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.

2. 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. 

3. 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. 

4. 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. 

5. 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. 

6. 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). 

7. 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. 

8. 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. 

9. 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. 

10. 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. 

11. 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." 

12. Have plenty of patience, keep it simple, and make it fun!