Toilet training a child requires great amounts of effort and patience. Toilet training a child on the autism spectrum presents additional difficulties that can stretch your efforts and patience even further. Fortunately, there are several well-researched training regimens that can facilitate this task. This doesn’t mean that the training will be easy or will be completed over a single weekend; however, following the guidelines presented by these programs will let you know that you’re on the right track.
First, it might be helpful to review the reasons for toilet training:
-It is a self-care skill that provides for greater hygiene and overall health;
-It provides for greater independence;
-It provides a sense of achievement;
-It allows for involvement in a greater number of activities and community events;
-It has positive impacts on the family, e.g. saves money and represents one less responsibility for caregivers.
Second, there are several criteria that help determine if your child is ready for toilet training:
-Consult with your child’s pediatrician to determine if there are any underlying health issues that would make toilet training inadvisable;
-Does your child retain urine for at least ½ hour to an hour (some sources recommend 1.5 -2 hours)?
-Does your child display discomfort if the diaper is wet or soiled?
-Is your child two years old or older?
-Can your child remain seated and engaged for 3-5 minutes?
-Is your child cooperative during dressing and undressing?
-These criteria are not set-in-stone absolutes, but should be a good predictor of success. The more criteria that are answered with a “Yes”, the more likely it is that your child is ready for toilet training.
Next, there are a number of questions that are often raised about toilet training:
- Should our child continue to use diapers during toilet training?
- No, your child should wear regular underwear. It is nearly guaranteed that a number of accidents will occur but that is typical of all toilet training. You can prepare beforehand by having a number of clean pairs of underwear handy and by putting mattress pad covers on bed and furniture; there are times when it may not be possible to keep up with the laundry. Still, moving to underwear decreases dependence on diapers and that can be a major step forward for many children.
- Should we train in various settings, e.g. home, grandparents’ house, school?
- That depends on the training regimen you choose. Some methods aim for toileting mastery at home before trying in other settings. However, if you can enlist assistance from family members and teachers then training in multiple environments can facilitate generalization of skills.
- Should we focus on self-initiation (i.e. your child independently goes to the bathroom and toilets) from the start?
- That varies from setting to setting. For example, in some schools children do not have immediate, free access to the bathroom as they need to first alert a teacher that they need a toilet break. Thus, many training regimens include a request to use “Potty” as part of their program. Ultimately, your child should be as independent with toileting as possible.
- Should we teach bowel control at the same time as bladder control?
- Some children develop bowel control at the same time as bladder control; other children take longer to develop bowel control. If your child needs more time to develop bowel control then reinforcement should be continued for successful toileting.
- What if my child tantrums and is resistant to training?
- Noncompliance can be common at the start. Tantrums can occur as your child might not like the new responsibilities or correction procedures if there is an accident. This should fade over time and remember to frequently reinforce compliance and successful toiletings!
- How long will it take?
- That varies tremendously from child to child. However, consistency with training and persistence with moving forward will pay off. Training can be facilitated by ensuring that appropriate methods are being used in all settings, e.g. home, school, daycare.
- Is there a better time of year to toilet train?
- Not necessarily, but many parents report summer is a good time because kids are at home and wearing fewer pieces of clothing making toileting easier.
Required resources/materials:
-Most important is for someone to take on the central role of point-person. This is usually a primary caregiver. The point-person will need to ensure that all people assisting with toilet training have the necessary materials, help and specific training on the toileting regimen. The point-person also informs others of progress and other pertinent updates. The point-person also needs to ensure that others are faithfully following through with the training regimen.
-Help. Don’t try to do it all by yourself; enlist the help of family members, friends and other caregivers. It’s a big job and many people will be willing to help (to varying degrees, of course!).
-Reinforcers (favorite snacks, toys, DVDs, high-5s, hugs, etc.) that will let your child know that he or she is doing a good job.
-A toilet or potty chair that is appropriate for you child.
-Lots of extra underwear and clothing.
-Data sheets that track progress (not every training regimen uses these, but they can be extremely helpful). You should also have a binder if the data sheets move between settings such as home and school.
-Extra liquids so that your child is not thirsty and is more likely to need to urinate. Some children will need to have this cleared with their pediatrician if a health issue possibly contraindicates extra fluids.
Initial steps of toilet training:
- Determine if your child is ready for toilet training using the above listed criteria.
- Choose a toilet training regimen for you child.
- Enlist others to help.
- Inform and train all others on the training regimen.
- Gather all necessary materials.
- Determine in which settings training will occur.
- Set a start date for training.
Actual steps of toilet training:
Unfortunately, this blog doesn’t have space to describe every step in detail. The resource list at the end is a good place to start to find detailed instructions, datasheets and discussions of common toilet training pitfalls. There are steps that are common to most regimens and we can look at those:
-Schedule opportunities for training, several per hour at the start;
-Immediately reward successful toiletings. Remember that the reward has to be something that your child is excited about and can be quickly and easily provided, e.g. hugs, high-5s, snacks, stickers, a favorite toy, a favorite tune on the iPod, etc.
-Dry pants checks- periodically prompt your child to check for dryness. If the pants are dry then reward with praise, stickers, etc. The dry pants checks should occur frequently at the start, as often as every few minutes.
-Systematically increase distance from toilet and duration of time between toiletings and dry pants checks.
-Many training regimens include positive practice for accidents. This involves providing verbal feedback, “Your pants are wet. It’s time to practice,” guiding your child to the toilet in a neutral manner ( i.e. don’t praise or comfort as we don’t want to inadvertently reward the accident), having your child change quickly into clean clothes, repeating the process of walking from the spot of the accident to the toilet three to five times.
Additional toilet training resources:
Toilet Training for Children with Severe Handicaps by Glen Dunlap and Robert and Lynn Koegel
- An excellent, well-researched toilet training regimen presented in a brief, easy to understand manner; includes sample checklists and datasheets
Toilet Training for Individuals with Autism or other Developmental Issues by Maria Wheeler
- Provides helpful discussions of common difficulties associated with toilet training
Toilet Training in Less than a Day by Nathan Azrin and Richard Foxx
- This book does not specifically focus on children with special needs; however, the authors have developed and thoroughly researched training regimens for a variety of populations
Toilet Training Persons with Developmental Disabilities: A Rapid Program for Day and Nighttime Independent Toileting by Richard Foxx
Ready, Set, Potty!: Toilet Training for Children With Autism and Other Developmental Disorders by Brenda Batts
