Even for the "typical" child, toilet training is often a difficult skill to master. For the autistic child, there are additional factors that may inhibit toilet training. The things that would encourage the typical child may not be effective with the autistic child.
Social motivation is a critical factor in determining "readiness" for toilet training. An autistic child may not be motivated by the opportunity to wear "big boy pants," or "big girl pants. The autistic child may not understand what is expected of him. Following all the steps necessary for toilet training may be difficult for the autistic child. Changes in the child's routine may also be a challenge. An autistic child may not be aware of the need to use the toilet.
The first step in toilet training your autistic child will be to determine their level of readiness.
* Establish a positive and meaningful routine around toileting and collect data about your autistic child's readiness for schedule training or for independent toileting.
* Use a simple chart to collect the data needed about the child's readiness. On a routine basis, the child is taken to the bathroom for a "quick check" every 30 minutes and data is recorded on each occasion.
* Over a period of 1 or 2 weeks, patterns of data begin to emerge.
- Is the child dry for significant periods of time?
- Is there some regularity in his wetting/soiling?
- Does the child show any indication that he/she is aware of being wet/soiled?
- Does the child pause while wetting/soiling?
* If the answer to all of these questions is no, it may not be time to toilet train the child.
* During this trial period, assess other aspects of the process of toilet training.
- Is the child beginning to pick up on the routine involved?
- Does the child have dressing skills?
- Are there any fears associated with the process of toileting?
- What is the child's attention span?
It may be beneficial to develop a task analysis of the steps of toileting. This can provide a picture of all the skills needed, and also let us you see where specific trouble areas may be. The task analysis can be very general or very specific, including everything from entering the bathroom, to flushing the toilet and leaving the bathroom.
When beginning the toilet training of a child with autism, you want to help the child learn that this set of behaviors (elimination) is associated with a particular place (the toilet). Moving all changing, cleaning, and toileting-related dressing to this setting helps the child realize the purpose of this room.
A second goal for creating clear physical structure to assist in toilet training is to create an environment that is secure and not over-stimulating. The child will be calmer and more responsive with good physical support for his body. Think about adding foot support, side rails, or other physical supports. Think also about the plumbing noises and echoes of many bathrooms. Many children appreciate soft music playing or the addition sound-absorbent materials.
Using Visual Supports-
For the autistic child, it may be helpful to provide pictures to demonstrate the sequence of events that occur surrounding toilet training. At the most basic level, a transition object may be used to let the child know that the toilet routine is beginning. An object that is associated with toileting may be given to the child to serve as the transition object that takes the child to the correct location. Once the transition to the toilet area has been made, it is important to continue to visually support each step of the toileting routine. We need to let the child know each step he is to accomplish, when the sequence will be finished, and what will happen when the sequence is finished. Again, using an object sequence, a picture sequence, or a written list are all ways to communicate this information to the child.
Once you have begun the process, you may notice areas that are more challenging. Below are some common solutions.
If you child resists sitting on the toilet:
- allow them to sit on the toilet without removing clothes
- allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually removed)
- use potty seat on the floor rather than up high
- take turns sitting, or use doll for model
- sit together
- add physical support
- help him understand how long to sit (sing potty song, length of 1 song on tape player, set timer 1 minute, etc.)
- as he gradually begins to tolerate sitting, provide with entertainment
If your child is afraid of flushing:
- don't flush until there is something to flush
- start flush with child away from toilet
- give advance warning of flush
- allow him to flush
Only want to flush:
- physically cover toilet handle to remove from sight
- give something else to hold and keep them busy
- use visual sequence to show when to flush (after replacing clothing, for example)
- when time to flush, give child a sticker that matches to a sticker on toilet handle
Plays in the water:
- give him a toy as distraction
- use a padded lap desk while seated
- cover the seat until ready to use
- put a visual cue of where to stand
Plays with toilet paper:
- remove it
- roll out amount ahead of time
- give visual cue for how much
Resists being cleaned:
- try different materials (wet wipes, cloth, sponge)
- consider temperature of above material
- take turns with doll
- supply a "target" in the water, such as a Cheerio
- larger target as toilet insert (contact papered or laminated cardboard with target drawn on it), gradually moved down
- add food coloring in the water to draw attention