Toilet training for children with autism spectrum disorder

• Toilet training strategies
• Overcoming toilet training challenges
• Toilet training setbacks and difficulties

• being able to tell you (or indicate by a sign or gesture) that he has wet or soiled his 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).

The steps for preparing your child and getting started with toilet training are also much the same for all children. Children with 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 cooperation, 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.

Toilet training strategies

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 the child, 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 (‘Charlie, well done for sitting on the toilet’)
• nonverbal praise, using gestures (clapping) or signs (thumbs up)
• a favourite activity (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 best to. 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.

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 left 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 
Social Stories™ are used to help children with ASD develop appropriate behaviours and responses. They might help children with ASD cope with challenging or confusing situations, like toilet training.

Social Stories™:

• 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.

Overcoming toilet training challenges

Toilet training a child with 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).

Sensory overload
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.

Toilet training setbacks and difficulties

Sometimes toilet training children with ASD is associated with other behavioural 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, constipation, and refusing to poo.

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 consider:

• 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 bathroom 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
Constipation is a common problem in kids. 

Constipation can be due to underlying health issues, but is usually caused by not enough water or other fluids or not enough dietary fibre. Sometimes it happens when the child avoids doing poos.

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 general practitioner. Your health professional will be able to rule out any underlying medical concerns, and assist you with strategies to manage your child’s constipation.

Video: Toilet training

16mb

For children with ASD, toilet training might start later, take longer and need some special strategies. But children with ASD will probably show the same signs of readiness as typically developing children.

This short video features parents of typically developing children sharing tips on toilet training, 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.

 

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