PFA Tips: Potty Time!
By Shelly McLaughlin, Director of Safety Programs, Pathfinders for Autism, and Steven Lindauer, Ph.D., Assistant Director, Pediatric Developmental Disabilities Clinic, Kennedy Krieger Institute
Reviewed and updated in 2024 by Rebekah Chesko, MS, CCC-SLP, BCBA, LBS, LBA, Director of Learning and Development, Behavioral Framework
Download a printable version of “Potty Time”
For two years I tried M&M bribes, Cheerios in the toilet for target practice, I let him run around the house naked, I put him in regular underwear thinking he’d hate having all of his clothes wet and soiled, tried the Dr. Phil advice my mom swore would work, and I might have even bought a voodoo doll. Nothing I did worked. “If I wear a pull-up, I don’t have to get out of bed during the night, stop playing with my toys, move away from the TV, …” And admit it – the last time you went to a football game you considered that option for yourself. And then magically, one day my son woke up and announced he was done with pull-ups. Just like that. Are there things I could have done to have shortened this two-year time frame?
Toilet training can be difficult and stressful for any child and their parents. Building this skill is a time commitment that requires patience and consistency. For children with autism, the toilet training process can take longer. The good news is there are ways to increase your child’s success and motivation to use the bathroom.
Rule out medical or physiological issues
If you’ve tried to toilet train your child and there was no progress, keep track of what you’ve tried and the barriers that were encountered. Start a journal or keep data on when your child goes, when they drink, and where they typically have eliminations. This is useful information to share with your doctor.
Don’t automatically assume that your child is making a choice not to use the toilet. Discuss this with your pediatrician to confirm that your child does not have biological problems that are interfering with their ability to control their bladder and bowel functions. Some of the medical issues you may want to assess with your medical doctor include constipation, blockages, food allergies or intolerances, and others. Your child may also have difficulty physically feeling the urge to go.
Ease their fears of being flushed away
Where do our deposits go once we flush them? How strong is that tidal wave swirl that goes to that unknown place? All your child sees is that everything in that bowl gets wooshed away never to be seen again. You may need to reassure your child that they can’t be taken away with the flush. They may not directly tell you about this fear, but keep in mind, expressing fears and other emotions aren’t necessarily easy skills for children with autism.
Other sensory sensitivities in the bathroom
There may be environmental reasons your child is resisting the bathroom. Is the toilet seat too hard? Does the cold toilet water splash up? Is the toilet paper too rough? Is the sound of the flush, or automatic hand dryers too loud? Don’t judge these factors using your perspective – only the perspective of your child counts here. These culprits may also play a role if your child does better in some situations, such as your home bathroom, but refuses to go in others, like the loud toilets at the mall. Be prepared to make environmental adaptations.
It’s a three-step process
Think of potty training as three different components:
- Going in the potty
- Being dry between going
- Initiating going to the bathroom on their own
All three components may need to be taught. In addition, some children may be great at going on the toilet, but not great at indicating they need to go, or staying dry in between scheduled tries.
Set a schedule
Whether you take them to the bathroom every 15 or 30 minutes, give them a visual schedule to let them know that another bathroom trip is coming up very soon. You may want to increase their fluid intake during this process to create more opportunities for practice and success in the bathroom.
Teach your child to sit
Although sitting isn’t necessarily required for urinating, learning to sit on the toilet helps prepare for toilet training bowel movements. Many kids learn to use the bathroom standing up, eliminating the opportunity to have a bowel movement in the toilet. Standing can be taught later after toileting successes.
Shape and reward in small increments
Change is hard – and even harder for children with autism. And now you may have to teach your child to do something differently. They have gone in the diaper/pull-up several times a day, so getting them to do something new may be very difficult. Therefore, rewards should be immediate and powerful.
Begin with small steps. Put your child NEAR the toilet (still in their pull-up) and reward them. Next step, put them ON the toilet (still in their pull-up) and reward them. Step three, put them ON the toilet WITHOUT their pull-up and reward them. If your child stays dry between bathroom trips, reward them! And of course, provide a big reward when they’re sitting on the toilet, without a pull-up, and eliminates in the potty!
Reward for initiation
For self-initiation, provide rewards just for the self-initiation part, even if they do not have a successful elimination. Again, you are teaching a new skill, and a difficult one at that. Therefore, powerful rewards will be needed.
Use visual cues
In each bathroom your child uses, keep a written or picture list of the steps your child must follow in the bathroom. For example: 1) close door; 2) pull down pants and underwear; 3) lift toilet lid; 4) sit on toilet; 5) pee or poop; 6) get six squares of toilet paper; 7) wipe butt; 8) repeat wiping butt until clean; 9) pull up underwear and pants; 10) flush toilet; 11) close toilet lid; 12) turn on water at sink; 13) get soap; 14) rub hands together with soap; 15) rinse hands with water; 16) turn water off; 17) dry hands; 18) all done. Make extra copies of the lists to take with you when you are not home!
Let the pictures do the talking
If your child is not able to verbally communicate when they need to use the bathroom, make sure they can easily signal to someone when they need to go. This could be making sure they have a picture of a bathroom in their pocket or having a bathroom button on the main page of their communication device – whatever works for your child. Prompting a request right before you transition the child to the bathroom will promote independence.
Create powerful reinforcers
Having strong reinforcers to reward small and large goals is critical to the success of any toilet training program. If Oreo cookies are your child’s favorite snack, only offer them when they use the toilet. This will make sure they are motivated to follow the steps of toilet training.
Use a social story
Social stories are commonly used to narrate an experience. Social stories help your child understand what to expect during a particular situation. Carol Gray, the creator of the social story model, has a book, “My Social Stories” (available on Amazon) and the first chapter is Using the Toilet. Here’s an example of the social story, “Going Potty”. You can create your own social story, and use pictures of your child for each step of the toileting process.
Investigate the barriers
If toilet training is still not successful, investigate the barriers. Start a journal or keep data on when your child goes, when they drink, where they typically have eliminations, etc. This can be useful for the shaping process, or to share with your doctor.
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