Skip to main content

Toilet training is a significant milestone in a child’s life. Using the toilet appropriately may increase independence and autonomy. It may also improve health and hygiene outcomes and increase participation in educational and social environments (Simon et al., 2022).

 

Children with autism spectrum disorder (ASD) often take longer to become toilet-trained than their typically developing peers. They also tend to struggle more with many aspects of the toilet training process. Most neurotypical children complete potty training between 2 1/2 and 3 years of age (Faulkner et al., 2017). Children with autism take a few extra months, with an average of 3.3 years (Williams, 2003). They also experience more toileting accidents and bedwetting after achieving daytime dryness (Faulkner et al., 2017).

 

Toileting is one of the most common skills parents and caregivers request their child’s ABA therapy team assist with, as it is a foundational skill. Read on to explore helpful tips for toilet training children with autism, developmental delays, and other neurodivergence.

 

What Are Common Potty Training Challenges for Children with Autism?

There are several potential challenges children with autism experience that may delay toilet training. While every child encounters unique challenges and successes, many common obstacles can contribute to slower acquisition of toilet training skills.

 

Co-occurring medical issues

Children with autism experience more occurrences of medical conditions, such as gastrointestinal health concerns. Recent research estimates nearly 40% of individuals with autism experience gastrointestinal conditions (Ward et al., 2023). Constipation and chronic diarrhea are both common. They can hinder toileting progress due to the immense discomfort and physical difficulty controlling bowel movements.

 

Sensory Sensitivities

Children with autism tend to have heightened sensitivity to certain environmental stimuli. They may have difficulty processing the textures, temperatures , sounds, or other aspects of the toilet and bathroom. For example, a cold toilet seat or the sound of flushing may be aversive. This can cause discomfort or anxiety and resistance to training.

 

Communication Delays

Delays in communication are among the primary components of an autism diagnosis. Challenges with understanding instructions and communicating needs can impede learning new skills.

 

Rigid Adherence to Routines

Children with autism tend to thrive on a consistent and predictable routine. Changes in routines or expectations can be difficult for them to adapt to. Toilet training can be an intrusive and significant change. As a result, some children may be resistant.

 

Delayed Motor Skills

Many motor ability prerequisites are necessary for the potty training process. These include walking to the toilet, unbuttoning/unzipping clothing, pulling pants down, and sitting on the potty. Learning to use the toilet can be more challenging when children have delays in these motor abilities.

 

When Should You Transition to Toilet Training from Pull Ups?

Parents often grapple with the decision to begin toilet training and transition their child out of diapers or pull-ups. Research shows that extended use of diapers can increase resistance to potty training. This makes it more challenging to make the transition (Tarbox et al., 2004). Other research has shown higher rates of incontinence and urinary tract infections in children who were trained later than 42 months (Bakker et al., 2002).

 

Potty training can start as early as 18 months. The American Academy of Pediatrics (AAP) recommends starting when the child shows an interest in the process (Kiddoo, 2012).

 

Look for the following signs of readiness to determine if your child is ready to begin toilet training.

 

  • Stays dry for at least two hours at a time during the day
  • Wakes up dry from naps
  • Follows simple instructions and imitates others
  • Hides/seeks privacy to poop
  • Appears interested and motivated to use the toilet
  • Interested in wearing underwear
  • Basic communication skills (i.e., can communicate they are wet)
  • Able to pull pants up and down
  • Can walk to and sit on the toilet without assistance

 

There isn’t clear research on exactly when the best time to begin training is. The above signs can help parents evaluate their child’s readiness. However, waiting for the child to show every sign before getting started is not usually necessary. The best time to begin potty training is when everyone is ready to support the child in learning the skill. If your child is currently in therapy, ask their behavior analyst or therapist for support in identifying the best time to start training.

 

Before starting, everyone must be on board with toilet training. Discuss plans with each of your child’s caregivers, such as parents, babysitters, teachers, and other family members. This will ensure consistency. If one parent is actively working on training the child, but the other parent keeps the child in diapers, this could significantly stall the process and confuse for the child. When everyone is committed to the process, implement a consistent plan for all to follow.

 

What are ways to Encourage Positive Potty Training?

There are many methods of potty training. Every child is unique, so what works for one may not work for another. Some parents take a “big day” approach, implementing intensive training practices over a few days. Others take a more gradual and systematic approach where the child slowly builds up a tolerance for the bathroom. Regardless of the specific procedure used, taking a positive and consistent approach is vital. Consider the following recommendations for encouraging positive training.

 

  • Make it fun! Talk positively about the toileting process. Sing songs and be silly. You can also allow your child to read a book or play with a special toy while on the toilet. The goal is to create an association that the toilet is fun and exciting.
  • Implement a consistent routine. Add toileting as part of your child’s daily routine. Try to stick with the same times and processes to establish consistency. This is especially beneficial for children who are resistant to changes.
  • Offer positive reinforcement for all toileting successes! Even if your child does not void in the toilet, provide praise and reinforcement when they make an effort. Successes can be as minor as walking into the bathroom or sitting on the toilet for one second. Celebrate those small wins.
  • Remain calm when your child has accidents. Do not punish your child for accidents or refusal to use the toilet.
  • Ensure consistency across people and settings. Communicate your child’s plan to everyone who works with them.

 

What are Some Tips for Parents to Consider for Toilet Training Children with Autism?

As you begin to dive into toilet training your child with autism, we encourage you to try the following tips.

