No parent goes without harsh feelings to the point of nightmares from the very idea of potty training. Take a moment. Breathe deeply. Let go of the horrors that are happening right now in your developed imagination. And keep in mind that at least one will actually happen. When we want to start potty training children with autism, it is advisable to come prepared.
When to start, and the method should be suitable for your child. For example, for a non-verbal child we will emphasize more visual support. Verbal children will require less visual support and. Words will work just fine.
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We also gathered a list of potty training product links. Not all of these are linked in this article.
Potty Training Children with Autism
The potty training process for children with autism can be simple or complex depending on the child’s abilities. Some children are trained quickly.
Difficulty letting go delays the process for a long time in some children. On the other hand, there are children who do not hold back at all. When they need to go they will just release.
In addition, the physical condition of the child must be considered. It is possible, for example, if he has hypotonia, that he needs muscle strengthening to deal with constipation and bowel movements.
To achieve daytime potty training, and nighttime later on, you need to carefully make a plan of action. Support must be given according to the child’s needs and abilities.
First, a physiological diagnosis must be made. Autistics often suffer from co-morbidities. This very commonly includes problems with the digestive system.
Another common problem that affects the ability to wean from diapers is hypo/hypertonia. A child with weak muscle tone can have difficulty pushing out stool. A child with high muscle tone will have difficulty releasing the anal muscles. (These were problems that Dolev suffered from before receiving stem cell therapy. Another small benefit of the treatment)
In addition, children with autism often have problems with sensory regulation. They may not be sensitive enough to their bodies and do not feel when the bladder is full. Possibly, they are too sensitive and afraid of the feeling of letting go.
For a physiological assessment, you should contact a pediatrician, and you can use a physical therapist.
Assessment of emotional and communication skills
In addition to the physiological assessment, make an assessment of emotional, verbal and non-verbal communicative ability.
How well does the child adjust to changes? What is his language and communication ability?
Ask the educational/therapeutic team to assess the child’s strengths and weaknesses. Make an assessment with regarding the emotional abilities.
Has the child developed a fear of the toilet? Is he afraid to release bowels or bladder?
Potty training plan of action for your child with autism
We performed assessments of the physiological, emotional, and communicative ability. Now it is time to make a plan of action.
Write in your plan of action how you plan to solve physiological problems diagnosed in the tests. For example, how do you plan to treat constipation?
- Diet? Have you consulted with a dietitian?
- medicine/supplements? Have you consulted with your pediatrician?
- And/or strengthening muscle tone? Has your phsical therapist given you exersize instructions?
How will we cope with emotional problems regarding releasing? (for example: a social story, potty training party, or a reinforcement chart)
If there is a communication difficulty to understand instructions, how will we handle it? (navigation card, communication board)
Before we start actually potty training, we will need prepare ourselves, the child with autism and the house.
Preparing the house
The first decision is where to potty train: will we use a potty or straight on the toilet? Where will a potty be placed?
Prepare navigation cards with the necessary actions. Prepare a social story on the subject.
Buy lots of potty training equipment such as multiple underwear, pants, extra beddings. Cover sofas with a spill protection cover. Preparing salty snacks and lots of drink.
In general, it is recommended to make the house accessible to the needs of children with autism.
Do not start potty training a child with autism if you are not available.
If you are nine months pregnant, now is not the time. Nor during the first week of kindergarten, etc…
Preparing the child
The child should be prepared long before taking off the diaper.
We will talk to him and read potty training books*. Show him the toilet and the potty*. Let them touch and sit on them.
Show them the potty training visual aids you prepared: the sequence of actions in pictures and the social story.
Start playing children’s tapes, YouTube videos, and songs on the subject. These are great visual and auditory tools.
When you feel that the issue is clearer to them and they show interest in the toilet or have already agreed to sit, you will slowly start to push for weaning.
Tools and advice for weaning from diapers
When potty training a child with autism use as many multisensory aids as possible:
Visual aids*: a navigation card, a social story, and a children’s tape can help the child understand the change
Auditory aids: a song or recitation can help signal that it’s time to take a bathroom break. (We used a lot of Daniel Tiger* and Signing Time*)
Tactile aids: choose a potty or toilet cover that is pleasant to touch. A potty can be toilet-like* to facilitate the transition to the toilet at a later stage. You can take your child to the store, choose a simple potty together, in their favorite color and decorate it together.
Noise-canceling headphones* can help deal with fear from the noise of flushing the toilet tank.
Visual support – visual navigation cards
Prepare visual navigation card of actions in for using the potty. Stick a copy of the card near the toilets and wherever we put a potty.
The navigation card consists of images that represent the actions in sequence:
- Entering the bathroom
- After that, pants and underwear are taken off
- Sit on the toilet or the potty
- Peeing or pooping (picture of a toilet with yellow or brown contents, or a child sitting on the toilet)
- Wiping the behind
- Pulling up pants
- Flush the toilet (or emptying the potty first)
- Wash your hands (it may be necessary to break it down into more steps)
- Dry hands
- Leaving the bathroom.
The navigation card can contain more or less actions depending on the child’s abilities.
For example, after a few weeks of using one version, we saw the need to adust it. Dolev was washing his hands only with water. So we broke down hand washing into three steps (rinse, soap, rinse).
Pay attention how your child performs the sequence. Any missed actions should be added. At the begining everything might require your mediation. But with time and practice, more actions will become routine. As actions slowly become automatic you can reduce mediation.
Potty Training Social Story
The Social story is a story with the child as the main character. It describes what he is expected to do.
The social story explains what they will be able to do by the end. It uses positive reinforcements like “big boy/girl”, “strong”, “smart”, etc.
