Justine is autistic. When I started working with the family, she was 5-years-old. She was not toilet trained and wore diapers. She did not seem to care if she was wet or soiled. She had limited language, but could let her parents know what she wanted by using single words, or taking her parent by the hand and leading them to what she wanted. But she didn’t let anyone know when she needed to urinate – she would just go in her diaper. When she had a bowel movement, she went into a corner and squatted.

Justine’s parents tried to have her go in the toilet. She would sit there, but would not void until her diaper was on. They wanted her to be toilet trained as soon as possible so she could go to the same day care that her brother went to. They were very frustrated!

Justine’s parents felt that she understood what they were telling her. Every time she wet or soiled the diaper, they told her that she needed to go in the toilet. Sometimes they scolded her. Sometimes they took her to the toilet. But, they were not seeing any progress.

Justine’s extended family was critical of Justine’s parents because she was not trained yet. They felt her parents were not strict enough with Justine.

First Steps – Reduce Everyone’s Stress

When I started working with Justine and her parents, we discussed that it is important to take the pressure off of Justine. If she feels stress and pressure about going to the toilet, it can make it harder for her to learn.

Many autistic children are very sensitive to others’ feelings. Some children just have greater difficulty learning to control their bodies. When they feel something is wrong, especially when their parents are upset, it makes it harder for them to relax their bodies and learn skills, including using the toilet.

Parents Felt Judged

Justine’s parents and I discussed what to say to their extended family about why she is not trained yet. They needed some emotional support to deal with the family pressure. I also suggested that they network with other parents in similar situations, because they were feeling isolated and that they were failing their daughter. (The Autism Community in Action (TACA) has chapters across the U.S. where you can network with other parents.)

First Steps

The first step of the actual toilet training was for Justine’s parents to take the focus off of Justine having to be toilet trained. They took a 2 week break and just matter-of-factly changed her diapers when needed. Visual learning is often a strength for children on the autism spectrum, so her parent went online and found a children’s toileting video that they thought Justine would be interested in. She liked it watched it often. Her parents also took a series of pictures of Justine going through the steps of using to the toilet, and put together a little book. Justine enjoyed looking at the pictures of herself. Justine’s parents also had Justine go with her sister when she went potty, because Justine looked up to her sister and often imitated her. Then her parents made a sticker chart. When she got 5 stickers, she could get a favorite figurine.

Using Rewards

At first, Justine would get a sticker just for sitting on the toilet while they sang a potty song from the video. Justine liked the stickers and rewards, and she developed a more positive association with the toilet. She started urinating in the toilet. Her parents praised her and gave her an extra sticker. After a few days of going in the toilet, she  only got stickers for when she urinated in the toilet, not just for sitting.

Toileting Progress

Justine was trained to urinate in the toilet within 1 month. She was still having bowel movements in her pants though. Her parents were coached to not make a big deal about it. They just periodically reminded her to poop in the toilet, and would have her help empty her diaper in the toilet, to reinforce the concept that “poop goes in the toilet”. It took about 3 months, and then she started having bowel movements in the toilet.

Following Up

Justine continued to have some accidents and her parents did get frustrated, and hoped that Justine would be trained quicker. So, we checked in periodically, and they were reminded to remain calm and not resort to pressuring Justine, as she could regress. They did stay calm and were very patient. Justine was completely trained by the time she turned 6. I know that seems late, but that is the reality for some children on the autism spectrum.

Final Thoughts

Patience and support is what it took to accomplish toilet training Justine without unnecessary struggles and stress for everyone in the family. If you’d like help with toilet training your child, please contact us.