Potty Training a Child With Autism

Children with autism are often extremely attached to their long-established routines. A transition from being in a diaper to using a toilet is a major change that, combined with communication challenges, can be very difficult for an autistic child. 

That’s why toilet training your child with autism may take a long time and require a lot of patience. This guide will provide you with some tools and tips to make the potty training of your autistic child easier.

Can a Child With Autism Be Potty Trained?

Teaching children who are diagnosed with autism spectrum disorder (ASD) independent toilet skills is essential for improving their quality of life. Extended use of diapers not only increases physical discomfort, but can also have a negative impact on their bladder control and self-confidence, and may limit their participation in social activities. 

Before starting to potty train a child with autism, it is recommended to consult a pediatrician to rule out any medical conditions that may prevent your child from effective toilet training. If there are no medical issues, most children on the autistic spectrum can successfully learn how to use the toilet. However, be prepared that the process will take lots of time and effort.

At What Age Should You Potty Train Your Autistic Child?

There is no perfect age to begin toilet training for children with autism. Every child has different skills and needs. You should keep in mind that autistic children are often delayed with toilet training, also compared to children with other developmental disabilities. The average age of successful toilet training for children with autism is 3.3 years in comparison to 2.5 years for children with other developmental disabilities and 2.3 years for children without disabilities. 

What Are the Signs That a Child With Autism Is Ready to Be Potty Trained? 

Several conditions need to be met before you can successfully start potty training your autistic child: 

• Your child has the gross and fine motor skills to carry out a toileting routine.
• Your child is able to imitate actions such as sitting on the toilet.
• Your child can sit on a potty, toilet, or toilet training seat without resistance.
• Your child is capable of pulling down his/her pants and underwear and pulling them back up on his/her own or with minimal assistance.
• Your child knows where the bathroom is located in your house.
• Your child stays dry for at least 2 hours during the day and after naps, which is an indicator of sufficient bladder/bowel control. 

In addition, children with autism who are ready for toilet training will:

• Express that they don’t like the feeling of a wet diaper either by trying to take it off or signing or gesturing that they’ve wet or soiled their diaper. 
• Show interest in the toilet by sitting on it or flushing it without being prompted to do so. 
• Let you know when they need changing by taking you to the bathroom to get a clean diaper, for example. 

How to Potty Train an Autistic Child?

Potty training of an autistic child consists of three phases: planning phase, setting up, and implementation phase. 

Planning phase

Teaching your autistic child to use the toilet requires careful planning. During this phase, you’ll need to prepare the following items: 

• Toilet training seat for children or a transitional potty
• A footstool if your child needs support while sitting on the toilet
• Two weeks’ worth of underwear
• Timer
• Wipes
• A basket filled with fun activities such as books and toys to keep the child entertained 
• A reinforcement bin with rewards like the child’s favorite candy, treats, toys, and stickers 
• A data chart to track the success of toilet training
• Visual supports
• Toilet training books 

Because children with autism are often visual learners, they can benefit from visual cues and prompts while potty training.

Picture cards

Picture cards indicate the sequence of actions the child is expected to accomplish: trousers down, pants down, sit on the toilet, pee/poop in the toilet, wipe, pants up, trousers up, flush the toilet. 

You can also create a step-by-step visual sequence of the toilet routine with the help of the Picture Exchange Communication System (PECS) icons. Alternatively, you may want to use actual photos you have taken of your child if he/she finds it more motivating. 

Social Stories

Personalized social stories can help children on the autism spectrum develop appropriate behaviors and cope with new and potentially confusing situations such as toilet training. 

These simple stories, written from the child’s perspective, explain in detail what will happen when they use the toilet. Make sure to read the story with your child multiple times each day until he/she starts understanding the process.

Your child’s speech and occupational therapists as well as early intervention or school teachers can help you create a toilet training social story.

Setting up phase

Once you have everything ready, you can start the setting up phase. Choose the bathroom in your home that your child feels most comfortable using and designate it as the training bathroom. You can then make it ready for potty training:

• Position a toilet training seat on the toilet or a transitional potty in the bathroom.
• Place underwear, wipes, and timer in the bathroom.
• Place the activity basket within reach. Your child should be able to easily access it while sitting on the toilet.
• Hide the reinforcement bin so that your child doesn't have access to the rewards.
• Place the picture cards where your child can easily see them, for example, at the back of the toilet door or by the toilet.
• Tape the data chart on the wall outside of the bathroom.

Implementation phase

The implementation phase will take time, consistency, and patience. Because children on the autism spectrum appreciate routine, it’s important to keep the sequence of behaviors the same every time. 

Make sure to use specific language to help your child understand what to do. Choose one word to refer to going to the toilet and have all the family members use it. Using several different words to describe the toilet, like potty or bathroom, can be confusing for children with autism.

Positive reinforcement and rewards can be useful in the toilet training of children on the autism spectrum. Use the reward that your child responds to best. Some children prefer praise and nonverbal encouragement like hugs or thumbs up, while others respond better to an object or a favorite activity. Whatever you choose, make sure the rewards are immediate and consistent and that your child clearly understands what behavior is being rewarded. 

When starting the toilet training, you should take your child to the bathroom every 20 minutes and have the child sit on the toilet for only 5 minutes. Sitting on the toilet for too long can feel like a punishment. Keep the child entertained by reading to him/her or have him/her play with the toys from the activity basket. Repeat the process consistently until bedtime and use the diaper for the night.

After a couple of days, you will start noticing a pattern: your child will either pee or poop more in the morning or afternoon. You can then increase the frequency of bathroom visits from every 20 to every 30 minutes, and eventually an hour. 

