Signs that children with autism spectrum disorder are ready for toilet training
Generally, children with autism spectrum disorder (ASD) will show the same signs of readiness for toilet training as typically developing children do. But these signs might appear when your child is older, and the training might take longer.
Some signs that your child is ready include:
- being able to tell you (or show you with a sign or gesture) that she has wet or soiled her nappy or clothes
- being able to follow a simple instruction, such as ‘sit on the toilet’, and being able to pull her pants up and down
- having regular formed bowel movements
- having adequate bladder control (able to stay dry for at least one hour at a time during the daytime).
Before you start toilet training, it might be helpful
to speak with your child’s paediatrician or GP. They will be able to rule
out any medical problems that might get in the way of toilet training
and say whether your child is likely to be ready to start.
Steps for preparing children with autism spectrum disorder for toilet training
The steps for preparing your child and getting started with toilet training are also much the same for all children. But children with autism spectrum disorder (ASD) might need a bit of extra teaching and some strategies adjusted to suit their needs.
An important first step is to realise that toilet training is largely about communication and working together with your child.
It might also help to think of toilet training as a series of smaller goals, rather than one big goal. For example, start with simply familiarising your child with the toilet, what it’s for, and how to use it. Then you could progress to starting the toilet training.
Our general article on toilet training
can help you get started. Then you can use the extra strategies below to help your child with autism spectrum disorder (ASD) go from nappies to the potty or toilet.
Toilet training strategies for children with autism spectrum disorder
Going to the toilet is a complex task, made up of many small steps. It can help to break tasks like toilet training down to their most basic parts and teach those smaller parts to your child with autism spectrum disorder (ASD), step by step.
Below we outline three strategies to help with toilet training your child with ASD: encouragement and rewards, visual aids and supports, and Social Stories™.
Encouragement and rewards
Rewards and positive reinforcement can help with toilet training. As your child learns each step of using the toilet, he can be rewarded, which encourages him to learn. Rewards and encouragement can include:
- descriptive praise – for example, ‘Charlie, well done for sitting on the toilet’
- nonverbal praise, using gestures (clapping) or signs (thumbs up)
- a favourite activity – for example, playtime with trains
- a star on a sticker chart
- a favourite healthy food.
Try a variety of rewards, and use the ones your child responds to best. Before you start, plan exactly what your child will be rewarded for, and ensure your child clearly understands what behaviour is being rewarded. Try not to overuse a reward.
Some rewards that motivate typically developing children – such as stickers or stamps – might not interest a child with ASD. Work out what rewards your child likes by presenting a variety of rewards – for example, hugs, high-fives, claps, foods, toys or activities – for a few seconds and watch your child’s response.
Once your child has made progress on a particular step, stop using food, activities and toys as rewards. Continue to use verbal and nonverbal praise.
We used a reward system – Sesame Street stickers for wee and a lucky dip bag for poo. He caught on straight away for his bladder, but it took longer with his bowels. We just kept asking if he needed to poo and waved the lucky dip bag in front of him, making it very clear he would get something if he went. One day something just clicked for him and we haven’t had an accident since.
Visual aids and supports
Children with ASD are often visual learners. So you can support your child’s learning by providing visual cues and prompts.
Visual schedules can help to reinforce the routine of using the toilet, and provide reminders for taking regular toilet breaks.
Try creating a visual schedule to show your child the toileting routine. You can use the Picture Exchange Communication System (PECS) or other visual aids. The schedule can be stuck on a wall close to the toilet or potty.
Go over the schedule with your child 2-3 times a day. Everyone who does toileting with your child will need to know and follow the routine. This way, training will be consistent.
On the right is a simple example of a visual aid for toileting. Download and print an A4 version of this visual aid for toileting (PDF doc size: 111kb).
Social Stories™ are used to help children with ASD develop appropriate behaviour and responses. They might help children with ASD cope with challenging or confusing situations, like toilet training.
- use simple story lines with clear pictures
- are written from your child’s perspective
- describe the situation, such as going to a birthday party, starting school or using the toilet
- give details about what happens in the situation
- suggest how your child might respond in the situation
- explain why your child should respond in a particular way.
Trained speech pathologists, occupational therapists and early intervention or school teachers will be able to help you create a Social Story™ for your child’s toilet training.
If your child will be going to the toilet at a friend’s home or somewhere else other than home, practise a new story for this situation with your child ahead of time. When the event actually happens, your child can use the story to help guide behaviour.
