The Trials of Toilet Training An Older Autistic Child - Autism Awareness
Toilet Training an Older Child With Autism. Picture of feet and toilet and diaper

The Trials of Toilet Training An Older Autistic Child

There is almost no literature available on training the older autistic child. Traditional children’s books all use the potty chair to teach toilet training. Animated characters on videos do not explain the elimination process or show exactly what to do. There are also other factors that come into play for children with autism: sensory issues, gastrointestinal concerns, anxiety, resistance to change, and often no social motivation to please the parents. Not all children will work for praise or rewards. Some children stand up to have a bowel movement and a change in the elimination position can cause difficulty. It took us nine years to get my son Marc using the toilet on his own, and here is how we did it.

Look For Signs That Your Older Child Is Ready To Toilet Train

By the time we started really trying to get him out of diapers, Marc had used the toilet successfully for urination for three years already, and was familiar with using the toilet. He knew when he was going to have a bowel movement, because he would ask for a Pull-up and then ask to be changed when he was done. He never had accidents and could hold his bowel movements until he was home, demonstrating control. With all of these signs in place, he seemed ready to start the toileting process.

Try A Variety of Approaches – Don’t Get Discouraged

My husband and I had tried various methods over the past 3 years. We used picture symbols breaking down the process of toileting on a Velcro strip. We kept a bowel movement chart for 3 weeks so we could see what time of the day Marc tended to have his bowel movement, and then we sat him on the toilet for those times. We created a social story for toileting. When none of those methods worked, we used a behavioural contingency plan with photos of Marc sitting on the toilet, a photo of broken pieces of Oh Henry bar in the toilet, and a photo of his reward – ripple chips. If he didn’t poop in the toilet (shown with a red line through the photo), then there would be no chips. None of these methods worked.

If Those Don’t Work, Try Something Else

The attempt in the summer of 2006 had to be different. Marc could read and was interested in the printed word. When Brenda Smith Myles spoke for Autism Awareness Centre, she talked about the use of Power Cards. Power Cards use the child’s special interest as a way to motivate them. The Power Card is a recipe sized card with the rules you want the child to follow as told to them by whom or what interests them. We decided to try this technique using Queen Elizabeth, someone Marc is very interested in.

Instead of putting all of the toileting steps on one card, we wrote out one step per card and avoided the use of all pronouns since Marc did not understand them. We kept the text as simple as possible. Everything was stated in the present tense using Marc’s name – “Marc sits on the toilet. Poo comes out.” His reward was a scrapbook to collect photos of the Royal Yacht Britannia. He was to get one photo of the yacht to paste in the scrapbook each time he made an attempt on the toilet. We soon discovered the Power Cards were anxiety provoking, and were back to square one.

Find The Root Of The Issue If Possible By Trial And Error

I realized there was much more to transitioning from diapers to the toilet. We had to discover what the root cause of the anxiety was. This is difficult to do when a child has very limited language skills. Was it having to sit down on toilet rather than stand? Was this a fear of having something fall away from Marc’s body? Did he think he was losing a part of himself? Was he in physical pain sitting down trying to release a bowel movement? It was time to try another strategy.

I tried draping a towel across the toilet bowl so Marc would not have the feeling that something was falling away from him – didn’t work. We then changed the emphasis to just sitting on the toilet. We asked Marc to simply sit on the toilet and then rewarded him with chips if he did. During the toileting process, Marc was smearing his feces all over the house. He picked out just enough to relieve the bowel pressure.

potty training in bathroom

Buy the Toilet Training E-Book

Ideal for quickly grasping concepts and strategies for Toilet Training.

Remember This Will Be Stressful For Everyone…And Likely Messy

During the first week of toilet training, Marc withheld his bowel movement for seven days. His anxiety levels were very high. Our first breakthrough was after the first seven days – Marc went on the bathroom floor. This was progress because even though he wasn’t on the toilet, he was in the right area so we rewarded him for that. Once he got the chips, he then withheld his bowel movements for only three days at a time. It took five weeks for Marc to stop smearing his feces, but we noticed it decreasing as Marc continued to have his bowel movements on the bathroom floor. Now it was time to up the ante.

We then said no chips unless the poop was in the toilet. He had watched Ron and I empty bowel movements out of his underwear into the toilet so this now became the step for him. He emptied his bowel movement from his underwear into the toilet with almost no mess which we rewarded him for. Marc was independently washing his hands with no prompting.

Marc had his first bowel movement while over at his Grandma’s house during the sixth week of toilet training. She was sitting him on the toilet with his favorite Thomas the Tank Engine book at regular intervals throughout the day for ten minute periods. He finally had the success we had been waiting for. The question was  – would he repeat this at our house? Children with autism have a difficult time generalizing so maybe he would only use the toilet at Grandma’s. Success came two days later. Marc used the toilet without any prompts from us. He didn’t flush the toilet and came and got us. He said, “Poo in the toilet. I want chips.” It was a celebration.

Break Down The Process Into Stages And Don’t Give Up

I discovered the key to toilet training an older child is patience, persistence, and breaking down the process into achievable goals. I wanted to give up when the fecal smearing was happening throughout the day for the first month. I was discouraged when the Power Cards didn’t work. I combed the internet for some words of wisdom and found nothing. The key was going in stages and rewarding each stage, then raising the bar as those goals were achieved. Any habit can take weeks to break. Marc had been in diapers for nine years and I was kidding myself thinking toileting would not take several weeks, maybe even several months. It was also important to take the emphasis off of having a bowel movement into the toilet. Getting into the bathroom was the first thing that needed to happen. We had jumped too many steps, not realizing how hard this transition was going to be for Marc.

Even though toilet training Marc was a challenge, it was worth it. He gained a new level of independence and confidence. Marc was so proud of himself. As parents, we were relieved to have achieved this milestone, one that we are still celebrating nine years later.

Helpful Reading

The Potty Journey

Toilet Training and the Autism Spectrum (ASD) – A Guide for Professionals

Toilet Training for Individuals with Autism and Related Disorders: A Comprehensive Guide for Parents and Teachers 2nd. Edition



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  1. Mary says:

    Does taking technology away if they don’t poop in potty help? My ex is thinking punishment but yet won’t take him to be checked. This frustrates me big time

    • Mary, no form of punishment or rewards work when it comes to pooping in the potty. You have to get the bottom of why this isn’t happening. This could be an interoceptive awareness problem – which means he can’t feel when he has to go, nor does he know how to release poop.

