Ahhh.....The Joys of Potty Training!

If just reading "potty training" makes you tense and nervous,  then you probably are currently struggling with the toilet training process, or you have a child who will begin the process soon. Teaching any child to move from freely voiding in a diaper or pull-up to using a toilet is a difficult process. Now toss into that situation a child who has ASD, and potty training can go from being challenging to being a frustrating and stressful experience for the entire household.

Children with Autism may have challenges in the areas of language/communication, sensory processing, social skills/social thinking, and behavior control that need to be taken into consideration when formulating a potty training program. Other issues such as motor planning, sensory needs (feeling a full bladder or a wet diaper), communication abilities, and preference for predictability and routine may make potty training more difficult. It is also common to see an increase in problem behaviors during potty training, or to see an emergence of new behaviors at this time.

It is hard to predict which kids will struggle with potty training and which will not. I have potty trained some clients in days. Other clients it took years before they were consistently successful. The amount of time needed to teach this skill to a point of independence will vary. Before you actually start potty training you can’t know with certainty what the process will be like. So the best approach is to be prepared and informed before you ever begin.

First, it’s important to redefine the potty training process. You may have other children you have successfully potty trained, you may have potty trained nieces or nephews, or maybe you have friends who have told you exactly what to expect. Throw all of those expectations out the window. 
Realize that your child with Autism is unique, and the techniques that worked for your nephew may, or may not, work for your child with Autism. 

A few potty training tips:

  • Children with Autism might take much longer to show interest in the potty or display signs of readiness than other children
  • Children with Autism may have fear or anxiety about using a toilet which could be exhibited through severe problem behaviors
  • Children with Autism may find a visual schedule helpful to remember the steps for using the bathroom
  • Children with Autism may need to be separately trained to stay dry through the night, even after they are potty trained
  • Children with Autism may need to be separately trained to defecate in a toilet, even after they are potty trained to urinate in a toilet
  • Children with Autism may need to be separately trained to request the bathroom (asking for the bathroom in a public place rather than voiding in their pants)
  • Children with Autism may decline to use unknown toilets, such as public bathrooms at a mall
  • It is critical to rule out medical issues as a reason for difficulties with bowel training. If the child has intestinal issues, chronic diarrhea or constipation, or is compacted with fecal matter, they are not “choosing” to have messy bowel accidents. They are not in control of their bowels, and any punishment or consequences will simply confuse or anger the child. A sign of underlying medical issues is a child with loose, watery stools, a child who does not defecate often (defecates 1-3 times per week), a child with a hard, distended belly, or a child with allergies. If any of these issues are going on, seek medical treatment before continuing.

This post is not going to be a step-by-step guide to potty training any child with Autism.  Just like when teaching any other skill, the approach must be individualized to the child and to their needs.
 What is important is to individualize any technique used to the specific child, to create motivation to use the toilet (copious amounts of liquids, or take them to the toilet shortly after meals), and focus on reinforcement for voids rather than punishment for accidents.

The most important things you can do before you begin potty training your child with Autism is decide on the approach you want to use and stick to it.

Toileting research:

  • Azrin N., Foxx R. Toilet training in less than a day. New York: Simon and Schuster; 1974.

  • Blum N. J., Taubman B., Nemeth N. Relationship between age at initiation of toilet training and duration of training: A prospective study. Pediatrics. 2003;111:810–814. 

  • Luiseli J. Teaching toileting skills in a public school setting to a child with pervasive developmental disorder. Journal of Behavior Therapy and Experimental Psychiatry. 1997;28:163–168.

  • McManus M., Derby K. M., Dewolf E., McLaughlin T. F. An evaluation of an ın-school and home based toilet training program for a child with fragile X syndrome. International Journal of Special Education. 2003;18:73–79.

  • Stadtler A., Gorsky P., Brazelton T. B. Toilet training methods: Clinical interventions and recommendations. Pediatrics. 1999;103:1359–1361. 

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