Families For Life | Toilet Training: Children with Autism Spectrum Disorder
Going to and using the toilet is an exciting and sometimes challenging step for any child. You can use some special strategies to make toilet training easier for your child with autism spectrum disorder (ASD).
Signs that children with autism spectrum disorder are ready for toilet training
Children with autism spectrum disorder (ASD) generally show the same signs of readiness for toilet training as typically developing children do. But these signs might appear when your child is older, and the training might take longer.
Some signs that your child is ready include:
being able to tell you (or show you with a sign or gesture) that she has wet or soiled her diaper or clothes
being able to follow a simple instruction like ‘Sit on the toilet’, and being able to pull her pants up and down
having regular formed bowel movements
having enough bladder control to stay dry for at least two hours at a time during the day.
Before you start toilet training, it’s a good idea to speak with your child’s paediatrician or GP. They can rule out any medical problems that might get in the way of toilet training and say whether your child might be ready to start.
Steps for preparing children with autism spectrum disorder for toilet training
The steps for preparing for and getting started with toilet training are much the same for all children. But children with ASD might need a bit of extra teaching and some strategies adjusted to suit their needs.
An important first step is to realise that toilet training is largely about communication and working together with your child.
It might also help to think of toilet training as a series of smaller goals, rather than one big goal. For example, start with simply familiarising your child with the toilet, what it’s for, and how to use it. Then you could progress to starting the toilet training.
Our general article on toilet training can help you get started. Then you can use the extra strategies below to help your child with ASD go from diapers to the potty or toilet.
Toilet training strategies for children with autism spectrum disorder
Going to the toilet is a complex task, made up of many small steps. It can help to break tasks like toilet training down to their most basic parts and teach those smaller parts to your child with ASD, step by step.
Below we outline three strategies to help with toilet training your child with ASD: encouragement and rewards, visual aids and supports, and Social Stories™. All children are different and what works with one child might not work for another. It’s a good idea to try a combination of approaches.
Encouragement and rewards
Rewards and positive reinforcement can help with toilet training. As your child learns each step involved in using the toilet, you can reward him, which encourages him to learn. Rewards and encouragement can include:
descriptive praise – for example, ‘Charlie, well done for sitting on the toilet’
nonverbal praise, gestures (clapping) or signs (thumbs up)
a favourite activity – for example, playtime with trains
a star on a sticker chart
a favourite healthy food.
Try a variety of rewards, and use the ones your child responds to best. Before you start, plan exactly what your child will be rewarded for, and ensure your child clearly understands what behaviour is being rewarded. Try not to overuse a reward.
Some rewards that motivate typically developing children – like stickers or stamps – might not interest a child with ASD. Work out what rewards your child likes by presenting a variety of rewards for a few seconds and watch your child’s response. You could try rewards like hugs, high-fives, claps, foods, toys or activities.
Once your child has made progress on a particular step, stop using food, activities and toys as rewards. But keep using verbal and nonverbal praise.
'We used a reward system – Sesame Street stickers for peeing and a lucky dip bag for poo. He caught on straight away for his bladder, but it took longer with his bowels. We just kept asking if he needed to poo and waved the lucky dip bag in front of him, making it very clear he would get something if he went. One day something just clicked for him and we haven’t had an accident since'.
– Parent of child with disability
Visual supports
Children with ASD are often visual learners. So you can support your child’s learning by providing visual cues and prompts.
Visual supports can help to reinforce the routine of using the toilet, and provide reminders for taking regular toilet breaks.
You could try creating a visual schedule to show your child the toileting routine. You can use the Picture Exchange Communication System (PECS) or other visual aids. The schedule can be stuck on a wall close to the toilet or potty.
Go over the schedule with your child 2-3 times a day. Everyone who does toileting with your child will need to know and follow the routine. This way, training will be consistent.
Social Stories™
Social Stories™ are used to help children with ASD develop appropriate behaviour and responses. They might help children with ASD cope with challenging or confusing situations, like toilet training.
Social Stories™:
use simple storylines with clear pictures
are written from your child’s perspective
describe the situation, like using the toilet
give details about what happens in the situation
suggest how your child might respond in the situation
explain why your child should respond in a particular way.
