out a toileting routine?
2. Can the child pull down his/her pants and underwear and pull up pants and underwear with little to no assistance?
3. Can the child imitate actions? (i.e., sitting on the toilet, wiping, etc.)
4. Can the child identify where the bathroom is located in his/her house?
5. Can the child sit on a toilet with a potty training seat or sit on a transitional potty without resistance?
When children with autism are ready for toilet training, they will begin to demonstrate the “Three Signs of Readiness” listed below:
1. They do not like the feeling of a wet or soiled diaper or pull-up and will show it by taking off the wet or soiled diaper/pull-up, and they vocalize displeasure in being wet of soiled and want to be changed.
2. They show interest in the toilet by sitting on it, flushing it, or watching an adult use it
3. They will take an adult to the bathroom to get a clean diaper or pull-up
How to potty train an autistic child
Prepare for Successful Potty Training Experience
Successfully toilet training children with spectrum disorders takes a lot of thought and preplanning. Being unprepared can lead to frustration for both parent and child. Training happens in phases, with the first two stages being the Planning Phase and the Setting Up Phase.
During the Planning Phase, it is essential to gather all the essentials materials needed for a positive experience. Below is a list of the top 10 items needed before beginning the toilet training process.
1. Potty seat with a stool, or a transitional potty
2. Buy lots of underwear (two weeks worth) with your child’s favorite characters on them
5. Lots of liquids and salty foods (buy the child’s favorite drinks and salty foods)
7. Get a basket and fill it 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.
8. Create a reinforcement bin and fill it with the child’s favorite candy, treats, toys, stickers, iPad, etc. The child is to have access to these items only for successfully using the restroom and should have no access to these items during the day.
9. Make a data chart to track the time the child is taken to the bathroom and if he/she is W= wet, D=dry, or has a BM=bowel movement.
10. Find toilet training books and/or create a social story on ways to use the toilet. Many applications (APPs) featuring social stories and books are available online. Choose books and apps that the child likes and captures his/her interest.
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. Make it inviting and potty training ready by:
1. Positioning the potty seat and stool on the toilet or the transitional potty in the bathroom.
2. Putting underwear, wipes, and timer in the room.
3. Placing the activity basket within reach of the child so he/she has access to it while sitting on the toilet.
4. Hiding the reinforcement bin in the room where the child does not have access to the reinforcing items.
5. Hanging up the visual sequence of the bathroom routine where the child can see it.
6. Taping the datasheet on the wall outside of the room.
Implementation of Potty Training Phase
The Implementation Phase is the third phase in the potty training process. It is important to remember that this phase takes time, structure, consistency, and lots of 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 a lot of activities planned or there are 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 begin reading 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 that has characters the child likes and point them out to the child and have him/her feel it is dry. Encourage the child to stay dry and tell him/her that the pee and poop go 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 he/she gets those items when the 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.
Once the child is in underwear, begin the step-by-step potty training process listed below:
Step 1: Encourage the child to eat salty foods that cause him/her to become thirsty, so the child is likely to drink more fluids. Offer the child his/her favorite drinks throughout the day to increase the fluids he/she is drinking. IF the child likes fruits and veggies, encourage him/her to eat them throughout the day.
Step 2: Set a timer for 20-minutes and consistently take the child to sit on the toilet every 20- minutes. Mark on the datasheet the time the child is taken to the bathroom and whether he/she is W=wet, D=dry, or have a BM= bowel movement when taken to the bathroom. If the underwear is wet or he/she has a BM in the underwear it is important not to get upset. Stay calm and in a neutral voice point out that he/she 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 his/her underwear and give him/her something from the reinforcement bin for staying dry.
Step 3: Set the timer for five minutes and have the child sit on the toilet. Keep the child entertained by reading to him/her or have him/her 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 him/her 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 him/her 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: Repeat the process until bedtime and put the diaper or pull-up on the child.
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 successes in the toilet, start to decrease the child’s fluid intake and 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, the child is on his/her way to being potty trained.
Additional Potty Training Tips
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 him/her to communicate that he/she needs to use the bathroom. There are many verbal and non-verbal ways to prompt children with autism to communicate that they need to use the toilet.
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 and 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 him/her to the bathroom and reinforce the child for communicating the need to use the bathroom.
Once children with autism are comfortable and successfully peeing and pooping in the toilet, encourage him/her to finish the toileting routine by prompting the child to wipe, flush the toilet, and pull up the pants independently. Show the child the visual sequence of the potty routine and slowly fade your physical and verbal prompts. Instead of using the reinforcing bin for peeing and pooping in the toilet, reinforce the child when he/she completes the entire bathroom routine independently.