  2. Michael says:

    Hello Maureen. My oldest is 10, and we have been struggling with him going poop for years. He’ll just not go, potentially for days at a time. It’s not that he’s resisting it, just that he doesn’t seem to ‘need to’. This leads to frequent accidents, where large amounts of poop end up in his underwear. He’s resistant to the idea of going to any sort of diaper, but he’ll literally walk around all day with poop in his underwear, sometimes to the point of leaking through to his pants, and has gotten onto furniture as well. I’ll ask if he can feel the poop in his underwear, and when attention is brought to it, he acknowledges it. However, if no one says anything, he’ll happily spend days in heavily soiled underwear if we’d let him.

    We’ve given him oral laxative to help soften the stool in his colon to try to get him to feel his bowel movements more. It seemed to be working, but once we stopped, he regressed regressed.

    He hasn’t been officially diagnosed with ASD yet, but between this and some other behavioral issues, we’re thinking he may be on the spectrum.

  3. Robin M says:

    Hello Maureen. I have a 13 year old autistic, non-verbal, with developmental delays, son that needs to be toilet trained. We have tried before to no avail. His teachers are willing to work with me and he does pee in the toilet primarily first thing in the morning. I would like to get your webinar or ebook or whichever is current and recommended? It’s February 2022. Thanks for helping an overwhelmed Mom!

  4. Natalie says:

    Hi wow this thread has been eye opening.. I have an 11 year old son, who’s always had problems with soiling… I potty trained him young and he started of great and then… soiling… all day and night… seen professionals, checked out physically if somethings wrong but nothing… the past year it has escalated he has started to wet himself  any time of the day or night… but is happy to sit in it, stay in the same clothes, if I ask him he lies and has a melt down and shouts… we’ve tried everything with him, he hasn’t been diagnosed with autism but I am starting to feel like maybe it is something we should look in to?
    I feel like mentally he just doesn’t care and he should, he doesn’t feel he’s done anything wrong and he always makes himself the victim.
    I am drained, frustrated, broken and I feel like a failure… I don’t know what to do?
    I’m scared for when he starts senior school in September, I don’t want him to get bullied or to have accidents in that setting! 
    Please if you have any advice I’m all ears… 

  5. Margarita Pogue says:

    Thank you all for your comments and I am learning so much from you all. I am a foster care social worker and have a foster child, male 10 year old who would not use the toilet for urinating or defecating. My co-worker and I have tried different techniques, and since we only see the child once a week, there is not much we can do? That is how I came across your website and I have purchased the webinar. We know consistency is key, and thank you all for all your patience working with these wonderful kids, especial thanks to Maureen Bennie!

    • Margarita, thank you so much for your kind words. I hope you find the toileting webinar helpful. Your foster child may also be experiencing trauma as well which could affect toileting. Let me know how things go.

  6. Anna says:

    Hi i hav 5 year old autistic boy he is still not potty or pee trained continuously on diapers i tried every technique but nothing works for him he can hold pee for long time he can sit on comode happily but never pee or poo i try then i lose hope one day i took him to bathroom after giving tim 3 glass of liquid he sit for 25 mins continuously weeping bt didnt pee em much worried i feel like he has not sense of wetness cz he never ask me to change diaper or trouser if he pees in it i am so depressed he understands few things

  7. Eric says:

    My 11 yr old son is Autistic, he poops and pees on his own and tries to wipe tho it’s not thorough. My problem is that when he is standing he doesn’t get the concept of holding and aiming he would rather lean into the toilet with no hands which makes a mess. He gets shy whenever I try to instruct him on how to hold and aim but it never sticks for moment when he is going on his own. We’ve decided to try buying a tall kids urinal but I feel like that’s only a bandaid for the issue which he will have to inevitably pee at a regular toilet.

    • Eric, I would just have him sit on the toilet for urinating. For many children, it is a more easier position to manage. Our son does this and he is now 23. This has transferred well to public toilets because my son talks to himself all the time which could be mistaken for an invite for sexual activity in a public washroom. By using the stall, this increases his safety in a public washroom.

      If you really want to have him stand, perhaps having something to aim at will help. Some people put Cheerios in the toilet for aim practice.

      An article about sitting while urinating

  8. Rubika says:

    Hi Maureen, I really appreciate you for sharing your resources to everyone. I have a question, I am wondering if you can help me understand how to teach a 12 year girl with ASD to wipe. She is able to do all steps of going to the toilet but does not wipe herself after she pees. She is currently taught to wipe herself from the front while seated; however, she just drops the toilet paper into the toilet without wiping. I am wondering if you have any feedback? Should I attempt to get her to stand up and wipe? I am not sure and I am really hoping you can help. I am definitely going to try the wet cloths like you suggested to get more feedback.

    • Rubika, it may be easier to stand up and wipe so that she can see what she’s doing. I am also a big fan of wet wipes as they do make wiping easier and more efficient. Just make sure you teach putting those into the garbage can and not flushing them down the toilet.

  9. Usha says:

    I have a 13 year old non verbal boy. He used to poo in the toilet just fine till recently when he started having erections. He rubs his penis while lying in his back and then always ends with diarrhea in his underwear. What is more frustrating is that he continues sleeping with his hand inside the underpants all soiled. This always happens at night even when he is asleep. Can you suggest anything?

    • Usha, I am wondering if he uses the diarrhea as lubricant. Could you teach him to use a lubricant? This will have to be introduced as a rule for this activity. It is a normal and natural thing to do at his age. You could also have him use wet wipes to clean himself after masturbation.

  10. Khaddy says:

    Thanks so much for your write up. Please I have a non verbal autistic
    7 yes oldchild who is yet to gain bladder nor fecal control. He began toilet training for years but it’s futile as he doesn’t poo in the toilet only in the diapers. Initially, when he was younger, he would cry a lot while being seated on the pottybut now he doesn’t anymore. However, we are yet to achieve successful toilet training. What do we do?