 

  • Maintain consistency. Once you decide on a plan for toilet training, stick to it for at least a few weeks unless your child is showing an adverse reaction to it. Maintaining consistency can help your child adapt to the new routines.
  • Respect your child’s pace and comfort level. It’s okay to start slow! Understand your child’s comfort level and avoid pushing beyond that. If your child has an unpleasant or traumatic experience, they may become more resistant to the toileting routine.
  • Prepare for the inevitable accidents. Understand that accidents will happen. Prepare your home to lessen the mess. Try placing a tarp on furniture and carpet for easy clean-up.
  • Use consistent language to avoid confusion. For example, avoid interchanging words like potty, toilet, and bathroom. Stick to the same words until your child begins making progress.
  • Utilize visual supports. Use a visual schedule to help your child anticipate the upcoming activities in their day, including potty breaks. Visual timers can also help them to visualize the time until the next bathroom trip.
  • Encourage your child to read books and watch videos related to toileting. Try books or shows with characters your child enjoys that highlight potty training. This may increase their excitement with their potty journey.

 

Enhance the Sensory Experience

Create a pleasant sensory experience when toilet training your child with autism. Everyone has different sensory needs and preferences. Identifying the sensory components that your child prefers can be difficult, especially if they struggle with communicating these desires. Therefore, it may take some trial and error. Consider these tips for adjusting the sensory experience of toileting:

 

  • Try different toilet seats. Your child may prefer to sit on a small potty chair, the regular toilet, or a training seat that goes over the toilet. Play around with different seats, if possible.
  • Use a footstool. A stool can make sitting on the toilet more comfortable and assist in passing bowels.
  • Avoid flushing the toilet if your child is sensitive to loud sounds. Once they learn the skill, you can gradually acclimate them to the flushing sound.
  • Evaluate the temperature in the bathroom. Consider taking steps to ensure your child is comfortable. For example, you might have them wear socks or put a space heater in the bathroom if it is cold.
  • Place a warm towel or a weighted blanket on your child’s lap for comfort.

 

Conclusion: Does Autism Affect Potty Training?

Children with autism may experience many unique challenges to potty training. Overcoming barriers to achieve toileting success can substantially improve a child’s quality of life. We encourage you to try the toilet training tips and recommendations outlined above. If you need additional support in your child’s toilet training journey, speak with their pediatrician, behavior analyst, occupational therapist, or other medical provider.

 

References

Bakker, E., Van Gool, J. D., Van Sprundel, M., Van Der Auwera, C., & Wyndaele, J. J. (2002). Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control. BJU international, 90(4), 456–461. https://doi.org/10.1046/j.1464-410x.2002.02903.x

Faulkner, V., Schanding, T., Fan, W., & Harris, G. (2017). Individuals With Autism Spectrum Disorder: A Study of the Age of Attaining Daytime Dryness. Consultant, 57(7).

Kiddoo D. A. (2012). Toilet training children: when to start and how to train. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(5), 511–512. https://doi.org/10.1503/cmaj.110830

Simon, M., Wilkes-Gillan, S., Ryan Chen, Y., Cordier, R., Cantrill, A., Parsons, L., & Phua, J. J. (2022). Toilet training interventions for children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 99, 102049. https://doi.org/10.1016/j.rasd.2022.102049

Tarbox, R. S., Williams, W. L., & Friman, P. C. (2004). Extended diaper wearing: effects on continence in and out of the diaper. Journal of applied behavior analysis, 37(1), 97–100. https://doi.org/10.1901/jaba.2004.37-97

Ward, J. H., Weir, E., Allison, C., & Baron-Cohen, S. (2023). Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Molecular Autism, 14. https://doi.org/10.1186/s13229-023-00565-2

Williams, G. (2003). Autism and Associated Medical and Familial Factors: A Case Control Study. Journal of Developmental and Physical Disabilities.

Authors

  • Nicole Partridge, BCBA

    Nicole is a born and raised Boston girl. She is a BCBA with a Master’s degree from Northeastern University and a Bachelor’s degree from Assumption College. Since her very first internship in college at a local elementary school, she knew working with children was going to be her calling. Over her career, she has worked with children with traumatic brain injury, students with emotional disabilities, and individuals of all ages on the autism spectrum, and has loved every minute. In her free time, she enjoys trying new restaurants, reading at the beach, listening to her favorite bands, and baking yummy treats for friends.

  • Tahra Cessna, M.S., BCBA

    Tahra Cessna is a BCBA and serves as the VP of Development for Bierman Autism Centers. Tahra previously served as the Chief Operations Officer for Positive Behavior Supports Corp., where she worked for nearly 14 years. Tahra has taken her knowledge of growth and expansion and used this as a springboard to guide her as she works to expand the Bierman footprint. Tahra currently serves as a subject matter expert for the Home and Community Positive Behavior Support Network’s (HCPBS) Family Chats and serves on the Psychology Board for Keiser University (Miami). She also serves as Head Coach for Special Olympics Martin County, Florida, and a founding member of CHIEF (Miami). Tahra has over 20 years of working in the field of applied behavior analysis, which has led to multiple publications on the topics of transitions, quality of life, and sexuality education and afforded more than 100 speaking opportunities at the national and international levels. A former educator, Tahra recognized the deficits of public and private schools in her area, which led her to open the Treasure Coast Autism Project or TCAP, a private, non-profit school for children on the autism spectrum. The school began in August of 2011, serving 11 students ages 8 to 11 in one classroom, and has expanded to serve hundreds of students from the elementary through high school ages. Prior to her work with Bierman Autism Centers, Positive Behavior Supports Corp., and The Treasure Coast Autism Project, Tahra was the Director and founder of Behavioral Building Blocks, where she and her team provided wrap-around Applied Behavior Analysis services within a clinic and home and community settings to over 75 individuals with special needs over the course of four years. Tahra is passionate about enhancing quality of life for her clients as well as for her team and uses the principles of organizational behavioral management to improve individual and group performance to guide individuals in attaining their personal and professional goals.