3. Hand Washing
Once children with autism are potty trained, finish the potty 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:
1. Turn on water
2. Put soap on hands
3. Rub the soap into hands
4. Rinse hands
5. Turn off water
6. 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 and by teaching too many skills at once extremely overwhelming to the child and setting him/her 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.
Children with autism love predictability and routine. You may notice that the child only goes to the bathroom used for potty training. Once the child feels comfortable with the potty training routine, encourage the child to use other bathrooms in the house. Go to family and friends’ houses and encourage him/her to use their bathrooms. Continually reinforce the child when he/she use different bathrooms. Remember, potty training is a step-by-step process.
Potty Training Concerns
Below are some of the common questions and concerns around potty training with children with autism and strategies to help.
What if my child is afraid of the toilet and does not want to sit on or 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 him/her 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 him/her 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 on the toilet for 10 seconds and then reinforce him/her. Increase the time that your child sits on the toilet until your he/she can sit comfortably. Do not get discouraged as this process can take many weeks. But with consistency, your child will eventually feel comfortable sitting on the toilet.
What if my child has an excessive interest in flushing the toilet?
Explain to your child that flushing is only when there is pee or poop in the toilet and deny access to having your child flush the toilet by closing the door and by putting a visual stop sign on the toilet.
What if my child has a fear 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 fearful of flushing the toilet, do not flush when potty training your child. Wait until he/she is out of the room to flush the toilet. When your child is potty trained and feels comfortable in the bathroom, have your child stand outside the bathroom when you flush the toilet. Then have him/her stand in the bathroom while wearing earplugs or headphones when you flush the toilet. Last, have your child with autism flush the toilet by himself or herself. Eventually, your child with autism will get used to the toilet flushing sound, and he/she will be less fearful of it.
What if my child wants to play with toilet paper?
If children with autism play with the toilet paper, keep it out of their reach and only give it to them after they pee or poop. Teach your child “the rule” that toilet paper is only to be used for wiping after peeing and pooping.
What if my child likes to play with the toilet water?
Playing with toilet water means children with autism have a sensory need that isn’t being met. Set up appropriate places in your house where your child can play with water, such as the sink, bathtub, or small pool outside. Deny access to the toilet by closing the bathroom door and putting a visual stop sign on the toilet. Children on the autism spectrum who play with the toilet water are not ready for potty training. Your child will not be ready until he/she learns the appropriate places to play with water.
What if my child is afraid to have a bowel movement in the toilet and becomes constipated?
It is very common for children with autism to hold in bowel movements while being potty trained. Often times, children will wait until they get their diaper or pull-up at night so they can poop in that. If this happens, do not get discouraged, as peeing and pooping are two different parts of toilet training. The first step is getting your child to successfully pee in the toilet. Once your child on the autism spectrum is peeing in the toilet 90 percent of the time, then you can start on poop training. Use the same potty training procedure, however, identify what time of day that your child is having a bowel movement and start taking your child to the bathroom during that time. Encourage your child to sit on the toilet and “poop in the toilet.” Also, have your child drink a lot of liquids and feed him/her foods with lots of fiber. You want your child’s stools to be soft so they can come out easily. When your child with autism successfully poops in the toilet, highly reinforce him/her with an extra special prize. If your child suffers from constipation regularly, you may need to consult a doctor on how to resolve the situation appropriately.
What if my son has difficulty standing while urinating?
If your son is used to sitting while urinating, you can teach him how to urinate while standing by providing a visual chart on how boys use the toilet. If he is afraid or does not want to touch his privates, you can ask a trusted male family member to show how to aim it in the toilet bowl. You may also use some target objects such as a colored toilet paper or a paper boat to encourage him to urinate in the bowl.
When To Give Up or Take a Break
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 the child is having more accidents in his/her underwear than successes in the toilet for over a week, then stop toilet training. These are indicators 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 as both parent and child are not ready. Once everyone is ready, potty training will be an easy and positive experience.
Potty training children with autism can be a very challenging process. However, by planning ahead and having the right materials available, it can do it done. In addition, structure, consistency, and patience also contribute to successful potty training. Potty training can be a positive and rewarding experience for both parent and child. It is a significant accomplishment, and it is one step closer to independence. Remember that patience and positivity leads to potty training success!