Two words that strike fear in most parents are toilet and training.
Toilet training, or "potty training", can be a scary process for any family but it may be particularly challenging for families of children with an Autism Spectrum Disorder. Research shows that children diagnosed with autism are often delayed in achieving toilet training success and that it may take more time to complete the toilet training process than other children. Potential barriers may include language deficits that may make it difficult for the child to say “I need to go potty!”, difficulty dressing and undressing when it is time to go, change in routines leading to negative behavior, or having aversions to the noises, smells, and bright lights that are associated with bathroom time.
Although these barriers can make it more difficult, toilet training is a very important skill to learn and a big step toward independence. Not only does it help families financially by not having to buy diapers and wipes, achieving toilet training success can open many social opportunities and activities while decreasing the child’s risk for abuse and neglect. Children may show signs that they are ready to start the toilet training process when they begin indicating that their diaper is dirty, staying dry for longer periods of time, and demonstrating the ability to follow simple instructions. It is important to note that it is never too late to start the process and these strategies may be used with people of any age!
The following strategies may help you get started with a successful "toileting" program.
- Oftentimes, potty training with autism is more about parents being ready to start than the children. It is important that you start a toilet training program when you have time to commit to it.
- Once you get started, implement a no more diapers rule! Exceptions can be made for nighttime and naptime, but limiting the amount of time spent in diapers is very important.
- Stock up on underwear! You will not want to run out during this process and we recommend at least 25 pairs.
- Start small - if they are afraid of the bathroom or don’t like wearing underwear, try some systematic desensitization with your BCBA (see previous blog for more info LINK HERE) by pairing positive reinforcers with the nonpreferred activity
- Get support lined up: Try to get other caregivers on board for stopping by to assist during the first couple days. You will need a break!
- Stock up on the appropriate cleaning supplies; accidents will happen! Plastic shower curtains on the carpet near the bathroom will help cut down on carpet cleaning. Disposable underpads/Chux on furniture or car seats can be helpful, as well.
- All kids learn differently and the amount of time the process takes will vary for every child.
- Set aside a long weekend so that you and your child can get a lot of practice before sending them to school or daycare.
- Avoid starting before going on any long family vacations. Trips out of town can cause disruptions is routine, which may make the process more difficult for everyone.
- Make sure to set aside time for yourself after the kids are in bed or throughout the day. This will be a stressful process and it’s important that you take time to decompress, as well.
- Build in opportunities and time to use the restroom during daily routines and activities. Add on an extra 15 minutes to your morning routine to make sure there is time for a trip to the bathroom before rushing out the door!
- Stick to a schedule, especially when starting. You may want to begin with short durations between trips to the bathroom (e.g., go every 15 minutes) then increase that time based on their success. Over time, a more manageable schedule can be implemented but starting with shorter durations will make it more likely that your child will urinate in the toilet.
- Visual supports may help some children. Some examples include:
- Using timers to show when it is time to use the bathroom or how long they need to sit on the toilet
- First/Then pictures can help a child learn what will follow bathroom time. Simple pictures or words can be shown to indicate what reinforcer or activity will happen when they successfully use the bathroom.
- Visual schedules are helpful to outline steps in a routine. They can include pictures or words that show each component and should be individualized for your child. A visual schedule for how to wash hands or pull up pants could help!
- Reinforcers should be delivered when your child urinates or defecates on the toilet. The goal is to teach them that they get access to their favorite things for this exciting new skill! Essentially, you will throw them a mini party when they use the bathroom successfully.
- Make sure that you have items that your child finds very motivating. Examples could include a favorite snack, access to a favorite toy, stickers, or screen time.
- Before starting toilet training, withhold access to the selected items so that it is “like new” when they see it again. Items are more motivating when you don’t have them all the time!
- Offer choices between potential reinforcers, but don’t go overboard. You may want to offer a surprise “grab bag” with small toys or make a snack tackle box with a few favorite snacks.
- Social praise should be a big component of "toileting" success! You will genuinely be so excited when they finally go on toilet, you will want to celebrate. Don’t hold back! Provide praise in a way your child likes – positive comments, high fives, hugs, cheering, clapping, singing songs, or doing silly dances are all good ideas.
- Teaching children to initiate a trip to the bathroom is an important component.
- Use the mode of communication they typically use, whether that is sign language, showing you a picture, or verbally telling you that it is time to go to the bathroom.
- Choose a consistent word to use to indicate it is time to use the bathroom; it could be potty, pee, bathroom, or a full sentence. Every time you take them to the bathroom, prompt them to imitate or echo you. Give them extra praise and access to reinforcers when they say it independently!
- One of the most important elements in any toilet training program is consistency. Make sure that everyone is on board and trained in the procedure who are using, including family members, school, day care, babysitters, and other caregivers or therapists.
- This is a new and difficult change for your child and they may not be thrilled about it at first! Going back to diapers may make it more difficult the next time you try.
- Stick with it! Limit attention for negative behavior and deliver lots of praise and access to reinforcers contingent of appropriate behavior and successes on the toilet. They will learn that this is the new expectation and it will get easier with time.
Children have different needs. A child with autism and toilet training can look different in each family. Understand those needs with our FREE DOWNLOAD, New to the Spectrum: A Parent's Guide to a New Autism Diagnosis.
Toilet training is not an easy skill to tackle but the benefits for your child and your sanity are huge! If you are not seeing improvements over time or unexpected struggles occur, contact a trained professional for additional assistance. Professionals who are trained in the principles of ABA can really help make a difference, if you need additional help.