Potty training is an important developmental step for every child but can often come with difficulties. The process can be confusing and navigating potty training advice and information found online, in books, or given by family and friends can feel overwhelming. Before you begin the teaching of toilet training, a child with autism needs to be ready to learn the toilet training. It’s important to realize that children with autism may be ready later than other children for potty training and that’s ok. Let your child’s motivation and readiness guide the potty training process, rather than your earnestness or desire for them to be out of their diapers once and for all.
How to Know if Your Child with Autism is Ready to Begin Potty Training
Even though there is no “right” age to begin potty training your child with autism, most pediatricians say you can begin the potty training process between 18 and 30 months. However, depending on your child’s developmental level, it may be best to begin toilet training much later on. There are several prerequisite skills that your child should be able to do before you begin potty training with autism. According to the Azrin and Foxx toilet training method, a research-based and widely used method of potty training for children with autism, your child should be able to complete the following skills independently:
- Your child should be able to stay dry for several hours and appear to know when he or she is going to urinate. This could be indicated through facial expressions or “squirming” in their seat. Additionally, your child should have demonstrated bladder control by urinating all at one time.
- Your child should be physically ready to toilet train by showing they can easily pick objects up and walk without assistance.
- Your child should be able to follow 10 instructions: point to nose, eyes, mouth, hair, sit on a chair, stand up, walk with parent to another room, imitate simple tasks, fetch a particular object, and place one object inside another.
While your child with autism is learning or developing these prerequisite skills, you can also help prepare them for potty training by exposing them to skills and experiences they will encounter during toilet training and assist them in being independent in the future. These include teaching your child different toileting words (“toilet,” “toilet paper,” “flush,” “pull up,” “pull down,” etc.), and modeling or normalizing appropriate toileting behavior and labeling the actions being completed (“Now that I’m finished, I’m going to flush the toilet”). This also includes practicing pulling pants or shorts up and down and learning how to use zippers, buttons, clasps, and snaps.
Finally, teaching your child to comply with instructions and “wait” without meltdowns will be extremely beneficial during the toilet training process. Allowing them to escape non-preferred tasks by tantruming without following your instructions will reinforce this behavior and increase the likelihood that it will happen during potty training.
Some children with autism may not be able to complete these prerequisite skills for up to 30 months of age and that is ok! If your child receives occupational therapy, speech therapy or Applied Behavior Analysis, discuss incorporating these skills into their sessions. You can also share your desire for your child to learn these skills with their teacher or daycare provider so that they may teach and reinforce these behaviors as well.
What to Do When Your Child is Ready
Once your child is demonstrating the prerequisite skills, it may be time to start the toilet training process. Before you begin, consider your schedule in the next few days or week. Do you have any vacations planned? A relative visiting? Working long holiday hours? If so, it may not be the best time to begin and it may behoove you and your child to wait a bit longer until you have a clearer schedule. Additionally, starting during times of stress, such as moving, starting a new school (or job) or the arrival of a new baby, may not be ideal timing for potty training with a child with autism.
You’ll want to set your home environment up for success. This includes creating a positive environment around toileting and setting a consistent routine (more on this later). The clothes your child wears should be easy to remove and only once they’ve made progress in toilet training should you begin working on removing pants with zippers and buttons. If your child can’t get their pants down in time or feel it is too difficult to remove them, they may resort to toileting in their pants as this is an easier and faster method of relieving themselves.
Having the right supplies at home will make potty training much more manageable and enjoyable. You will need:
Toilet training seat or potty chair: Depending on your preference, you’ll need a toilet training seat or a separate potty chair. A toilet training seat is a smaller seat that you attach directly to your toilet at home. It can be beneficial because your child will learn toileting on the same toilet they will use in the future and will be more likely to use other toilets in other environments because they look similar. However, using a toilet training seat can be intimidating for some children as the toilet seat is higher up, can be difficult to get on, and their feet won’t touch the floor.
A potty chair is a separate chair that can be placed on the ground and will need to be emptied after each use. Potty chairs are helpful because they are closer to the floor, making them less intimidating or challenging to use and it can be taken with you when you leave the house to ensure that your child has something to use when they’re not at home. The biggest downside to using a potty chair is that you have the empty and clean them after each use. No matter what you choose, make sure you stay consistent and positive through the process.
