Tackling toilet training for autistic children

Toileting is an essential skill that requires time, patience, and effort to master. 

Many autistic children face more challenges than neurotypical children when it comes to toilet training, making the process more complex. However, with the right information and a safe and positive environment, families can successfully support their autistic child through this important developmental milestone.

Misconceptions around toilet training

Several misconceptions about autism and toilet training can create unnecessary challenges for families, and understanding these myths can help families teach this skill more confidently. 

Your child does not need to be able to dress or undress independently to start toilet training; many children learn dressing skills at the same time as toileting skills. Being able to copy others or communicate verbally is also optional, as key toileting skills can be taught through alternative communication methods (e.g., visual supports).

Remember, teaching toilet training to a child with autism will be different to teaching a neurotypical child. Ultimately, there is no ‘right’ or ‘wrong’ way; all that matters is that you and your child are safe and comfortable.

Before you start

Before beginning toilet training, there are a few skills your child will need:

• Some awareness of urinating: Recognising the sensation or act of urinating helps children understand toileting. Eventually, this can help them signal to people around them that they need to use the toilet or use it independently.
• Ability to sit comfortably: Your child should be able to sit safely and comfortably for several minutes without needing to stand up.
• Periods of nappy dryness: Your child should be able to keep their nappy dry for periods of time before toilet training begins. Identifying these periods can help families and professionals plan toilet training attempts (when your child will try to use the toilet).
• Understanding of ‘first, then’ instructions: Whether verbal, written, or visual, your child will need to understand these instructions to some extent (e.g., ‘First, we take off our nappy/underwear, then we sit on the toilet.’)

In addition to the skills mentioned above, your child should be comfortable in and around bathrooms. A professional such as a psychologist, occupational therapist, or behavioural specialist, should be called in to assist you if your child has any anxieties or phobias around using the toilet. Your child must also be safe - if they engage in self-injurious behaviours or have any medical issues (e.g., chronic constipation, diarrhea), a professional must also address these immediately.

Getting started

Once you are confident that you and your child can start toilet training, it’s time to plan how you will approach this process. A clear and consistent plan can make things less confusing and overwhelming for everyone involved.

Families must consider how much time they can realistically dedicate to toilet training. Some methods are more intensive and require scheduled times, while others are more flexible. The time commitment will also depend on who is involved in the process, such as parents, carers, relatives, or professionals. 

Before getting started with toilet training, families should also prepare the following items:

• A seat/potty/insert that your child can sit on safely and comfortably for several minutes. Ideally, this will not be too cold for them to sit on. A stool should also be placed under your child’s feet if they don’t touch the ground.
• Plenty of water for your child to drink, giving them more opportunities to practise using the toilet and keeping them hydrated.
• Toys and activities to reduce anxiety or boredom while waiting on the toilet. This also helps to create positive associations with toileting for the child.
• Rewards for successful attempts to use the toilet, such as toys, activities or snacks. Keeping these close to the bathroom so you can easily give them to your child helps to motivate and encourage them.
• Changes of clothes, underwear or nappies close by. Consider how many layers of clothing your child usually wears and how easily and quickly they can be taken on or off. For this reason, many families opt to try toilet training in the warmer months, even keeping their child in just a nappy when practising toilet training at home.

Practice sessions

Practice sessions can help build your child’s understanding and confidence around using the toilet, and there are a few approaches and resources families should consider to make these sessions successful. 

Finding visual aids such as books or videos about toilet training can help your child learn and be more motivated. Many free videos on YouTube use popular children’s characters or toys to explain toilet training, making the process more entertaining. Families can also use these resources to practise ‘first, then’ instructions, such as ‘first, we flush the toilet, then we wash our hands, then we go and play.’

Practice sessions should also involve spending time in the bathroom and sitting on a potty, toilet or insert so the child can learn to do this safely and comfortably. To start, work towards your child spending ten or fifteen minutes in the bathroom, even without using the toilet - this helps them familiarise themselves with the space and reduces their anxiety. After achieving this, you can encourage your child to practise sitting on a potty or toilet for a minute, then two, then five or ten. 

Practice sessions can also address other aspects of toileting, such as transitioning from nappies to underwear. Families might, for example, cut a hole in their child’s nappy or have their child wear underwear underneath the nappy to help them gradually transition out of nappies, which is a big step in toileting. 

Positive reinforcement

Encouragement and praise are very important when toilet training an autistic child, as they reinforce positive behaviours and motivate the child to continue progressing with the skill. Here are some examples of how you can give encouragement and praise to a child with autism:

• Descriptive praise: verbal praise that explicitly states what the child has done well. For example, ‘Well done for sitting still on the toilet!’ Using the child’s name before giving the praise is even more effective.
• Visual supports: using reward chats or visual supports can help to communicate to your child that their behaviour is good. For example, creating a reward chart where your child receives a star or sticker each time they successfully use the toilet helps communicate their progress to them.
• Other rewards: providing your child with other rewards, such as their favourite toy or activity, after they successfully use the toilet, can help create positive associations with toileting and encourage your child. ‍
• Nonverbal praise: gestures that show you are happy, excited or proud, such as a thumbs up, high five, big smile or clapping. Keep in mind that these nonverbal cues can be challenging for young autistic children to understand, so reflect on your own child’s comprehension before using them.

