6 Readiness Indicators for Toilet Training Young Children with Special Needs

Potty Training

Summer is the season when time seems to slow a little, when families “hang out” more, and take stock of their accomplishments and responsibilities to each other.

Across the globe, many people are currently  involved in a time-honored summer ritual; toilet training young children for the coming school year. Society as a whole treats toilet trained children differently, and has different perceptions and expectations for them.

The Toilet Training Process

Toilet training is a process for any child, but especially for those with Autism/special needs. A comprehensive social skills resource for these children, therefore must involve working on toilet training. In reality, it is considered to be one of the early social communication milestones that is overtly demonstrated in neurotypical children.  In Western cultures, toilet training is usually done with children around age two.

Of course, one needs to account for a child’s mental and psycho-social age,  instead of the chronological age, when addressing social skills development, even regarding toileting. As with any social skill, a child needs to be ready to learn. A child needs to have the groundwork done, and the “stage set”. Toilet training children with Autism can be challenging. It requires a level of motivation and cognition in the child, and a level of guidance and patience on the adult’s part as well.

Toilet Training Children With Autism

We want the special needs child to endear himself to others, yet we need to remember that these children, with their unique “inner landscape” and neuro-motor functioning, resulting in a different Theory of Mind (TOM), may be “blocked”,  or on a different time table. That is not to say that we shouldn’t make toilet training our preschoolers with ASD a priority! We just need to go about doing so in a sequential, organized, methodical, and consistent fashion.

This will help the child understand and internalize what is expected of him/her. It will also help him generalize what he learns to all environments such as home, school, and Grandma and Grandpa’s house etc.

Is My Child With Autism Ready To Be Toilet Trained?

Upon deciding to work on this important daily living skill, the child’s entire team needs to get on board and make it a group effort. The child’s success and mastery of this skill will certainly affect his future hygiene, social development, and overall behavior. One therefore needs to look at readiness indicators before starting to work on toilet training.

Below are some factors that may “block” a child with Autism from being ready to be toilet trained. These factors can include:

Sensory issues

Sensory Issues such as partial or total lack of sensation in certain body parts leading to unawareness of being wet, reduced Sensory Integration resulting in decreased body awareness and proprioception, and aversion to smells and/or hyper-sensitivity to smells

Behavioral issues

Behavioral issues such as transitioning difficulty, inability to cope with changes in routine, disorientation to person/place/time, and reduced ability to “tune in” and attend to the task at hand

Cognitive issues

Cognitive issues affecting understanding of the sequence of events (e.g. “Get undressed, sit on the toilet, stand up, wipe up, and flush.”) and/or target vocabulary involving body parts, articles of clothing, oral directions containing verbs (e.g. “Flush the toilet, turn on the sink, take soap, and wash hands.”) and part- whole relationships (e.g. “Pick up the toilet seat…..Push down the handle to flush.”)

Parents and professionals thus need to play detective and figure out if the child in question is truly ready to learn to be toilet trained.

Checklist of Readiness Indicators-Prerequisites For Toilet Training:

1. Joint Attention and rapport, so that positive reinforcement is meaningful.

2. Communicative Intent, so that child can ask for toilet and/or indicate wetness.

3. Understanding Causality (cause& effect, contingencies),  so that child can make a connection between his action(s) and your reaction(s).

4. Body Awareness so that child feels when he/she is wet and knows from where.

5. Understanding Part-Whole Relationships, so that child can follow the steps and make sense of the toileting process and the vocabulary involved.

6. Physical Agility, so that child can walk to toilet, climb up, and sit upright to use it, without any medical condition barring physiological/anatomical ability such as low muscle tone (hypotonia), spastic muscles, or poor motor planning and coordination resulting in difficulty walking (reduced ambulation) and chest i.e. thoracic rotation (sitting upright using the abdominal “core” muscles).

* This post has been adapted with permission from  Socially Speaking™ Toileting Protocol, with permission

Penina Rybak
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  • UTAvsFan

    Sooo, what if your kiddo never meets all the criteria ;) With a dual dx of Down syndrome and autism, as well as sensory issues, I don’t think my kiddo will ever meet these criteria. He is non-verbal and doesn’t sign. He doesn’t understand causality… I could go on. He’s 4 1/2 and we failed miserably at our recent first attempt at potty training :)

    • Billyboy.com.au

      I felt exactly the same way about my child, he is 9 now and has been going to the toilet (daytime) independently! I don’t even have to remind him anymore. This has been for the last 6 months. Honestly I wouldn’t have tried any earlier, you will know when he ready! Trust your instincts.

    • boogs

      4 1/2 is so young! Don’t doubt your Childs abilities! Dual diagnosis or not your child needs you to always have hope so you may drive positive change in his life. Just find what works for him. Mine is almost 6 still not potty trained. Were starting yet another technique next week and we’ve pretty much done it all. Just keep up that hope it will happen. Fight the good fight.

  • http://www.SociallySpeakingLLC.com/ Penina Rybak MA/CCC-SLP

    For UTAvsFan: Don’t give up! You now have info to open a dialogue and ask for a team meeting to chart your course of action! I obviously don’t know you or your situation but feel that the prerequisite goals to address are the Readiness Indicators I mentioned. Get the OT involved in the adventure :) At age 4.5 he still has time, don’t worry :) You can connect with me on LinkedIn to Email me questions, or use the form on my website’s page Helpful Suggestions: sociallyspeakingLLC.com. Good Luck!
    Penina Rybak MA/CCC-SLP, TSHH
    CEO Socially Speaking LLC

  • Anita

    my 6 yr old has always had a fear of the toilet so I literally cannot get him near a toilet let alone to sit on one. he will flush it for me but he is standing as far away from it as he can and stretchs to flush it. when it flushes he gets further away. what can I do?, getting desperate now.

    • KMO

      We have had sensory kids who we start sitting backwards on the toilet – if your child resists his feet off the ground, this can be the ticket. Helps reduce fears and give a good grounding

    • Branches of Life

      Is it a noise issue connected with the sound of a flushing toilet? Have you considered skipping the flushing part of toilet training for now, and just focusing on voiding into it until that’s something he’s comfortable with?

  • Eileen Jackson

    My son is 20 years old today, and on the severe end of the autism spectrum. Toilet training was one of the biggest hurdles we faced and the our best advice to any parent would be bribery, which is probably another word for “positive reinforcement”. Our son would never fit into the checklist above but he did understand go potty on the toilet and get a music CD.The goal is to get them out of diapers and bribery really does work along with age. Our son was 6 before he urinated and 9 before he had a BM in the toilet. It took lots of “potty” presents and Disney soundtrack CD’s , about a $500 of investment which was nothing compared to what we all gained. Just speaking from actual experience I think it is sometimes best to just relax and not put too much thought into the process just do what it takes to reach the goal. We had many, many years of expert advice , sometimes it helps and is always worth looking at, but common sense plays a huge role in raising a child on the autism spectrum and it works pretty good too!