Potty training is a process that every parent, or sometimes educator, struggles with but when trying to potty train autistic children, it can prove even more challenging. The 'rules' of potty training often don't apply for autistic children, as the autistic traits of cognitive rigidity, sensory processing and struggling with change are all at play and it can prove difficult.
Potty training can be a long and draining process for all parties involved! You're going to have to be persistent and patient, but hopefully it should all pay off. The common method of gradually switching to pull-ups and then regular underwear, giving a child lots of juice and placing them on the potty every 30 mins until they get the hang of it probably won't work for an autistic child. You're going to need to be creative and overcome some additional obstacles in order to successfully potty train a child with autism.
Is My Child Ready to be Potty Trained?
All children develop at different speeds, but children are typically ready to be potty trained between the ages of 2 and 4. However, children with autism tend to have a slower development than neurotypical children, so they may be older than this when they are ready to be potty trained. Rather than using age as a guide, let the child's behaviour tell you when they are ready to begin potty training. Some of the behaviours to look out for are;
Pulling at their wet or dirty nappy, including just taking it off!
Showing interest in the bathroom or toilet
Starting to go longer periods between wet or dirty nappies
Communicating with you when they need a nappy change
These behaviours may not occur until a child is much older, by which time they have probably outgrown the typical nappy sizes. DryNites offer nappy type pants in ages 4-7, and there are similar offers from Pampers and Bambo who go up to ages 8-15. It may be worth finding what type of nappies each child prefers - some like the ones with tape that are similar to baby nappies, whereas some can prefer the flexibility of pull-up type pants.
Top Tips for Potty Training Autistic Children
Introduce the Potty
Don't just rush in and try to get a child to sit on the potty the first day you buy it. You need to familiarise them with it physically and conceptually first. Start by buying your potty of choice and just leaving it in the bathroom for a few weeks so that the child sees it every day and could inspect it if curious.
You can also start reading a few potty training books to introduce the concept of a potty and what it is used for. Some of my favourites are;
A great book I would recommend for you is "Understanding Autism: Potty Training & Personal Care".
Create a Relaxed Environment
Ensure that the bathroom is a calm, relaxed environment that is free of distractions. If a child needs additional supports when using the bathroom, such as foot rests or rails, ensure that these are installed and that everything is accessible for the child. Be considerate of sensory needs as well. Strong smelling soaps and chemicals should be avoided, and if there are loud extractor fans or hand dryers, these could also be distracting.
Baby Steps
As with introducing anything new to autistic children, it is important to take baby steps and go through the process very gradually. The same applies to potty training. Break the whole process down into small chunks and gradually attempt them over a long period of time. The steps could be;
Sitting on the potty fully clothed
Sitting on the potty in a nappy or pull-ups
Encouraging to pee in their nappy whilst on the potty
Encouraging to pee in their nappy whilst on the potty with the sides of the nappy undone
Take a clean pull up or nappy, place on the base of the potty and get the child to sit and pee on it
Pee into the potty!
You could have these steps up in the bathroom in a visual timetable format to help remind the child what steps they need to take for proper bathroom use.
Reward System
Rewards always go down well. Try to reward the child any time they meet potty expectations, whether it's just sitting on the potty or going the whole way and using it completely. Use both verbal and physical praise as soon as you can so that it is clear what behaviour you are praising and trying to reinforce. The reward they get for using the potty should be something they only get in this situation and it should be something that motivates them sufficiently. Sticker reward charts that are themed, like this one, also work well as this is visually reinforcing!
Make Potty Training a Positive Experience
You don't want any aspect of the potty training process to evoke negative emotions within the child as this will make the training aspect far more difficult. Do not force the child to use the potty if they clearly do not want to and do not force them to stay there until they have used it.
Accidents Happen
Going from nappies or pull ups to perfect potty use is not going to happen overnight and even when you think a child has grasped it, accidents will happen. If this happens, just act normal, clean up and move on. Don't make a big deal of it, and certainly don't punish the child! It will take a long time for children to understand and read the signals their bodies are sending them, especially for autistic children, so be patient and accept that this is a big change that will take time to master.
Help Them Learn Their Body
We've already mentioned a few times that interoception, the ability to understand internal bodily signals, is something that some autistic children can struggle with. For some, they have little understanding of those signals and cannot tell when they are hungry or need the toilet. For others, they can be hyper sensitive to these signals and can end up going to the bathroom the second they might feel the need to urinate. Here are some great ways to teach various interoception awareness skills.
Have a Visual Schedule
Similar to how you display visual timetables, it may be worth having a visual step-by-step schedule of how to use the potty put up somewhere in the bathroom. This will remind the child of what to do throughout the whole process, and can increase independence when they eventually go to the toilet unaided. Steps could be;
Pull down trousers
Pull down underwear
Sit on potty/toilet
Use potty/toiler
Take toilet paper or wipe
Wipe
Put paper/wipes into toilet
Pull up pants
Pull up trousers
Flush
Wash hands
There are some great visuals from Do2Learn which you can print and laminate. Be sure to keep any routine the same so that children can become familiar with the steps they need to take during each part of the bathroom experience.
Be aware of gastrointestinal issues
Around 36% of autistic children have more gastrointestinal issues compared to 2-5% of their peers. This can include things like constipation which also makes toilet training more challenging. If you note that children are showing signs of constipation, make a note of this and consult the relevant people, such as the school nurse.
Teaching a child to use the toilet correctly can be a difficult task, whether they are on the autism spectrum or not. But if your child is autistic, the process of developing a toilet routine can take longer, and involve its own particular challenges. This guide hopefully provides some useful steps that will hopefully make your toilet training a success.