Different approaches

Various approaches to toilet training exist, which can be confusing for parents and carers supporting an autistic child. Choosing a method that suits your child’s learning style and the time and energy commitment your family can make is important.

The two main approaches to toilet training are called ‘schedule training’ and ‘initiation training.’ Schedule training involves trying to use the toilet at specific times each day. It’s less demanding and can be a good starting point. Initiation training, on the other hand, is more intensive and involves frequent toilet use at unscheduled times. Families can start with scheduled training and decide whether to move to initiation training based on their child’s progress.

Families must consider other important factors when deciding how to approach toilet training. First, choose how many people will be involved in toilet training an autistic child. Whether it is one parent, two parents, parents and relatives or parents and professionals, anyone involved with toilet training a child with autism must approach the process in the same way. Without a consistent approach, a child with autism may become confused, leading to anxiety, behavioural challenges or regression in their progress. 

It is important to have a consistent approach when using rewards for toilet training. Some families find that using rewards motivates their autistic child and makes the process more effective. Other families prefer to avoid using rewards or find that they are not a helpful incentive. Using rewards is a very personal choice, but if your family does decide to use them, make sure they are given out consistently so as not to confuse or upset the child. 

It is also essential for families to consider where they will practise toilet training. Some might prefer to only toilet train at home, while others might also want to practise at relatives’ houses or in early learning settings, such as childcare. It is ultimately a personal decision based on your and your child’s comfort level, and the approach might change depending on the situation (e.g., using nappies at special events if it will be difficult to access a toilet quickly).

Common challenges and solutions

Challenges are inevitable during toilet training. By closely observing your child’s mood and behaviour, you can identify and address issues early, helping everyone stay on track.

Finding the right approach

In the early stages, finding the best way to teach your child how to use the toilet may involve trial and error. Focus on determining how your child learns best (e.g., books, visual supports) and what challenges might prevent them from starting or progressing with toileting.

Remain open to trying new things or adjusting your approach if things are not working or your child regresses in their toileting. Although it can be frustrating or upsetting when a certain approach does not work, forcing it to work can cause your child’s progress to stall or even regress. 

It is perfectly normal and okay for parents and carers of autistic children to find toilet training overwhelming. Approaching this process works best when everyone feels calm and positive. If you are struggling on a particular day, taking a break is better than trying to push through. If toilet training frequently overwhelms you or your child, take a break and try again in a few weeks or months. If you need to take a break, be kind to yourself; this is not a sign that you have done anything wrong; your child might just not be ready yet.

Sensory sensitivities

Many autistic children have sensory sensitivities, which can cause challenges during toilet training. For example, a child with noise sensitivities might find the sound of a flushing toilet too loud, making them fearful to use the bathroom. Explain what this noise is to your child and why it happens, and let them practise flushing the toilet themselves to help familiarise themselves with the sound. Some children might also find wearing headphones or earplugs helpful when starting toilet training. 

Autistic children can also have sensory sensitivities around touch and temperature. Warm up the bathroom or toilet before your child uses it if you can, as children may be uncomfortable spending time in a much colder room. Use a potty/insert and place a stool under your child’s feet if they don’t touch the ground, which can help them to sit more comfortably without worrying about slipping or falling. 

If your child has sensory sensitivity around light, consider whether the lights in your bathroom or toilet are too bright and need to be adjusted. As mentioned above, giving your child comfort objects that provide sensory input, such as fidget toys, can help them remain calm on the toilet. 

Bowel movements and night-time training

Many parents worry about their children managing urination but struggling with bowel movements or having accidents at night. Night-time training usually starts once a child has had dry nappies at night for a whole month. If your child avoids using the toilet, it can cause health problems like urinary tract infections (UTIs). Seek professional advice if this behaviour or other concerns arise.

Seeking professional support

Professional support can be very helpful if you’re struggling with toilet training challenges. Psychologists, occupational therapists, GPs and behaviour support therapists can offer guidance and strategies tailored to your child’s needs, particularly if your child demonstrates behaviours of concern or health problems that impact their toileting.

Toilet training an autistic child successfully involves patience, persistence, and flexibility. Families can navigate this important developmental milestone with the right approach and support. Remember to celebrate small successes along the way and seek help when needed.

Toilet training is a significant step towards independence for your child. By understanding their unique needs and providing a supportive environment, you can help them achieve this important skill.