Tips and Tricks: How do you Potty Train an Autistic Child?

August 12, 2021 No Comments

Oh my goodness gracious…I never thought I’d make it to the point where I could sit down and offer someone else advice on how to potty train an autistic child.  A couple of years ago, I was certain we would never, ever master this task.  We made it!  It was messy…but we did it. 

*Some autistic people do not use a toilet.  This may be the case for your child.  If it is, embrace them for who they are.  Love them.  Move forward.  Remember: we are here to be our child’s number one cheerleader, advocate, and supporter.    The verbiage of “potty training” is meant in the traditional context of teaching a child to use a toilet.  It is meant to be interchangeable with “toileting” in this context.  

Step One: Acknowledge your feelings.  This stinks.  Literally, sometimes.  It can be very, very frustrating for you and for your child. Parents of autistic kiddos often feel “darned if we do” and “darned if we don’t”.  It’s a tough place to be sometimes.  Personal Opinion: as long as you’re doing the best you can to be your child’s advocate and supporter, acknowledge and work through your feelings. We don’t have to shove those down and pretend like everything is okay all the time.  Sometimes this is really hard.  Messy.  Emotional.  That’s okay!  It doesn’t mean we love our kids any less, it just means we may have to deal with some extra feelings sometimes. 

Step Two: Let’s do this!

We started with pee first.  Your child may be ready for both pee and poop.  Your child may or may not be ready for overnight training.  Your child may do this completely by himself….or not at all.  As parents, we just have to accept this.  Hang in there!  Every story is different.  Your version will likely not be like mine. 

My child let me know he was ready for pee training by holding his pee at preschool.  He wouldn’t use the bathroom at all for many hours straight.  His body was ready, but he didn’t know what to do.  I used a modified version of the “3 Day Potty Training” method.  I let him go…totally free (at home).  He and I had a standoff for 8…EIGHT hours!  I gave him a lot of beverages.  When he finally couldn’t take it any more, I said “just go…it’s ok…go peepee” and he started to pee…right in the kitchen.  I slid over a little potty and he saw the pee go in.  After that, he realized it was ok to pee in the potty. I think anxiety was  at play.  Using social stories seemed to reduce that for us.  

When you’re ready to get started with potty training, make a plan…but be ready to rework it if you need to.  

  1. First….address any underlying sensory, emotional, or physical obstacles.  Are they anxious because this is new?  Are they incontinent or withholding due to dietary or physical differences? Address those first.  
  2. Use visuals and social stories to explain the steps of toileting and hand washing.  Don’t force it, but stay positive and put the tools in place to increase understanding of the concepts.  
  3. You might consider putting favorite things on the visuals to increase interest and show that you care about your child’s favorite things. Use those “restricted interests” (I call them favorite things).  If your child’s favorite thing is dinosaurs….decorate the schedule, the potty, the undies, ALL of it with dinosaurs.  This is taking something that is a characteristic of autism (restricted interests) and using it as a bridge for success!   
  4. Lower your expectations.  If you’re here, you may have already started…and it may not be going well.  That’s ok.  Some kids get very used to routine.  If they’ve pooped or peed in their pants for their entire life, this is going to be a BIG change.  It may make them very anxious and we need to be as patient as possible. 
  5. Watch for their signals: touching their privates, holding their pee for extended periods of time, observing others using the bathroom can all be signs of toilet readiness.  
  6. Use social stories.  I have a set of these in electronic format.  No prep, no print, digital!  
  7. Use visuals, visuals, and more visuals.  You can find bathroom visuals here.  If finances are tight or you enjoy making your own materials, you might try using Boardmaker community online to create whatever visual suits your family.  

We use the visual picture schedules at our house on the mirror or bathroom door.  We use the social stories when calm to discuss what to do and how to do it.  

My son never directly let me know that he was ready for poop training: it happened by accident one time when he was on the toilet.  When he saw that it was okay, he was okay with trying it. 

Hang in there!!!!  Be consistent. Don’t scold. Celebrate successes (sitting on the potty, big step).  Take a breath and acknowledge your feelings too.  This is hard!!!

Once we mastered potty during the day, my child indicated that he didn’t want to wear a pullup at night either.  I was at a crossroads; I didn’t feel he would be safe going in and out of his room at night and really wasn’t sure what to do.  A family member suggested a bedside potty.  We found an adjustable one on amazon.  This has worked well for a couple of years now.  My son can manage to use it safely and for the most part cleanly overnight and keeps his underwear clean and dry.  We did have to make visuals specifically for this too, but eventually he slid them under his door at night to let me know he didn’t need those anymore.  😉 

We use a bedside potty in our son’s room for overnight toileting.  Due to elopement and drowning risk, this is what has worked best for our family.  This version is adjustable and has held up well for several years now.  It’s easy to clean and manage.  We also opted to put in vinyl flooring to reduce the rigor of cleaning. 


Other recources for toilet training:

Autism Little Learners for social stories and visuals

3 Day Method

Remember to look at the big picture and adjust your expectations if needed.  Autistic individuals might not be able to explain why this isn’t working for them.  They need and deserve our patience.

What do the “experts” say?  Multiple perspectives below:

Lang, Mia MD (2008), Among healthy children, what toilet-training strategy is most effective and prevents fewer adverse events (stool witholding and dysfunctional voiding)? Pediatric Child Health; 13(3): 203–204. *Note that this article specifies “Healthy Children”

Cocchiola, Michael A, Martino, Gayle, Dwyer, LisaMichael A. Cocchiola, Jr. (2012), Toilet Training Chidlren with Autism and Developmental Delays: an Effective Program for School Settings, Behavior Analysis Pract. Winter; 5(2): 60–64.*This article is from a behavioral perspective, which is a controversial topic 

Cleveland Clinic (2020), Toilet Training in Children with Autism Spectrum Disorder

Vance, Tara (2021), On Autism, Getting Dressed, and Toileting, www.neuroclastic.com *This is an opinion piece written by an autistic parent.  While there aren’t citations, many argue that anecdotal experiences of autistic adults are valid forms of evidence-based practice. 

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Elizabeth has been a Speech Language Pathologist since 2005. She has special interests in Autism and ADHD. Some of Elizabeth's experience comes from years of development and training in pediatric private practice, but the majority has come from raising her four children. Her household includes neurodiverse family members. Elizabeth enjoys supporting families and professionals with her experience from both sides of the table. Learning to merge the "normal" and "autistic" worlds has led to the most success, both professionally and at home. Read More

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    Prior Speaking Experiences

    -Guilford Child Development: Autism in the Early Childhood Setting
    -Cheshire Speech and Voice: Effective Tools for increasing Sensory Integration for Speech/Language Intervention; Autism
    -Caldwell Community College and Technical Institute: Autism
    -CHIPS Greensboro: Autism for Professionals
    -NCSHLA: Teletherapy (Including the Parent Perspective)
    -Telepractice Today: Podcast (Parent and SLP Perspectives)
    -UNC Chapel Hill: Guest Lecture
    -Abled Not Labeled: Presenter (Intro to Neurodiversity)
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