Toilet Training the Child with Autism

It’s the ultimate goal of any parent of a young child: to get the child off diapers as quickly as possible. As you may have guessed, toilet training can take longer for children with autism.

However, don’t be discouraged. Almost all children, regardless of where they are on the spectrum, can be toilet trained. And for many children, toilet training can go more quickly than you’d think — within a week, if approached correctly. The trick lies in having the right system.

Is My Child Ready?

First and foremost, all children – if they’re physiologically able to – should be toilet trained. It’s a huge predictor of the child’s future independence. And as the child grows, a lack of toilet training can be very stigmatizing.

Age three is a great age to begin. That’s within the age range for typically developing children, and it’s likely that any “mistakes” will still be manageable.

Additionally, you may consider:

-Is your child ambulatory?
-Can your child respond to simple commands, like “sit down”?
-Is your child able to see?
-Has your child been exposed to the potty? Does he show any interest? Occasionally we find that toilet training can be as simple as telling the child what to do!


Tips for Starting Toilet Training

Commitment. If you want to be successful, you have to be committed, you have to set aside time, and you have to plan to be home. Also, plan for messes. If your judgmental sister-in-law will be visiting, it’s not a good time!

Underwear. Once you start toilet training, the child should stay in underwear during the day. This rule holds no matter where you are during the day. Putting the child in pull-ups to go out of the house will only sabotage your efforts.

We also know that many parents advocate the “no clothing” approach. However, during training we want the child to know when he is wet, and being wet should be uncomfortable. Underwear helps the child feel this wetness. It also allows the instructor to know if the child has had an accident, so that the instructor can immediately whisk the child to the bathroom and the child isn’t left to sit in the mess.

Schedule. Toilet training is all about time management. Start by putting your child on the toilet every five or ten minutes. Also, pay attention to your child’s fluid intake. You should start to see a correlation: If I give Joe four ounces of juice, it will come out in 30 minutes. Schedule the training around these time windows.

Rewards. This plays a very big role in toilet training. Remember, diapers have worked for the child his whole life! He doesn’t know anything different, so it’s important to find a strong reinforcer that will encourage him to make the switch. At first, you might offer a reward for just going into the bathroom and sitting on the potty. Eventually, the reward may be for successfully going in the potty or for staying dry for the whole day.

Potty Chair versus Toilet? In our opinion, why have an intermediary? The child will eventually need to learn to use the toilet anyway, so starting with a potty chair only means you’ll have one more transition to eventually make. Definitely, use a small portable toilet seat if your child is too small for the actual seat. But otherwise, we recommend sticking with the real deal.

Standing versus Sitting? Typically we don’t recommend teaching standing urination for boys until they’re fully bowel trained. Some children may strain during urination, which may end up with the child defecating while standing. And we won’t even get into the issues that can arise from poor aim … Let’s just say that many problems can be avoided by teaching sitting urination first.

Refusing Toilet Training

If your child has an aversive reaction to toilet training, the first step we recommend is to take your child to the physician to make sure there’s no underlying physical concern such as a urinary tract infection.

If your child is healthy, then we can look at the process a bit more deeply.

-Keep a log of when his diapers need to be changed and when he has a bowel movement. Are there any times the diaper is dry? This can help us target the best times to work with the child.

-Bring the child into the bathroom and expose the child to the toilet. Make it a fun place to be, maybe give the child a sticker for sitting on the toilet. But keep the experience short and low-key without requiring or expecting the child to void on the toilet.

-Do this for a couple of days.

-If your child still refuses to use the toilet, start to increase his fluid intake so that it’s not an option not to go.

-If an accident happens, it’s not a big deal. Walk him into the potty, tell him that the toilet is where we go to pee, and see if the child can void anything else.

Over the course of several days, you should start to see the results you seek.

If you’re looking for more information about toilet training, we frequently recommend this terrific book: “Toilet Training in Less Than a Day” by Nathan Azrin.  Or contact us and we can send you information on our full toilet training protocol!


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