One of the most challenging life skills a parent needs to teach their autistic child is how to use the bathroom. Autistic children resist change. That makes toilet training particularly difficult, but not impossible. Developmental delay increases the challenge, since a potty chair will be too small for most children by the time they’re ready to train. However, with a child-oriented approach centered on readiness and positive reinforcement, children with autism can learn to use the toilet the same as any other child.
How Developmental Delay Affects Toilet Training
While toilet training autistic children is similar to training a typical youngster, developmental delay affects timing. When toddlers reaches two or three, most are ready to begin training, but an autistic child doesn’t function at their chronological age. Most autistic kids don’t reach the mental age of two or three until they are at least five – and sometimes older. It is common for autistic youngsters to be eight or even nine before they are ready to begin using the toilet.
Although the developmental delay can embarrass parents, especially if the child attends a day-care center or mom uses a babysitter while she works, rushing the toileting process only results in failure. A child must be able to:
- understand what you want him to do
- physically sit on the toilet for at least five minutes
- have enough motivation to eliminate in the toilet
- control his muscles: not empty his bladder or bowel for a few minutes
- communicate by word, picture, or gesture that he needs to go
In addition, parents of autistic children need to deal with any sensory issues from the bathroom itself, bowel problems, or behavior issues like diarrhea, constipation, bright lights, fear of flushing the toilet, tantrums, or noncompliance that might interfere – prior to beginning the training.
How to Break the Diaper Habit in Children with Autism
In addition to the new method and place of elimination, many parents find their children firmly attached to their diapers, which have been part of the child’s routine since birth. Replacing them with underwear will probably upset the child, but most parents find this initial step essential. As long as the child continues wearing diapers, he won’t understand what is now required of him. He will continue soiling his diapers, because that is what he has always done.
To help ease the child into the transition, make him a part of the buying process. Since autistic kids don’t find pleasure in pleasing mom and dad, wanting to eliminate in the toilet must come from something he cares about highly. If possible, use his obsession to your advantage. If he loves trains, let him pick out underwear with printed trains on them. If he has a favorite cartoon or movie, try to match the characters; but above all, let him do the choosing.
Use Positive Reinforcement to Motivate
In a typical toddler, positive reinforcement can include mom or dad being happy when he eliminates in the toilet. However, autistic children need a more self-serving type of reinforcement. Just like the underwear, use something the child is particularly fond of, like:
- M&Ms, jelly beans, tootsie rolls, or a dairy-free chocolate chip
- his favorite drink poured into a juice glass
- a special toy or game saved just for toileting
- a reward chart that uses stickers for success
Whatever you choose, it must be highly valued by the child. Otherwise, it won’t hold enough motivation for him to make the change.
How to Begin Toilet Training Autistic Kids
The first step in any life skills program is always observation. So take a few days (a couple of weeks is even better) to watch how often, and when, your child soils his diaper. Write it down, but don’t attempt to curtail anything. What you’re looking for is a pattern. Since training children with autism is more intense than a typical toddler, you need to know how often to put your youngster on the toilet. Once you have that information, you can draw up a plan that will work well.
The key to helping these kids is to design a realistic schedule, then weave that plan into your child’s daily life. That way it will become their new routine. For each child, the degree of intensity will differ, depending upon the data collected, but a reasonable prompt will range from every 30 minutes for those who eliminate often, to every couple of hours.
Start by getting rid of the diapers. If necessary, during the observation period, get your child familiar with his new underwear, the toilet seat, flushing, undressing, the feel of the toilet paper, and anything else that may upset him. Then on the day you plan to start training, look at your schedule and offer the child something to drink about 15 to 30 minutes prior to what your recorded data shows is his regular elimination time.
Place the child on the toilet seat about 5 minutes early. Let him sit there for 5 to 10 minutes, until he eliminates in the toilet. If he succeeds, give him whatever positive reinforcement you plan to use; but be sure to keep that reinforcement specifically for bathroom success only. The child needs to learn to associate the treat with going to the bathroom.
If he isn’t able to go, then say something like, “well, I guess you don’t have to go right now." Take him off the toilet, give him another drink, wait about 10 or 15 minutes, and then try again. If you don’t get him to the toilet in time, shorten the intervals. Initially, the goal is to help him understand what you want him to do.
Never Punish When Toilet Training Autistic Children
Like typical kids, some autistic children will toilet train easily and some will resist – especially those who don’t find soiling their diapers or underwear disgusting. However, never punish, scold, or show the child anger when they have an accident, or are unsuccessful. You want to make going to the bathroom a pleasant experience. Positive reinforcement is essential, since the child has to be willing to leave their current activity to go to the bathroom, but so is the routine. Consistently follow the schedule, even if you leave the house.
Once the child has learned to eliminate in the toilet, the routine itself will be all the reinforcement he needs. Until then, however, be patient and don’t stress about it. It will happen, but with autistic kids, toilet training may take longer.
1. Fred R. Volkmar., Lisa A. Wiesner. A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Wiley: August, 2009.
2. Kim Bookout., Karen Williams. The Everything Guide to Potty Training: A practical guide to finding the best approach for you and your child. Adams Media: July, 2010.
3. Maria Wheeler., Carol Stock Kranowitz M.A. (Foreword). Toilet Training for Individuals with Autism or Other Developmental Issues, 2nd Edition. Future Horizons: September, 2007.