Toilet Training a Child with Autism
Toilet training is teaching an entire new skill. Teaching new skills to children with autism spectrum
disorders works best when the steps to the task are organized into simple pieces. Teaching must
also be consistent at all times and become predictable to the child in terms of rewards and
consequences. In order for toilet training to be successful, the child must move from depending
on reminders (timed trips to the bathroom) to recognizing the signs of a full bladder and taking the
necessary actions him/herself.

As parents we look forward to that time when our child is finally toilet trained. We expect our child
to learn to use the toilet as part of the growing up process. Not every child is alike, some children
are difficult to train and may make toilet training harder on the parent. Learning to use the toilet is
part of socialization. Children become interested in training when they become aware that other
children and adults use the toilet. They assume that using the toilet is part of being considered a
“big boy or girl.”

Most children enjoy the recognition and gratification they receive from adults when using the toilet
as well as the rewards that come their way. However, young children with autism have trouble
applying the same social interaction reason to toileting. They also are being asked to change set
routines and rituals and they also may not be aware of or able to control their bodies just yet.

Signs of Readiness

For children on the autistic spectrum, it’s recommended to look for signs of readiness. Signs may
include the following:

•        Awareness that he or she has wet or soiled, a desire to remove the wet or soiled diaper
(pulling at it, taking it off, digging in it, and or vocalizing displeasure.
•        Getting a clean diaper, or taking you to the bathroom
•        Ability to imitate actions (sitting on the toilet)
•        Responds favorably to some form of positive reinforcement (a learned behavior increases
after you reward it with something the child likes)
•        Stays dry/clean most nights

When to start toilet training a child with autism:

•    Many children with autism train later than the average age. Many succeed at urine training
before bowel training. Many take longer to train, some reports suggest up to a year to become
dry and two years to become clean.

•   Start toilet training when you can be positive and the child is able to: sit comfortably on a potty
chair or toilet for a couple of minutes, stay dry for at least 60 minutes, is aware of being wet or
dirty, is showing interest in other people going to the toilet, showing some signs of cause and
effect, and is willing to cooperate. Be prepared for it may be a long learning process.

Communication Problems with Toilet Training

For children with a communication deficiency visual learning may be an appropriate way to teach
toileting skill. Does the child understand language? Does he or she understand "potty", "diaper",
"dry pants", "toilet", "bathroom", or any other words, signs, or pictures/symbols that may convey
the idea of toileting. Children with Autism may have difficulty understanding and associating words
with actions and most will at least need more time to process what you say. Can the child express
the urge or need to use the toilet? Expressive language is almost always a problem for children
with an autistic disorder. It will be important to be able to read their cues and/or teach a way to
express the need or urge to use the toilet.

Special consideration for children with autism:

•   A child with autism may not be able to communicate a need to go to the bathroom, therefore
body signals from the child, routines, and visuals might be significant aides.

•   The child with autism may learn to use the toilet at home and be unable to adapt to a new
situation easily.

•    A child with autism may have sensory difficulties such as discomfort by the hard toilet seat,
being afraid of water splashing, or want to play in or watch the swirling toilet water.

•   In public bathrooms children with autism sometimes fear the hand dryers, have problems with
the doors, the way the toilet flushes, or any number of challenges.

•   Having a bowel movement is often harder and occurs less often. Some children go off alone
and squat, some insist on wearing the pull-up or diaper to make a bowel movement, some fear
that it hurts, some smear feces, and others want to be clean so much that they react to getting
anything dirty on them.

•   Rule out any medical problems and account for fears that may have developed due to pain
from constipation or urinary tract infections in the past.

Before you begin toileting make sure your child does not have a medical problem which would
interfere with making toilet training a success. This can be ruled out by the family physician after a
routine physical. Contact your physician if you notice any unusual signs like too much or too little
urination, painful urination, urinates frequently or unable to hold urine. The same applies to
concerns with stool. Children with Autism have a higher than expected rate of bowel problems
(constipation or loose stools or both) and require extra care if this is the case.

Making Toilet Training a Success

•        Before starting, keep a record for a few days, charting every 20 – 30 minutes whether your
child is dry, wet, or dirty. Some diapers have a strip that changes color to make this easier. Chart
periodically, maybe once a day each week after starting training to keep track of progress,
problems, and tendencies.

•        When you start training, prepare the environment with the needed equipment and remove
extra distractions.

