Toilet training can be trying for any family—but when your child has developmental delays, including autism, the process can seem almost impossible. Our expert comes to your rescue—with clear, step-by-step instruction on how to achieve success.
The standard toilet training literature preaches traditional wisdom: Your child will tell you when they are ready, read a few books, expose your child to the bathroom, and just like that, they’ll be toilet trained! Children with many special needs, however, have greater success with a more structured and systematic approach to toilet training.
When do I begin?
There are some signs to look out for which signal that your child may be ready for toilet training, including:
- Child’s diaper is dry for long periods of time
- Child appears to know when he/she is about to eliminate (facial expression or posture may change; child may even choose a corner or somewhere private)
- Child can follow simple instructions
- Child responds to some form of reinforcement
- Child shows discomfort when soiled
- Child is interested in the potty/bathroom
- Child signals that diaper is soiled
In typically developing children, these signs may appear between 18-30 months of age, but children with developmental delays may show these signs at a much later stage, or may not show them at all. This should not discourage you from toilet training your child; if by 3 years old your child is not showing these signs, go ahead and begin the process anyway. Beforehand, consult your child’s physician to rule out any medical issues that may hinder the process.
Be sure to choose the right time to begin the toilet training process—weekends or stay-at-home vacations when you can be fully committed with no other distractions are some possibilities. A time when your child is sick or being weaned off the pacifier or naptime may not be the best times to introduce a new skill. Organize a meeting with your spouse and all of your child’s caregivers, teachers, and therapists to brief them so everyone can follow the same protocol.
The key to successful toilet training for your child is consistency. Most important, be relaxed and confident in your abilities to train your child to use the bathroom independently. If your child senses that you are anxious, chances are he/she will be more resistant and non-compliant. Also, prepare for possible changes in your child’s behavior or mood when the toilet training process begins. Be extra patient and focus on fun activities during down time.
Prepare your child.
These are all skills your child will need to be familiar with during the actual toilet training process so give them a head start by preparing them early:
- Keep the bathroom door open and let your child explore.
- Have your child watch members of the family go to the bathroom.
- Allow your child to see eliminations in the toilet.
- Allow your child to experience flushing.
- Read books about toilet training that have clear and relevant pictures.
- Show your child videos about toilet training (check out this Elmo video).
- If you buy a small potty, place it in the play area and use your child’s favorite dolls or animals to act out the toileting process.
- Teach your child the language associated with toilet training (e.g., “pee-pee” or “I need the potty”). This is essential so that your child learns how to request the potty on their own, a skill that may be very difficult and may come much later in the process for children with developmental delays.
NOTE: If your child uses pictures or sign language to communicate, expose them to the potty symbol/picture (printable images on Google or Do2Learn) or hand sign for “bathroom.”
Prepare the environment.
- Roll up area rugs.
- Block off areas that are “off limits” during toilet training (carpeted areas, couches, etc.).
- Remove stuffed animals and books if you don’t want them to get soiled.
- Cover fully carpeted areas with plastic sheets or shower curtain liners.
- Keep dry towels and disinfecting wipes handy for easier cleaning in case of accidents.
What to Buy:
- Many pairs of underwear (medium shades of blue and gray are the best because you can immediately see when they are wet!)
- Modified potty (optional)
- Step stool (to place in front of toilet if needed)
- Wet wipes
- Digital timer with alarm sound (child should hear it)
Reinforcement Is Key!
Rewarding your child for successful eliminations in the toilet is an essential part of the process, helping him or her learn the correct steps and build confidence. The key is choosing a reinforcing item that your child can have ONLY when they successfully eliminate in the toilet.
Choose perishable items (snacks, drinks) and give your child a very small piece or sip so that they are highly motivated to get more. Repetition over time will teach your child the toilet training contingency: If you eliminate in the toilet, you get special treats! Make sure to give the reinforcing item directly after elimination to quickly teach this connection. You can do this by keeping the item in a clear bag in the bathroom cabinet or very close to the bathroom out of the child’s reach.
It is also important to pair these treats with social praise (“Great job making pee-pee on the potty!!”) because you will eventually be able to fade out the reinforcing item and provide more natural, social praise when your child eliminates on the toilet. Calling your child’s favorite family member to boast of the good news may serve as a highly effective reinforcer as well.
Written by, Nadine Maher, M.Ed., BCBA, Clinical Supervisor and Behavior Consultant at NYCIT. She specializes in young children with developmental delays and Autism.