Useful tips for potty training

• Many parents find it easier not to use a potty as part of toilet training to avoid any additional transitions. You can go straight to putting your child on the toilet or use a toilet training seat to limit the number of changes during the toilet training process.
• If your child is sensitive to or upset by the sensory aspects of going to the toilet, let them get used to sitting on the toilet seat by practicing for a few minutes every day. 
• Ensure that everyone working with your child follows the exact same method and routine to ensure consistent and efficient training.
• Have your child use underwear as soon as possible. This will help the child associate accidents with wetness and discomfort.
• Keep in mind that peeing and pooping are two separate parts of toilet training. After you teach your child to successfully pee in the toilet, you can start on poop training.
• At the beginning of the potty training, it is a good idea to encourage autistic children to eat salty foods. This will make them thirsty and they will be likely to drink more fluids throughout the day. 
• Don’t worry about accidents. When they happen, don’t focus on them and just briefly remind the child to use the toilet next time he/she needs to go.
• Try to stay calm and positive. Toilet training your autistic child may take a long time. As long as your child is making progress and is having a positive experience, you should continue with the training. The more they practice, the more familiar the process will become and the easier it will be to use the toilet.

When to take a break from potty training

If your child is resistant to going to the bathroom and there are no signs of progress, consider taking a break from potty training. You should wait for at least three months before starting the training again. 

Don’t think of it as a failure, but rather an indicator that the child is not yet ready to be potty trained. Once they are ready, toilet training will become a positive experience. You may want to consult your child’s occupational therapist or early intervention service if you feel you need more intensive support.

However, if you don’t see any improvement at all after several weeks, you should see a pediatrician. There might be a medical reason like constipation or urinary tract infection behind your child’s lack of response to toilet training. 

Issues That Autistic Parents Face When Potty Training Their Child

There are many challenges you are likely to face when potty training your autistic child. Here are some of the most common ones:

What if my child is afraid of the toilet and doesn’t want to sit on or go near it?

If your child is afraid of the toilet, start the training by using a transitional potty. Have the child sit on the potty outside the bathroom and slowly transition it into the bathroom. Alternatively, your child may accept to sit on the toilet with the seat down or with clothes on. Gradually, have the child sit on the toilet with the seat up on a training seat. 

What if my child has an excessive interest in flushing the toilet?

Explain to your child that flushing is done when there is pee or poop in the toilet and is only done once. You can put a visual stop sign on the toilet or deny access to the toilet by closing the bathroom door.

What if my child has a fear of flushing the toilet?

Children with autism are often afraid of flushing the toilet because the loud sound is overwhelming to their sensory system. Always tell your child in advance that you are going to flush the toilet. At first, wait until the child has left the bathroom to flush. Gradually, when he/she is more comfortable, let him/her stand in the bathroom (while wearing earplugs at first) when you flush the toilet. Once they get used to the sound, they can try flushing on their own. 

What if my child wants to play with toilet paper?

Explain to your child that toilet paper is only for wiping after going to the toilet. Keep the toilet paper out of their reach or use tissues, wipes, or folded toilet paper instead. 

What if my child likes to play with the toilet water?

Encourage your child to play with water in other places in your home such as the sink or bathtub. Deny access to the bathroom or put a visual stop sign on the toilet. Or you may want to place safety catches on the toilet until your child can understand that it is not a place to play. 

What if my child is afraid to have a bowel movement

Children with autism can find bowel movements frightening. In fact, it’s very common for autistic children to hold in bowel movements while they are being potty trained. If this is the case, you may want to let your child poop in the diaper while in the bathroom. Slowly transition to having him/her poop into the diaper when sitting on the toilet until eventually he/she feels comfortable sitting on the toilet with the diaper off.

Teaching a Child to Ask to Use the Bathroom

Encourage your child to let you know when he/she needs to go to the toilet. It is especially important to help children with limited verbal abilities to express themselves when they need to use the toilet. They can communicate through nonverbal signing or PECS cards, for example. If your child uses an assisted communication device, add a picture of a toilet that he/she can press to give you an audible cue. 

Hand Washing 

Once you have successfully potty trained your autistic child, you can teach them how to finish the potty routine and wash their hands after they use the bathroom. It is essential to concentrate on only one task at a time. Teaching potty training and hand washing at the same time can be overwhelming for an autistic child.

Make sure to follow the same sequence each time: turn on the water, wet the hands, rub the soap into hands, rinse hands, turn off the water, and dry hands. Just like you did with the toilet training, you can create a step-by-step visual sequence of the hand washing routine using the PECS icons or photos that you have placed at the child’s eye level by the bathroom sink. 

Resources

• Books about potty training will help autistic children visualize the process, especially when they can relate to a character’s experience. Here are some books suitable for children on the autism spectrum: 
  • Ready, Set, Potty!: Toilet Training for Children with Autism and Other Developmental Disorders (Amazon)
• Time to Pee (Amazon)
• On Top of the Potty (Amazon)

• Bear in the Big Blue House - Potty Time With Bear (Amazon)

• Picture cards can help children with autism understand the exact sequence of actions required for toilet training. Several websites offer free printable picture cards: 
  • Potty Training Visual Schedule for children with autism. 
  • Toileting Picture Cards from View2Do. 
• Toilet training apps can be useful for children on the autism spectrum, particularly less verbal ones. These apps can both help them communicate the need to go to the toilet and provide a visual schedule. 
  • AvaKid See Me Go Potty is a communication app that helps children with developmental delays and communication disabilities say when they need to go to the bathroom. 
  • Potty Training Social Story from TouchAutism is customizable for boys or girls and designed not to overwhelm sensitive children.