Toilet training can be challenging for many caregivers and professionals, but it should never be stressful or upsetting for the child. Some children are ready to toilet train around the same time as their peers, and others are not. For some children with autism, the process will be fairly quick – they will just “get it.” For others, it will be a journey that might include long pauses and resets. Independence, privacy, and self-advocacy are the long-range goals here. But when you are ready to get started, below are some basic tips to consider:
1. Look for Signs that the Child May be Ready to Toilet Train
- The child shows awareness that they are soiled (e.g., taking off soiled clothing; expressing discomfort in soiled clothing; requesting caregivers to change them).
- The child comments using words associated with the bathroom.
- The child shows interest in the toilet or others toileting.
- The child hides while voiding.
- The child experiences fewer soiled diapers throughout the day.
2. Associate the Toilet with Fun Activities and Items
- Spend time with your child in the bathroom doing fun activities.
- Change your child in the bathroom so that they associate voiding with the bathroom.
- Prior to toilet training, begin sitting your child on the toilet at natural times without expectation for voiding (e.g., first thing in the morning, before bath time, before bed).
- Be sure your child is willing to sit on the toilet for 3-5 minutes without expectation to void – this is a pre-requisite for toilet training.
- Ensure your child will sit on the toilet and is happy and relaxed sitting on the potty.
3. Identify a Reward
- Identify a reward for toileting that can be easily delivered immediately.
- The reward should be able to be withheld except for rewarding toileting success.
- Choose a reward that will not produce challenging behavior when it is removed (e.g., iPad may be a difficult item for your child to relinquish, if chosen for a reward, and you may experience challenging behavior upon removal).
- Stock up on the reward of your child’s choosing!
- In addition to items/activities that might be chosen as rewards, always use lots of positive praise and smiles to acknowledge the child’s progress.
4. Commit to a Time to Train
- Choose a time that you and your family can fully commit to toilet training (multiple days without obligations and without big changes upcoming).
- Choose a time that your child will be home from school for multiple days if possible (e.g., summer, spring break, holiday vacation, long weekend).
- If it is not feasible to dedicate full days to toilet training, try to collaborate closely with school/daycare/babysitter, etc. to ensure consistency.
5. Collect Baseline Data to Select Toileting Interval
- Collect at least two full days of baseline data on when your child is naturally voiding in their diaper or pull-up. Here is one data collection form that you could use.
- Conduct frequent checks of their pull-up or diaper to ensure accurate information.
- Average the amount of time between voids. For example, if the times between voids is 30, 41, 35, 48, and 33 minutes, the average would be 37 minutes. Decrease the average interval by 5-10 minutes to identify the initial toilet training sitting interval that’s appropriate for your child. Consider a toileting interval of 30 minutes starting out. You want your child to be sitting prior to having an accident.
6. Choose Undergarment and Potty Seat
- Get cool undies that your child will be excited about.
- You can toilet train without pants or by putting underwear under a pull-up if you are worried about cleaning up accidents.
- Underwear will allow your child to experience the feeling of being wet or soiled.
- If the child can sit comfortably on the toilet without holding themselves up, no need for a potty seat. Consider a potty seat if needed based on your child’s size.
- Some prefer to use a separate child’s potty; for some children, learning to void in a different toilet can be a barrier when that potty is not available.
7. Begin Sitting on a Schedule
- Keep your child in underwear once you begin toilet training to prevent confusion, except at nighttime or in the community.
- Increase fluid intake to increase natural opportunities.
- Direct the child to the toilet on the identified toileting interval (every 30 minutes from example data above). Have them sit for 3-5 minutes using a timer to show the child how long they are sitting.
- Never hold a child on the toilet! If the child does not want to sit or expresses dissent, go back to step 2 and provide opportunities to associate the toilet with reinforcement. Determine if there are fears and sensory issues surrounding the toilet/bathroom. Toilet training through tears is never the way to go. A child needs to be calm and relaxed in order to learn.
- Outcomes after sitting:
- SUCCESS: When child voids on the toilet when directed to sit, immediately provide access to the reward, pairing reward with positive praise! Child can stand up upon voiding. Reset the timer for full toileting interval.
- SIT WITHOUT VOID: Have the child get up from the toilet once the timer goes off, wait 5 minutes, and then see if the child wants to sit again. Sit the child every 5 minutes until they void. If the child voids, follow instructions in SUCCESS step.
- ACCIDENT: If the child has an accident, calmly take the child to the bathroom to change/clean up. NEVER reprimand the child or express disapproval. Reset the timer for the full interval.
- Each time you take your child to the bathroom, have your child communicate “bathroom” in some way (e.g., saying “potty,” signing bathroom, gesturing, picture exchange, etc.).
- Give lots of praise and special rewards anytime your child takes themselves to the bathroom without being prompted to do so. These initiations are big steps!
- Collect data! Here is one data collection form that you could use.
8. Fade Toileting Schedule and Encourage Initiation
- At two days with no accidents, increase toileting schedule by five minutes to allow for your child to experience the feeling of having to void.
- Continue to slowly increase the interval once you are seeing success at longer intervals (e.g., two days with no accidents=increase the interval to 35 minutes, then to 40 minutes, etc.).
- If experiencing many accidents, remain at current toileting interval.
- Notice signals that the child needs to void and prompt them as needed, keeping the child near the bathroom as you approach time to sit.
9. Fade the Reward
- Begin to fade reward to a varied and less predictable schedule.
- Continue to reward independent trips to the bathroom or requests for the potty.
- Always pair rewards with social praise so that praise will ultimately function as the reward.
10. Celebrate Success!
- Toileting successes may ebb and flow, adjust schedules and expectations as needed.
- If your child begins to have accidents after being toilet trained, consult with their physician. It is important to rule out medical issues.
- If your child begins to hold their urine and bowel movements, immediately stop the toileting protocol and contact their physician.
- Be patient and stick to the toileting protocol like glue.
- Celebrate your child and yourself – this is a big accomplishment!
Alana Iannello, MAT, BCBA, joined the ASNC Clinical team in 2017 and provides LifeLong Intervention services in the Asheville area. Learn more about LifeLong Interventions and Clinical services.
Tags: asnc clinical, autism, autism asperger parenting tips, autism behavior, autism communication, Autism Society of North Carolina, Autism Spectrum Disorder, autism support, toilet training