When it comes to toilet training, typical children as well as children with autism can be difficult to teach. Not all children respond to the same teaching techniques or instructions, so methods that are progressive with one child may not be as successful with the next. However, the best way to communicate with a child through this training process is by analyzing the problem through the child’s perspective and implementing a visual concept or structure for the child to better understand what is expected of him or her.

And just how might the characteristics of autism influence the difficulty of diagnosed children learning how to independently use the toilet when necessary?

1.)    A child with autism may not understand what is being expected of him in the bathroom, due to their incapability to understand language or imitating models.

2.)    A number of children with autism have trouble organizing and sequencing information, and therefore may struggle in grasping the appropriate sequence of steps and/or focus necessary required in using the toilet.

3.)    Child’s difficulty in accepting changes in their routine may also be problematic     

4.)    Sensory Issues: Child may not know how to read the body cues that tell him or her that they need to use the bathroom. The child may also be overwhelmed by the sensory environment of the toilet (loud flushing noises, echoes, running water, chair with a giant hole in it hovered over a puddle of water, etc.)

5.)    Most two or three year olds will gain a sense of pride and accomplishment from pleasing their parents by using the toilet appropriately. This type of motivation is rare with children with autism.

When attempting to toilet train a child with autism, one of the first things that need to be done is defining a realistic goal. A child’s independent toilet usage may take a little while to establish, but in the meantime, each step towards that independence is a goal in itself. However, in order to choose a starting point for the training, it is necessary to observe and assess the child’s understanding of the toilet process. In the beginning, caretakers should begin by establishing a meaningful routine around toileting and collect data about the child’s readiness for schedule training or for independent toileting. We highly encourage parents to implement a chart similar to the sample chart depicted below and use it to collect data. On a routine basis, the child is taken to the bathroom for a “quick check” every 30 minutes or so, and the data should be recorded on each of the occasions:

The goal of implementing a chart like this is to uncover any kind of pattern that exists in a child’s toilet habits. Over a period or one to two weeks, a pattern of data should emerge, and parents should begin to ask themselves these following questions.

1.)    Is my child dry for significant periods of time?

2.)    Is there some regularity in my child’s wettings/soiling?

3.)    Does my child show any indication that he is aware of being wet or soiled?

4.)    Does my child pause while wetting or soiling his or herself?

If the answers to all these questions is no, then the child is probably not ready for independent toileting, but a goal to establish a positive bathroom routine is still appropriate. During the charting phase, parents should also be sure to pay attention to the other aspects that are a part of the toilet training process.

1.)    Is my child beginning to pick up on the routine involved?

2.)    How are my child’s dressing skills?

3.)    Does my child have any fears or interests related to the bathroom (reaction to flushing, water, toilet paper roll, or other bathroom fixtures)?

4.)    What is my child’s attention span throughout the training process?

Hopefully, by the end of this assessment process, we will have the data needed to create an appropriate goal to work toward. One of the principles of this structured teaching method involves designing the physical environment to mirror a setting of success for the child’s sake. The best way to accomplish this is by creating a distraction free environment clear of boundaries. Our goal is to help the child associate the behaviors or concept of elimination with a particular place, the toilet. So, moving all diapering, cleaning, and toilet-related dressing to the bathroom setting will help the child to understand the sole purpose of the bathroom. Some families even go as far as blocking off half the bathroom during the training process, so that the child does not get confused or distracted by the other things that are apart of the bathroom, such as the bathtub, shower, bathing toys, combs, brushes, toothbrushes, etc.

Another goal of the training process involves creating an environment that is not over-stimulating. The child may be more responsive if the environment around him or her has the proper supports and is calm in nature. Parents should consider giving their child their child food support or other physical supports that will keep their child cooperative during the training process. Caretakers have even implemented soft playing music or other sound-absorbent materials to block out the echoing, plumbing noises, and the other distracting, annoying sounds heard in the bathroom.

