By Denise Reynolds, RD
Toilet training a child is sometimes difficult to do even in the best situations. But add on top of that challenges such as autism, and parents can be overwhelmed by the task. Obviously, becoming independent with bathroom habits is critical as the child becomes older. With all the skills and resources parents have at their disposal, the most important for toilet training is patience.
Remember first that autism is not mental retardation or lack of intelligence. This is important to keep in mind when introducing new skills to an autistic child. However, the lack of appropriate verbal and nonverbal communication can make toilet training challenging.
Also understand that there are milestones that need to be achieved before attempting toilet training in even normally developing children. These include recognizing a child’s readiness for the task, such as being able to sit, walk, dress and undress, and the ability to recognize the bodily clues that indicate the need to use the bathroom. Positive reinforcement is recommended for any child tackling something new ?to them.
A child with autism, however, has impaired social interaction skills. They may not respond to the same motivation that a normally developing child would. For example, writes Danica Mamlet in Autism and Toilet Training, difficulties in comprehending language and logic may inhibit the ability to understand what is expected in regards to the toilet procedure. They may not understand it when you explain why they need to eliminate in the toilet and not in the diaper. They may also feel resistance to the change in routine, the stimulating environment of the bathroom (bright lights, noise coming from running water), and the change in temperature they feel when taking off their clothes.
In addition, a child with autism often has gastrointestinal problems that make a regular toilet training schedule a challenge. GI problems such as abdominal pain, bloating, gaseousness, constipation, and/or diarrhea, are more prevalent in children with autism. Try to correct these problems if you can before toilet training, so that discomfort will not be yet another obstacle to overcome. For example, if your child is constipated, ensure he is drinking adequate amounts of water and eating enough dietary fiber to make stools soft and easier to eliminate.
For successful toilet training, Mamlet encourages the use of visual cues versus verbal cues. A system that uses picture icons with each step identified is recommended as a tool to teaching toilet independence. A consistent routine capitalizes on the autistic child’s need for repetition.
To accommodate resistance to change, gradually introduce the bathroom routine over time. First, have him or her enter the bathroom clothed, then clothed to sit on the toilet, then in diapers, and then unclothed. The use of separate potty chairs is not recommended, as your child would then have to transition later to the bigger toilet—yet another change to tackle. But do make sure the seat of the toilet is comfortable and secure.
If your child attends a preschool or day care, speak with the teachers about how you can follow their schedule at home as closely as possible. Open communication here can be very helpful as you exchange tips with each other regarding what is best for your child.
The use of a transition object (a preferred book or toy) may be used to teach your child when it is time to go potty. For example, part of your routine may be to eat dinner, play with a certain toy for 30 minutes, and then pick up his or her transition object and take it to the bathroom where he will follow the visual chart to remove clothing and sit on the toilet. Other parents like using “potty” dolls that pee after giving them a drink as teaching tools.
If your child is verbal, have him or her learn some appropriate bathroom words to describe when he needs to go. Nonverbal children can be taught some simple sign language, or here the use of picture cards may be helpful. One mom of an autistic son uses the Picture Exchange Communication System (PECS) and places laminated cards in each room of the house so her son can pick one up when he needs to go to the bathroom.
Remove as many obstacles and distractions as you can. If your child is light-sensitive, put lower wattage bulbs in the bathroom lights for a more dim room. If your bathroom is large and the child seems overwhelmed by that, make a half-bath his own, if possible, with favorite features and colors.
Just as with a normally developing toddler, the use of a reward system is key to reinforce positive behavior. Again, the key here as a parent is patience. Potty training an autistic child is likely to start later and take longer than it would with another child. Each child has their own personal clock and like all of their other skills that they develop, potty training will come in time, too.
Denise Reynolds is a consultant dietitian and writer based in Greenville, North Carolina. This article, Potty Training Tips for an Autistic Child, was reprinted with permission and originally ran on www.examhealth.com April 20, 2012.