  11. Dan says:

    I have a 13 year old autistic boy that has started holding his poop although he never used to.

    we have started giving him enemas every 3 days as worry so much that he dosent poop we have left it at the start for about 7 days.Any advice what we can do our doctor says get him to sit and relax on the toilet but he will not sit for more than 30 seconds

    • I would ask your doctor if you can give your son PEG-3350 instead of an enema. As for the sitting part, you have to practice sitting 6 – 8 times per day, starting with 5 seconds and working your way up to a longer period of time by increasing the sitting time by 5 – 10 seconds at a time. You need to work up to 3 minutes for peeing, longer for pooping. I have all of this information and more in my recent toilet training webinar that I gave today. It would be worth your while to view it when I post the recording next week.

  12. Sharon says:

    My child has a disability he is 20 now he goes to the bathroom and pee but he won’t fit and poo he knows when he wants to cause he goes into the bathroom and do it on himself when you want to clean him he will walk up and down with it on him until he feels like letting you clean him if you get him to sit on the toilet he will keep it up and don’t do anything. If we pull him to sit on it he fights but he will not mess himself when he is out he keeps it up until he reach homes I just don’t know what to do cause getting him to sit on the toilet he keeps it up and don’t do anything 

  13. Val says:

    I’ve been working with a 13 years old no verbal autistic boy. When I first started working with him , he would have bowls and reach in his pull up and smear bowl everywhere. From furniture, to all over himself. I was able to work with him enough for him to stop reaching and smearing his bowel. But we have try every thing we can to make sure he pee and poop in the toilet. He made some progress and end up pooping and peeing in the toilet. Now when we take him to the toilet , he holds it and them peep on the couch and floor. He can hold it for a long , long time. I don’t know what else to do . Any advice

  14. Bety says:

    My soon to be 5yrold son can pee in the toilet, sitting and standing. But he does not poop in the toilet or potty seat. He either hides to poop in his underwear or he takes off his pants and underwear and squats on the bathroom floor. My son does not have autism ( according to doctor and therapist) he does have a speech delay. your website has inspired me to try new ideas. I was successful in positioning him mid-push to the toilet so he could see his poop in the toilet but that did not change anything. I have tried toys, squatty stools, sing alongs, but not flashcards, I will try this soon. Are there any specific suggestions for boys who prefer to squat? FYI he goes around the same time every day. Thanks!

  15. Sandy says:

    I have a 13 year old nephew. He is a verbal autistic child. Finally have him potty trained but my question is how can you get his to use the public washrooms. He will hold himself until he is in pain but refuses it. It is difficult to do family events cause he will only pee in his own bathroom.

    • This is often the next challenging piece that happens after successful toilet training at home – generalizing that to other places. Often the problem is the variance in toilets – shape, height, color, flushing sound. Make sure your nephew understands that toilets come in all shapes and types. You may have to explain that this is a toilet when you are in another location. What you might try and do upon arrival at another location, is find the bathroom and take a look around. This can take the mystery out of it and help with familiarity. You may even need to introduce a visuals card that outlines the toileting steps as your nephew may see each bathroom as a new situation and forgets what to do or is not transferring the skills. This is called critical mass.

    • This skill falls under what we call critical mass which is the ability to generalize a skills across many contexts. Your nephew may also not recognize toilets outside of his own as a toilet if it is a different style and color. You may have to first find the bathroom upon arrival and explain that this is a toilet too and he can use it just like at home.

  16. Ashlynn Davis says:

    Hi my name is Ashlynn.. I have a 9 year old who wears underwear he’ll pee on the toilet no problem but the pooping he does in his underwear n he’ll try to clean himself up before I know what he’s doing.. it’s very hard and stressful I’m trying to put him on when I know he’ll poop but it hasn’t worked n he’s still going in his underwear. I’m looking to talk with his OT to see if she’ll help me but if someone here can that’ll be great.

  17. Heather says:

    I work with a 19 year old student who doesn’t wipe well. She will do a quick swipe, then pull up her pants. She then smells. My biggest barrier is that she is SO inconsistent with her focus and actions. It is difficult for her to learn any type of routine. Any advice?

    • If your student is struggling with wiping, try using wet wipes instead of toilet paper. Because they are moist, then can be easier to use than toilet paper which can feel abrasive. It may also help her to stand up and bend over slightly to wipe rather than reach back while sitting down. You didn’t tell me what position she in while wiping – sitting or standing up.

    • I would consider using wet wipes to make the wiping job easier. You may also have to model how many wipes to do, or that the cloth has to look white before she can stop. There has to be some structure to know what to do.

  18. toddgyates says:

    I have a 3.5 year old with autism that we are struggling to get on the toilet. We change him in the toilet when he does poos and he is fine with this. He even flushed the toilet after we empty the pull-ups. But he will not sit on the toilet. He is scared of it. Pretty sure he’s afraid of falling in. 

    We have managed to get him to sit on it only once. We had a kids attachment, but at the time, he refused to use it because mummy and daddy don’t use one. So I sat him on the toilet as normal. He was only there for a few seconds, but it scared him. Now he won’t sit at all. He won’t even sit on top of the lid while it’s down. I’ve tried rewards of his favourite foods and toys. NOTHING will convince him to sit on it. 

    We have no idea what to do. And we certainly aren’t going to force him for obvious reasons. 

    • Because your son is so young, he may be small in size and does not feel stable when sitting on the toilet. You can get toilet seats that have a flip down smaller ring built into them. This is not a separate insert – it’s built right onto the seat. This may help your son be able to feel the edge of the toilet seat and know that the opening is smaller. He also should not have his feet dangling above the floor. Add a step stool to increase balance and stability.

      You may have to take a break for awhile and try again since there has been some fear. He may also not be ready for the big toilet yet. Many children have this in-between stage where they may be fine being changed in the bathroom and help with the process, but they are not ready to sit on the toilet and go through it all. 3.5 years old is very young to be toilet trained with autism if there is an accompanying intellectual disability or speech delay.

