Written by Quiera Bonds, RBT
Potty training can have unique challenges that can be hard to implement. Children with autism spectrum disorder (ASD) may learn to urinate in the toilet first and have a more difficult time with making a bowel movement (Dalrymple & Ruble, 1992). The following factors may inhibit a child’s ability to successfully use the bathroom:
Language: Language could mean the child is having a hard time comprehending and being able to use the language to say they have to use the potty. Children may also have difficulty with understanding language and following one-step directions (e.g., “go to the potty” or “sit down”).
Dressing: Dressing can be a concern due to the child’s ability of being able to pull their pants down as well as pulling them up.
Sensory defensiveness: This can be a concern because some children may be afraid of sitting on the toilet seat or hearing the sound of the toilet flushing.
Problem behaviors: A child may experience tantrums or noncompliance when transitioning to the toilet.
Other toileting barriers may include: Non-ambulatory, lack of sight, and not meeting the recommended potty training age of 2.5 years old.
Having knowledge of these factors is important. This is the first step in assisting a child with meeting their developmental needs.
The next step in helping the child effectively potty train is to use appropriate intervention methods. Some of these methods include:
Prompting: These are cues that help guide a child to successfully exhibit that skill. Prompting hierarchies, or levels of support, are different levels of support that help guide a child to complete the skill and achieve independence.
Prompting types include:
Verbal (e.g. telling the child to go potty)
Gestural (e.g., pointing to the potty)
Visual (e.g., showing the child how to use the potty with pictures or books)
Modeling (e.g., showing the child how to use the potty with a stuffed animal)
Physical (e.g., physically guiding the child to complete all the bathroom routine steps)
Some of the prompting hierarchies used are:
Most-to-Least: This includes using the most intrusive prompts first, such as physically guiding a child to the bathroom and physically guiding them to sit on the potty.
Least-to-Most: This includes using least intrusive prompts first, such as verbally telling a child to use the bathroom.
Activity schedules: These are visual supports that outline the specific activity expectations. Including a visual schedule with the bathroom routine may eliminate the barriers to problem behaviors. This would outline the specific expectations of following a bathroom routine and outline when the child would move on to another activity (e.g., preferred activity).
Following a bathroom routine with specific intervals: Having a schedule for the child has been one of the most effective ways. Parents can develop an interval schedule for the child to follow based on how long the child can hold it at maximum (e.g., 10 minutes). Having a set number of times, the child will sit on the toilet a day can help.
Start off by just having the child sit on the toilet for 5-10 seconds for the first few trips and gradually increasing the time.
Having a timer can also be extremely helpful as well. This will tell the child when it is time to sit and when it is time to get off the toilet.
Parents should not wait for the child to tell them they have to use the toilet when first following a bathroom routine. It would be beneficial to tell the child when they need to go potty.
Make the potty trips part of the child’s daily routine. Be consistent with the same times every day.
Parents should use simple and easy language (e.g., go potty) and/or pictures (e.g. picture of a potty is presented). This will help the child learn what to say when they do ask for the potty (Foxx & Azrin,1973).
Visual supports: This breaks down tasks that have multiple steps through pictures to help the child follow each of the steps needed in order to use the bathroom correctly. Taking pictures of the actual bathroom and placing them on a board next to each step might be the most effective way to help a child with using the toilet.
Having a visual schedule will help the child know what to expect when they are making their trips to the toilet. A visual schedule is a graphic representation of scheduled tasks and activities. It breaks down tasks that have multiple steps and helps to ensure the child follows. Taking pictures of their bathroom at home and placing them on a board next to each step will help with them using the toilet. An example of this:
Token boards: This is a reward system that parents can use to help their child comply with difficult tasks in exchange for preferred items or activities. Children must follow through with the desired behaviors (e.g., steps in the bathroom routine) in order to earn a token for each step and exchange those tokens for a preferred item or activity (e.g., cartoon time or a piece of candy). This reward would only be used for potty training purposes and the child would not have access to them any other time. It is also good to give the child verbal praise when they use the toilet. An example is “good job going in the potty.” All these steps will help make it easier and successful when potty training a child with autism spectrum disorder.
Other important notes for parents when potty training their child:
Make sure the child is drinking plenty of water. This will contrive more opportunities for the bathroom.
Know that accidents may happen! It is important to redirect the child to the bathroom and ensure that they are still learning.
Encourage positive interactions during potty time! Sing songs, read a book, and have other happy distractions.
Do wet/dry checks. If the child is wet, then immediately take them to the bathroom. Let them know that voiding or bowel movements go in the potty. For example, a parent or other caregiver may say, “uh oh! Pee pee goes in the potty.”
Avoid diapers during potty training. That could delay potty training because a child may not feel it, which may lead to a decrease in motivation. Try potty training underwear.
Don’t worry! Potty training can be a long process.
References:
Carbone, Vince. “Potty Training Self-Initiation Protocol.” All Points Licensed Behavior Analysts, LLC, 21 May 2020, allpointsaba.com/.
Dalrymple, N.J. & Ruble, L.A. (1992). Toilet training and behaviors of people with autism: Parent views. Journal of Autism and Developmental Disorders, 22 (2), 265-275
Foxx, R. M., & Azrin, N. H. (1973). Dry pants: A rapid method of toilet training children. Behavior Research and Therapy, 11, 435-442.
Luiseli J. Teaching toileting skills in a public-school setting to a child with pervasive developmental disorder. Journal of Behavior Therapy and Experimental Psychiatry. 1997; 28:163–168.
William, G., Oliver, J. M., Allard, A., & Sears, L. (2003). Autism and associated medical and familial factors: A case control study. Journal of Developmental and Physical Disabilities, 15, 335-349.
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