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Potty-Training Children with Autism Spectrum Disorders: Special Considerations

"Any tips on potty training a child with an Autism Spectrum Disorder?"

Potty-training success hinges on physical and emotional readiness, not a specific age. Many children with Autism Spectrum Disorders (ASD) show an interest in toilet-training by age 2, but others might not be ready until age 3 or even older — and there's no rush. If you start toilet-training too early, it might take longer to train your youngster.

Is your ASD youngster ready? Ask yourself these questions:
  • Can your youngster pull down his/her pants and pull them up again?
  • Can your youngster sit on and rise from a potty chair?
  • Can your youngster understand and follow basic directions?
  • Does your youngster complain about wet or dirty diapers?
  • Does your youngster seem interested in the potty chair or toilet, or in wearing underwear?
  • Does your youngster stay dry for periods of two hours or longer during the day?
  • Does your youngster tell you through words, facial expressions or posture when he/she needs to go?

If you answered mostly yes, your youngster might be ready for toilet-training. If you answered mostly no, you might want to wait awhile — especially if your youngster has recently faced or is about to face a major change, such as a move or the arrival of a new sibling. A toddler who opposes toilet-training today might be open to the idea in a few months.

There's no need to postpone toilet-training if your youngster has a chronic medical condition, but is able to use the toilet normally. Be aware that the process might take longer, however.

When you decide it's time to begin toilet-training, set your youngster up for success. Start by maintaining a sense of humor and a positive attitude — and recruiting all of your youngster's caregivers to do the same. 

Next, follow these practical steps:
  1. If your ASD youngster has frequent accidents, absorbent underwear might be best. Keep a change of underwear and clothing handy, especially at school or in childcare.
  1. Some ASD children respond to stickers or stars on a chart. For others, trips to the park or extra bedtime stories are effective. Experiment to find what works best for your youngster. Reinforce your youngster's effort with verbal praise, such as, "How exciting! You're learning to use the toilet just like big children do!" Be positive, even if a trip to the toilet isn't successful. 
  1. After several weeks of successful potty breaks, your youngster might be ready to trade diapers for training pants or regular underwear. Celebrate this transition. Go on a special outing. Let your youngster select "big kid" underwear. Call close friends or loved ones and let your youngster spread the news. Once your youngster is wearing training pants or regular underwear, avoid overalls, belts, leotards or other items that could hinder quick undressing. 
  1. When you notice signs that your youngster might need to use the toilet (e.g., squirming, squatting holding the genital area, etc.) – respond quickly. Help your youngster become familiar with these signals, stop what he/she is doing and head to the toilet. Praise your youngster for telling you when he/she has to go. Teach females to wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder. When it's time to flush, let your youngster do the honors. Make sure your youngster washes his/her hands after using the toilet. 
  1. If your youngster resists using the potty chair or toilet or isn't getting the hang of it within a few weeks, take a break. Chances are he/she isn't ready yet. Try again in a few months. 
  1. Accidents often happen when ASD children are absorbed in activities that — for the moment — are more interesting than using the toilet. To fight this phenomenon, suggest regular bathroom trips (e.g., first thing in the morning, after each meal and snack, before getting in the car, before going to bed, etc.). Point out telltale signs of holding it (e.g., holding the genital area). 
  1. Place a potty chair in the bathroom. You might want to try a model with a removable top that can be placed directly on the toilet when your youngster is ready. Encourage your youngster to sit on the potty chair — with or without a diaper. Make sure your youngster's feet rest firmly on the floor or a stool. Help your youngster understand how to talk about the bathroom using simple, correct terms. You might dump the contents of a dirty diaper into the potty chair to show its purpose, or let your youngster see family members using the toilet. 
  1. If your youngster is interested, have him/her sit on the potty chair or toilet without a diaper for a few minutes several times a day. For males, it's often best to master urination sitting down, and then move to standing up after bowel training is complete. Create a potty-training social story, read a toilet-training book, or give your youngster a special toy to use while sitting on the potty chair or toilet. Stay with your youngster when he/she is in the bathroom. Even if your youngster simply sits there, offer praise for trying — and remind your youngster that he/she can try again later. 
  1. Occasional accidents are harmless, but they can lead to teasing, embarrassment and alienation from peers. If your toilet-trained youngster reverts or loses ground — especially at age 4 or older — or you're concerned about your youngster's accidents, contact his/her doctor. Sometimes wetting problems indicate an underlying physical condition (e.g., urinary tract infection, overactive bladder, etc.). Prompt treatment can help your youngster become accident-free. 
  1. Most ASD kids master daytime bladder control first, often within about two to three months of consistent toilet-training. Nap and nighttime training might take months — or years. In the meantime, use disposable training pants or plastic mattress covers when your youngster sleeps. 
  1. ASD children don't have accidents to irritate their moms and dads. If your youngster has an accident, don't add to the embarrassment by scolding or disciplining him/her. You might say, "You forgot this time. Next time you'll get to the bathroom sooner." 
  1. Have plenty of patience, keep it simple, and make it fun!