  19. Cristen says:

    Hi I’m looking for some help .. my son is 9 he isn’t able to sit on the toilet and poop the only way he is able to go is in the squat position  I’ve tired the squat thing to bring up his legs but he is extremely resistant to it he will ask for a diaper never has accident I just can’t seem to get him to figure out how to push it out in the sitting position we can sit for a hour and nothing but the second he squats he goes. Any advise would be so helpful 

    • I am wondering if this squat position is due to the consistency of the stool (on the harder side which makes elimination more difficult) or that the squat position is required to give interoceptive feedback. Here is some information on interoception and toilet training –

      If you son experiences constipation which is often the case if daily fluid intake is low or there are dietary restrictions, maybe talk to your doctor about using PEG 3350 which is an over the counter product. We found this helped our son a great deal with elimination and still have to go back to using it from time to time.

      This may also sound like a weird idea, but I am wondering if holding a small pillow in front of his stomach and leaning forward on that would help with positioning? The other thing you could do is consult an occupational therapist for some ideas on repositioning. I usually find the squat position has to do with stool consistency or to give feedback for sensation.

  20. Kelesia says:

    I have a 5 year old with non verbal autism I have tried to toilet train him in the past with no success. Lately he has started smearing after he poops in his pull ups he removes it and smears all over the place. What would the best step to start with?

  21. Twyla Gallaher says:

    I would let him get a pair of underwear before he goes into the bathroom like he did with the pull ups and try getting him a squatting stool where he can put his feet on it and itt helps them to have a bowel movement in that position. My son would sit all the time 8n the corner of his bedroom and raise his legs to move his bowels so the squatty stool works I think they sell them at Walmart. Good Luck I hope I helped you some. I think your wonderful parents. I forgot to mention sometimes their minds don’t match their body so many different sensory issues going on in their body it’s so much harder for them to focus and feel like us but I believe patience is the essence of all. We all think they should go like us it’s so sad because they are wired differently.

    • Twyla, you have touched on an important point by saying that individuals with autism are wired differently and each person is unique. There is no “one size fits all” when it comes to doing anything. Everyone has their own way of doing things. We just have to be patient, support, and be prepared to change our strategies if they are not working.

  22. Alison Cook says:

    My son is 6 years old and on the autism spectrum. It took us a while, but he urinates successfully in the toilet (only sitting). He hasn’t pooped in the toilet, but we had successfully gotten him to request a pullup and then go in the bathroom to poop. I’d wait outside the bathroom and prompt him to tell me when he was done. This was going well, until we removed the pullups cold turkey. I have another son, with language delays, that was also doing the same toileting process. Recently, when my family was watching the boys, they were able to bribe my younger into pooping in the potty. He’s had a history of holding poop (up to 8 days on time), but is now trying to use the toilet. So, what’s working for one child is not working for the other. My 6 year old, without having access to a pullup, is now pooping in his pants whenever and wherever. No more asking for a pullup, no more going into the bathroom…just going. I have never seen him sit to poop, he usually stands up and leans forward. I need help trying to figure out what to do now. Do I give the pullups back to my oldest? I’d rather clean a scheduled BM in a pullup, then risk it coming out whenever and wherever, without warning. But is that what is best for him and his bathroom success? Please help!

    • You may have taken away the Pull Ups too quickly. I recommend cold turkey with the Pull Ups because most children won’t use the toilet at all if they have access to them. He may need more time on this step of understanding that he is to have the bowel movement in the bathroom. You have not told me what happens after he poops in the Pull Up. Was he shaking the bowel movement into the toilet out of the Pull Up (the next step I would recommend).

      When we went cold turkey with the Pull Ups, our son started pooping in his underwear too, but we had him come into the bathroom and empty the underwear contents into the toilet. This lasted one week of doing this.

      I think you may need to create some sort of extra step here because your son associates the bowel movement with the Pull Up. Maybe use the Pull Up as the cue for toileting – he doesn’t wear it but he goes and gets it like a key to the bathroom. There is also a chance that your son isn’t ready for the pooping part yet. Our son was 6 mastering urinating but 9.5 for the bowel movement. I am not sure if he is language delayed as that can also be associated with a delay in toilet training.

      I am also suspecting because of the elimination position, he needs pressure to feel the bowel movement passing or help it come out. Does he lean forward onto something like a countertop or bathtub? The poop may be hard in consistency and painful to pass. Is his fluid intake good? What is his diet like? Please also have a look at my fecal smearing article as I do have more information on toileting in it –

  23. Whittany says:

    I have been working on toilet training my ASD 4 year old for over a year now. Peeing in the toilet only took about a week, although he still has accidents when he has routine changes. Poop has always been an issue, most of the time I notice his pre-poop rituals and rush him and can sometimes catch him in time. Anyway, I started rewarding him with a popsicle when I caught him in time and he could make it, after this he started telling me when he had to go and I felt like we finally succeeded. Then there was a dreaded holiday weekend and he started having accidents after about a month accident free. I thought after he adjusted back to his schedule he would go back to pooping in the potty but now he is not only NOT going in the potty, but also smearing it all over the house. The popsicles don’t seem to help now either and I feel so defeated.

    • Whittany, this is normal to have some setbacks or regression. I want you to have a look at my smearing article to see if you can pinpoint anything that applies – Fecal smearing has a very specific cause and you’ll have to figure out what that is. Is he withholding his poop? How is his diet? Low fiber diets or a lack of fluid intake can affect bowel motility. Why did things go downhill on the holiday weekend? Were you travelling? Were there changes to the schedule?

      Rewards often don’t work after a period of time so you’ll have to change your game plan. Peeing is often mastered well before pooping. It took my son 3 years to poop successfully on the toilet after learning how to urinate.

      Your response to the situation is important too. You want to be as low arousal as possible. This is explain in the fecal smearing article.

  24. NJT says:

    I have a child in my class who will not use the toilet, but at school is happy that his toileting routine consists of going into the toilet and with adult support being changed, however at home, he has started refusing to go into the toilet area at all – I imagine this is about control, however mum is concerned. Is there any advice I can give her?

    • I would need to know what the differences are between toileting at school and at home. Why the sudden refusal at home? Does he need my assistance at home and it not getting it so he is protesting? I need more information here.

  25. Dylan Jones says:

    My son is 11 and its not getting him to use the toilet, its getting him off the toilet that is the issue. He has is verbal with ASD and PDA. He uses the toilet as a kind of safe place to avoid going to school, going for walks and anything that sets of his sensory issues and creates fear and anxiety. He ends up getting very stressed with severe stomach cramps and resulting pain after sitting there for hours…. Any tips for changing this habit and getting him out?  

