How to Toilet Train Your Child with Autism

1
Prepare to Be Patient

little girl anxious near toilet
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Toilet training is never easy, and, for many children on the autism spectrum, it can be a real challenge. Some of the usual motivations for toilet training such as peer pressure, a desire for independence, or a need to feel clean and dry may not be present in a child on the autism spectrum.

Most children with autism can learn to use the toilet independently. But the process often takes time, energy, and perseverance!

2
Be Sure Your Child Is Healthy

Many children with autism have gastrointestinal issues. And, of course, if your child is suffering from diarrhea, constipation, bloating, or other gastrointestinal issues, it may be tough for him to toilet train.

If your child seems to gastrointestinal problems, check them out before you start toilet training. Signs of GI problems can include unusual crankiness, positioning to press on the abdomen, reluctance to use the toilet or poop, or inability to evacuate. See your pediatrician and, if necessary, a pediatric gastroenterologist. It may even be possible to treat constipation with something as simple as prune juice.

3
When to Start Toilet Training

Doctors recommend that children are typically ready for toilet training when they show an awareness that they're wet or poopy, can pull their pants up and down, and are comfortable sitting on a toilet. 

These signs, while appropriate for typical children, may be irrelevant to a child with autism. Children on the spectrum may have less sensitivity when it comes to cold, wet, or sticky sensations. They may also have muscle tone issues that make it harder for them to pull pants up or down. In addition, while many toddlers actively want to use the toilet because they see others doing it, children with autism rarely compare themselves to others.

Because of these differences, autistic children, however, may be ready to use the toilet before they've mastered all those other skills. Says Kimberly Kroeger-Geoppinger, Psy.D., a clinical psychologist and assistant professor of pediatrics at the Cincinnati Children's Hospital Medical Center, "For us, the prerequisites include ambulation, the ability to get up and down -- and that's it."

4
Start Hydrating

Check with your pediatrician to find out how much liquid your child can safely drink in a day. Then, push the fluids for a few days. If possible, mix juice with water, or alternate between milk, juice and water. The more fluids your child drinks, the more likely he is to urinate often - and be successfully in urinating into the toilet.

5
Get Ready for a Potty Party

Put together all the things you'll need to keep your child comfortable and content while seated on the toilet for a long time. If you like, consider bringing books, toys, and even a TV into the bathroom.

Also collect "motivators" -- special treats to give your child when he successful urinates or poops in the toilet.

Also, make sure that the toilet is comfortable. For some children, that will mean wrapping the seat in towels for extra cushiness. Other children may be most comfortable on a potty seat with handles that help them feel secure while sitting on the toilet.

6
Start Your Potty Party!

To toilet train your child, have him or her sit on the toilet (taking breaks every half hour) for as long as you CAN. Dr. Kroeger and her team literally spend all day in the bathroom, from the time the child wakes up until he goes to bed. Drinks, food, and playtime can all take place in the bathroom.

Sooner or later, during the course of the day, your child will urinate into the toilet. When he or she does do the deed, celebrate! Give your special motivators, toot horns, whatever it takes to show that you're proud. Take a break, and then go right back to the toilet.

7
Focus on Bowel Movements

Many children will have relatively little problem with urination, but seem reluctant to poop in the toilet. Many reasons can explain this, says Dr. Kroeger.

  • "If there is a problem, we look at why. It may be constipation, or it may be that the child doesn't like the splash that occurs when a bowel movement hits the water. If that's the problem, we work slowly to desensitize."

Dr. Kroeger also offers tips for managing toilet teaching when your child wants to poop only in a diaper. The key to success, she explains, is taking the process step by step.

  • First, figure out when your child is going to poop, and have him poop in the diaper - in the bathroom.
  • Slowly, fade to having him poop into the diaper - on the toilet.
  • Next, have him pull his pants down before sitting on the toilet.
  • Last of all, have him sit on the toilet with diaper off.

These steps may take a long time, and you may need to break them down further and further. The key to success, however, is making it possible for your child to succeed and earn that motivating prize.

8
Toilet Teaching Tips for Working Parents

Dr. Kroeger and her team work with children for five to six days to achieve their results. But if you're a working parent, and can't spend days in the bathroom, Dr. Kroeger suggests a modified approach.

She recommends starting by carefully recording when your child is urinating and making a bowel movement. Based on that schedule, you can sit your child on the toilet when you know he's most likely to go to the bathroom. The more often you do it, the better, since it gives your child more opportunity to be successful, win motivating prizes, and reinforce positive behavior.

9
How to Manage Fecal Smearing

It is not unusual for children with autism to smear their feces on themselves, on the walls, on their clothes. Dr. Kroeger has some specific advice for parents finding themselves in this unpleasant situation. "Children do what they do for one of only four reasons," she explains: to get attention, to get something they want, to escape from something unpleasant, or to have or avoid a particular sensory experience. So why are they smearing feces? What happens when they do it? Are they getting attention? Are they being allowed to escape a situation they don't like? Are they getting something they want? If they're not getting any of these outcomes, they're probably enjoying the sensory input they're getting.

Once you know why your child is smearing feces, you can fill their need in another way. For example, you can give them attention and praise when they go to the bathroom without touching their feces.

10
Resources

In addition to the "potty party" approach to toilet training, see these resources:

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