Toilet Training Autistic Children

The Challenge Ahead

One of the most significant milestones in a child’s life is when he or she finally succeeds at toilet training. For the typical child in Western culture, the process begins around the age of two and takes on average, the better part of a year, if not longer. Many factors will determine how a child fares in the toilet training process: readiness, gender and temperament are just a few. When a child has a developmental disability, such as an autism spectrum disorder, the process can become much more complicated, and other factors like sensory integration issues come into play. This article will discuss some popular strategies for helping your autistic child to master toilet training and gain independence. All kids are different, so the approach that works for one may not work for another, but one thing is universal: have patience. It may take a combination of methods to help your child succeed in reaching this milestone.

Some Special Obstacles for Autistic Children

Autism presents its own set of challenges during the toilet training process. Children with ASD’s are often unreceptive to changes in their routines, so after years of becoming accustomed to using a diaper, the willingness to transition to using the toilet is generally absent. Similarly, transitions can be tough; therefore, not only will the child not welcome a new routine, but having any activity interrupted in order to use the toilet just makes matters worse. Sensory issues can make toilet use frightening (the loud sound of the toilet flushing) or can create intense feelings of physical discomfort (like the cold feeling of a toilet seat against the child’s skin). In addition, Sensory Integration Disorder can make a child less aware of his body’s functions or less sensitive to the sensation of having gone in his pants, which makes it difficult for the child to know when he needs to go once he gets past all the other aversions. Finally, while many children are motivated by a social desire to please their parents or to keep up with their peers, these are not necessarily motivators for an autistic child.

What Did Not Work for Us

We spent over two years toilet training our son, Gus, and in that time tried numerous strategies. Some of those methods were disastrous. The use of disposable training pants seemed to extend the process. Gus dislikes the sensation of wet clothing, but the disposables were just absorbent enough to prevent him from feeling uncomfortable. One summer, we tried letting him run around outside (in a sheltered garden) bare-bottomed. He was quite gleeful about the new sense of freedom; unfortunately, he also refused to eliminate and just chose to hold it until he was inside in a diaper of some sort. We were advised to try a weekend sort of “boot camp” approach: having him stay on the toilet until he went, and no diapers whenever he got off the toilet for breaks. That lasted for about a day. We knew his body’s schedule, but he insisted on holding his poop. Worried that he’d become impacted, we gave in.

Strategies We Found Successful

We eventually figured out that three things worked well in Gus’s learning process: behavior modification (using positive reinforcers), videos and books, and his dislike of wet clothing. We switched from disposable training pants to the old-fashioned kind made of cotton inside and a vinyl outer layer. Those allowed him to feel when he was soiled and motivated him to get to a toilet before he went in them. He responded well to praise and stickers, so we always had a generous supply of both ready for even the smallest success. Finally, he enjoyed two videos in particular: Once Upon a Potty and the Bear in the Big Blue House toilet training videos. They played constantly in our home for a while. We also coordinated our efforts with his school and that made a world of difference.

Other Options

Other methods to consider when toilet training an autistic child are:

• Task Analysis using visual cues
• Social stories
• Infant Potty Training (which if successful avoids the issue of having to change routine since diapers never become a routine).

Again, the most important factor in helping your child to gain toileting independence is your unconditional love and patience.