Toilet training a child with autism and developmental delay is a little different than with a neurotypical child.
This is because:-
* they may have neuromuscular disorders and developmental delay so it takes them longer to learn new skills
* they may have rigid thinking which makes it harder for them to want to do something new
* they may have trouble with communication and have limited verbal skills
* they may have sensory issues which leads to anxiety
After having two children who were toilet trained relatively easily it was all new with Isla. The first time we tried neither Isla or I were ready. After many many accidents we decided to put it off until summer when less clothes were more acceptable and appropriate.
Have a plan and the right equipment
When we tried again there were still no signs that Isla was ready. We were under time pressure this time though with her starting kindy so this time we had more of a plan.
With Isla being a little bit older she was able to sit on the toilet without a potty which worked easier for us and made more sense to her.
We invested in a decent ring/support to put on the toilet seat and a stool which she would put her feet on. A lot of children with ASD, including Isla, often have poor muscle tone. This made it difficult for her to sit on the seat as even though she was big enough she was unsteady. The stool and the seat with her legs at 90 degrees steadied her, letting her concentrate on the task at hand. She only recently at the age of 8 has stopped using both but we used them consistently for years and we would also pack the seat when going away. When we were unable to take the stool due to luggage space we would improvise.
Toilet timing versus toilet training
Now the main difference with Isla was she was toilet timed. With my other girls they would tell me when they needed to go. Isla on the other hand wasn’t getting the same signals through so we had to tell her when to go otherwise it would result in an accident. No1s was fairly easy but No2s took some time and a lot of patience and even now we are caught out every once in a while.
Timers and timing
We used a timer to remind Isla (and me) that is was time to go to the toilet. At first we started going every half an hour and then increased it to every hour. We tried to give her lots of fluids (mostly unsuccessfully). Even if she wasn’t successful, we praised and washed hands and then tried again in half an hour. Admittedly this is easier than it sounds. What would happen is that she would sit and not go but then wet her pants 5 minutes later. However consistency finally paid off and she eventually got the idea.
We took photos of Isla and made her a chart of what to do and put it on the wall by the toilet. You can click here to download a visual schedule I have created or you can tailor make your own easily. She had visuals at kindy and was on a toileting schedule for the whole time she was there. Isla had trouble pulling down her pants and pulling them back up. When she was told it was toilet time she would just pull them down then and there and often come out of the toilet with nothing on. This was another thing we had to work on (and still are) but she has got a bit better as her motor skills have improved with age.
No 1 and No 2s and distraction
No2s still are a bit of a problem with us. Isla can’t always feel the sensation of wanting to go so I have to rely on timing and watching her for signs. Crouching down and generally looking pretty uncomfortable are often a give away as well as a tell-tale aroma. I don’t pretend to be an expert (although I’m not sure who is) but we were advised to let her sit with her IPAD and praise and reward instantly when she was successful (even before she got off the toilet (not entirely hygienic I know). We tried to use a reward chart but Isla didn’t really understand its purpose at the time. She was more about instant rewards so she would get a Freddo Frog as soon as she was successful.
Isla is still unable to wipe herself but occasionally tries with mixed results. The teaching of this hasn’t come as easily as expected for her due to poor motor skills but we are practicing with the use of visuals and using a hand over her hand technique so she can slowly get the hang of it. It has also been suggested to me to use flushable wipes which might be a bit easier than just toilet paper.
Leaving the house
They say it’s not a good idea to confuse with a nappy when toilet training but I must admit on our first few outings out the house I wasn’t that confident. However before long we were going out nappy less armed with a couple of changes of clothes. I still don’t go too far afield without a change of clothes and some wipes! Always make sure you visit the toilet before you go and don’t forget the timings when out and about.
Isla is still in pull ups at night. Some times she’s dry and some times she isn’t. You are entitled to pull ups after your child turns 5 (in Auckland) through the Incontinence Service. Your GP or Paediatrician can make a referral. That is our goal for the summer to get her dry through the night. We are just enjoying our uninterrupted sleeps since Bo (Isla’s assistance dog) arrived but is something we need to work towards now.
Isla is in a Satellite Class at school with extra support so has set times to go to the toilet. For most children that struggle with knowing when they should go or who put off going to the toilet, would benefit from a set toilet time. Most children who have trouble with this will not say “yes” when asked “do you need to go to the toilet?”. A set time on their visual schedule (if they have one) or a prompt from their teacher or teacher aide a little before morning tea or lunch could be ideal. I think is easier for them to visit the restroom while it is quiet and they are not distracted unlike busy break times. I am sure most schools are more than happy to help with this.
So to sum up:-
- Set a date and be consistent and follow through. If it really doesn’t work after a few days trying leave for another few weeks and try again.
- Use a stool and seat if needed for stability and take with you when you are out.
- Get a timer, visual chart, instant rewards and lots of pairs of knickers!
- Use distraction – books, toys, ipads, leap pads etc
This is our experience with toileting. Of course all children are different and have different sensory issues that may also interfere with toileting. We also have no experience with little boys!!! If you have further suggestions that have worked for you please leave in comments below.