Timer or watch: It is also beneficial to keep a timer handy so you know when to remind your child to sit on the toilet. Your child also may enjoy having their own watch that beeps when it’s time to use the toilet. Goally can also help manage time and a child with autism’s potty training expectations about how long they should take to use the bathroom.
Reinforcers: Select small toys or treats that can be used to reinforce each small progressive step towards independent toilet training. Make sure you only use these reinforcing items during toilet training as that will keep them exciting and motivating.
Underwear: Letting your child pick out their own underwear will help with the transition out of diapers. Make sure to have plenty on hand as accidents will happen!
- Goally device: Using your Goally helps create a toilet routine that your child with autism can easily follow while potty training. You can also set a timer that lets your child know how long to sit on the toilet. This will give them a sense of independence and ownership and can make the process more fun for them!
During toilet training, continue creating a positive environment by offering praise, reinforcement, and excitement for every small progressive step. If your child pulls down their pants on their own for the first time, make sure to point it out! If they only need one reminder instead of two to flush the toilet, reward them with a high five! Every step closer towards independence deserves recognition. Avoid using negative words such as “yucky” or “dirty” and never punish or scold your child with autism when they have an accident. And yes, there will be accidents so be prepared with fresh underwear and an extra dose of patience.
The Potty Training Process
There are many methods to approach toilet training but most rely on the same basic principles: timing, reinforcement, and consistency. According to the Mayo Clinic, having your child sit on the toilet without their diaper every two hours, as well as immediately when they wake up in the morning and after their nap, is the best course of action. This is where having a timer or watch or a Goally will greatly benefit you and your child as it helps ensure that you are consistently reminding your child that it’s time to use the toilet.
While they sit, read them a book, sing with them, or allow them to play with a toy. Give your child with autism specific praises for sitting on the toilet (no matter how short of a time period), pulling down their pants, waiting patiently on the toilet or any small achievement. Remember, you want to create a fun and positive toilet training experience. Boys should first be taught to urinate while sitting down and can be taught to stand after bowel training. After they have sat, have them complete the rest of the toilet training routine including practicing wiping, flushing, and washing their hands. They may need a lot of assistance with these steps, but it is still allowing them to experience and practice steps they will eventually complete on their own.
Keep an eye on your child for any signs of needing to use the restroom. This could be squirming, squeezing their legs together, or leaving the room to find a secluded area to use their diaper. At these first signs, calmly but quickly address your child and help them identify these as signs to use the bathroom (“I see you’re wiggling in your chair, I think you need to use the bathroom”). Walk them to use the restroom and praise them for using the toilet and showing you that they had to go. After a few weeks of consistent toilet use, you can begin transitioning them out of diapers and into training pants or underwear. Once your child with autism has learned all the steps to potty training, begin using backwards chaining to increase their independence.
Potty Training Challenges and Additional Resources
Of course there will always be challenges or difficulties during the toilet training process. Health issues should always be ruled out when your child is having a difficult time learning to use the toilet. Some children with autism may need each step of potty training broken down into smaller steps. Other children may need help getting used to just sitting on the toilet. In these cases, speak with your pediatrician, therapist, BCBA or other professional to help create a unique, specific plan for your child.
As stated before, The Azrin and Foxx Toilet Training Method is a detailed plan to help most children learn to potty train quickly. It is practiced widely amongst BCBA professionals with positive outcomes. It utilizes a doll to model appropriate toileting, positive practices when your child does have an accident, and potty trials every 15 minutes. You can find their methods online or purchase their book for a more detailed version. Goally can also be an important aid with intensive potty training for your child with autism.
Potty training your child with autism or other disabilities does not have to be frustrating for you or your child. Although your child may experience more difficulties than some other kids, with patience, consistency, a few extra tools and setting the environment up for success, your child can successfully learn to use the toilet on their own!
Mallory Giacopuzzi is a Board Certified Behavior Analyst who has over 10 years of experience serving children, adolescents, and adults with disabilities and their families in a classroom, clinic, and home setting. She is the Program Administrator for an Adult Day Program for adults with autism and other disabilities and a Case Manager for in-home ABA services.
Editor's note: This information is not meant to diagnose or treat and should not take the place of personal consultation, as needed, with a qualified healthcare provider and/or BCBA.