Toilet training can be quite the monumental task that takes a great deal of patience and perseverance, even more so for children with autism.
Autistic children learn differently than that of their neurotypical peers, they interpret and respond to the world around them in their own unique way. Therefore the autism toilet training process may require a more individual approach.
The process of toilet training for autism children may begin when they are a little older and when it’s more developmentally appropriate for them. The process in general may take a little longer and have a few extra setbacks. Different strategies may need to be thought of and used to assist in making it a stress-free and positive experience.
Ensure they are ready
I think this is the most crucial thing to consider. I began the toilet training process with two of my daughters when they were just over two. But with my autistic daughter I waited until she was nearly 4 and I’m so glad that I did.
Beginning the process too early can lead to confusion and frustration, which may result in meltdowns and difficult behaviours to manage. Waiting until your child shows signs they are ready can sometimes be the most important step in toileting.
-Are they showing interest? (with the toilet or when you use the toilet)
-Have you noticed behaviour changes when they have wet or soiled their nappy? Perhaps they are feeling uncomfortable when they didn’t before, or it now causes some distress.
-Are their bladder and bowel movements becoming more regular and predictable with longer periods in between?
-Are they able to follow steps?
-Are they telling you or signalling when they have wet or soiled themselves?
Social stories are a great way to explain situations to children with autism, as they are often visual learners. Social stories present information in a literal and specific way, which explains events and helps to eliminate anxiety about not knowing what to expect.
They are particularly useful in toilet training as you can read them before you start the process so children know what to expect and what steps to follow. A different social story on toileting can be made up for home and for when you are out and about. They are quite simple to make and just require direct and simple language with pictures; you can make them yourself or have a therapist help you.
Some examples of sentences you might use in a toileting social story.
‘I am going to start going to the toilet’
‘My mum will help me learn how to use the toilet’
‘Going to the toilet isn’t something to be worried about’
‘A lot of my friends go to the toilet’
‘When I go to the toilet I get a sticker on my chart’
The language used will differ depending on age, abilities and what steps are taken for each family but they will be very similar in that they provide a specific explanation of what to expect.
Visuals are often used for children with autism as they aid in providing information in times that may cause overwhelming feelings. They provide visual information that children can refer to and look at anytime they need without having to constantly ask questions, they reduce anxiety. Visual supports provide structured predictability and prepare children about what is expected and steps required in a process.
In regards to toileting you could have visuals set up in the bathroom of your child completing all of the necessary steps.
-Pulling down pants
-Sitting happily on the toilet
-Toilet paper for wiping
-Pulling pants up
-A finished sign
Going through the visuals repeatedly beforehand and giving your child time to practice some of the steps can ease any thoughts of concern or worry before toilet training commences.
Extra consideration and thought should go into the setup of the environment to make it a calming place free of distractions while eliminating things that could lead to frustration. Set the environment up for success!
-Think about sensory needs. Are their distractions in the bathroom? Will the flush cause anxiety? Should the blinds be down?
-Have visual cues and reminders visible
-Is the equipment suitable? Does it allow for independence? Perhaps having a smaller seat set up on the toilet to provide a sense of comfort and security. A bench for feet to rest on, or a step stool to be used at the basin to wash hands independently. Children with autism can be sensitive to triggers that cause frustration so setting the environment up to eliminate this is important.
Often it is thought that eliminating the use of a potty for children with autism is a good idea, as the lack of familiarity in other places other than home can cause uncertainty. Using a regular toilet (with or without seat attachment) can make the process easier in the long run.
Praise and reinforcements
A reward system of some sort is a positive way to motivate your child. Perhaps it’s a sticker chart. My daughter was nearly 4 when I first started toilet training, to begin with she put a stamp on a chart each time she happily sat on the toilet and we pulled out the big guns (sticker) each time she was successful at going. This was all the motivation she needed.
If stamps and stickers won’t cut it, you could try a tally and once they hit a certain amount they get a small reward or choose their favourite activity to do. Whatever it is, deciding on a motivating reinforcement reward of some sort can be the perfect encouragement tool to aid in success.
Positive praise is equally important, continuing to reassure and encourage your little one is imperative. Focusing on all of the little wins and not on the setbacks.
A lot of the time autistic children thrive on predictability and routine and this can be built upon by developing a successful toileting schedule. Make your child a part of the process of developing the daily plan; “Today we are going to sit on the toilet every 20 minutes”.
Use visuals and timers to remind you both of this and praise your child each time they stick to it. Make a new plan the following day/s by extending the time a little bit or acknowledging when the reward changes.
My daughter thrives off seeing things visually so we used to write down how many times she successfully went to the toilet each day. Velcro is always appealing, perhaps laminating Velcro pictures with a happy face for trying and a star for successful attempts to add to a chart.
The main thing is to be consistent and stick to the toilet training schedule and reward systems you put in place. Make it a stress free event with no expectations on how long it will take for your child to be successful and celebrate the little wins along the way.
-Enthusiasm to look at the visuals and/or read the social story
-Sitting on the toilet
-Signalling they want to go
- Independently doing some or all of the steps
-Not having an accident for a certain period of time
-First day of success
-First time going out without a nappy
These are all big moments, all moments that deserve a lot of praise and recognition. With most of these strategies we successfully toilet trained my daughter in a few days. I think the biggest success factor for us was waiting until she was ready and not forcing it.