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• Resists sitting or doesn’t sit and relax long enough: Encourage your child to sit with his/her clothes on. Make sure the

seat of the potty chair or the toilet is comfortable to your child, maybe it needs to be softer, maybe lined with a diaper, maybe

warmer, or maybe your child’s feet need to be more stable. Some children may need to have the hole on the toilet smaller and

experimenting with various sizes of seats or even covering the toilet with a towel or cardboard may help. Give your child a reason

to sit such as his special reward that he/she gets while sitting. Use modeling by sitting together or having a doll or favorite stuffed

animal sit. Give the child a visual or auditory cue about how long to sit by a visual timer or the length of a song. Help your child

relax while sitting by providing support for feet and body where needed and rubbing your child’s legs. Sometimes children are so

tense that they can’t relax and go.

• Afraid of flushing or excessively interested in flushing: Encourage your child to play in water that swirls in other

places than the bathroom and at appropriate times. Always let your child know when you are going to flush the toilet when he/she

is in the bathroom. Gradually bring your child closer to the toilet by providing a place for the child to stand while you are flushing.

When your child is ready allow him/her to flush and either run or stay and watch. Establish a rule that you only flush once then

you are all done.

• Afraid of public bathrooms: stalls, hand dryers, different sinks, toilets that flush automatically: At first, it may be

necessary to be aware of the public bathrooms you may frequent to know what is likely to cause your child problems. Some of

these can be avoided like being far away from the dryer and not walking under it and practicing with soap dispensers and sinks

that go on by themselves in a fun way. Protect your child from toilets that automatically flush since some splash a lot. The more

you know about the quirks of the public restroom the more you can prepare you child. The handicap stalls are wider and more

accessible many a sink next to the toilet.

• Playing in water or with toilet paper: Take the toilet paper off the roll and put it up until your child can master the use of

it. Put safety catches on toilets until your child can understand that toilets are not places to play. Allow lots of water play in

appropriate places and even swirling water to watch such as in “tornado bottles”. Lower water toilets aren’t as much of a

temptation while sitting. Use tissues that are folded or pre-measured, a box of wipes, and folded toilet paper are helpful.

• Resists being cleaned or not wanting to be dirty: Sometimes smearing of feces begins by the child trying to clean

himself. They may try to clean up then make a mess. For whatever reasons your child may be having trouble in this area it is

wise to stay as calm as you can. Establish a clean up routine that is not especially rewarding, but is comfortable and quick. Make

sure the wipes are big enough and comfortable enough for your child including temperature and texture. If your child gets some

feces on his hand and is distraught help the child wipe it as soon as possible. Show the child that they can wash their hands clean

with soap and water. Sometimes as children with autism grow older they become upset when something happens like a toilet

overflowing or they get their hands dirty and react out of proportion, so we want to assure them early on that this can be fixed

quite easily.

• Fear of having bowel movements or constipation: This is a common problem for many children with autism at some

time in their childhood. It may be contributed to by diet, not sitting long enough, not being able to relax, their activity level, or

various other factors. It is helpful to help a child recognize that the grunting and squatting he/she is doing helps make a bowel

movement and that is good. Many children go and hide in a corner to do their poop and resist a change. Help them move closer to

the bathroom and perhaps identify where to squat by using a plastic mat as the spot. Gradually influence the action to the potty or

toilet over time the child associates the grunts and pushes as signals. A child may have to go in the diaper even while sitting for a

while so try a diaper-lined toilet seat. If a child experiences constipation on a regular basis bowel movements may be

uncomfortable and you may need to seek advice from you doctor.

• Trouble in standing while urinating: When your son is sitting to urinate and completely toilet trained or when he shows

an interest in standing he may need help. A visual chart of how boys use the bathroom may be helpful. For example action

pictures of a boy putting the seat up, standing while urinating and aiming in into the toilet. Sometimes boys do not want to touch

their penis because they may have been told not to touch on some occasion. A male in the family may need to demonstrate how

to point and aim. Something may be used for a target like a floating paper, a Cheerio, or colored toilet water.

• Regression in toileting: Sometimes a child who is fully toilet trained will begin to have many accidents. Evaluate changes

that have occurred and what information or additional supports may help your child feel comfortable again. Some reasons

regression may occur are after an illness, after a parent has been away, after a move, after starting school, after a baby has been

born, or when going to the bathroom has been painful. Your child may be in a situation where he doesn’t have the skills to tell

someone he needs to go and holds it too long. His supports may not be in place. Sometimes at school there is something about the

environment or the schedule that is causing problems for your child. Go back to all the original supports that worked and put

them back into your child’s life while reassuring your child that he/she can and will succeed.

