Toilet Training Older Children With Autism

Introduction

Normally a lot of children with Autism spectrum disorder have delays in all areas of development, this causes them to lag behind the developmental milestones. This is because they find it difficult to learn/acquire new skills. They also find it difficult to break long-standing routine which makes it difficult for you to change their routines or teach them anything (in this instance wearing a diaper or using the toilet).

How do I know that my autistic child is ready for toilet training?

When autistic children are ready for toilet training they show certain signs that are typical or normal for developing children sadly as autistic children get older it becomes increasingly difficult to toilet train them even when they show these signs and hence can take longer to train toilet train them.

You know your autistic child is ready for toilet training when they start to show signs like:-

1. Being able to alert you or call your attention to her whenever she has soiled or wet heir diaper or clothes using gestures or signs.
2. Having consistent or regular bowel movements.
3. Defecating or pooing at regular intervals.
4. Being cognitive enough to follow simple sets of instructions like “sit down there” or “pee in the toilet”
5. Being self sufficient enough to take off his clothes.
6. Staying without peeing for more than an hour.

Can my autistic child get to old for toilet training?

The answer is simple a child cannot get too old for toilet training, although the earlier your start the better for you and your child.

It’s important for parents with autistic children to know that it’s normal and even expected for autistic children to take longer than the average child to get ready for toilet training and to actually master the toilet training, this is because many autistic children generally suffer from developmental delays.

The average child is fully toilet trained by age six but for autistic children( especially nonverbal autistic children) or children with developmental delays/challenges the process takes longer, so if your earlier attempt to toilet train your child failed you may want to wait and try when they are a little older.

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Toilet Training Older Children With Autism

Here are some strategies that you can employ when toilet training older child with Autism:

1. Out with the diaper and in with the underwear: introducing underwear to your child is a very effective way of making your child aware of when he “needs to go” because he start to associate the feeling of wetness and discomfort to going to the toilet.

The effectiveness we admire modern pull-ups and diapers for is a hindering factor in toilet training because it gives a consistent and comfortable feeling of dryness and hence your child is unaware if he has wet himself or not.

You may want to limit the no diaper strategy to when you’re at home with him because it will help to prevent “accidents” in public places like schools, churches, cinemas, and maybe even in your car.

2. The reward system: you can also use the reward system to encourage your kid to use the toilet by using select toys, games, activities, snacks or treats that will help to encourage your child to use the toilet ( preferably his or her favorite object or snack). For example whenever he or she successfully urinates in the toilet you can let him or her have more time on the iPad or give him or her a treat. This will make your child use the toilet more often and effectively because she anticipates a reward for her good behavior. If your autistic child does not understand words like if or when you can use picture to illustrate it for him for example you can put a picture of a child sitting on the toilet and then use an arrowhead to show the child with any reward you have decided on.

The reward system is efficient because it relays your expectations to your child in such a way that the will motivate them to comply with your expectations.

Note: it’s also important that the rewards are delivered immediately after every successfully trip to the toilet  because the faster they associate these rewards with their progress or success in the bathroom the faster they will endeavor to acquire this skill. Do not let the rewards go on for too long as soon as your kid seems to be mastering the skill stop the rewards or else it can lead to a draw back when you stop the rewards too late.

3. Use of simple and clear communication: use simple and clear signs or words to teach your kid how to use the toilet. You can even use a picture to explain it you him or her.

You may also find that is better to say “time to pee” rather than “ do you want to pee?” or “do you have to go?” It can also be more effective if you show your kid a picture or visual  of using the toilet while pointing him in the direction of the toilet or asking him to use the toilet without any further discussion.

4. Pay more attention to your child’s routine: in this method you have to have your child’s routine down pat. You can do so by keeping track of when her“ accidents” usually happen and then try to prevent it. For example, you may notice that your child’s pees around 30-40 minutes after a glass of milk, orange juice or any other liquid so using this information you stage or schedule her toilet trips at the times when she seems to be more likely to pee so as to build this habit and help her acquire this skill.
5. Use of encouragement or praises: another way to encourage your child to use the toilet is by praising him for every step or aspect of using the toilet he manages to master for example if your child sits in the toilet you can say “ John is a good boy, he sat on the toilet” or you can simply clap for your child, high-five your child, give him a thumbs up, or do anything that can show that you’re pleased with him.
6. Try to be more sensitive: initially your child may not show any signs that indicates that he has to go for example gripping himself, crossing his legs; so they tend to go without warning but as he begins to become more aware of when his bladder is full he begins to show signs of wanting to use the toilet. Parents and caretakers should try to be more sensitive and attentive to such signs that indicates that the child has to go to the toilet; (some of the signs that a child may use are looking longingly in the direction of the toilet, pointing at their toilet picture or even handing you there toilet device the) and promptly respond to them to encourage future use of these signs.
7. Use of visual aid: most autistic children find it easier to learn with visuals, so you can follow this example to toilet train your child by providing visuals on the simple steps involved in toilet training. This will help to give them clues on how to use the toilet. You can use the Picture Exchange Communication System (PECS) or any other visual aid to toilet train your child.
8. Create a schedule and stick to it: make a schedule for using the toilet and go over it with your child, make sure everyone who helps you child with the toilet knows and stick to the schedule this will help to establish a routine in which your child can become comfortable and confident to the extent of using that toilet by herself.
9. Use of specific language: Try to Use  specific language when relaying instructions to your child about using the toilet so as to reduce confusion for example you should say to your child “ peter, sit on the toilet and pee” rather than pointing to the toilet and saying “ sit”.
10. Be consistent: being consistent can help you reduce confusion and avoid setbacks for you child an example is using different words like toilet, bathroom, the loo etc. to refer to the toilet When speaking to your autistic child should be avoided, get everyone in the house to use a specific word to refer to the toilet so your child’s immediately understands what to do when he hears the word.
11. Consider all sensory sensitivities: simply put sensory sensitivities refer to your child’s awareness of each if his or her sensory channels for example touch, taste, smell etc. If you notice that your autistic child seems to be uncomfortable or overly sensitive to the sensory aspect of using the toilet you can help her feel comfortable by;

• Explaining to her the reason for everything to reduce her anxiety ( like if I push this button you will hear a flushing sound and water will come out).
• Provide a stool or step so that her legs don’t dangle when she seats on the toilet.
• If your child seems to be afraid of falling into the hole let him practice with a training seat.
• If the floor feels cold, wear socks on her feet.
• Let him hold any object that seems to calm him while he sits on the toilet.

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Note that:

1. Don’t be over anxious for results and don’t get upset when your child’s progress seems to decline rather be patient and try to make the toilet a happy place for her to visit. You can do so by using stickers or fun colors to decorate the toilet.
2. It’s very important for parents to consult with their pediatrician or healthcare provider before starting toilet training so that you can check for and eliminate any medical conditions that can potentially disrupt or hinder toilet training, and inform your when and if your child is ready for toilet training.

With children who can’t speak or have verbal limitations you can teach them signs with which they can inform or alert you whenever they have to go. You may also consider fixing a picture relating to using the toilet to you child’s clothes so that she can simply point at it to tell you she has to go. For children who require  an assisted communication device, you can fix a picture relating to the toilet so she presses it to tell you she has to go.

Melinda Godfrey