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Toilet Training Your Aspergers Child: Part I

"Any tips for toilet training my Aspergers son? It's not been going very well so far. Help!"

Even for the normal child, toilet training is often a difficult skill to master. But for the child with Aspergers or High-Functioning Autism, there are additional factors that may inhibit toilet training. The things that would encourage the average child may not be effective with the "Aspie."

Social motivation is a critical factor in determining "readiness" for toilet training. An Aspergers child may not be motivated by the opportunity to wear “big boy pants.” He may not understand what is expected of him. Following all the steps necessary for toilet training may be difficult for this child. Changes in his routine may also be a challenge.

An Aspergers child may not be aware of the need to use the toilet. The first step in toilet training will be to determine his level of readiness.

Assessment--

1. Establish a positive and meaningful routine around toileting, and collect data about your child's readiness for schedule training or for independent toileting.

2. Use a simple chart to collect the data needed about your 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.

3. 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?

4. If the answer to all of these questions is no, then it may not be time to toilet train the child.

5. 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 will also let 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.


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Toilet Training Your Aspergers Child: Part II


Physical Environment--

When beginning the toilet training of a child with Aspergers or High-Functioning Autism, you want to help the child learn that this set of behaviors (i.e., elimination) is associated with a particular place (i.e., 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 Aspergers children appreciate soft music playing or the addition of sound-absorbent materials.

Using Visual Supports--

For the Aspergers 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. You will 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.

Trouble Shooting--

Once you have begun the process, you may notice areas that are more challenging. Below are some common problems and their solutions.

If you child resists sitting on the toilet:
  • allow him to sit on the toilet without removing clothes 
  • allow him to sit with the toilet covered (e.g., cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually removed)
  • use a potty seat on the floor rather than up high and take turns sitting
  • use a doll to model sitting on the toilet seat 
  • as he gradually begins to tolerate sitting, provide him with some entertainment (e.g., a sing-along)

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

If your child only wants to flush:
  • physically cover toilet handle to remove from sight 
  • give something else to hold and keep him busy
  • use visual sequence to show when to flush (e.g., after replacing clothing)
  • when time to flush, give child a sticker that matches a sticker on toilet handle

If your child 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

If your child plays with the toilet paper:
  • remove it 
  • roll out amount ahead of time
  • give visual cue for how much

If your child resists being cleaned:
  • try different materials (e.g., wet wipes, cloth, sponge) 
  • consider temperature of above material
  • take turns with doll

If your child has bad aim:
  • supply a "target" in the water, such as a Cheerio
  • supply larger target as toilet insert (e.g., contact papered or laminated cardboard with target drawn on it), gradually moved down
  • add food coloring in the water to draw attention

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