Anonymous said...

My 8 year old daughter has Aspergers. She still wets her pants (and occassionally soils them too) several times per day both at home and at school. She also wets on a nightly basis. We have talked with her dr. She can control it in certain places (store, restaurant...)but she seems to always go where she is comfortable being. Her dr. feels it is a behavioral problem. Would just like another take on what could possibly be going on taking ASD into consideration.

Anonymous said...

the only thing i can say is, IM SO GLAD THAT PART IS DONE!!!! clayton was close to 4 when he finally potty trained, it was a nightmare! especially when i see now how quickly his brother and sister (both younger) potty trained!

Anonymous said...

My son was 3 and my daughter was 4.5 years. He was much easier and she was sooo hard and stubborn. She had no desire, didn't care about being wet or dirty, and we tried everything. From treats to potty pets. She said she didn't want treats and her potty pets could starve to death, she didn't care. Finally one day she did it. They definitely can't be pushed or forced, they have to be ready like any other child, it just might take them a little longer.

Anonymous said...

maybe buy your child a special potty or a book about it with sounds, it helped mine, but he was 4 years and 5 months when he was potty training, and encourage him as much as you can, also desensibilize him to the noise of the toilet, i used to pour a container of water in the toilet, to show him where his wee will go and the sound of a flushing toilet, good luck

Anonymous said...

My boy is 4 and still shows no sign of even caring about potty training. Its not that he doesnt know he has to go because he will go and hide when he knows he is going to poop. Nothing seems to encourage him, we even promised him a 'big boy' bike if he learns but still no joy. We are getting to the point where we are going to run out of diaper sizes soon as he is big for his age (was weaing size 5 t-shirts at 31/2)

Anonymous said...

My son is 11 and still has night time enuresis (wetting) no one has been able to help! If someone has pointers that would be awesome????!!!!!!!

Anonymous said...

I used to have to send my son to the bathroom every 10 minutes to "make sure" and then slowly increase the longer he could hold it or until he could tell me. It was a long process. He like to get a sticker after each visit. My middle child doesn't have aspergers (only my oldest) but for him we had the characters on the underwear "talk" to him and it worked wonders. Good luck!

Anonymous said...

My son is 10 and also has night time enuresis. It really frustrates him and have tried bed wetting alarms, and lifting him every night. He is now too big to be lifted and he can stand the way the bed wetting alarm feels on him. Any suggestions are welcome!

Anonymous said...

My son was almost 4 when trained. The problem was the sensation of a cold seat on a bum. I allow him to get buck naked and squat over it. Bizarre and precarious but it worked since that day. Public restrooms are a nightmare.

Anonymous said...

My son has significant auditory defensiveness, so we worked with him on not being scared of the flush. Poor guy still covers his ears before flushing with his foot. if your child has problems with echoalia be prepared for the mimicking of flusher noises! What a journey autism has proven to be...

Anonymous said...

My son was fine at night since age 2, but he had intermittent constipation, and he was not successful with consistent toilet use until he was 7 years old. Once he was ready, it all clicked and he did well. Before that, nothing helped. It was a long haul. I'm still happy every time he uses the toilet!

Anonymous said...

My son was 5 when he finally potty trained, but was a bed wetter until he was 12. We finally discovered it takes patience patience patience and consistancy consistancy consistancy. We had to outlast his stubborness. As a last straw (knowing he was perfectly capable of using the toilet), each time he had an accident, he went to time out. I don't necessarily recommend this, but it worked for us. One long weekend of many timeouts and wet pants, he decided using the toilet was preferable to sitting in a chair staring at a blank wall. We also let him skip the flushing part until he was older, the noise made by the toilet freaked him out.

Anonymous said...

On the bedwetting comments left by others, both of my children were bedwetters, 1 has aspergers, 1 is neurotypical. Our doctor told us they eventually outgrow it. Both of mind did, when they hit puberty, both were 12. If your child has outgrown diapers (mine did when he was 3, use goodnites, they go up to 120lbs and work as well as diapers.

Anonymous said...

I'm sure this isn't for everyone, but we let him go naked from the waste down for two days. I noticed that when he was in the bath tub or just getting out, he'd tell me he had to go. He seemed to get it that he couldn't go on the floor. He was confused with the training underwear or regular underwear. If he had anything on his lower half, he'd go in his pants. So I had him go pants less for a weekend. Then I added shorts w no undies for a few days, then pants, then underwear and pants. He was completely potty trained in less than a week and that was a few months before he turned 3.

Unknown said...

Have you tried taking him to a specialist as it sounds like irritable bladder? Pay to get medical testing done I reckon. Some things can be overlooked and blamed on behaviour when it's in fact medical.

Tara Willis said...
This comment has been removed by the author.

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