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Potty Training with Autism: No More Nappies


Though potty training your child with autism may take a lot of time and effort, mastering the skill of toileting would indicate a great step towards independence in their lives.


It is well-understood that children with autism are very different. Although potty training may be effortful for children with autism as well as their caregivers, there are various steps and accommodations to support this process. In comparison to their neurotypical peers, children with ASD may require more time before they are ready to be potty trained. In addition, they also generally take longer to get potty trained. It has been noted that the average age for children with autism to become potty trained is 3.3 years old, compared to 2.3 years old for neurotypical children (Williams et al., 2003). There are many possible explanations for this difference, and the common ones include general developmental delay, rigidity in routines, difficulties in communication, sensory overstimulation, and anxiety, which can all contribute to challenging behaviors (Autism Speaks, 2016).


How do I know my child is ready?


To emphasize, there is no specific age to begin potty training for children with autism as the process is different for each child depending on their condition and level of functioning. However, there are a few observable signs that may indicate that your child is ready for potty training. These include:


1. They can understand the basic one or two-step instructions

Example: Pull down pants and sit on the toilet

2. They show discomfort when their nappies are soiled or wet by pulling them off

3. They can communicate verbally or nonverbally that their nappies are full

4. They have obtained bladder and bowel control and can to keep their underwear dry for at least two hours at a time


How do I begin?


It is first crucial to start by keeping track and recording the child’s current bladder or bowel movements throughout their time at home and in school for approximately 2 to 4 weeks (Suppo and Mayton, 2012). Recording consistent data in preparation for potty training is key as such information would inform you of the times to target for training. During this recording period, it would also be important to check and rule out any possible health concerns (e.g., gastrointestinal problems). In addition, through close observations, you may also identify barriers to effective potty training (e.g., difficulties in communicating one’s needs) that are to be considered before the formulation of a plan.


Next, prepare the materials and outline the plan. Materials would include the essentials such as a toilet training seat, potty chair, stepstool, training pants, and underwear, as well as accommodations such as visual aids and reinforcers, where appropriate. Generally, the plan should include the targeted times, which are the times your child would likely need the toilet (i.e., to wee or poo), as well as brief directions of the plan. As suggested by Suppo and Mayton (2012), for instance, directions would include:


1. Give praise when bladder and bowel control is observed (i.e., underwear stays dry for about 2 hours) and when it is time to bring them to the toilet

2. Let your child choose a reinforcer as a reward for using the potty

3. Have your child sit on the potty when they show the need to wee or poo

Example: Wriggling around, passing wind, being quiet, trying to move away from you

4. Minimize interaction if your child wets their pants in between toilet times

Note: This is recommended to make your approval of their success in using the toilet more pronounced, but it also does not mean showing disapproval


Accommodations


It is key that accommodations are selected and prepared based on your child’s level of needs and functioning. As noted by Suppo and Mayton (20 12), behavioral approaches are effective in supporting the potty training of children with autism. Typically, such approaches would include the use of visual supports, positive reinforcement, and systematic instruction.


Use of visual supports


Visual aids and prompts come in various prompts. Firstly, a toileting card (e.g., a picture of a girl or boy using the toilet) can be used to encourage your child to communicate their needs to use the toilet. Once they have understood the purpose of a toileting card, place it in locations that are easily accessible to the child (e.g., in a communication binder) and give praise when they use it.


Secondly, it is very common for a visual schedule to be used in potty training with children with autism. Given that change is difficult for children with autism, it is key to try to break down the steps of going to the toilet into smaller parts. A visual schedule would include a clear summary of the steps of using the toilets that are kept as simple as possible and it should be placed in the toilet where it is clearly visible to the child during training. To add on, to facilitate understanding, it is also important that such visual supports are paired with short and simple verbal instructions. Here is an example of a visual schedule provided by Autism Speaks (2016) in their toolkit:





Use of rewards


Finally, the use of a reward system (positive reinforcement) is another behavioral approach commonly incorporated in the potty training of children with autism. As much as possible, reinforce the desired behavior of using the toilet through praise and the provision of rewards such as toys or snacks. Rewards can also be used to train children to sit on the toilet for an increasing amount of time to reach the target amount of time (e.g., 15 minutes).


Conclusion


Teaching your child to use the toilet can certainly be an arduous process. However, mastering this skill would also indicate a great step towards independence in your child’s daily life. Accidents and setbacks are normal and providing negative reactions to them may be unhelpful and discouraging. The celebration of the smallest successes at each step can go a long way to encouraging your child to be nappies-free. Therefore, it is imperative that parents and teachers consistently encourage communication as well as autonomy throughout the process.


References:



Autism Speaks, (2016, December 12). Seven toilet training tips that help non-verbal kids with autism. https://www.autismspeaks.org/expert-opinion/seven-toilet-training-tips-help-nonverbal-kids-autism


Golden Care Therapy (2021, December 17). Potty training a child with autism. https://www.goldencaretherapy.com/potty-training-a-child-with-autism/


Suppo, J. L., & Mayton, M. R. (2012). A portable potty plan for children with autism. Young Exceptional Children, 15(4), 3-16.


Williams, G., Oliver, J. M., Allard, A., & Sears, L. (2003). Autism and associated medical and familial factors: A case control study. Journal of Developmental and Physical Disabilities, 15(4), 335-349.


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