Supporting a child on the autism spectrum to be independent in their toileting can be a daunting prospect for parents. There are many reasons why this may prove more challenging for a child on the spectrum than with a more typically developing child. Communication is a key issue. Does the child understand the language associated with this process, do they understand the expectation, can they indicate that they need to go to the toilet? There may be sensory issues associated with learning to use the toilet such as disliking the feeling of the toilet seat, for others, the sound of the flush may be frightening. Some children are unconcerned with the sensation of being wet.
Other issues may be that the child is not able to tune into the messages their own body is sending and will therefore be less able to act on such signals. For other children beginning to use the toilet signals a change to the long established routine of having a nappy on. New routines cause anxiety and this makes approaching toileting concerning for all. There is also the issue of readiness. The child may not yet be developmentally ready. This can be emotionally difficult for parents as they may feel a social pressure to have their child independent in their toileting.
This is by no means an exhaustive list of reasons why a child on the spectrum may take longer or may need a very specific approach in order to enable them to be independent in this area.
Below we have listed a series of pointers to help you focus your thinking on this area. Our Autism Advisors can provide more detailed, individualised advice and support.
- Assess “readiness”: is the child showing signs of awareness of any aspects of toileting? What are they? An example might be that whilst a child is still using a nappy they may start to go behind the couch when they need to use the nappy. Another may be that the child tries to remove wet or soiled nappies.
- Plan your approach: Make a “toileting” plan. If possible discuss your intended approach with a trusted friend or a professional who has a good general knowledge of the autism spectrum. You might also think about how toilet training can be approached in general and work out the areas that may be potentially problematic for your child. Anticipating issues can help minimise stress.
- Identify useful resources and information. There are a number of publications (some are shown below) that give good advice.
- Think carefully and as objectively as you can about the actual toileting skill your child is showing. Think also about what is motivating for them. Many children on the spectrum will not be motivated by your approval or pleasure they will need something that is more personally motivating and rewarding for them. Think about how a treasured item or a topic of interest might help.
- Consider factors such as the toilet environment. It can help to “audit” the environment with a view to identifying anything that might trigger sensory processing difficulties. It can be helpful to stand in the environment and notice the level of ambient noise, the intensity of lighting used, are surfaces very reflective and, whilst not pleasant to consider, odours. Think also about how secure your child feels in that environment. Do they find the scale of the actual toilet overwhelming? If so, a footstool can help make children feel more grounded when sitting on the toilet.
- Consider communication. Your child’s speech and language therapist may be able to advise on using visual and other communication supports that will increase their understanding of the process.
- Developing toileting skills is not always straightforward. It may take longer to develop the skills and some unique and creative strategies may require to be developed. Your child may also seem to take a few steps back before moving forward.
You know your child best and a harmonious home life should continue to be a priority. Your child may not be ready for toilet training at an age and stage you might expect. Whilst this can be anxiety provoking it does not mean it will never happen.
Eric: (Education and Resources for Improving Childhood Continence) Leaflet (April 2007): Potty and Toilet training …a helpful guide for parents.
Fouse, B. & Wheeler, M. (1997) A Treasure Chest of Behavioral Strategies for Individuals with Autism. Arlington: Future Horizons.
Notbohm, V. & Zysk, E. (2004) 1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders. Texas: Future Horizons.
Wheeler, M. (1998) Toilet training for Individuals with Autism & Related Disorders: A comprehensive Guide for Parents & Teachers. Texas, Future Horizons Inc.