Toilet Training in Autism
What are the prerequisites?
Anyone who has done a bit of reading about toilet training, or discussed the same with a GP or other professional will likely be aware of the list of readiness signs. Most books or professionals will reference a set of readiness behaviours outlined by Brazelton et. al (1999) including:
- Recognizing when wet/soiled
- Shows discomfort when wet/soiled
- Able to pull pants up/down
- Able to communicate need
- Displays predictable patterns: (Wake up dry; Go 2 hours between voids)
- Show an interest
- Display routines (hide, squat, etc.)
But what if children are not showing readiness signs?
Well, most families we have met are told to keep waiting. Sometimes, that works, but sometimes families find themselves with adolescents or teens in nappies. And for some children with autism who may have limited communication skills, sending them to school or respite still requiring full assistance with intimate care can be quite scary for families.
Over 10 years ago, I had the opportunity to work at an autism centre with some amazing psychologists running a toilet training consultation programme. Based on some work in this programme, Kroeger & Sorensen (2010) published a set of reinforcement-based procedures used to successfully toilet train two children with autism who displayed limited signs of readiness. Even prior to their journal article, we presented a conference paper showing positive results using the same procedures with a larger group of children (Sorensen-Burnworth, Kroeger, Eidman-Sheahan, & Lentz, 2006). Of 13 children aged 3-13 attending our centre with whom an intensive, reinforcement-based programme was used, most displaying no more than 3 prerequisites:
- 7 of the children were toilet trained within 3 – 7 days
- One participant toilet trained in 9 days
- Two withdrew from the training
- Two continued to require additional training for bowel movements
So what do we say?
We certainly won’t argue that things are that bit easier when children are displaying signs of readiness, but we’ve observed first-hand that many of these prerequisites can be taught with the right strategies. It does however require a lot of work, very individualised strategies, and constant monitoring of what works and what doesn’t.
Toilet training in autism can be a huge chore, but also an unbelievably rewarding accomplishment. It requires full commitment and what feels like an endless number of days washing laundry and cleaning the furniture. So, if you’re looking to tackle toilet training full-on, we suggest you consider giving it a try, but keep in mind the following parent readiness signs that will help you set up for success:
If you need a bit of guidance, have a look at our short course for parents, and be sure to use the code ‘reachlaunch2020’ to get 40% off. And then if you would like assistance creating an individualised programme, read more about our toilet training consultation programme, or get in touch.
Brazelton T. B., Christophersen E. R., Frauman A. C., Gorski P. A., Poole J. M., Stadtler A. C. et al. (1999). Instruction, timeliness, and medical influences affecting toilet training. Pediatrics 103, 1353-8.
Kroeger, K. & Sorensen, R. (2010). A parent training model for toilet training children with autism. Journal of Intellectual Disability Research (6), 556-567.
Sorensen-Burnworth, R., Kroeger, K., Eidman-Sheahan, S., & Lentz, J (2006). Reevaluating “Necessary” Prerequisites for Toilet Training Children with Autism: 32nd Annual Convention of Association of Behavior Analysis International, Atlanta, Ga.