    • The toilet is often a safe haven for people because they know they will not be bothered in there. You have to set a time limit in the toilet for your son as he doesn’t know how to pull himself away. Create an oasis somewhere else- maybe his bedroom. Teach him to listen to music, meditate, deep breathing – but all in his room. It sounds like your son is “stuck” and needs help coming up with other alternatives.

  26. Animesh Kumar says:

    I have a 6.9 year old non-verbal child, with cognitive delay, and severe Autism. For the first six years of his life, I relied completely on therapists to define his goals, and programs to help him toilet train. Most of the times, I was told that he may take a very long time to be toilet trained, and children like him are sometime no toilet trained till their late teens. When he turned six around mid-2018, he was still in a pull-ups, and when not in one, he would urinate and do BM all over the place (including smearing) with absolutely no control. Since the summer of 2018, I decided to pull him out of all therapy, and built a home-based program focused on him. I got a person (not trained on Autism), but with immense love and dedication to work with him. The two of us worked with my son round the clock – getting rid of pull-ups, and spending hours and hours driving him to understand toileting. Lots and lots of failed attempts. But persevere we all did. It was tough love, but it yielded fruits. Flash forward, in six months, my son is fully toilet independent (both Urination and BM). He does not need help to use the toilet. He is still not able to communicate, but he knows when he has to go… and finds the toilet to go. And you can tell by the look on his face that he feels accomplished.

    • Thank you for this inspirational toilet training story. You have highlighted one of the most important points of all – this is all about trust and building a relationship. You supported your son and let him know he was loved and respected through the entire process. I applaud you! You found someone who loved your son for who he is and he instinctually would know that he was cared about by this person as well as yourself.

      Getting rid of those Pull-Ups is key. I have too many people who tell me they are using them at different points of the day and you can’t get this process done with diapers in the picture. You have given you son a very important skill and also the independence that will carry him forward into his teen years and adulthood. More options will be open to him being toilet trained. Thank you for taking the time to write. I think your story will inspire others to persevere. Toileting is a lengthy process and you have to stick with it.

  27. Jessica Kesselman says:

    Hi Maureen- I’m so happy to come across your site. I want to ask you about something you wrote in another comment, about BM’s while standing. You wrote, “You can try having him blow bubble while on the toilet which mimics the diaphragmatic release.” I wonder if this is the core issue my son is having. He can’t blow or spit. And he has never had a bowel movement sitting down! My son is 14, pretty much non-vocal except that he can tell us “poop”, and can urinate in the toilet standing up. He has never voided sitting down, and he has never pushed out a BM sitting down, Hence, he goes in his pants. Recently, he has started taking his pants off before having a BM. He does this in private, in his room. I see this as progress! Now to get him to do this in the bathroom. Do you think its possible this could be a physiology thing, if he can’t blow or spit, he can’t figure out the BM-while-sitting thing? This is the first I ever heard of the connection. Any thoughts or direction where to learn more would be helpful!

    My son, Charlie

    • Jessica, this is great progress about your son taking off his pants before having the bowel movement. Question – does he crouch down to have the bowel movement or drape himself over the arm of a chair? If you can tell me his preferred elimination position when he is alone, that would be helpful. I know you say he does it standing up. Is this the same position in his room? The pushing motion to release a bowel movement is difficult to teach. Some people tense up. Bowel motility can be affected as well if your son is not well hydrated or he holds his poop in too long. Is the bowel movement hard or soft? If the bowel movement is hard, you may want to try giving a spoonful of mineral oil to soften the stool. I suspect he may be standing up because this is the easiest way to get the bowel movement out.

      Does he know to sit down to have a bowel movement? Has he seen others do it sitting down? Sometimes we assume our kids know these things but they don’t. You can also have him pick up the bowel movement in his room and bring it to the toilet, flush it down, and give him praise or some kind of a reward. He still may not have made the connection to releasing the bowel movement in the toilet. Here is a link to how to teach blowing – . You’ve probably tried these methods but just in case you haven’t, the tips may be helpful.

  28. Audrey Bowen says:

    Hello Maureen, I work at a daycare and I am using Smarties as a motivator for the child to use the bathroom. He is becoming really consistent peeing in the toilet. How will I know when to decrease the Smarties and is there a routine to use.

    • Audrey, I know some behaviorists get really up in arms about not fading rewards once a task is accomplished, but I am of the opposite school of thought. We let our son have ripple chips for years after pooping in the toilet. We also found it did not affect him going to the toilet if he didn’t have chips as a reward. My son faded this need on his own but it did take him several years. Honestly, every person is very different and you don’t want regression. Just make sure you aren’t giving him the entire box of Smarties – just give a couple of them. You can then cut back to just one Smartie. You can also have a celebration that this task is mastered and say the Smarties are no longer needed because he is a bright boy and has done the task beautifully. If there is protesting, keep the Smarties going. There is no one way to do this. My daughter only needed the Smarties once and then she never asked for them again.

  29. Chris says:

    My daughter has just turned 7 and we, like many others, feel like we have tried every method possible. Our current problem is that she is holding her wee in for up to 12 hours and has constant urine infections (which she will not take antibiotics for). She wees and poops on the floor and will only wear a pull up to leave the house. Might give the power cards a try. Thank you for this article.

  30. Monica says:

    That was a good read. My boy has mastered day time toileting but is still in incontinence products at night. He’s 13 now. Any ideas on getting him pull up free at night would be greatly appreciated.

  31. Kimber says:

    Hi, I have a 7 year old son who has autism. He is fairly high functioning and he is verbal but has more of the sensory and anxiety issues that come with it. We have been trying to potty train him for what feels like forever and he will NOT poop on the potty. He will sit and push for a few minutes then get up and poop on the floor. He has suffered with severe constipation in the past which I do believe initially caused the anxiety to go, but now how to we get passed it?

