Toilet training can be a difficult skill to learn for any child, but especially for one with autism. Parents of children with autism need to understand that there are certain attributes of autism and autism spectrum disorders that make it especially difficult for their child to learn to use the toilet with regularity and routine. Every aspect of toilet training comes into conflict with autistic personality traits, making the challenges of toilet training for parents of autistic children far greater than for other parents.
Routine and regularity are very important to children with autism. Changing a routine forces the autistic child out of his comfort zone, and he will usually resist such changes. Moving from the use of a diaper to the use of the potty is a major change in routine. Some autistic children may wear diapers for three or more years before beginning the process of toilet training; that is a deeply embedded routine they have to learn to change. Therefore, it can take extra time for them to build the new routine into their daily lives. Parents can help with this transition by creating visual schedules for potty training showing all the steps required in the new process or routine.
Motivation and Reward
For children who do not have autism, potty training is a rewarding experience. They feel pride when they get to wear "big kid" underpants like their friends who have already completed the process, and they look forward to receiving their parents approval when they use the toilet. For children with autism, such ideas about motivations and rewards are usually not part of their thought process. An autistic child does not particularly care about her peers and their underwear options, nor does she regularly seek approval from her parents. According to the TEACCH Autism Program's website, this is due to the autistic child's "difficulty with understanding and enjoying reciprocal social relationships." Parents will have to find other motivating factors to help their autistic child learn to use the toilet, such as rewarding her with extra time to participate in a favourite activity.
The bathroom is a place full of sensory stimulation. From the toilet seat itself ,which can be cold and hard, to the water inside it and the noise of the flush, the toilet can be frightening or fascinating to the autistic child. On top of that, the need to take off clothing in and of itself can provide sensory overload as the child has to adjust from the feeling of having his clothing on to having it off. All these sensory experiences may frighten or distract the autistic child in the bathroom. Even if he is successful in using the toilet, he may be overly interested in the sensory experience of the faeces and smear it around the bathroom, or he may not enjoy the sensation of the toilet paper and have difficulty cleaning up after himself. Parents may have to help an autistic child ease into the experience of toilet training with a lot of guidance and patience, helping the child become accustomed to one sensation at a time.
An autistic child may not be able to connect his own bodily sensations with the functions they indicate. In other words, she may not be able to connect the feeling of needing to go to the bathroom with the act of using the toilet. Therefore, she may have regular accidents in her journey toward toilet training success. This could continue even after she has learnt to use the toilet regularly, as she may be distracted by other things and forget to pay attention to her body's cues that she should stop what she is doing and use the bathroom. Parents will need to practice patience with accidents and establish a regular routine for using the toilet to prevent accidents whenever possible.
Parents who experience challenges with their attempts to toilet train an autistic child need to approach and solve those challenges individually. A child who has difficulty with the routine or steps involved in toilet training needs a poster in the bathroom to remind him of those steps. A child who is uncomfortable with toilet paper may need to use wet wipes or tissue instead. A child who plays in the bathroom will need regular monitoring when he is in the bathroom. A child who has a hard time learning to aim may need a target in the toilet, such as a small piece of cereal to aim at. By approaching the process of toilet training one simple step at a time, parents can help their autistic child learn to toilet train just like his peers.