Sunflower Development Center LLC

Introduction

Toilet training is a developmental milestone that many parents eagerly anticipate as their children grow. However, for parents of children diagnosed with autism spectrum disorder (ASD), the journey of toilet training can be particularly challenging. This article provides a guide to help caregivers navigate these toilet training obstacles.

Children with ASD often face challenges with verbal and non-verbal communication. Understanding and expressing the need to use the toilet can be especially difficult for them. Many children with ASD also have sensory sensitivities. The feel of toilet paper, the sound of flushing, or the sensation of sitting on the toilet seat can be overwhelming, which may cause bathroom avoidance behaviors. Additionally, many children form rigid toileting routines, and varying from these routines may cause challenging behaviors. Generalizing skills learned from one environment (e.g., at home) to another (e.g., at a daycare or preschool) can be challenging, too, as mastery of toilet training may occur at home but not in other settings. Lastly, some children with ASD may experience delays in fine and gross motor skills, making it challenging to manipulate clothing, navigate the bathroom, or control their bodily movements effectively.

Toilet training considerations

Before implementing any toilet training program, your child should have the following prerequisite skills:

● The ability to sit for at least five minutes.

● The ability to follow simple directions.

● Basic dressing and undressing skills.

● The ability to hold urine for at least 1.5 hours.

Furthermore, many children may show interest in toilet training by removing their wet or soiled diapers, asking to be changed, or crying when a wet diaper or pull-up touches their skin. Understanding the difference between wet and dry conditions is also helpful. When the child begins to show interest and has demonstrated the prerequisite skills, it’s time to consider potty training!

When implementing a toilet training program, there are several options. Many caregivers consider using an intensive toilet training protocol, including dressing the child in light clothing only, such as underpants, socks, and a t-shirt or tank top. Limited clothing helps the caregiver spot an accident and allows the child to produce in the toilet faster than waiting to remove clothing. An intensive toilet training program can be implemented in the home by placing the child’s activities inside or near the bathroom to encourage swift voiding in the toilet. This procedure should be followed at least five hours daily when implementing an intensive protocol. Teaching with this intensive approach often leads to faster acquisition of toilet training.

If an intensive toilet training protocol is not an option, caregivers may consider less time-consuming interventions, such as sticking to a toileting routine, choosing a window during the day (1-2 hours) to practice toilet training, or only training on the weekends. Whatever method is selected, it’s important to remember that the child will likely still require a diaper or pull-up for bedtime and long travel periods (car/airplane) until the toilet training process is completed.

Steps for Successful Toilet Training

Step 1: Drink lots of fluids!

Pushing liquids should always occur first when the toilet training starts. A person can’t empty their bladder if it’s not full, and it’s essential to have your child connect the sensation of a full bladder and elimination behaviors. Caregivers should ensure that the child’s most preferred liquids are available and push the liquids as often as possible. Other suggestions include expanding new liquids and selecting various hot or cold drink options, including popsicles. Further, purchasing new cups with the child’s favorite character may help to pair drinking liquids with positive things.

Step 2: Create a schedule!

Understand your child’s current toileting schedule and routine. One suggestion is to observe your child for at least three consecutive days and record the time, setting, and other conditions when a wet or soiled diaper is noticed. After this data has been collected for three days, the interval between wet or soiled diapers will be used to implement a set of scheduled trips to the bathroom. For example, if your child has an accident every 90 minutes, toileting trips would be scheduled for 60 minutes throughout the day to avoid the accident.

If the interval is set but your child continues to have accidents before the scheduled bathroom trip, the interval should be adjusted to a shorter period between bathroom trips. It’s also critical to remember that we want to teach the child various bathroom-related behaviors, such as requesting the bathroom, entering the bathroom, sitting on the toilet, and voiding in the toilet, independent of relying on these scheduled bathroom trips. The child can be taught to request the bathroom vocally, using sign language, a speech-generating device, or pictures.

Step 3: Make it fun!

Once the child’s routine is identified, the next step is to find ways to motivate your child to use the toilet. One suggested way is to purchase new foods or toys and observe to see which ones your child is the most interested in. This process is called a preference assessment. Once these toys or items are identified, they will be isolated and used only for successful voiding in the toilet. These preferred items should only be used for potty training; otherwise, they may lose effectiveness. It’s also a good idea to frequently assess preference and add various items that may act as reinforcers.

Step 4: Create a routine

A combination of a prompted schedule and immediate prompting in response to an accident should be implemented throughout the training sequence. Set a timer for the determined interval, and when the timer goes off, prompt your child to request the bathroom. Following the request, they should be seated on the toilet briefly (1-2 minutes). If they don’t void, the caregiver should say, “It looks like you don’t need to use the potty; we’ll try again later.” If the child voids in the toilet, they should receive immediate positive reinforcement with the identified reinforcer. After brief access with the reinforcer, they should be prompted to stand up from the bathroom, flush the toilet, re-dress, and wash their hands.