  32. Mitch says:

    Hi Maureen: My granddaughter is 8 and a non-verbal autistic child. She is 8 right now. About a year ago my daughter and granddaughter moved back home with me and my wife. Evi is not potty trained. I believe it is my daughters fault she always makes excuses and says Evi is not trainable. Evi will number 2 in her pull ups then smear it on the walls and floor, she also will actually eat her soiled pull up both number 1 and 2, my daughter says her doctor told her that it is not a real big deal but I don’t believe that. The sad fact is ME and my wife were making progress, but it also caused a huge fight between me and my daughter. Evi will also pull her pull up down, pee or poop on the floor then walk away, and again my daughter ignores it. It is a constant fight between me and my daughter to get her to clean Evi’s room, no matter how much poop is on the floor and walls or how many pee puddles there are. I do not believe this is healthy for my granddaughter, but my daughter just does not get it, she will let Evi eat with poop on her hands and so on. Again I believe that Evi can be potty trained with work, but how do I get it through to my daughter that Evi is smart enough to do so, and get my daughter to understand how unhealthy it is for my granddaughter. My last point to make here is this. I have a major health concern that being stage 2 small cell lung cancer undergoing chemo, and my risk of getting sick from the lack of potty training is great, because most of the time it is me that is cleaning up the mess. Any suggestions to help get my daughter with the program? I don’t want to have to make her leave because she has no other support or options.

    • Dear Mitch,

      Toilet training is not an easy process, particularly if your granddaughter has cognitive delay and is non-verbal. My son was not successfully toilet trained until he was 9.5 years old. My parents blamed me too, but it was not my fault. I have a new blog post on this topic coming out tomorrow so please have a look on my homepage as this blog post will explain a lot of the problems with toilet training, why they occur, and how to get this process started. You should read a book called What to Do About Smearing – It explains why this happens and give lots of great ideas around toilet training. Eating the poop can be an effort to get it off of her hands or something she finds stimulating. It is important to get her toilet trained to ensure that her future has lots of options for her. Some programs won’t take children who aren’t toilet trained, for example. At the same time, shaming and making a person feel guilty will not be helpful. My mother ruined my relationship with her over this issue as she was convinced that she could have had my son toilet trained at 3 (it would not have happened unless she did it under duress and in an abusive way). Each child is an individual and no two children with share the same reasons for their toileting issues.

      It may be helpful for Evi to be part of the clean up process and lead to the bathroom as soon as this happens. She may not understand that toileting happens in the bathroom so you will need to teach her where this process happens. Evi will need close supervision so that you can catch her taking off the Pull Up etc. and leading her to the bathroom. It sounds like she has alone time in her room and is able to do this while no one is watching for a period of time.

  33. Keneilwe says:

    Hi Maureen
    I have an autistic son who is 7 years old, who struggles with going to the toilet. He will say he want to pee but when we get to the bathroom he just seats and does nothing. He would sit there for about 10 minutes but nothing. But few minutes after standing up he would pee sitting on the floor. What can I do? I have tried picture cards but did not work. He is not really into cartoons and staff but he loves music.

    • First of all, make sure you son is stable when on the toilet- that his feet are not dangling and planted firmly on the floor or on a stool. Where are his hands while he is trying to pee on the toilet? Are they holding him steady on the seat? If so, get a smaller toilet seat insert so that he feels well balanced on the toilet seat.

      He may also not know how to release his bladder. Try having him blow bubbles while on the toilet. This mimics the diaphragmatic release. He may have difficulty getting the feel of this release which is why he ends up going on the floor.

      Let him listen to music while seated on the toilet to relax him. Or – after a successful pee in the toilet he can listen to a favorite song.

      Your son may still not know that the pee is supposed to go into the toilet. When he goes on the floor, mop up the pee and squeeze out the cloth over the toilet so that he can see that’s where the pee goes.

  34. Jennifer says:

    I provide direct support to a 21 year old man. He is non-verbal and on the spectrum. We were informed by family that he was never officially potty trained. However he is fully capable of standing or sitting to pee. Although he currently is having issues with incontinence both at home and day programming. He will go on his floor or closet or just wet himself with clothes on. We believe this is a behavioral response. As he will be prompted to use the toilet, not go and then go in his pants minutes later. The biggest issue we are having is voiding. He poops standing up and in his hand. He then takes it to the toilet or sink and flushes or rinses it down. He will clean his hands with prompting though not thoroughly without help. In the 16 months I have worked with him he has never  pooped in the toilet. I am at a complete loss on how to help him. Pretty much the only thing he loves to do is watch Barney videos on his tablet. And he will be so focused on this that I believe part of the toileting issue is that he doesn’t want to stop watching to go to the bathroom. Any advice would be immeasurable for me. Thank you!  

    • Without having seen this young man in action, I’ll give you some ideas on what I think may be happening. You say he lives at home and attends a day program. I am asking this because sometimes it’s the difference in the toilet that causes someone not to use it. For example, if the toilet seat at home is white but the toilet seat at his day program is black, he may not see that toilet as the same object because the toilet he knows is white. This is called absolute thinking. What you have to try and teach is context and make each toilet as similar as possible. All toilets are in a little room, have a white seat, with toilet paper etc.

      Let him sit on the toilet with the tablet in his hand watching Barney. If you take it away from him when he is going to use the bathroom, this may cause anxiety for him and he may feel frustrated. It may be why he goes in his pants minutes later.

      Another problem can be in the change of elimination position. If he goes in his hand, that tells me he may be standing up. When you have to sit on the toilet, the change in the position can be confusing for the pushing. Some people tense up when they have to push poop while sitting down. You can try having him blow bubble while on the toilet which mimics the diaphragmatic release.

      What I would not do is use the Barney videos for any kind of punishment (i.e – if you poop in toilet, you get Barney videos, if you don’t – no Barney videos).

  35. Ken says:

    Hi Maureen,
    I have a non-verbal 16 year old son. He knows how to eliminate in the toilet before. But weeks after he had a bigger room, he started peeing on the floor and worse, he have been defecating in the room. Like your son Marc, he is also smearing the walls of his room with feces.
    How can I retrain him?

    • I would say this may be happening because of the room change and there is anxiety over this. He may settle in and go back to the toilet over time. Can you let me know if he is still doing this behavior?