•        Plan a schedule that will match the report you gathered. If you child usually stays dry for an
hour, anticipate to take him/her to the bathroom about 10 minutes before. Try to match the
schedule to the natural cycles of the day.

•        Plan the routine that you will have your child follow and make a picture chart of that routine
so that your child and everyone who helps him can follow it. Change the cue level by decreasing
examples as the child achieves the skill.


•        Watch for signs of readiness such as when your charting shows being dry for an  hour,
your child indicates in some way that she is wetting or soiling diapers, indicates in some way that
she has soiled or is wet, regular bowel movements, or interest in others going toilet.

•        Keep positive, praise attempts, praise being dry and clean, use reinforcement and give
your child time.

•        When your child has some success with understanding toileting help him/ her learn to
indicate that they are going to the toilet with a sign, word, or picture or several of these. Children
today often use potty, pee and poop, but signing toilet may work or a picture of the toilet may be
helpful. Visual cues as part of your routine helps the child tell you when they have to go potty.

Visual and Verbal Cues in Toilet Training

• Give a visual and verbal cue –such as an auditory giving the child a buzzer or bell. Decide what
verbal cue you will use such as go potty, go pee, or go to the bathroom. If you use a signs, pair it
with the verbal cues.

• Enter the bathroom with the cue needed (verbal, light touches, taking the child’s hand, or more
physical assist).
 
 • Pull pants down to ankles with cue
 
 • Sit down with cue
 
 • Pee or poop or both with cues
 
 • Get toilet tissue and wipe with cue
 
 • Stand up with cue
 
 • Wipe, if needed, and throw tissue in toilet with cue
 
 • Pull up pants with cue
 
 • Flush toilet with cue
 
 • Turn on water and wash hands with cue
 
 • Turn off water and dry hands with cue


Use visuals: For many children, having a picture of a toilet or potty chair as a cue to go helps.
You might also make a picture schedule to sequence the major activities of the day adding the
toilet pictures before or after these. Children have learned to go on their own in this way. The
pictures can be laminated and put on with Velcro or inserted in plastic sleeves so you or your
child can take them off or change the order. There are also videotapes about using the potty that
some children with autism have reacted well to. Other parents have made videos for their child to
watch, some have paired music with the pictures. Model for you child, use books and pictures
sequences about going to the toilet. Visuals help your child know what to do, remember what to
do, and learn from the sequence.

Use imitation: Imitation is a type of visual. Many children with autism are delayed in their imitation
abilities, but many do watch carefully to what is going on around them even if they don’t seem to
immediately imitate. Watching someone close to their size use the potty may be useful, but it is
helpful for them to see that going to the bathroom is something everyone does. Some children
might respond to the use of a doll to go through the steps.

Teach privacy and modesty: Most young children undress anywhere and don’t care who sees
them go potty. However, as they are approaching four years of age, they often begin to want
more privacy. Children’s needs must be considered and children have to be taught what society
expects. Consider teaching your child to undo and pull down pants only in the bathroom as well
as pulling up and fastening pants before leaving the bathroom. Once your child is toilet trained
teach him to close the door. Also you might want to consider teaching your child when and where
he must be clothed or covered and not naked. Teach them to ask for ask for help with bathing.

Use words that are appropriate: Some children with autism are constant with the words they
heard when very young and will not change to more appropriate words later. However, if you are
aware of the need to be age appropriate it usually works to use the words that everyone else of
the same age is using.

Ideas for Specific Problems That May Be Encountered:

•        
Resists sitting or doesn’t sit and relax long enough: Encourage your child to sit with
his/her clothes on. Make sure the seat of the potty chair or the toilet is comfortable to your child,
maybe it needs to be softer, maybe lined with a diaper, maybe warmer, or maybe your child’s feet
need to be more stable. Some children may need to have the hole on the toilet smaller and
experimenting with various sizes of seats or even covering the toilet with a towel or cardboard may
help. Give your child a reason to sit such as his special reward that he/she gets while sitting. Use
modeling by sitting together or having a doll or favorite stuffed animal sit. Give the child a visual
or auditory cue about how long to sit by a visual timer or the length of a song. Help your child
relax while sitting by providing support for feet and body where needed and rubbing your child’s
legs. Sometimes children are so tense that they can’t relax and go.

