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.

Some signs that your child is ready include:

being able to tell you (or show you with a sign or gesture) that they’ve wet or soiled their nappy or clothes
being able to follow a simple instruction like ‘Sit on the toilet’, and being able to pull their pants up and down
having regular, formed bowel movements
having enough bladder control to stay dry for at least one hour at a time 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 help you get started. Then you can use the following three strategies to help your autistic child go from nappies to the potty or toilet:

encouragement and rewards
visual supports
social stories.

It’s a good idea to try a combination of these approaches 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.

Some autistic children are afraid of the toilet, so make sure the toilet is a comfortable place. For example, try to make the temperature in the toilet or bathroom similar to the rest of the house, and check that the light isn’t too bright. You can also put a step in front of the toilet for your child to rest their feet on.

Using encouragement and rewards to help with toilet training

Praising and rewarding your child as they learn each step involved in using the toilet can encourage your child 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 sticker chart.

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

Once your child has made progress on a particular step, stop using activities and toys as 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.

Visual supports and toilet training

Autistic children are often visual learners. So you can support your child’s learning by providing visual Simple toilet training steps cues and prompts.

You could try creating a visual support or schedule to show your child the steps in using the toilet. You can 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).

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 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 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.

Tips to help toilet training go well for autistic children

These tips can help your child make progress with toilet training:

Consider skipping the ‘potty’ stage if your child has difficulty with change. Going straight to putting your child on the toilet, perhaps with a toilet training seat, limits the number of changes for your child during toilet training.
Try washable reusable training underpants or underpants with a protective liner. These help your child become aware of the feeling of wetness, so they’re useful if your child has trouble knowing when it’s time to use the toilet.
Use specific language. For example, say, ‘Eddie, sit on the toilet and do a wee’. This is clearer than asking your child to ‘sit on the toilet’ and helps 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 autistic children.
Teach your child a way of letting you know they need 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. Sitting on the toilet for too long can make your child feel as if they’re being punished.
Try to stay calm and positive. Autistic children can have difficulty understanding new situations and other people’s emotional responses.

Handling sensory sensitivities: tips

If your autistic child 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 your child comfortable – for example, if the floor is cold, put socks on your child’s feet.
Use a stool for your child to put their feet on.
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.
Let your child hold a favourite object while sitting on the toilet.

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 for autistic children: tips

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

Behaviour problems
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, and refuse to poo.

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

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 with strategies to 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, try keeping a record of the times your child wees or poos in their pants 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 their pants.

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 isssues.

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.