Quick Tips for Potty Training Children With Autism and Special Needs
The subject of potty training or toilet training, simple as it seems, can be anything but easy for children with autism or special needs. This milestone is one that all parents strive for as it is an important part of a child’s development.
The current advice from many pediatricians is that you should begin to potty train a child from around the age of three to four years, encouraging your child to sit on the potty several times a day in order to make the transition from nappies to using a toilet.
For parents with a child with special needs and autism, this milestone may seem unachievable. My own experience as a pediatrician for more than two decades has shown me that for most children with special needs or autism, becoming toilet trained is an achievable and realistic goal.
As a pediatrician in the United Kingdom, I see a lot of children who are not fully potty trained at a much older age than four with enormous consequences for them and their parents as they enter school. In the 60s and 70s, there was a strong focus towards a child-centered approach when families would simply wait until the child was ready to be potty trained.
This approach may have worked well when parents learned to recognised triggers to voiding when the child was still using cloth nappies, and the child had the opportunity to recognize the feeling of being wet on voiding. Today, as we have disposable nappies which are highly absorbent and keeps the child dry at all times, the ‘wait until he/she is ready’ approach is no longer advisable.
Teaching potty training often requires a high degree of dedication and perseverance for parents of children with autism or special needs as these children often lack the understanding and social awareness that is often a trigger for other children who would for example request to wear pants and not nappies when they are starting nursery; or indicate a desire to use the toilet like their peers.
Potty training was probably one of my biggest challenges bringing up my son Brendan with autism. Potty training is a skill that can be approached ‘one step at a time’ and included within a behavior program with lots of positive reinforcements. It should begin when your child develops physiological maturation of the bladder and bowel and is able to stay dry for 1.5 to 2 hours, and there are no underlying medical problems.
Here are some steps to help with the potty training process:
Step 1: Introduce the scene
Introduce your child to the toilet environment and increase his/her awareness of the connection between the toilet, voiding and pooing. Each day, spend some time with your child sitting him/her on the toilet seat and encouraging him/her to void or poo. Ensure that your child is not suffering from constipation and establish good healthy eating habits and a good diet early on.
Step 2: Set the routine
Show your child the skills required in using the toilet, such as pulling the pants down independently, sitting on the toilet, wiping, flushing, and washing hands. Use visual aids in the toilet as reminders of each step in the routine.
Step 3: Repetition and positive reinforcements
Repetition is the key; there is simply no short-cut to achieving the goal. Give your child lots of praise if he/she should happen to go in the toilet. Use a potty star chart with a picture of a boy/girl on a potty as a visual rewards indicator. Only reward the behavior if the child has achieved the target behavior. Let your child accept that the toilet is part of his/her routine.
Potty training most children is achievable, even for children with autism and learning difficulties. Once they are potty trained, it gives children a vital degree of independence and self-regard. For parents and carers, the effect of this milestone is enormous. But it takes a great deal of time, effort and persistence—in some cases so much so that parents give up, believing it will never happen. My own personal and clinical experience has shown me time and time again that as long as we take charge, invest our time and persist, I believe that many skills can be achieved.
Click here to find out more
Potty Training Tips for Children with Autism and Special Needs:
- For successful potty training, the key is routine and persistence. It can sometimes take months of perseverance and determination.
- Do not allow your child to have any distractions when he/she is able to sit and stay on the toilet. Playing iPad or reading a book while sitting on the toilet will not encourage a child to void or poo.
- Encourage your child to open his/her bowels every day by taking him/her to the toilet at the same time each day. Let the child spend some time on the toilet until going at this time becomes a habit. Use reward charts as positive reinforcement.
- Devise a visual reward systems to use with your child. Use stars and charts to show progress and to offer rewards for tasks completed.
- Include plenty of fresh fruit and vegetables in your child’s diet to ensure a healthy diet and he/she is not constipated.
- Bedwetting is common and can be associated with constipation.
- Consider using an alarm to help resolve bedwetting.
- Be consistent in your approach between carers when implementing a behavioral
- As far as possible, ignore challenging behaviors and concentrate on encouraging positive and cooperative behaviors.
- Challenging behaviors, distress, and anxiety can stem from your child’s frustration at not being able to communicate.
- Do not despair if on occasions accidents happen.
These websites provide further information on the common childhood bowel and bladder problems and where you can get help and support for your child.
May Ng, MBBS (Hons), FHEA, FRCPCH, MSc, LLM, PhD, is a Consultant Paediatric Endocrinologist and Honorary Senior Lecturer at the University of Liverpool, United Kingdom. She completed her undergraduate degree under full scholarship in University of Sydney, Australia and her pediatric training in Australia and the United Kingdom. She was the recipient of the prestigious UK Medical Research Council Fellowship and completed further training to obtain a Masters in Medical Science and PhD degree in paediatric endocrinology and diabetes. Dr Ng also holds a Master of Laws degree and is active in medico-legal work. She is Chair of the UK Association of Children’s Diabetes Clinicians, Officer for British Society of Paediatric Endocrinology and Diabetes and Training Advisor for Royal College of Paediatrics. She is in the Diabetes UK Council for Healthcare Professionals and Online Learning Committee for European Society of Paediatric Endocrinology.
She is an active researcher with over 150 publications and has presented at more than 100 scientific meetings. She serves on the editorial board for several international journals including as Editor-in-Chief and as Associate Editor and is a regularly invited referee for many high impact journals. She is a clinical lead of multiple national award-winning initiatives such as Diabetes UK Mary Mackinnon Award 2018, winner of 2015 Diabetes Quality in Care award, Highly Commended runner-up for Diabetes Team of the Year National BMJ Awards 2015, finalist for the HSJ Clinical Leader of the year 2015 and finalist in the UK Asian Woman of Achievement Award 2016.
She is also a book author of ‘A Journey with Brendan’ documenting life with her son with autism as both a mother and pediatrician.
This article was featured in Issue 84 – The Journey to Good Health and Well-Being