This Means That They May Struggle With:
- Understanding the words for toileting and so may not understand what is expected of them.
- They may not have or be able to say the words to let others know that they need to wee or poo.
- May interpret language literally and therefore be confused by some of the expressions we use to describe weeing or pooing . E.g. going to the toilet is literally about going to a place. It does not describe doing a wee or poo.
Using picture cue cards and social stories may help overcome these issues
Gradually Increase The Interval
Gradually increase the 5 minute interval as your child builds success with toileting and as the number of accidents decrease. If your child voids in the toilet consistently for 1 day with no accidents, increase the interval by 5 minutes. If there is a dramatic increase in the number of accidents, reduce the interval to the last time frame where your child was successful.
Teach Requesting The Bathroom
Once your child is self-initiating for one month with no accidents, you can begin to teach her to ask for the bathroom by stopping her when she walks to the bathroom, temporarily blocking access to the toilet and prompting her to say potty . Do not teach your child to request the bathroom until self-initiation is strong.
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Toilet Training Setbacks For Autistic Children: Tips
Setbacks are part of toilet training for all children. They can include behaviour problems, constipation and things going backwards.
Behaviour problems Sometimes autistic children who are toilet training can behave in challenging ways. For example, they might be afraid of the toilet, go in places other than the toilet, fill the toilet with paper and other materials, continually flush the toilet, smear poo on the wall and other places, and refuse to poo.
ConstipationConstipation is a common problem in children. If your child avoids doing poos, it might be constipation.
Constipation is usually caused by not enough water or other fluids or not enough dietary fibre. Some autistic children are selective eaters, which can cause them to become constipated more easily than other children.
If you think your child is constipated, see your paediatrician or GP. They can rule out any underlying medical concerns, and help you with strategies to manage your childs constipation.
Things going backwardsSometimes childrens toilet training progress might stop or things might seem to go backwards.
Sometimes these issues might be related to things like stress, illness, constipation or diarrhoea. Your GP or other professionals working with your child can help you sort out these isssues.
What If My Child Is Afraid To Have A Bowel Movement
Children with autism can find bowel movements frightening. In fact, its 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.
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Try A Variety Of Approaches Dont Get Discouraged
My husband and I had tried various methods over the past 3 years. We used picture symbols breaking down the process of toileting on a Velcro strip. We kept a bowel movement chart for 3 weeks so we could see what time of the day Marc tended to have his bowel movement, and then we sat him on the toilet for those times. We created a social story for toileting. When none of those methods worked, we used a behavioural contingency plan with photos of Marc sitting on the toilet, a photo of broken pieces of Oh Henry bar in the toilet, and a photo of his reward ripple chips. If he didnt poop in the toilet , then there would be no chips. None of these methods worked.
Right Age To Potty Train Children With Autism
The age at which any child is fully potty trained varies widely even in neurotypical children. The answer here will depend on where your child falls on the spectrum, their communication skills, the extent of any existing sensory challenges, and if there are any significant gross motor
Delays, explains a potty training coach certified by the Institute of Pediatric Sleep and Parenting in both Potty Training and Special Needs and the founder of Mother Together.
There is no identified perfect age to potty train children with autism. Children usually show signs of potty training readiness by the age of two to three years. However, children with autism and other conditions may take longer to be potty-training ready based on the severity and symptoms of their condition.
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Why Is Potty Training Such A Challenge
When you think about the requirements for potty training and the inherent deficits present in the typical symptomology of autism, the conflicts can be obvious.
Children with autism may struggle with the social skills to get an adults attention to let them know that they need to toilet. They often have limitations around language to communicate such needs, as well as the receptive skills to understand and follow directives when an adult is trying to help.
We know that individuals with autism thrive on routine, and have an intense need for sameness so the shift from wearing diapers to underwear, and using the bathroom can be huge.
Teaching any new routine is a task that requires a multi-sensory, well-planned, team-based approach. Toileting training may not happen overnight, for children with autism, it can be a lengthy process. The consistency amongst environments will be important too toileting needs happen everywhere, so flexibility around what toilet you use and where that toilet is located is crucial.
Children with autism often have fine and gross motor challenges so the physical skills to dress and undress, and to climb up and balance on a toilet seat, must be considered. The dexterity to manipulate fasteners like buttons, zippers, and snaps can be difficult. The body awareness and upper extremity control to manage pants around the hips can be tricky as well.