Trained speech therapists, occupational therapists and early intervention or special education teachers will be able to help you create a Social Story™ for your child’s toilet training.
If your child will be going to the toilet at a friend’s home or somewhere else other than home, practise a new story for this situation with your child ahead of time. When the event actually happens, your child can use the story to help guide her behaviour.
When you’re writing a Social Story™, use words and pictures that are appropriate for your child’s developmental level. Suggest possible responses and behaviours, rather than making the story an exact ‘script’ to follow.
Overcoming toilet training challenges for children with autism spectrum disorder
Toilet training a child with ASD can be more challenging than training a typically developing child. This is because children with ASD are often very attached to their routines and don’t like change. This might make it more challenging to go from diapers to the toilet.
Try these tips to help your child make progress with toilet training
Consider skipping the ‘potty’ stage if your child with ASD has difficulty with change. Some parents go straight to putting their child on the toilet, sometimes with a toilet training seat. This limits the number of changes children experience in the toilet training process.
Try washable reusable training underpants or underpants with a protective liner (which are less absorbent than diapers or pull-up training pants). If your child has trouble knowing when it’s time to use the toilet, these might help your child become more aware of the feeling of wetness.
Use specific language. For example, say, ‘Eddie, sit on the toilet so you can pee’. This is clearer than asking your child to ‘sit on the toilet’, and will help your child understand what to do.
Choose one word to refer to going to the toilet. Get everyone in the family to use it. For example, always say ‘toilet’ or ‘loo’ or whatever your family is comfortable with. The different words we use to describe the toilet – potty, loo, bathroom – can be confusing for children with ASD.
Teach your child a way of letting you know he needs to go to the toilet. This could include nonverbal signing or the use of the Picture Exchange Communication System (PECS).
Five minutes sitting on the toilet is enough. If you get your child to sit on the toilet for too long, she could feel as if she’s being punished.
Try to stay calm and positive. Children with ASD can have difficulty understanding new situations and other people’s emotional responses.
Sensory overload
If your child with ASD is sensitive to or upset by the sensory aspects of going to the toilet, try ways of controlling your child’s sensory experience of toileting. For example:
Get your child familiar with sitting on the toilet seat by practising for a few minutes every day. Make him comfortable.
Use a foot stool if your child needs foot support while sitting on toilet.
Use a training seat if your child is frightened of the big hole over the water.
Tell your child there will be a noisy flushing sound, and explain the reason for the noise.
Toilet training setbacks and difficulties for children with autism spectrum disorder
Sometimes toilet training children with ASD is associated with other behaviour problems, like being afraid of the toilet, going in places other than the toilet, filling the toilet with paper and other materials, continually flushing the toilet, smearing poo on the wall and other places, and refusing to poo. Constipation can also be a problem.
If you find you’re having any of these problems or if there hasn’t been any improvement after a few months, here are a few ideas to think about:
Keep a record of the times your child wets or soils for a week or so. If a pattern develops, target these times by taking your child to the toilet just before your child would normally pee or poo in her pants.
Speak to your paediatrician or GP for advice. There could be a medical reason for your child’s lack of response to toilet training. Medical reasons might include constipation or a urinary tract infection.
Speak with the other people who are working with your child, like a psychologist, occupational therapist or your child’s early intervention service. They might be able to offer more intensive support.
Constipation
Constipation is a common problem in children. If your child avoids doing poos, she might be constipated.
Constipation is usually caused by not enough water or other fluids or not enough dietary fibre. Some children with ASD are picky eaters, which can cause them to become constipated more easily than other children.
It’s worth noting that normal bowel habits vary a lot among children. Some children do a poo 2-3 times a day, but others go only every 2-3 days. If you think your child is constipated, see your paediatrician or GP. Your health professional can rule out any underlying medical concerns, and help you with strategies to manage your child’s constipation.
If toilet training becomes a battle with no signs of progress, take a break for now. Consider starting the training again in about three months. Don’t feel that you’ve failed – it might just be that your child isn’t ready.
© raisingchildren.net.au, translated and adapted with permission
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