Consistency in Toilet Training

Your child can be toilet trained. However, training your child with autism will likely take more planning, attention to detail, and

consistency than training typical children. (Remember that all children with autism are different and some are easy to train.) You

have to organize the sequence and provide a schedule and consistency until your child understands how all this relates to his body

functions. Keep your expectations realistic and reinforce your child for trying as well as for success, always reassuring the child

that he/she will succeed and there is plenty of time to try, and be persistent.

Can I please here some success stories??

For children with a communication deficiency visual learning may be an appropriate way

to teach toileting skill. Does the child understand language? Does he or she understand

"potty", "diaper", "dry pants", "toilet", "bathroom", or any other words, signs, or

pictures/symbols that may convey the idea of toileting. Children with Autism may have

difficulty understanding and associating words with actions and most will at least need

more time to process what you say. Can the child express the urge or need to use the

toilet? Expressive language is almost always a problem for children with an autistic

disorder. It will be important to be able to read their cues and/or teach a way to express

the need or urge to use the toilet.

Special consideration for children with autism:

• A child with autism may not be able to communicate a need to go to the bathroom, therefore body signals from the child,

routines, and visuals might be significant aides.

• The child with autism may learn to use the toilet at home and be unable to adapt to a new situation easily.

• A child with autism may have sensory difficulties such as discomfort by the hard toilet seat, being afraid of water splashing,

or want to play in or watch the swirling toilet water.

• In public bathrooms children with autism sometimes fear the hand dryers, have problems with the doors, the way the toilet

flushes, or any number of challenges.

• Having a bowel movement is often harder and occurs less often. Some children go off alone and squat, some insist on wearing

the pull-up or diaper to make a bowel movement, some fear that it hurts, some smear feces, and others want to be clean so much

that they react to getting anything dirty on them.

• Rule out any medical problems and account for fears that may have developed due to pain from constipation or urinary tract

infections in the past.

Before you begin toileting make sure your child does not have a medical problem which would interfere with making toilet training

a success. This can be ruled out by the family physician after a routine physical. Contact your physician if you notice any unusual

signs like too much or too little urination, painful urination, urinates frequently or unable to hold urine. The same applies to

concerns with stool. Children with Autism have a higher than expected rate of bowel problems (constipation or loose stools or

both) and require extra care if this is the case.

Making Toilet Training a Success

• Before starting, keep a record for a few days, charting every 20 – 30 minutes whether your child is dry, wet, or dirty.

Some diapers have a strip that changes color to make this easier. Chart periodically, maybe once a day each week after starting

training to keep track of progress, problems, and tendencies.

• When you start training, prepare the environment with the needed equipment and remove extra distractions.

• Plan a schedule that will match the report you gathered. If you child usually stays dry for an hour, anticipate to take

him/her to the bathroom about 10 minutes before. Try to match the schedule to the natural cycles of the day.

• Plan the routine that you will have your child follow and make a picture chart of that routine so that your child and

everyone who helps him can follow it. Change the cue level by decreasing examples as the child achieves the skill.

• Watch for signs of readiness such as when your charting shows being dry for an hour, your child indicates in some way

that she is wetting or soiling diapers, indicates in some way that she has soiled or is wet, regular bowel movements, or interest in

others going toilet.

• Keep positive, praise attempts, praise being dry and clean, use reinforcement and give your child time.

• When your child has some success with understanding toileting help him/ her learn to indicate that they are going to the

toilet with a sign, word, or picture or several of these. Children today often use potty, pee and poop, but signing toilet may work

or a picture of the toilet may be helpful. Visual cues as part of your routine helps the child tell you when they have to go potty.

Visual and Verbal Cues in Toilet Training

• Give a visual and verbal cue –such as an auditory giving the child a buzzer or bell. Decide what verbal cue you will use such as

go potty, go pee, or go to the bathroom. If you use a signs, pair it with the verbal cues.

• Enter the bathroom with the cue needed (verbal, light touches, taking the child’s hand, or more physical assist).

• Pull pants down to ankles with cue

• Sit down with cue

• Pee or poop or both with cues

• Get toilet tissue and wipe with cue

• Stand up with cue

• Wipe, if needed, and throw tissue in toilet with cue

• Pull up pants with cue

• Flush toilet with cue

• Turn on water and wash hands with cue

• Turn off water and dry hands with cue

Use visuals: For many children, having a picture of a toilet or potty chair as a cue to go helps. You might also make a picture

schedule to sequence the major activities of the day adding the toilet pictures before or after these. Children have learned to go on

their own in this way. The pictures can be laminated and put on with Velcro or inserted in plastic sleeves so you or your child can

take them off or change the order. There are also videotapes about using the potty that some children with autism have reacted

well to. Other parents have made videos for their child to watch, some have paired music with the pictures. Model for you child,

use books and pictures sequences about going to the toilet. Visuals help your child know what to do, remember what to do, and

learn from the sequence.

