I think one of the most difficult hurdles of parenting is potty training.
It is embarrassing for me to admit, but I had a difficult time potty training my son. Actually, getting him to pee in the toilet wasn’t so hard; it was getting him to poop that was problematic. I dispensed advice all day to parents on all kinds of behavioral issues, but was ashamed at my failure when it came to my own son. He wanted to “hold it in” and not go. I eventually had to take him to a specialist to determine if there was a gastro-intestinal problem. Of course there wasn’t. There was just the stubbornness of a child who didn’t want to go. He would turn red as a beet and look as if he were going to explode, and still nothing would happen. I started to think that he was going to join the ranks of the less than one percent of kids who weren’t trained by age 4. Miraculously, about a week before his fourth birthday, he decided to use the toilet.
There are endless books on the subject of toilet training. While it is true that some children can be trained in a day, many cannot. Young children have very few options when it comes to control. They are generally not allowed to make choices. Consequently they exert control over things that no one else can influence: sleeping, eating and toileting. As every experienced parent knows, you can’t force a child to sleep or eat or go to the bathroom.
So if toilet training is complicated for the average child, it is even more so for children with special needs.
When attempting to train a child with autism, a multitude of factors need to be considered. It is imperative that the child’s level of cognitive functioning, social-emotional aptitude and sensory issues all be considered. Normally, toilet training is appropriate once the child indicates awareness of the urge to go. That may not be realistic if the child is non-verbal. Many schools require a child to be toilet trained in order to attend. If that is the case with your child, then you have to try to potty train using behavior strategies.
One of the first things I recommend is for the parent to assess their child’s reaction to the bathroom. This is actually beneficial to any parent who is looking to potty train their child. However, because autistic children have so many sensory issues, it is important to determine that the child is comfortable in the bathroom. Does the child already enjoy bathing and associate the bathroom with a good experience? If not, then it is a good idea to start training with a portable potty in an area of the home that the child likes. Or you can attempt to get your child comfortable with the toilet by taking them in fully dressed and just sitting them on the toilet for a few minutes each day prior to training. Add some sensory friendly items to the bathroom. Making a pleasant sensory environment will help dispel some fears at the outset.
The next concern is the toilet or the portable potty. As adults, we don’t give the toilet much thought other than acknowledging what it is designed for. We don’t think about the sensory aspects which might be frightening for a child with sensory issues. The toilet seat is cold; it is hard; it doesn’t feel secure. A flushing toilet makes an unusual sound. What’s more is that voiding into a toilet and watching a bowel movement vanish can be scary. Some children think that a part of them got flushed away.
Be aware before you get started on training that it may take months or it may happen quickly. Try not to get discouraged (okay, I admit I did) and realize that your timeline and your child’s may not coincide. I am going to try and give some tips that will help with specific issues. Overcoming sensory obstacles and emotional issues will help facilitate the process.
Be sure to get a child sized seat if you are using your toilet. Having too much space is uncomfortable and fear-inducing. The new padded seats that go over the regular seat are very good.
Decide ahead of time if you want to potty train on a schedule, or if you’d rather try the technique advocated by the “train in one day” proponents.
If you train on a schedule, then you want to feed your child at specific times, and then follow up with a trip to the toilet. Alternatively, you can put your child on the potty, and then keep them there until they go. While they are on the toilet you give them a lot to drink, and while waiting engage them in play and activities. When I worked with children who were trained in this manner, I would set up a low table in front of them and play with them while they sat. Periodically I would check to see if there was any “progress”. With either style of training, it is good to give a reward like a sticker when the child is successful. Also remember to give verbal praise along with the reward.
Usually the child is initially successful only with urinating. Certainly it is easier to know when a child needs to pee, which makes scheduling trips to the potty fairly easy. Bowel movements are a different story. I know from my own situation that succeeding with one does not guarantee an easy time with the other. Children with autism can have a fear of letting go of their bowel movements into the toilet. If this is the case, there is a good trick you can try. I mentioned it previously in a post about sensory issues. You can try cutting a hole in the back of the diaper or pull up. Then sit your child on the toilet while wearing the diaper. They will think they are making in the diaper. Once they have voided, show them what they did. Be very enthusiastic about the accomplishment. Keep repeating this practice while gradually making the hole larger and larger. This technique is good for several reasons. Wearing the diaper on the toilet allows the child to feel secure. Repetition of sitting on the toilet helps develop a new habit. The reward and praise make it a positive experience.
If your child has issues with the sound of the toilet flushing, you can try to minimize the sound by focusing your child on something else. One thing is to sing a song while the toilet is flushing. Make it fun by having your child make up the song. If your child is non-verbal, then play some favorite music while the toilet flushes. You don’t want to avoid the flushing because it is an important component of toileting. Try and be creative about ways to make the flushing less scary. Some toilets, like low volume flushers which are good for the environment, don’t make much noise.
Staying calm and keeping the training positive is very important. If your child has an accident, don’t reprimand them.
Making the situation negative or stressful will only hinder progress. Eventually your child will learn. It just may be on their timeline, and not on yours.
For more tips and strategies, About.com has some good advice.