When are children with ASDs ready for toilet training?
Children may be ready for toilet training when they
Tell a parent or caregiver they need a dry diaper (or bring one to them).
Go off by themselves to have a bowel movement.
Take an interest in others’ going to the bathroom.
Stay dry overnight and for longer periods.
Being ready may also be linked to other medical and developmental factors. For example, your child may need to be treated for constipation. If your child has constipation, having a bowel movement may be painful, so the child may not want to go to the bathroom and could start to withhold stool (which may make constipation worse). If your child has a developmental delay or his level of understanding is less than that of a 1- to 1½-year-old, he may not be able to tell you when he needs to go to the bathroom, but you may be able to set up a routine to clock or time-train him.
How should we start toilet training?
Children with developmental delays may not be fully ready for toilet training, but clock or time training is a good start. For a few days, keep track of when your child has bowel movements and wet diapers. When you are ready to start clock training, you may want to have the child drink more fluids so she will need to urinate more often. Schedule times for your child to sit on the toilet. To avoid accidents, be sure to schedule times more often than your child usually wets. For example, if your child has wet diapers every 3 hours, schedule a time to sit on the toilet every 2½ hours.
To teach your child to sit on the potty, you may need to support her with music, a story, attention, or a favorite toy. Slowly increase the time your child sits on the potty (up to 2 minutes).
Your child does not need to urinate (you may call it peeing or something else) or have a bowel movement each time she sits. Your child needs to be able to relax on the toilet to go, so teach sitting as the first step. If your child is sitting on a full-sized toilet, she should be comfortable with her feet on a stool so all her muscles can relax. Consider using an adapter seat with side supports if your child seems unsteady.
If your child does not have the language to understand your teaching, use hand signals or pictures to let your child know it's time for sitting on the toilet. It may be helpful to show your child pictures of each step of the process to help her learn the new routine: sitting on the toilet, using toilet paper, flushing, and hand washing. Make an activity board with each picture attached in sequence. As each step is completed, you might remove the picture from the board or place it in the “completed” section. If your child is not verbal, teach your child a sign or provide a picture she can hand to you to indicate that she needs to use the toilet to help transition her from a time- trained schedule (see Resources).
When your child urinates or has a bowel movement in the toilet, reward her right away with something that is not given at any other time during the day. Rewards can be an inexpensive grabbag prize; a favorite toy, treat, or song; plus praise and hugs. If your child has a bowel movement between scheduled trips to the potty, she should help put the stool in the toilet and flush it away. Never punish your child for accidents. It may take weeks to months for training to catch on.
After clock training is successful, work on teaching your child to tell you when she needs to use the bathroom and in time to be completely independent.
American Academy of Pediatrics HealthyChildren.org: www.HealthyChildren.org
Schaefer CE, DiGeronimo TF. Toilet Training Without Tears. Rev ed. New York, NY: Signet; 1997
Wheeler M. Toilet Training for Individuals with Autism or Other Developmental Issues. 2nd ed. Arlington, TX: Future Horizons; 2007
Family handout from Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians, 2nd Edition, developed by the American Academy of Pediatrics (AAP) Council on Children With Disabilities Autism Subcommittee (ASC).