Remember, reinforcement should be given IMMEDIATELY after voiding occurs, not after they follow all of the other steps. If reinforcement is withheld until all steps are completed, the child is learning the entire toilet training routine instead of making the connection that voiding in the toilet will provide reinforcement.

NOTE: Avoid pairing sitting on the toilet with iPads or other electronic devices, as the child may learn that the behavior of sitting accesses the reinforcer, as opposed to the behavior of voiding accessing the reinforcer.

Step 5: Finalizing the training

Accidents: Should an accident occur, the caregiver should immediately interrupt the accident by saying, “Hurry! We need to go to the potty” in a loud voice and help to guide the child to the toilet immediately. If no urination occurs, the caregiver can help the child re-dress into dry clothing, but they should not receive any other form of reinforcement. Using a loud voice may interrupt the accident long enough to help the child sit on the toilet to void. The voice tone should be positive and happy, similar to a game of racing to the bathroom, instead of a punitive or harsh tone. Remember, being closer to the toilet will help facilitate a fast transition, which may lead to quicker success for the child.

Requests to use the bathroom: If a spontaneous request to use the bathroom occurs, this should be honored and reinforced with immediate verbal praise such as “Great job telling me you have to use the potty!” Once the child voids in the toilet, they should also access the reinforcer, as previously described. Remember, requesting and voiding are two separate behaviors, and ensuring that the reinforcer is only accessed for voiding is essential for success. Once your child spontaneously asks for the bathroom consistently for a few days, and when accidents remain low, the scheduled bathroom visits should be discontinued, but the response to an accident should stay the same.

6 Strategies for Continuing Success with Toileting

Now that we’ve discussed the suggested recommendations to teach your child to use the toilet, we will review some additional tips to help your child stay on track.

Strategy #1: Create a Visual Schedule.

Use visual aids like schedules or pictures to help your child understand and anticipate the toilet training routine. Visuals can provide a sense of predictability and structure.

Strategy #2: Gradually Expand Your Child’s Toileting Skills.

Gradually expose your child to the different aspects of toilet training. Start with simple activities like sitting on the toilet seat with their clothes on, then progress to flushing the toilet, and eventually to the complete toilet training procedure.

Strategy #3: Incorporate Sensory-Friendly Elements.

Make the bathroom environment sensory-friendly and fun by using soft lighting, comfortable seating, and other familiar items. This can reduce challenging behaviors that may be associated with sensory sensitivities.

Strategy #4: Establish a Consistent Routine.

Stick to a consistent toilet training routine to give your child a sense of predictability. This routine should be followed at home and gradually introduced into other environments.

Strategy #5: ALWAYS Use Positive Reinforcement.

Reinforce positive behaviors with praise, rewards, or a preferred activity. Positive reinforcement can motivate the child to engage in the toilet training process.

Strategy #6: Be Patient and Flexible.

Understand that toilet training may take longer for children with ASD. Be patient, celebrate the small victories, and be flexible in adapting strategies based on your child's needs and progress. Urine training is typically achieved first, followed by bowel movement training. Don’t give up; success will eventually come!



Conclusion

Toilet training can be one of the biggest challenges you will face when raising a young child with Autism. By using these strategies, you can achieve the goal of independent toileting. Stay patient, keep motivating your child, and you will soon be able to flush those concerns away!

Disclaimer:

The information provided in this article is for general informational purposes only and is not intended as a substitute for professional behavior analytic services. It is crucial to consult with a qualified professional, such as a Board Certified Behavior Analyst (BCBA) or the child's physician, to obtain advice tailored to specific situations. Toilet training is a complex process influenced by various factors, and individual differences in children may require personalized strategies. While efforts have been made to ensure the accuracy and reliability of the information presented, it is not a replacement for professional guidance. The authors disclaim any liability arising directly or indirectly from using the information provided in this article. This disclaimer extends to any decisions or actions readers take based on the information contained herein.

About Sunflower Development Center

If you're a parent or caregiver, you know that every child with autism is unique, with their own set of strengths, challenges, and limitless potential. At Sunflower Development Center LLC in Raynham, MA, we understand this implicitly, and that's why we're committed to providing ABA Therapy that's as individual as your child. Autism can present various challenges for children, from social interactions and communication to sensory sensitivities and behavior management. Families often search for effective, evidence-based solutions to help their children thrive. That's where ABA Therapy comes in. It's a highly effective, scientifically proven approach that breaks down complex behaviors into smaller, manageable steps, making it easier for children with autism to learn and grow.

Our ABA Therapy is all about creating tailored, engaging experiences that make learning fun and effective. We offer both in-home and in-center therapy designed to meet your child's specific needs. What sets us apart is our naturalistic, play-based approach. We believe in learning through play because children are more likely to engage and learn when they have fun. Our experienced therapists create a nurturing, safe environment where your child can thrive. To learn more, visit our website at www.sunflowerdc.com.