Remember This Will Be Stressful For Everyoneand Likely Messy
During the first week of toilet training, Marc withheld his bowel movement for seven days. His anxiety levels were very high. Our first breakthrough was after the first seven days Marc went on the bathroom floor. This was progress because even though he wasnt on the toilet, he was in the right area so we rewarded him for that. Once he got the chips, he then withheld his bowel movements for only three days at a time. It took five weeks for Marc to stop smearing his feces, but we noticed it decreasing as Marc continued to have his bowel movements on the bathroom floor. Now it was time to up the ante.
We then said no chips unless the poop was in the toilet. He had watched Ron and I empty bowel movements out of his underwear into the toilet so this now became the step for him. He emptied his bowel movement from his underwear into the toilet with almost no mess which we rewarded him for. Marc was independently washing his hands with no prompting.
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Autism Sensory Struggles: Potty Training Unconventional Fashion And Transitioning From Training Pants
Guest blog by Heather Leah
Parents who have children with autism are all too familiar with sensory sensitivities, hyper-acute reactions to texture changes, and rocky responses to lifes transitions. Were careful to give our child a five-minute warning before each change in activity, then a gentle two-minute warning, followed by a soft touch and a gradual countdown perhaps singing a familiar transition song.
But what do you do when those big life changes start happening the ones you cant count down to?
Potty training is a challenge for parents of neurotypical and non-neurotypical children alike. But sensory issues and life transitions can make the change from diapers to underwear a struggle for children who have autism and sensory processing disorder.
The Unique Struggles of Potty Training and Underwear Transitioning
As a toddler, my child became accustomed to the snug, safe feeling of a diaper around his bum. He wasnt happy to change into his big boy underwear, no matter how many superheroes were featured on the fabric.
Trying to Dress My Hyper Sensitive Child
As he got older, he entered Elementary School wearing the worst of womens fashion. He insisted on wearing a womans mock turtle neck, shorts, socks to his knees, and sandals. It was the only kind of outfit that he felt comfortable in. Teachers pulled me aside to helpfully explain that I needed to dress my son in more age appropriate clothes.
What If My Child Likes To Play With The Toilet Water
Playing with toilet water means children with autism have a sensory need that isnt being met. Set up appropriate places in your house where your child can play with water, such as the sink, bathtub, or small pool outside. Deny access to the toilet by closing the bathroom door and putting a visual stop sign on the toilet. Children on the autism spectrum who play with the toilet water are not ready for potty training. Your child will not be ready until he/she learns the appropriate places to play with water.
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How Do These Affect Toilet Training
To be able to use the toilet appropriately and successfully we need to learn a series of skills, but learning these can be more difficult if children are on the autistic spectrum. Causes of the difficulties will vary according to how the autism affects them. Success with toilet training involves working out what is causing issues for the child and making changes to reduce the effect of the issues.
Avoid Teaching Other Skills While Toilet Training
You may find it tempting to try to teach your child other skills during this time, like how to ask for the bathroom or how to dress himself. Keep the process pure and simple. Do not require that your child ask for the bathroom or dress himself. This increases the effort required of your child and decreases his motivation to use the toilet. Teach these skills after your child has mastered voiding on the toilet.
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Review On Autism Data
According to numbers published by the Center for Disease Control in 2018, approximately 1 in 54 children are diagnosed with autism. This statistic represents a 15% increase in autism prevalence as compared to numbers from 2016. While boys are 4 times more likely to be diagnosed as compared to girls, there is progress in identifying the condition in females, who do not always fit the stereotypical picture of autism that boys may.
Autism is identified by three key components of behavior:
- Persistent deficits in social interaction
- Deficits in communication, symptoms often present before age 3
- Restricted repetitive patterns of behavior, interests or activities :
- Repetitive or stereotyped motor movements, use of objects or speech
- Insistence on sameness, inflexibility with routines, ritualistic patterns of behavior
- Restricted, fixated interests that are abnormal in intensity or focus
- Hyper or hypo reactivity to sensory input
How To Manage Fecal Smearing
It is not unusual for children with autism to smear their feces on themselves, on the walls, on their clothes. Dr. Kroeger has some specific advice for parents finding themselves in this unpleasant situation. “Children do what they do for one of only four reasons,” she explains: to get attention, to get something they want, to escape from something unpleasant, or to have or avoid a particular sensory experience. So why are they smearing feces? What happens when they do it? Are they getting attention? Are they being allowed to escape a situation they don’t like? Are they getting something they want? If they’re not getting any of these outcomes, they’re probably enjoying the sensory input they’re getting.”