Use imitation: Imitation is a type of visual. Many children with autism are delayed in their imitation abilities, but many do watch

carefully to what is going on around them even if they don’t seem to immediately imitate. Watching someone close to their size

use the potty may be useful, but it is helpful for them to see that going to the bathroom is something everyone does. Some

children might respond to the use of a doll to go through the steps.

Teach privacy and modesty: Most young children undress anywhere and don’t care who sees them go potty. However, as they

are approaching four years of age, they often begin to want more privacy. Children’s needs must be considered and children have

to be taught what society expects. Consider teaching your child to undo and pull down pants only in the bathroom as well as

pulling up and fastening pants before leaving the bathroom. Once your child is toilet trained teach him to close the door. Also you

might want to consider teaching your child when and where he must be clothed or covered and not naked. Teach them to ask for

ask for help with bathing.

Use words that are appropriate: Some children with autism are constant with the words they heard when very young and will

not change to more appropriate words later. However, if you are aware of the need to be age appropriate it usually works to use

the words that everyone else of the same age is using.

What's the best way to communicate to your child that it's

time to go to the bathroom?

If you notice your child needs to go to the bathroom but

isn't initiating the process his/herself, try some subtle

cues to get them headed to the bathroom.

Hand them a "toilet cue" - an item like a toy, sticker or

picture to let them know it's time to go.

Use an empty wipe box as an indicator.

Try adding some sign language to your repertoire. The

sign for toilet is the letter "T" waved slightly.

Toilet Training Tip Number 2:

How can I overcome my child's fear of sitting on the toilet

Lots of autistic chidren develop a fear or discomfort of

sitting on the toilet. This reaction can be worked through

by helping the child become familiar with the toilet without

requiring them to actually use it.

Practice sitting them on the toilet fully clothed.

Let the child play, read, or color while sitting on the toilet

fully clothed. They will become gradually more comfortable.

Allow your child to sit on your lap on the toilet. As

you hold the child, they will be secure knowing you

are there to help them and will gradually relax.

Practice the procedure using a doll or favorite toy.

If your child is able to observe the procedure with their

favorite item, and realize nothing bad will happen,

over time the unease will go away.

Toilet Training Tip Number 3:

What do you do if your child refuses to urinate in the

toilet?

Sometimes children don't fully understand what they are

being asked to do. Communication problems can make the

discussion of urination challenging. The best thing to

do may be to use the "show me" method.

Adding food coloring to the water helps illustrate

what urinating in the toilets is all about. Just like

magic, a little urine combined with the previously

colored water will guarantee a color change. This can

be very intriguing for the child trying to master the

skill.

Having something to aim for is always fun as well -

try biodegradable packing peanuts, special made animal

shaped toilet floats, or cheerios cereal.

Toilet Training Tip Number 4:

What can I do to get my child to use a bathroom at a public

place?

Sometimes the fear of the unknown is the biggest hindrance for

us all. Try to make trips to public restrooms as predictable

as possible.

Provide a travel toilet kit stocked with toys, a visual

cue, preferred wipes & hand cleaner.

Bring along a Walkman or MP3 player to mask some of the

sound of others in the bathroom.

Accompany the child into the bathroom to direct them and

eliminate unnecessary distractions.

Toilet Training Tip Number 7:

What do you do if your child plays with faeces?

Answer:

Some kids love to play with the faeces or "smear". Although

this is disgusting to us, the child thinks this is a fun, sensory

toy. Provide them with some sensory options or make it so

difficult to get at the faeces that they don't have the option.

- Put the child in bicycle pants. These pants are so tight

fitting, and usually come up high enough to cover the nappy,

making it very difficult for little hands to get inside at it.

- Use a reinforced belt. Many outdoor recreation stores

offer belts made from a webbing material with a sturdy belt

closure. Not only will this belt be hard to work under,

but also the closure will be difficult to open.

- For small children, some parents like to use cloth dog

collars. These collars are made of a sturdy web material

and have closures that are hard for the child to open.

- Offer a belt with a variety of toys to play with attached

to the belt. Keep rotating the toys, so it's always

something new and intriguing. Koosh balls, yo-yo's, silly

putty, and cartoon toys, stretchy toys - all are good options

to keep little hands busy.

Thank you for all your support!