Potty training a child — any child — isn’t easy. While elimination is a normal and natural process, learning where to go is not.
Most children in the United States have achieved core physical, cognitive, and emotional potty training milestones by age 2 years. At this point, they’re ready to begin learning what the potty is and how it works. Then they need several months (or years) of training.
Children with autism often need more time. They may not start training until later in life, and when they do, they may need help picking up core messages.
Common Toilet Training Challenges in Autism
Every child with autism is different, as are the potty training problems they face. But most fall into a spectrum.
Children with autism may deal with:
- Late training. Your child may not be ready to start potty training on a typical schedule. Some don’t have the tactic when they enroll in school.
- Nighttime accidents. Your child may not have potty training problems during the day. But your child may awaken with wet or soiled bedding after a nap or a night’s sleep.
- Bowel accidents. Your child may master urination in a potty, but bowel issues remain.
A child who doesn’t have potty training mastered may miss out on crucial socialization opportunities. Your child may not notice the potty problems or feel shame about them, but other children may be uncomfortable with the way your child looks or smells after an accident.
Keeping an incontinent child clean is expensive, especially if your child needs large-size diapers and disposable training pants. Skip a diaper check, and your child could develop skin irritation or infections.
Toilet training is also considered a critical part of independent living. If your child can’t master this step, you may worry about the future.
Why Is Potty Training So Hard?
On average, children with autism need lessons that last about 1.6 years to achieve urine control, and some need more than 2 years to achieve bowel control.
Difficulties can be:
- Physical. Your child may struggle with digestive disorders that lead to constipation. A child who feels pain or discomfort is likely to avoid the potty.
- Linguistic. Your child may not be able to tell you, either verbally or physically, that it’s time to go to the bathroom.
- Sensory. Some children with autism struggle to interpret signals from the bowel and bladder. They may not know it’s time to go until an accident is in progress.
- Habitual. Children with autism appreciate routines. An incontinent child likely has years of habits built around diapers and disposable training pants.
Teaching your child may also be difficult. Your child only needs to visit the bathroom a few times per day, limiting your opportunities to practice the behavior.
Set Potty Training Expectations
Read online articles, and you may believe you can potty train any child in just a few weeks. Know that your child is an individual, and while you can help, you may need months or years to do this work.
As long as your child is making progress, you’re on the right track. But if your child starts worrying about visiting the bathroom, sitting on the toilet, or discussing potty training, you may need additional help.
Your child may also be frustrated or upset during potty training. A nonverbal child might express that discomfort with challenging behavior, and that’s common during potty training. Be patient with your child — and yourself — as these episodes occur. You are all doing the best you can.
Potty Training Tips for Parents
Does your child stay dry throughout the night? Does your child come to you for help when soiled or wet? These two signs indicate your child might be ready to start potty training.
Take these steps before you get started:
- Prepare the bathroom. Choose one bathroom as potty training central. Equip that room with tools to keep your child comfortable. Some children benefit from a training seat to reduce the size of a scary hole filled with water. Others appreciate a step stool to make the bowl more accessible. Put a timer in the bathroom, too.
- Choose your tools. Fill a basket with toys, bubbles, and whistles your child might use while on the toilet. Some of these items will keep your child entertained. But others (like bubbles) can entice your child to push, which can help with elimination.
- Find reinforcers. Fill another bin with items you’ll use to reward successful elimination. Use different rewards for urination and bowel movements.
- Say goodbye to disposable training pants. Modern diapers pull moisture far from your child’s skin. Infection rates dip, but that whisking can keep your child from feeling a sense of wetness. Moving to underwear gives your child the opportunity to learn from the body.
- Create visual supports. Create a story in discrete steps your child will understand. You might use: ask to go potty, pull down pants, sit on the toilet, wipe until clean. Find a sequence and visual cues that work for your child.
With preparation done, it’s time to get started with:
- Increasing fluid intake. The more your child drinks, the more chances you have to practice together.
- Setting a routine. Determine how often you’ll visit the potty. Some families set a 30-minute schedule. Others go hourly. You know your child and what will work best for you.
- Practicing. Use your visual supports and terminology during your practice sessions. Keep your cues short and understandable. Say “Visit the potty!” and head to the bathroom you’ve chosen.
- Keeping sessions short. Spend a maximum of about 3 minutes on the toilet during each visit, and use your timer to ensure you’re not making your child sit for too long. Use bubbles and toys to make the visit fun, but remind your child why you’re there. Reward your child for successful trips.
- Watching for distress. Some children with autism are worried about the sound of a flushing toilet. If needed, ask your child to wait outside the bathroom while you flush.
If your child has an accident between your visits, don’t panic. Bring your child back to the bathroom for cleanup. Place solid accidents in the toilet and use a simple cue, such as “Potty goes in the toilet,” to explain your choice.
Potty Training ABA Therapy
You know your child, your household, and your routines. But sometimes an outsider can bring your family critical help. An applied behavior analysis (ABA) therapist can be an ally during potty training.
An ABA therapist may help you with:
- Cues. Your therapist may spot subtle signs that a bathroom visit is in order. You may miss these physical signs during the hustle and bustle of everyday life.
- Supports. A therapist may identify bathroom tools your child needs. Grab bars may be helpful for some children, for example. Others appreciate a high footstool to rest their feet as they push.
- Sequence. Your therapist may make critical adjustments to your social stories and visual cues. These changes can make potty training easier for your child to understand.
A typical ABA potty training session may sound much like the steps we’ve outlined above. Your therapist takes the child to the bathroom, offers rewards for success, and repeats as often as needed.
But ABA therapists have specific, concrete skills. They’ve spent years training children just like yours to learn new behaviors. A therapist may help your child — and your family — master this skill quicker than you could do alone.
References
Toilet Training: Common Questions and Answers. (October 2019). American Family Physician.
Parent’s Guide to Toilet Training Children With Autism. Autism Speaks.
A Parent-Oriented Approach to Rapid Toilet Training. (August 2017). International Electronic Journal of Elementary Education.
Toilet Training for Children With Autism. (March 2017). Autism Awareness Centre.
Seven Toilet Training Tips That Help Nonverbal Kids With Autism. (February 2016). Autism Speaks.
Toilet Training Children With Autism and Developmental Delays: An Effective Program for School Settings. (2012). Behavior Analysis in Practice.
Errorless Toilet Training: The Potty Party. (June 2020). International Electronic Journal of Elementary Education.
