Toilet Training Children with Autism and Developmental Delays

Toilet training a neurotypical child can be difficult but toilet training a child with autism or developmental delays can come with its own challenges.  The following strategies come from Overcoming Autism (2014) by Lynn Kern Koegel and Claire LaZebnik and The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders (2007) by Dr. Mary Lynch Barbera Toilet training is important for many reasons: maintaining the dignity of the child, independence in self-care, and the time and expense of diapers or pull-ups are some of the biggest reasons to train your child to use the toilet.   Always consult your child’s pediatrician before beginning a toilet training program. This article will help you identify some of those challenges and strategies to conquer toilet training with a child with autism or developmental delay.
Challenge #1: Knowing when they are ready.
Most neurotypical children begin toilet training around 2-3 years old; however, children with autism or developmental delays may or may not be ready at that age.  According to Barbera (2007) some signs that your child could be ready to begin are that they notice when they are wet or soiled, they remain dry for periods at a time, they show interest in other self-care skills (i.e. hand washing, dressing, etc.), and they hide or move away from you to have a bowel movement.  If your child is showing some or all of these signs, it is likely that they are ready to begin a toileting program.
Not only is it important for your child to be ready, but it is also vital that it is an appropriate time for your family.  Avoid beginning a toileting program if you cannot devote the necessary time to ensure its success, if your family is moving soon, or if your child has just been diagnosed and in the beginning stages of an intervention program.
 Challenge #2: How to prepare them for toilet training.
If your child is not displaying any of the signs that they are ready to begin a formal toileting program, there are a few things you can do to help them along.  These strategies can also be used with children who are about to begin toilet training.

1. Incorporate potty books into your reading collection.
2. Begin using obvious language around bathroom times (i.e. “let’s go to the bathroom” or “time to go potty!”).
3. Begin wet/dry checks. While your child is still wearing diapers or pull ups, you can begin checking to see if they are wet or dry.  A dry diaper would receive reinforcement (i.e. “wow! You’re dry!”) and a wet diaper would result in changing.
4. Always change your child’s diaper in the bathroom.
5. Pair reinforcement (i.e. enthusiastic verbal praise, a gummy bear, a preferred toy, etc.) with sitting on the toilet for any amount of time (even if their pants are still on!) and work on extending the time seated.

 Challenge #3: Beginning a formal toilet training program.
It is important that once you decide to start, you stick to it.  Make sure that it is able to be done in all of the child’s environments with all of their caregivers (babysitters, grandparents, daycare, etc.).  It might be beneficial to have a week or two at home when starting the program.  Create a written plan for all caregivers to refer to with information on how to reinforce, what to do following an accident, and how often to take trips to the bathroom.  Your current behavior analyst (BCBA) can help you create the plan or you can contact Emerge for a consult with a BCBA.  Some important things to include in a program will be:

1. Wearing underwear during the day. Pull-ups or diapers can still be worn at night as nighttime potty training usually develops later.
2. Increase intake of liquids during the day. Keep a water bottle with liquids the child is likely to drink frequently with you.
3. Frequent trips to the bathroom. Begin by taking your child to the bathroom every 20-30 minutes.
4. Reinforcers ready to go. Identify reinforcers (child’s preferred items) to give immediately after a success.  I recommend keeping them in the bathroom for easy access and quick delivery.
5. What to do when they have an accident. Be prepared for accidents – they will happen.  Decide with your behavior analyst the best way to react to your child after an accident.  Typically it requires a trip to the bathroom to sit on the toilet but some programs will have additional steps.  It is best for this section of the program to be individualized to your child.

Challenge #4: Bowel movements.
Often, bowel movements will ‘just happen’ in the toilet during the initial toilet training program.  If this happens, throw a party! Reinforce your child for pooping in the toilet with enthusiastic verbal praise and their most favorite treat or toy.  If bowel movement accidents are still happening, try upping the ante with reinforcement for bowel movements on the toilet (i.e. buy them a new toy, turn on their favorite show, have a dance party in the living room, etc.).  Make sure that you are aware of the signs they are about to have a bowel movement (often this is telling you to go away, an odd sitting or standing position, or walking to a different room or behind furniture) and redirect them to the toilet before they can have an accident in their pants.
While toilet training a child with autism or developmental delays can be difficult, it is possible! Stick to it and don’t be afraid to ask for help if it is too overwhelming or difficult.  Your child’s behavior analyst can be a great resource.  Contact a behavior analyst at Emerge for a consultation or to begin an Applied Behavior Analyst (ABA) program.