•        
Afraid of flushing or excessively interested in flushing: Encourage your child to play
in water that swirls in other places than the bathroom and at appropriate times. Always let your
child know when you are going to flush the toilet when he/she is in the bathroom. Gradually bring
your child closer to the toilet by providing a place for the child to stand while you are flushing.
When your child is ready allow him/her to flush and either run or stay and watch. Establish a rule
that you only flush once then you are all done.

•        
Afraid of public bathrooms: stalls, hand dryers, different sinks, toilets that flush
automatically: At first, it may be necessary to be aware of the public bathrooms you may frequent
to know what is likely to cause your child problems. Some of these can be avoided like being far
away from the dryer and not walking under it and practicing with soap dispensers and sinks that
go on by themselves in a fun way. Protect your child from toilets that automatically flush since
some splash a lot. The more you know about the quirks of the public restroom the more you can
prepare you child. The handicap stalls are wider and more accessible many a sink next to the
toilet.

•        
Playing in water or with toilet paper: Take the toilet paper off the roll and put it up until
your child can master the use of it. Put safety catches on toilets until your child can understand
that toilets are not places to play. Allow lots of water play in appropriate places and even swirling
water to watch such as in “tornado bottles”. Lower water toilets aren’t as much of a temptation
while sitting. Use tissues that are folded or pre-measured, a box of wipes, and folded toilet paper
are helpful.

•        
Resists being cleaned or not wanting to be dirty: Sometimes smearing of feces
begins by the child trying to clean himself. They may try to clean up then make a mess. For
whatever reasons your child may be having trouble in this area it is wise to stay as calm as you
can. Establish a clean up routine that is not especially rewarding, but is comfortable and quick.
Make sure the wipes are big enough and comfortable enough for your child including temperature
and texture. If your child gets some feces on his hand and is distraught help the child wipe it as
soon as possible. Show the child that they can wash their hands clean with soap and water.
Sometimes as children with autism grow older they become upset when something happens like a
toilet overflowing or they get their hands dirty and react out of proportion, so we want to assure
them early on that this can be fixed quite easily.

•        
Fear of having bowel movements or constipation: This is a common problem for
many children with autism at some time in their childhood. It may be contributed to by diet, not
sitting long enough, not being able to relax, their activity level, or various other factors. It is helpful
to help a child recognize that the grunting and squatting he/she is doing helps make a bowel
movement and that is good. Many children go and hide in a corner to do their poop and resist a
change. Help them move closer to the bathroom and perhaps identify where to squat by using a
plastic mat as the spot. Gradually influence the action to the potty or toilet over time the child
associates the grunts and pushes as signals. A child may have to go in the diaper even while
sitting for a while so try a diaper-lined toilet seat. If a child experiences constipation on a regular
basis bowel movements may be uncomfortable and you may need to seek advice from you doctor.

•        
Trouble in standing while urinating: When your son is sitting to urinate and completely
toilet trained or when he shows an interest in standing he may need help. A visual chart of how
boys use the bathroom may be helpful. For example action pictures of a boy putting the seat up,
standing while urinating and aiming in into the toilet. Sometimes boys do not want to touch their
penis because they may have been told not to touch on some occasion. A male in the family may
need to demonstrate how to point and aim. Something may be used for a target like a floating
paper, a Cheerio, or colored toilet water.

•        
Regression in toileting: Sometimes a child who is fully toilet trained will begin to have
many accidents. Evaluate changes that have occurred and what information or additional
supports may help your child feel comfortable again. Some reasons regression may occur are
after an illness, after a parent has been away, after a move, after starting school, after a baby
has been born, or when going to the bathroom has been painful. Your child may be in a situation
where he doesn’t have the skills to tell someone he needs to go and holds it too long. His
supports may not be in place. Sometimes at school there is something about the environment or
the schedule that is causing problems for your child. Go back to all the original supports that
worked and put them back into your child’s life while reassuring your child that he/she can and will
succeed.

Consistency in Toilet Training

Your child can be toilet trained. However, training your child with autism will likely take more
planning, attention to detail, and consistency than training typical children. (Remember that all
children with autism are different and some are easy to train.) You have to organize the sequence
and provide a schedule and consistency until your child understands how all this relates to his
body functions. Keep your expectations realistic and reinforce your child for trying as well as for
success, always reassuring the child that he/she will succeed and there is plenty of time to try,
and be persistent.
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