Toilet training: autistic children

Signs that autistic children are ready for toilet training

Autistic children generally show the same signs of readiness for toilet training as typically developing children. But these signs might appear when autistic children are older, and the training might take longer.

If your autistic child is ready for toilet training, they might be able to:

tell you (or show you with a sign or gesture) that they’ve wet or soiled their nappy or clothes
follow a simple instruction like ‘Sit on the toilet’
pull their pants up and down
do regular, formed bowel movements
stay dry for at least 2 hours during the day.

Before you start toilet training, it’s a good idea to speak with your child’s paediatrician or GP. They can rule out any medical problems that might get in the way of toilet training and say whether your child might be ready to start.

Getting started on toilet training with autistic children

The steps to toilet training are much the same for all children. But autistic children might need extra support and strategies adjusted to suit their needs.

Our article on toilet training can get you started. Then you can use the following strategies to help your autistic child go from nappies to the potty or toilet:

encouragement and rewards
social stories
video modelling
visual supports.

It’s a good idea to try a combination of these strategies to see what works best for your child.

Regardless of which strategy or combination of strategies you use, it’s also a good idea to break down the process of going to the toilet into smaller parts. You can teach these parts to your child step by step – for example, pull pants down, sit on the toilet, wipe bottom and so on.

Encouragement, rewards and toilet training

If you praise and reward your child as they learn each step of using the toilet, it can encourage them to keep trying. You could try:

descriptive praise – for example, ‘Charlie, well done for sitting on the toilet’
nonverbal praise, gestures (clapping) or signs (thumbs up)
a favourite activity – for example, playtime with trains
a star on a reward chart.

Before you start, plan exactly what behaviour you’ll reward, and make sure your child understands. Try a variety of rewards, and use the ones your child responds to best.

Once your child has made progress on a step, gradually fade out any rewards, but keep praising your child.

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.

Social stories and toilet training

Social stories can help autistic children cope with challenging or confusing situations like toilet training.

Experienced speech pathologists, occupational therapists 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 happens, the story can help your child know what to do.

When you’re writing a social story, use words and pictures that your child can understand. Suggest possible responses and behaviour, rather than making the story an exact ‘script’ to follow.

Video modelling and toilet training

Autistic children are often visual learners. So you can support your child’s learning by using video modelling. For example, you and your child could watch animations that show children doing each step of going to the toilet.

Visual supports and toilet training

Visual cues and prompts can be a good option for autistic children. Simple toilet training steps

You could try creating a visual support or schedule to show your child the steps in using the toilet. You could use the Picture Exchange Communication System (PECS) or other visual aids. Stick the schedule on a wall close to the toilet or potty to remind your child of the steps.

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 schedule. This way, training will be consistent.

A simple visual aid for toileting is shown here. Download and print an A4 version of this visual aid for toileting (PDF: 111kb).

Adapting toilet training steps and strategies for autistic children: tips

These tips can help you adapt the process of toilet training to your child’s needs:

Skip the ‘potty’ stage if your child has difficulty with change. If you start with a toilet training seat on the toilet, this limits the number of changes for your child.
Make going to the toilet part of your everyday routine. For example, ask your child to sit on the toilet at the same times each day.
Start with sitting on the toilet for a short time and build up to a maximum of 5 minutes. Sitting on the toilet for too long can make your child feel that they’re being punished.
Choose and use only one word for the toilet. Get everyone in the family to use it. For example, always say ‘toilet’ or ‘loo’. If you use various words, it can be confusing for your child.
Use specific language when talking about going to the toilet. For example, say, ‘Eddie, sit on the toilet and do a wee’. This helps your child understand what to do.
Teach your child how to let you know they need to go to the toilet. This could include nonverbal signing or using the Picture Exchange Communication System (PECS).

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.

Handling sensory sensitivities: tips

If your autistic child is sensitive to the sensory aspects of going to the toilet, try to make the environment and experience comfortable for your child. For example:

Try washable, reusable training underpants or underpants with a protective liner. These help your child become aware of feeling wet. When the pants get wet, you can point this out in a positive way. For example, ‘Your pants are wet. That means you did a wee. Next time you could use the toilet’.
Control the environment if you can. For example, if the floor is cold, put socks on your child’s feet. Make the temperature in the toilet similar to the rest of the house. Check that the light isn’t too bright.
Put a stool in front of the toilet for your child’s feet if their feet don’t reach the floor. This can help your child to sit comfortably and feel more stable.
Use a training seat if your child is frightened of the big hole over the water. Get your child familiar with the seat by encouraging them to sit on it for a few minutes every day.
Tell your child there will be a noisy, flushing sound, and explain why. Let your child practise flushing or wear headphones if they find the noise distressing.
Let your child hold a favourite object while sitting on the toilet.

Toilet training is more likely to go well if you can stay calm and positive. When you’re calm and positive, you can help your child to manage their feelings as they learn this new skill.

Toilet training setbacks for autistic children: what to do

Setbacks are part of toilet training for all children. They can include challenging behaviour, constipation and things going backwards.

Challenging behaviour
Sometimes autistic children who are toilet training can behave in challenging ways. For example, they might be afraid of the toilet, go in places other than the toilet, fill the toilet with paper and other materials, continually flush the toilet, smear poo on the wall and other places, or refuse to poo.

If your child is behaving in these ways, professionals like psychologists or occupational therapists can help you develop strategies to try.

Constipation
Constipation is a common problem in children. If your child avoids doing poos, it might be constipation.

Constipation is usually caused by not enough water or other fluids or not enough dietary fibre. Some autistic children are selective eaters, which can cause them to become constipated more easily than other children.

If you think your child is constipated, see your paediatrician or GP. They can rule out any underlying medical concerns and help you manage your child’s constipation.

Things going backwards
Sometimes children’s toilet training progress might stop, or things might seem to go backwards.

If this happens, you could keep a record of when your child wees or poos in their pants. If a pattern develops over a week or so, target these times by taking your child to the toilet just before your child would normally wee or poo in their pants.

Or you might notice that your child wees in their pants when they’re away from home. This might be because your child doesn’t like the sensory environment of unfamiliar toilets. Options for managing this include getting your child to put on headphones to use the toilet.

Sometimes these issues might be related to things like stress, illness, constipation or diarrhoea. Your GP or other professionals working with your child can help you sort out these issues.

If toilet training becomes a battle with no signs of progress, take a break for now. Consider starting the training again in about 3 months. Don’t feel that you’ve failed – it might just be that your child isn’t ready.