It is often used by special education professionals as preparation for a transition into a more independent stage.
Social stories can be used to help the child understand a lesson.
When you talk to the kindergarten staff to coordinate the efforts on potty training your child with autism give them copies of the social story. Provide the reinforcement charts and any positive reinforcements as well. Our educational staff used additional methods and gave us ideas to integrate into the process at home.
Reinforcement Charts and Positive Reinforcements
When we got to potty training out children with autism, we made a reinfocement chart to track successes. Every time they managed to do something in the potty or the toilet, they put a toilet sticker on a chart.
We saw that the process was going to be long for Dolev. So we printed the toilet drawings, stuck velcro to them, and made a reusable system.
You can be creative with whatever your child connects with. We also tried gold stars, which was a much smaller effort. However, our kids didn’t really connect to the stars for some reason.
If the chart alone is not enough, you can give prizes for successes. When they gathered enough successes in the chart, we handed them a small gift from the gift box.
We have a wooden suitcase that we call “treasure chest”. It is full of cheap gifts. You can create a paper medal, a small candy or any other reward you like.
The idea is that success on the toilet equals a reward. For a verbal child, this can be an equivalent verbal reward (“Well done”, “Hurrah! You did it!”, etc.).
When I tried to potty train my boys with autism, I tried almost everything.
Then someone told me try to have a potty party.
I invited some friends. The house was decorated with toilet theme decorations*. We ate cookies shaped like poop, and drank pineapple-flavored “pee” juice.
We read a bunch of potty training stories* (including the social story I made). There were potty games*.
The highlight was playing with slime* and yellow* and brown* finger paints. The slime is liquid and soft, and feels a bit like brown pee… well you can imagine.
We applied these onto diapers. We stuck the diapers on cardboard, and hung them for decoration on the wall near the toilet for a few days. Every time we passed by we looked and told them it was more fun to pee and poop in the toilet.
Look on our list for more Amazon.com potty training resources*.
Cooperating with the Kindergarten Staff
The potty training process should be done simultaneously at home and in the educational framework, especially with autism. (Unless it was successfully completed while on vacation)
For example, as part of the preparation process for weaning, our eldest was exposed to different textures – he played with materials such as slime and dough, all of which were brown in color, to simulate stools with different textures.
Patience is the key
It is very unlikely to be a quick process. Along with all the tips in the article, you must work hard.
Take them to the bathroom, proactively, all the time.
Sometimes it works and sometimes it doesn’t.
Do not give up! But do not be afraid to postpone potty training until a later age, if you feel that the child is not ready.
The process took us a very long time. More than two years with Dolev, who at the time was very low functioning. And it’s without night training!
Nevo took about a year and a half. He had a reverse problem of not being able to pee. His nights were dry from the beginning, so we had to teach him to release.
You will likely need more than one potty party. We had at least four.
There will be moments of crisis. You will need a lot of patience.
For many children, it will simply take time. Lots of work on building habits. Send the child to the bathroom on regular intervals, every hour and a half, and their body will eventually adjust.
Keep in mind that even after finishing the process, you may have to remind them quite a few times.
Preperations for outings
Plan for horror shows outside the home. Always take a potty or a toilet adapter with you everywhere. Take extra clothes and cleaning equipment.
Prepare your parents and friends. This is the situation!
When your child pees in the living room, in the middle of grandma’s birthday, you will be ready to handle the emergency.
Be prepared! When you suddenly see brown sludge oozing down the child’s leg in the playground – you will be ready with a bag, wipes, a very large changing pad, and a change of clothes.
Instructional Videos On Potty Training a Child With Autism
I speak English as a native language, and can provide service in English. However, as an Israeli, my main target audience are Hebrew speakers. Therefore, most of my recorded content will be in Hebrew.
If you speak Hebrew, you are welcome to check out my instructional videos on potty training a child with autism on Youtube Channel or on our autism parenting Facebook group.
Here’s the starter video (out of seven):
To help children with special needs reach independence us parents need to do work. They need to be taught to shower, get dressed, and other basic skills. Teaching them to sleep (a skill that should come naturally to a child) is not an easy task for an autistic child.
Acquiring ADL skills is not a simple task with communication problems. However, there are adapted tools for imparting these skills. We introduced the social story, and the navigation card, but there are more.
No parent is happy about potty training, especially with autism. Without a doubt, one of the most repulsive and embarrassing parenting tasks. Keep in mind that like everything with special children, it takes more time.
Make a thorough plan of action, long before you jump into the deep water.
hope it helps. Advice from the experienced – if you are seeking potty training guidance – look for someone who has experience with children with special needs. It requires quite a bit of understanding in the field.
Shira Reiner – developmental nurse and parent guide
It takes a village to raise a child
I recommend looking for support groups with experienced special needs parents. For this purpose, we have opened another Facebook group for parenting skills. This is in addition to our Stem cell therapy support group for families looking for information about the treatment based on umbilical cord blood or stem cells. Both of these groups are mainly for Hebrew speakers but you are welcome to join if you think it can benefit you.
For those who are not active on Facebook, join our silent WhatsApp group, where you will receive notifications about events we organize. Again most of these will be in Hebrew, but you can catch the odd English lectures. You can find recordings of these on our youtube channel.
There are many experienced parents in social media groups. You are also welcome to contact us of course for parental guidance or any of our other services.
The Autism Essentials Israel blog is written by Hagai and Shira Reiner, two parents of children with special needs – autism, epilepsy, and more. We focus on the essentials of raising special needs children in Israel, but much of our content will be relevant globally
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