Toilet Training for Children with Autism
Toilet training can mean something quit different for those of us with children on the spectrum. While my daughter was using the toilet relatively smoothly by the age of 6, it took my son, Marc, until he was 9.5 years to finally be fully toilet trained. It can be done and luckily there are some very good resources out there to help. Because each of my children had such differences with their physical struggles, what motivated them, and their interoceptive awareness, the toileting process was not the same journey for both.
Clear a block of stress-free time
Families need to be free of additional stressors such as a move, illness, a new baby, divorce or any other major change to family life. The parent has to feel ready to make the commitment to toilet training and not feel pressure from extended family, friends, or therapists to start the process. This can be a long emotional process so it’s better if you aren’t trying to do it while juggling other major life stressors.
For our son, successful toilet training took 6 weeks.
Look for signs of toileting readiness
How do you know when your child is ready to start toilet training? Chronological age should not be a factor. Children with autism often exhibit significant developmental delays so you should look for signs of readiness.
Two absolute signs of readiness are staying dry throughout the night and asking to be changed when soiled or wet. This can be indicated verbally or through a cue such as getting a clean diaper or the diaper is removed by the child.
How do you know when your child is ready to toilet train?
The signs of training readiness are:
- The child is dry for 1 – 2 hours at a time or if the child stays dry throughout the night.
- The child has the cognitive development of 18 – 24 months. Don’t confuse this with chronological age.
- The child has formed bowel movements.
- The parents are emotionally ready and professional team around the child is on board.
- The child is 4 years old with no medical conditions that would prevent this process.
- Medically, there is no reason not to start toilet training.
- There is no additional stress in the home. It is not the time to toilet train during a move, divorce, death in the family, or major illness. Wait until things have stabilized.
How do you ensure toilet training success?
To make toilet training a success:
- Everyone that is involved with the child has to be part of the planning – parents, grandparents if they are involved, and any support people.
- The same language and routine should be used across all environments so as not to confuse the child. Keep the visual supports the same.
- Create a good toileting environment where the child feels safe. What I mean by that is if the child is using the regular toilet, use a footstool for balance if the child’s feet don’t touch the floor. Use a toilet seat insert if the toilet opening is too large. I found a great flip down seat at RONA. This may be easier to use than having to put in an insert.
- Have a few toys in the bathroom for relaxation and distraction.
- Create a reward system to keep motivation levels high and show progress.
One struggle many children face is how to push without becoming tense. When you tell a child to push, they tend to tense up their stomach muscles. A great Saskatchewan OT told me the best way to teach the push motion is by either blowing bubbles or using a blow toy that has a visual with it such as a pop bottle whistle with a string that goes around when you blow into it. The blowing action allows the diaphragmatic release to happen.
Use potty training resources specifically for those with autism
I am not going to go into all the details in how to do the actual toilet training part because there is a great book that explains beautifully how to do this process. The book is called The Potty Journey and it is one of the best books I’ve ever read on the subject. Unfortunately, this book was not written the summer we trained our son – too bad because we could have been saved a lot of heartache.
Other resources you can look at:
Don’t give up, keep trying, try different approaches until you find one that works
My advice to anyone trying to toilet train is to have patience because it can take many weeks to turn the corner. Our son held his bowel movements for up to a week at a time. He was also a fecal smearer. We did not get past these 2 hurdles until week 5 of toilet training. It also took us some experimenting before we could find a motivating reward which turned out to be a ripple chip. A little aside – our son continued to ask for ripple chips after every bowel movement until he was 14. A behaviorist would say I was in the wrong for not fading that reward, but my attitude was if he needs a few ripple chips to keep him on the right track, then that was fine. He hasn’t asked for ripple chips in 7 years.
Marc has never had an accident since he was toilet trained. You can read about our toileting trials in this article.
Please feel free to e-mail me at email@example.com with any specific questions you may have about toilet training.
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