Autism and Toilet Training

Toilet Training Methodology for Children and Young Adults with Autism: Toilet training can be a real challenge for children with autism spectrum disorder (ASD). There are several reasons why these children may take a long time to become toilet trained. Often, children with ASD learn to use the toilet at an older age. Most children with ASD learn to urinate and defecate in the toilet later than other children (Tsai, Stewart, & August, 1981). Every child with ASD is unique, but these children have some common challenges that can lead to difficulty with toilet training. Being aware of these challenges will help you consider various ways to help your child. Here are some things to consider: Physical: There may be a physical or medical reason for your child's toileting difficulties. Discuss these issues with your child's pediatrician. Language: Children with ASD have difficulty understanding and using language. Don't expect an autistic child to ask you to use the bathroom. Dressing: Some children with ASD have difficulty pulling down or pulling up their pants. Fears: Some children with ASD are afraid of sitting on the toilet or hearing the toilet flush. Training them to use the toilet with a visual program and making it part of their routine can make this urge less traumatic and easier. Body Signals: Children with ASD may not be aware of needing to go to the bathroom, or of having wet or soiled their clothes. Need for consistency (aka routine): Children with ASD may already have a specific way of urinating or defecating. The idea of learning a new way to use the toilet can be difficult. Different toileting: Some children with ASD learn to use the toilet either at home or at school, but have difficulty using it in other settings, such as public restrooms or their schools. “It's not a sprint, it's a marathon.” - Gary Heffner A study by Dalrymple and Ruble (1992) found that, on average, children with ASD require 1.6 years of toilet training to stay dry during the day, and in some cases, up to 2 years to control stool production. Despite the journey taking several years, a lifetime of independent toilet training is worth it! Don't give up! The following ideas are helpful for toilet training young children, adolescents, and adults with ASD. Although the challenges described above may make you unsure of the best way to toilet train, this goal is achievable. Children with autism can still progress toward toilet training independence. Remember that toilet training advice that applies to typically developing children often needs to be modified for children with ASD. Where to start? "Visit-based" or "Scheduled" training teaches children how to become toilet trained without imposing additional requirements. Adults set the schedule and help the child's body assimilate them. 6 sessions. Set a goal of sitting your child on the toilet 6 times a day. Initially, they may only sit very briefly (as little as 5 seconds per visit), with one longer visit per day to try to use the toilet. Over time, the child may sit for longer periods (e.g., up to 10 minutes). You may want to use a timer to indicate when your child can stand up at each opportunity. If your child urinates or defecates, allow them to stand up immediately. It is recommended that boys be taught to sit to urinate until they have learned to defecate regularly in the toilet. Don't ask - lead. Don't wait for your child to tell you they need to go to the bathroom, or to say yes when asked if they feel the need. Instead, tell them it's time to go. Schedule. Make bathroom visits part of your daily life. Schedule these visits as part of your normal routine. Keep the same times each day, or the same daily activities. Communicate. Use the same words, symbols, or pictures during each visit to the bathroom. This helps children learn toilet language. Keep up the good work. They say it takes three weeks to create new habits. Once you've established your routine and methods, continue to pursue the same goal for three weeks. Create a visual schedule. Pictures can help your child understand what to expect during bathroom visits. Take pictures of items in your bathroom (e.g., the toilet, toilet paper). Place the pictures on a piece of paper in the correct order to show your child each step of the bathroom visit. There are also websites that offer potty training pictures that you can print. If your child doesn't yet understand pictures, you could show them the actual objects (e.g., the toilet paper roll) that correspond to each step. Define rewards. Make a list of your child's favorite things, such as their favorite meals, toys, and videos. Decide which ones would be easy to offer your child as soon as they urinate or defecate in the toilet. A small snack (e.g., fruit snack, cracker, chocolate chip cookies) usually works. In addition to providing a reward for using the toilet, you could also offer them extra time to do one of their favorite activities (e.g., watch a video, play with a toy) after their visit to the toilet. Details to practice… Support your child. Make sure to use encouraging language when discussing potty training with your child. Use positive words when your child is present. Praise your child's effort and cooperation, no matter how big or small the effort is. Stay calm and direct when potty training your child. Stick to the schedule. Establish a regular schedule for toileting, whether you're at home or away. Use the same vocabulary to discuss cleanliness. Make sure everyone follows the same plan. Talk to other caregivers. Share the potty training plan with them and ask them to follow the same routine and use the same vocabulary.