  36. Iris Cast says:

    Hi Maureen! I am hoping you could help shed some light into our situation. I have an 11 y/o with Autism. We’ve been working on potty training since he was 3, I will get rid of all pull ups next weekend per your suggestion above. I am concerned that my kiddo is not phased by having a BM in his underwear and staying it in for long periods of time. Is there anything I can do to keep him from going in his underwear? We’ve tried positive reinforcements, picture reinforcements with his favorite candy, reminders 20/30 mins. after eating. He just prefers to go in his underwear. we try to keep all the bedrooms locked so he doesn’t have access to a bedroom to go poop in but there have been times that we’ll forget to lock it. Any ideas? Thank you!!

    • Iris, you need to get him to empty the bowel movement out of this underwear into the toilet, get him to wipe and flush, then offer a reward. He may not understand that the bowel movement does have to end up in the toilet. Our son did the bowel movement in his underwear as well, but once he had to empty that into the toilet, wipe and flush for the reward, he phased out going in his underwear within two weeks. He may still be going in his underwear to get the sensory feedback of feeling the bowel movement leave his body plus the underwear offers some resistance to help with feeling what a bowel movement feels like when it leaves his body. Let me know if this works.

  37. Denise says:

    I have a 17 year old autistic non-verbal daughter. She has bowel movements in a pull-up only. I know she knows what to do, she is just very stubborn. Thank you for writing this article. It gives me hope!

    • Change is hard for everyone. You have to go cold turkey with the Pull Ups. My son was so clever and able to hold his bowel movements for days until I caved and put a Pull Up on him. Sometimes the feeling of the stool dropping away and into the toilet is such a new sensation, it causes stress. You could try putting Saran Wrap over the toilet bowl and letting your daughter still have the sensation of the bowel movement leaving her body and still making contact with her bum. I know it sounds unusual to try this, but sometimes these in-between steps are needed.

  38. Rae says:

    Please , please help!! My son is 16 , and REFUSES to sit on the commode to have a bowel movement. For weeks and weeks I will suggest go to the bathroom, and after a while he will start to get upset and become violent when asked. He rather go in his underwear, and most days I have to fight just to get him to let me change him. He pullls it out and puts it in the trash, sink, bowl or his mouth (gag).

    • This one is tough. He has to be shown that the bowel movement goes into the toilet. Can he do it in his underwear, then have to put the stool in the toilet and get rewarded for that step? We had to make this as a step for my son as well. We were able to fade this step after a week and get him sitting right on the toilet. Does you son have an unusual elimination position? Sometimes this is a problem as well.

  39. Sarah says:

    Hi Maureen,
    We are currently working with a parent to toilet train her child. We have a lot of questions as he sounds similar to your situation. Is there any way we could contact you by email?

  40. Sinia says:

    My grandson is 8 years old. He uses the bathroom with no problem. The only problem is when he sits on the toilet to poop and pee comes out he doesn’t understand how to keep the pee in the toilet and it goes all over the toilet and floor. Do you have any tips to help him with keeping the peep inside the toilet when he sits in the toilet to poop. Thank you .

  41. Julia says:

    Thank you so much for this information! We are desperately trying to toilet train our 6 year old son who has a rare genetic condition, is intellectually delayed and has Autism. He also has behavioural challenges that cause him to resist care. We are not totally sure if he has bowel control but are hoping to try this method. With his medical condition he suffers from severe constipation which he takes medication for. I am hopeful after reading this article that there may be hope to succeed. I am even considering a leave from work to try. Any suggestions if this method could be achieved in out of home scenarios? He attends school and daycare….Thank you for being so strong!

    • Julia, generalization of toileting can take some time. The important thing is to be consistent in all situations. For example, if you are using picture symbols for toileting, those same ones should be used everywhere. Use the same language around toileting. Because some toilets may be higher off the ground, you have to make sure the child can still sit stablized because feeling off balance can cause issues. With our son, he used the toilet successfully everywhere right away. I am not completely sure why as this is not often the case.

    • Grandma Ang says:

      I have read that letting a boy take of his pants and underwear and then getting them to sit facing the tank is helpful. It also has the added benefit of watching what is happening. 

  42. Farah says:

    Getting into the bathroom was the first thing that needed to happen. We had jumped too many steps, not realizing how hard this transition was going to be for Marc.

    im holding my self from crying as im reading this at work
    my son is only 4..i emptied his poop from the pants in the toilet hoping to teach him where poop goes..he did just that..pooped in his pants and then went to scope it by his hand to throw it in the toilet. i was so disgusted and it showed in my face. i didn’t see it this way..i didn’t see it as a step forward.. why didn’t i? thank you so much for giving me a new perspective

    • Farah, don’t be too hard on yourself. Toileting is a very complex issue and no child progresses in the same way. What you want to celebrate is now your son knows where the poop goes and this is a huge step! It won’t be long now before he learns that it is even easier just to sit on the toilet and not have to handle the poop himself. You’re on your way to successful toilet training. This is really something to celebrate!

  43. Samantha says:

    Hi. I have a 6yo son with autism. I have tried every toilet training method I could think of. He will only poop at home and he asks for a pull up. He goes and hides like a baby does and poops on all fours. I stopped the pull ups cold turkey but he would just go in his underwear. It doesn’t bother him. He could care less if he’s changed immediately or not. After 2mos I just went back to pull ups because I got tired of cleaning out his underwear. I also have a 13yo daughter who is severely disabled (non-mobile & non-verbal) and of course I have to change her diapers. I feel like I’m changing poop diapers all day. Sometimes between the two of them I change 6-10stinky diapers. I try to explain that poop goes in the potty but he sees me changing my daughter so I’m wondering if that is part of the problem. He asks me everyday why she can’t walk and things like that. He just doesn’t understand. And he doesn’t get why he should have to use the potty and she doesn’t. I try to explain that children his age should go in the potty and he just says no. I just don’t know what to do.

    • Samantha, I would try going cold turkey again with the Pull-Ups if you can and when your son poops in his underwear, you take him to the toilet to empty out the poop from the underwear. He may need to start learning that poop goes in the toilet and he has to be part of the process emptying it.

      The fact that he eliminates while on all fours tells me he may have some pain or difficulty passing a stool. Are his bowel movements hard or soft? Does he have any pain passing a stool. When on all fours, does he rock back and forth?