When writing a Social Story™, use words and pictures that are appropriate for your child’s developmental level. Suggest possible responses and behaviours, rather than making the story an exact ‘script’ to follow.
Overcoming toilet training challenges for children with autism spectrum disorder
Toilet training a child with autism spectrum disorder (ASD) can be more challenging than training a typically developing child. This is because children with ASD are often very attached to their routines and don’t like change. This might make it more challenging to go from nappies to the toilet.
Try these tips to help your child make progress with toilet training:
- Consider skipping the ‘potty’ stage if your child with ASD has difficulty with change. Some parents go straight to putting their child on the toilet, sometimes with a toilet training seat. This limits the number of changes children experience in the toilet training process.
- Try washable reuseable training underpants or underpants with a protective liner (which are less absorbent than nappies or pull-up training pants). If your child has trouble knowing when it’s time to use the toilet, these might help your child become more aware of the feeling of wetness.
- Use specific language. For example, say, ‘Eddie, sit on the toilet so you can have a wee’. This is clearer than asking your child to ‘sit on the toilet’, and will help your child understand what to do.
- Choose one word to refer to going to the toilet. Get everyone in the family to use it. For example, always say ‘toilet’ or ‘loo’ or whatever your family is comfortable with. The different words we use to describe the toilet – potty, loo, bathroom – can be confusing for children with ASD.
- Teach your child a way of letting you know she needs to go to the toilet. This could include nonverbal signing or the use of the Picture Exchange Communication System (PECS).
- Five minutes sitting on the toilet is enough. If you get your child to sit on the toilet for too long, he could feel as if he’s being punished. Children with ASD can have difficulty understanding new situations and other people’s emotional responses. Try to stay calm and positive.
If your child with ASD is sensitive to or upset by the sensory aspects of going to the toilet, try ways of controlling your child’s sensory experience of toileting. For example:
- Get your child familiar with sitting on the toilet seat by practising for a few minutes every day. Make her comfortable – for example, if the floor is cold, put socks on your child’s feet. Try to match the temperature in the room to the rest of the house.
- Use a foot stool if your child needs foot support while sitting on toilet.
- Use a training seat if your child is frightened of the big hole over the water.
- Tell your child there will be a noisy flushing sound, and explain the reason for the noise.
For our son, it all revolved around change. We started by teaching him to wee in the garden, then into a bucket in the garden, then into a bucket inside, then into a bucket next to the toilet, then finally into the toilet. This took nearly a year! I tried to make the toilet a happy place for him to visit by putting Bob the Builder stickers all over the door and letting him have little matchbox cars.
Toilet training setbacks and difficulties for children with autism spectrum disorder
Sometimes toilet training children with autism spectrum disorder (ASD) is associated with other behaviour problems, such as fear of the toilet, going in places other than the toilet, stuffing up the toilet with paper and other materials, continually flushing the toilet, smearing poo on the wall and other places and refusing to poo. Constipation can also be a problem.
If you find you’re having any of these problems or if there hasn’t been any improvement after a few months, here are a few ideas to think about:
- Keep a record of the times your child wets or soils for a week or so. If a pattern develops, target these times by taking your child to the toilet just before your child would normally wee or poo in his pants.
- Speak to your paediatrician or GP for advice. There could be a medical reason for your child’s lack of response to toilet training (such as constipation or a urinary tract infection).
- Speak with the other people who are working with your child, such as a psychologist, occupational therapist or your child’s early intervention service. They might be able to offer more intensive support.
Constipation is a common problem in children. If your child avoids doing poos, she might be constipated.
Constipation can be caused by underlying health issues, but it’s usually caused by not enough water or other fluids or not enough dietary fibre. Some children with ASD are picky eaters, which can cause them to become constipated more easily.
It’s worth noting that normal bowel habits vary a lot among children. Some children do a poo 2-3 times a day, but others go only every 2-3 days. If you think your child is constipated, see your paediatrician or GP. Your health professional will be able to rule out any underlying medical concerns, and help you with strategies to manage your child’s constipation.
If toilet training becomes a battle with no signs of progress, take a break for now. Consider starting the training again in about three months. Don’t feel that you’ve failed – it might just be that your child isn’t ready.
For children with autism spectrum disorder (ASD), toilet training might need some special strategies. But children with ASD will probably show the same signs of being ready.
In this short video parents of typically developing children share toilet training tips, especially on knowing when your child is ready. For example, your child might:
- show interest in the toilet
- want to watch you go to the toilet
- tell you he’s done a wee or poo in the nappy.