Once you know why your child is smearing feces, you can fill their need in another way. For example, you can give them attention and praise when they go to the bathroom without touching their feces.
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When Is A Child Too Old For Toilet Training
It is never too late to begin the toilet training process. Most children are continent by ages five to six years old. Some children with autism or other developmental challenges may be older before they begin toilet training. You may have tried toilet training at an earlier age without success for many different reasons. Whatever your childs age, start at the beginning of this tool kit to determine readiness and then, based on your childs level of understanding and skills, develop a toilet training plan.
If a child is functioning cognitively at less than two years of age, he may not be a good candidate for the typical toilet training process that requires awareness of the need to eliminate. Or, if a child is older and has not responded positively to establishing a toileting routine, he may benefit from habit training. Habit training involves regularly accessing the toilet on a set schedule based on your childs elimination patterns. The goal is for using the toilet to become a learned behavior. For more information on Habit Training, see Part 5: Habit Training.
Handling Sensory Sensitivities: Tips
If your autistic child is sensitive to or upset by the sensory aspects of going to the toilet, try ways of controlling your childs sensory experience of toileting. For example:
- Get your child familiar with sitting on the toilet seat by practising for a few minutes every day. Make your child comfortable for example, if the floor is cold, put socks on your childs feet.
- Use a stool for your child to put their feet on.
- Use a training seat if your child is frightened of the big hole over the water.
- Tell your child there will be a noisy flushing sound, and explain the reason for the noise.
- Let your child hold a favourite object while sitting on the toilet.
For our son, it all revolved around change. We started by teaching him to wee in the garden, then into a bucket in the garden, then into a bucket inside, then into a bucket next to the toilet, then finally into the toilet. This took nearly a year! I tried to make the toilet a happy place for him to visit by putting Bob the Builder stickers all over the door and letting him have little matchbox cars.
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Toilet Training Strategies For Children With Autism
Toilet training is a major milestone for both the child and the parent. Triumph builds greater independence for the child and successful teaching skills for the parent. Often toilet training is the bridge to helping parents feel as though they actually know what theyre doing. But what if toilet training doesnt go as planned?
Children with autism often learn differently than their peers. With challenges with language and motivation that is sometimes difficult to understand, parents often struggle with successful toilet training. While toilet training is no easy task for any parent and child duo, it becomes just a bit more difficult for children with autism, leaving parents to wonder if its even possible. The 12 steps below will take you on the path to successful toilet training.
This Means That They:
- May assume that you know when they need help and not realise that they need to tell you.
- Changes in their routines are very confusing for them and may make them fearful or anxious.
- They may struggle to transfer knowledge: if they learn to do something in one. place they may not realise that they should do the same thing in other places e.g. if they learn to use the toilet at home, they may not realise they should do so at school as well.
Making changes slowly and gradually, with the support of picture cues or social stories may help them to feel safe and accept the changes better.
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Be Sure Your Child Is Healthy
Many children with autism have gastrointestinal issues. And, of course, if your child is suffering from diarrhea, constipation, bloating, or other gastrointestinal issues, it may be tough for him to toilet train.
If your child seems to gastrointestinal problems, check them out before you start toilet training. Signs of GI problems can include unusual crankiness, positioning to press on the abdomen, reluctance to use the toilet or poop, or inability to evacuate. See your pediatrician and, if necessary, a pediatric gastroenterologist. It may even be possible to treat constipation with something as simple as prune juice.
Find The Root Of The Issue If Possible By Trial And Error
I realized there was much more to transitioning from diapers to the toilet. We had to discover what the root cause of the anxiety was. This is difficult to do when a child has very limited language skills. Was it having to sit down on toilet rather than stand? Was this a fear of having something fall away from Marcs body? Did he think he was losing a part of himself? Was he in physical pain sitting down trying to release a bowel movement? It was time to try another strategy.
I tried draping a towel across the toilet bowl so Marc would not have the feeling that something was falling away from him didnt work. We then changed the emphasis to just sitting on the toilet. We asked Marc to simply sit on the toilet and then rewarded him with chips if he did. During the toileting process, Marc was smearing his feces all over the house. He picked out just enough to relieve the bowel pressure.
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