Toilet Training for Children with Autism Spectrum Disorder

Hi everyone! Welcome back to TheParentPartner! I took a break from the site due to moving, but I am so excited to be back! This blog is centered around potty-training and what to expect during the process.  To start this blog, I think it is important to say: Potty-training is not an easy feat, and as neurotypical adults, it's not something that we remember, as most of us completed it during the ages of 1.5 and 3 years old. Now that WE are the adults, and may need to potty-train a child with Autism Spectrum Disorder, the criteria is a bit different.

Potty training for children with Autism usually occurs between the ages of 2 and 6 years old. For those who have seen my August 2024: The Importance of Early Intervention and Screening for Children with Autism Spectrum Disorder with Dr. Janet Siddiqui, you may remember that the ideal time to start interventions with children with Autism is around ages 2 and 3. Restroom training, or "potty training," is very rewarding in the long run and incorporates the development of many other skills, but can also induce stress and frustration for you and your child. Every child is different, and it is totally okay is there is some difficulty learning certain steps. This is ultimately a journey (NOT a marathon) and any progress is a great step towards learning independence with transitioning to/ using the restroom.

Are there any differences that come with potty-training a child with Autism?

There are some parts of potty-training that may be a bit different with a child with Autism. 

• Firstly, there may be differences in sensory processing for your child. A few of the children I work with like to remove their pants fully because they dislike the feeling of their pants being around their ankles. You should also find out what parts of the bathroom are aversive, or are reinforcing (and it is usually either or in respect to the toilet flush sound).
• There are also differences in communication abilities in some cases. Sometimes your child can approximate their sounds to sound like "potty" but if they struggle with some words or are nonverbal, they may need to rely on a picture of the toilet bowl, either in their PEC book or AAC (Augmentative and Alternative Communication) device to ask to use the restroom. 
• Your child may also have limited fine motor skills, so pulling their pants up and down can be more difficult for them as well.

How can you tell if your child needs to urinate or defecate?

• Sometimes they will do a “potty-dance” where they are a bit jittery and seem to be moving their hip area frequently, sometimes stand in a “knock-kneed” position. There are a few instances I have seen in my RBT experience, your child may be skirmish and then proceed to hide before she or he urinates on themself. If there are no direct signs, you should take your child to the restroom regularly on a schedule. From my experience, every 30 minutes to an hour has been helpful to start getting your child into the habit of going to the restroom regularly, but any scheduled period can work as long as you let your child know!
• Another sign is if your child becomes agitated or uncomfortable. This can be discomfort from the feeling of holding in, or that they may have already started urinating on themselves.

So, what can we do?

• You can start by regularly bringing your child to the restroom on a schedule. This allows them to become comfortable with the habit and gives them opportunities to mand for the bathroom themselves.
• Place a restroom sticker on their room door or other rooms where they may sometimes urinate on themself. Place it within their line of sight so they can point to it or they can point and accompany their gesture with the word "potty" or "bathroom."
• Any approximation towards the pointing gesture or towards saying potty (ie. "pah-" or "-otty") deserves some reinforcement! Give your child a big hug or a high-five!
• Bring your child to the restroom and let them bring a reinforcing, fun item with them. Allowing your child to bring a highly reinforcing item with them to the restroom can help with limiting elopement, and assists with them associating the restroom with something positive. 
  • If they still struggle with transitioning to the restroom, you can use the "first __ then___" image below to show them that right after potty-time, there is a fun item waiting for them!
• Once you have made it to the the bathroom, ask your child to pull down their pants and underwear. Help them by placing your hand over theirs and going through the motions of pulling down their pants before you assist them on the toilet. Then have them sit there for 5-10 minutes while they play with their fun item. Continuously remind them that "pee is for the potty."
• After waiting 5-10 minutes, then allow them to flush the toilet and pull up their pants. Help them by placing your hand over theirs and going through the motions of pulling up their pants. Then move to the sink to wash hands.
• Right after leaving the restroom, deliver the reinforcing fun item. Great job!

If you are actively starting restroom training, you may need some liquids and higher fiber foods on hand to jumpstart the process. This will result in more opportunities to restroom train during the day. You can do it! Keep practicing and look for chances to work on it. This is yet another milestone that you and your child will get accomplish and continue to build upon in the future!