  44. Sylvia Barron says:

    I have a 42 -year old son with severe autism. He has been toilet trained since childhood, but I skipped a step in trying to avoid feces eating or smearing, so for almost 37 years I or another adult has been wiping him. ?This has led to him coming soiled from day program when his coach ignores my request that he needs that assistance. I’m racing the clock in planning for his future with me gone, I’m 63 and have tried for months to show him how to wrap the toilet tissue in his hand to wipe and have failed over and over. He washes his hands, but continues to wipe his butt cheeks without going into the crack. Any help will be much appreciated.

    • Sylvia, your son may need to lean forward with his legs a bit spread in order to get in between the butt cheeks. You may also want to try using wet wipes as they give more sensory feedback so your son may get better input with a wet wipe. Sometimes just a change in position helps. It may be too much for him to spread his cheeks on his own, handle the toilet paper, then wipe. If this doesn’t work, write back to me and I’ll do some more brainstorming.

  45. Amanda Ruth says:

    I am a 23 year old single mother of a 7 year old little boy, he’s currently in the process of being diagnosed through the IU13 unit here in Pennsylvania. I was at wits end with him having to use a diaper to relieve himself. My family blames me and says its because I’m a crappy mom, but this article right here, just proved them wrong. My sons uncle on his fathers side has autism– Asperbergers’ to be precise. I cannot thank the author enough, both for stating that this is a normal problem for autistic children, but also that it can be broken. THANK YOU SO MUCH !

    • Amanda, my son was not toilet trained until he was almost 10 and my daughter was 6. I was blamed by everyone for this – my mother especially. There is new research emerging that another part of this problem is interoception. This is the eighth sensory system that tells you how you feel internally (thirst, pain, need to go to the bathroom etc.). In people with autism, interoception is impaired. This can be taught in some individuals to recognize these internal signals, but not every person will be successful with aspects such as emotions.

      The first place to start with this process can just be teaching your son that relieving himself happens in the bathroom. Always take him in there when you are changing his diaper and get him involved in the diaper changing process. There is a really good book to read as well called The Potty Journey which I highly recommend. A nurse wrote it. I believe that every child can be toilet trained unless there is a true physical/medical reason that this can’t happen.

  46. Maria says:

    My 21 year old with autism and behavioral issues is non-verbal . I am trying to get him off pull ups at home first but it’s been difficult. Any suggestions?

    • You have to go cold turkey with the pull ups if you want to get rid of them. My son could hold his bowel movements for a week at a time waiting for me to give in with the pull up. Teach him that toileting happens in the bathroom and help him make the association that’s where that activity occurs. If you have specific questions, feel free to ask me.

  47. Jennifer says:

    This is a great article. I’m going to try this with our 12 year old son.
    Just wondering if you taught the entire toileting process of wiping and washing hands after having a bowel movement from the very beginning or if you taught that later? Thanks for sharing!

    • Thank you for your kind words, Jennifer. To answer your question, you have to teach the entire toileting process as a complete routine. It is really difficult to try and add in separate steps later. My son took 6 weeks to learn the entire routine, but he has never made a mistake since and he’s soon to be 21. He has always washed his hands and often uses Wet Wipes after a bowel movement. He puts those wipes in the wastepaper basket.

  48. Stacey says:

    My 3 year old has autism but also tuberous sclerosis,Epolepsy ,developmental delay,she underwent brain surgery a year ago,everyone is making me feel pressured to potty train her,she can’t yet talk,walks very wobbly,and at the moment is getting into her nappy and eating playing with her poop,I tell her what it is and that it’s yuk not to eat it etc then wash her ,I’m feeling pretty useless just now and deflated to be honest and I just don’t know where to start,I hv two older children and a one year old

    • Do not give in to the pressure to toilet train. You never go by chronological age to start this process. You have to look where a child is developmentally. Look for signs of readiness - . If the signs aren’t there, don’t start. You can also look at the topic of interoception –

      I have two children with autism – one was toilet trained at 6 and the other closer to 10 years of age. We had years of fecal smearing and some eating, but now that we have done the process, we have never looked back.

      When your daughter is getting into her nappy, take her to the toilet and have her empty the contents of the nappy into the toilet. This is often the first step in helping a child to understand where poop eventually goes.

      It sounds like your daughter is having gross motor issues since her surgery. Toileting involves gross motor movements so don’t put so much pressure on yourself. It is better to wait until your daughter is more stable than to push and put unnecessary stress on both yourself and your child.

  49. Tessa Bools says:

    We have spent years trying to toilet train our severely autistic 10 year old, who is still in pull ups, because he constantly wees and poos. He has absolutely no control over his bowel movements, and constantly wets himself inbetween toileting and changes of pull ups. We have to change him all the time. I would like to go cold turkey, and take the pull ups away. But I would probably have to change him  even more frequantly. Also I  don’t think school are ready for him to start wearing “normal pants,” just yet. Thanks for sharing your article. I might try some of the ideas.

    • Tessa, you may have to determine if there is an actual physical problem that is causing frequent bladder and bowel movements. I spent 3 solid years trying to train the bowel movement (ages 6 – 9). One place to start is to help the child realize there is an actual place for wee and poo and that is the bathroom. Keep him in the Pull-Ups but see if you can get him to associate going with being in the actual bathroom. Can you son be involved with the clean up? Often, when the child becomes involved, they are more motivated to get rid of the Pull-Ups. Please let me know if you try any ideas. This is not easy, believe me. I thought my marriage would end over the trials of it all.

  50. Sherie paris says:

    We are about to restart toilet training for our 16 year old. Having tried all the typical routes before, it’s been great seeing this and maybe we can use these tips to finally achieve some success. Thank you for sharing

    • Sherie, I am a huge believer that any person with ASD can be toilet trained unless there is an actual physiological reason it can’t be done. The key is to experiment and stick with it. Ours was a 6 week process. The previous 3 years of trying, I had always given up at the end of the third week. I really kicked myself when I saw we were probably half way to success on those 3 tries, but I just didn’t know it.

      The first step is helping the child realize that elimination happens in the bathroom. We also found we had to get rid of the diapers completely, otherwise Marc could hold on to a bowel movement for up to 7 days and he could wait for that diaper at any point.

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