After setting an appropriate goal for the child, it is important to teach with visual supports or prompts in progress toward reaching this goal. This visual set up will be designed to let the child know the steps or sequence that will unfold on the road toward achieving their goal. To initiate the training, an object that is associated with the bathroom or toilet may be given to the child to symbolize the transition object that takes the child to the correct location. Note: this object could simply be a picture of something glued to a note card or piece of paper, as long as it serves its purpose of initiating the bathroom routine and helps the child know what is to occur and where. Once the transition to the toilet has been accomplished, it is necessary to continue the visual support for each step of the toileting routine. The child needs to know each step he or she is expected to complete, when each specific sequence will finish, and what is expected out of him or her next. Using an object sequence, picture sequence, or written list is necessary for the child to visual concept the routine and put it into effect.

Once the visually supported transition and sequencing system has been established, the next step is to continue the problem-solving techniques to troubleshoot through the specific details. Whenever a child has a problem with any steps along the way, it is important for parents to take a step back and ask themselves, 1.) What might my child’s perspective be and 2.) How can I simplify and/or clarify the confusion or misunderstanding through visual structure. Here are some examples below:

1.)    My child resists to sit on the toilet

            - allow child to sit without removing clothes

            - allow child to sit with toilet covered

               (cardboard underneath seat, gradually cutting larger hole, towel under

            - use potty seat on the floor rather than up high

            -take turns sitting on the seat, or us a doll to set an example

            -sit together

            -add physical support

            -help him understand how long to sit on seat (sing potty song, set a timer)

            -as child begins to tolerate sitting, provide with entertainment

            - don’t flush until there’s something to flush

            - start flushing with the child standing away from the toilet (gradually

            - give advance warning of flush, set up flushing cue system, “ready, set,

            - allow child to flush

            - cover toilet handle, so it’s removed from sight

            - give child something else to hold or play around with

            -when it’s time to flush, give child a sticker that matches a sticker that

              parent has placed on the flush handle

5.)    Playing in water

            - give him toy with a water feature as distraction, such as tornado tube

            - use a paddled lap desk while seated

            - cover the seat until ready to use

            - put a visual cue of where to stand

            - if it’s a big problem, remove toilet paper all together, and use Kleenex

            - roll out amount of toilet paper to be used ahead of time

            - give visual cue to indicate how much child should take (tie off with a

              clothes pin, or make a tape line on the wall of where to stop)

6.)    Resists being cleaned

            - try different materials (wet wipes, cloth, sponge)

            - consider temperature of the materials used

            - take turns with doll

            - put a target in the water, like a piece of food

            - add food coloring to the water, to make it more obvious and visible

8.) Retaining when diaper is removed

            - cut out bottom of the diapers gradually, while allowing child to wear altered diaper to sit on   

              the toilet

            - use doll to provide visual model

            - increase fluids and fiber in diet

            - may need to contact doctor if there is a bowel problem

And lastly, another important step of the toilet training process is planning for a way for the child to initiate the toilet sequence. The first trips to the bathroom may be initiated by an adult who will direct the child to a transition object to go to the bathroom. However, the child will eventually need to be able to communicate his or her need to go to the bathroom, especially if the child does not know where a toilet is available. Just like in the previous exercises, it is necessary to do some analysis, and design a goal assessment for the child. Caretakers should ask themselves, is the child currently making any kind of signals or signs to indicate that they need to go to the bathroom, or are they totally reliant on the adult’s initiation? If there are any behavioral signals that an adult observer can read, they should use these signals as opportunities to teach their children more appropriate or systematic techniques to communicate their bathroom necessities. Many children may naturally begin to use the same tools or techniques that were used by the parents to get their child to go in the first place. A child who is sometimes able to verbally express that they need to go to the bathroom, may not feel comfortable saying so, when they are in a new place or when they around a number of people. This is why there must be a systematic way for the child to indicate or express symbolically that they need to go to the bathroom.

TEACCH-Applying Structured Teaching Principles to Toilet Training. http://www.teacch.com/toilet.htm