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Toilet Training Children with Autism

Let’s face it: toilet training is one of the trickiest parts of early parenting. This is especially true for families of children on the autism spectrum, whose sensory sensitivities, trouble with changing routines and communication struggles can complicate the process.

“A large majority of learners come to us without being toilet trained,” says Breanne Hartley, Clinical Director of Little Star Center Inc., a nonprofit network of Applied Behavior Analysis centers and in-home programs. “The process can be lengthy, and it takes a lot of effort, but it’s a high priority for parents, so we often will put other goals on hold while we concentrate on the toilet training process, making it as fun and rewarding as possible.”

Toilet training is rarely quick or easy, but local experts suggest parents of children on the spectrum approach the task this way:

 

Watch for signs of toileting readiness

 

Keep in mind that the ability to learn to use the toilet is based on a child’s developmental age, not his actual age. So, if you have a child that is 4 ½ for example, if he is functioning on the level of a 1-year-old, he may simply not be ready for this step yet.

 

Early signs of toileting readiness in a child, include:

 

  • Being able to stay dry for 1-2 hours between diaper changes or overnight.
  • Acting differently and/or seeming to notice when he/she is wet or dirty.
  • Going off by him/herself prior to having a wet or dirty diaper.
  • Coming to you in distress when wet or dirty.
  • Showing an interest in activities of daily living such as bathing, dressing, toileting, etc.

 

“Until the child is ready, it will be an exercise in futility,” says Cheryl Crisp, an Assistant Professor of Nursing at IUPUI Columbus with more than 30 years experience as a pediatric nurse working with children with special needs. “Toilet training starts with the parent being trained in the signs of readiness.”

 

Establish communication

 

If your child is nonverbal or isn’t a strong talker yet, look for other ways to communicate about the toileting process.

Some ideas include using the sign language sign for toilet, introducing the PECS (Picture Exchange Communication System) symbol for toilet or using gesturing, like pointing to their diaper. Whatever you choose, pick one method of communicating and be consistent.

 

Use distractions and rewards

 

Motivation is an important aspect of toilet training. Be sure there are many opportunities for your child to have liquids around your home. Once in the bathroom, make it an enticing environment by bringing in favorite toys, books, coloring pages and iPad games – anything to keep them entertained while they wait. If your child understands actions and consequences, consider creating a sticker chart and a reward box filled with small but meaningful toys.

“It’s important to establish the bathroom as a fun place to be,” Hartley stresses. “Bring in the iPad. Bring in the child’s favorite foods. We like to reserve especially powerful rewards for the moment when they eliminate on the toilet.”

 

Make a routine and stick to it

 

For children on the spectrum who crave order and routine, doing the same thing every time you are in the bathroom is ideal. A picture board or social story can help establish toileting routines, and you should go through each step with your child every time you take him or her to the bathroom.

 

Don’t punish accidents

 

Accidents are bound to happen, but making a fuss when a child can’t make it to the toilet in time can backfire.

“You don’t want to make a big deal out of it because sometimes negative attention is just as powerful as positive attention, and they may then do it on purpose,” Crisp says. “The child has to feel their way through this process. It’s a learning curve for them.”

Some children on the spectrum may not have regular elimination due to special diets, stomach problems or strong likes or dislikes of certain foods. Work with your child’s doctor to determine any needed changes of diet or medications.

 

The path to successful toilet training is a bumpy one for any child. But with some extra patience and a sensitivity to the needs of your particular child, you’ll accomplish this important milestone together.

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