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December 2010



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Training Time!


First Published Sunday, 4th May, 2008.

While some autistic children are toilet trained without any difficulty, becoming clean and dry at an unusually early age, others are late in learning and may be very resistant to training. The general rule is not to make any fuss about children’s mistakes but to take them to the potty/bathroom regularly and especially at those times when they are most likely to need to empty their bowels or bladder. This would include upon waking after a dry night or daytime sleep, after meals and after drinks given between meals. If successful, the child should be given lots of praise and attention for successful performance and perhaps some other suitable reward(sticker, token etc) that ties in with the child’s main interests and is meaningful to him/her.

Many children on the spectrum dislike, even fear the potty or toilet. A very cold seat will be enough to worry some. The flushing may terrify children, though it may fascinate others. Resistance to change in an established routine is one of the reasons for delay in toilet training. Many will only wet or soil when wearing a nappy. Some may display excellent bowel and bladder control, remaining clean and dry for hours until a nappy is placed on them. As babies, they had learned to associate bowel and bladder function with wearing a nappy and cling to this routine after infancy has passed.

When it came time to training my three children, as well as a multitude of others in my care(special needs children included), maintaining a relaxed, calm approach complimentary to a reliable, structured routine enabled training to occur as a natural progression over time. That’s not to say that there weren’t challenges along the way, such as my youngest son hiding behind curtains or under the trampoline, having discovered yet another cosy place to release a movement. They say that boys are harder to train than girls. Our daughter(AS) was trained within 3 days as it simply “clicked” with her. She was 2 yrs of age and went directly from nappies to underwear. A musical potty worked well for our youngest son. Our sons(both AS) took substantially longer to train, but what matters is that old phrase “all in good time” as eventually, with patience and perseverance, when your child is good and ready(often with ‘gestalt’ learning) the pieces simply come together, falling perfectly into place after a period of time.

The following information includes a look at a very helpful book, some helpful toilet training sites and how to handle one of the less desirable behaviours, smearing.

games make it better!

BOOK: “Toilet Training for Individuals with Autism or other Developmental Issues”


Table of Contents

Ch 1 …. The Importance of Toilet Training

Ch 2 …. Determining Readiness

Ch 3 …. Developing a Toileting Routine

Ch 4 ….Dressing for the Occasion

Ch 5 …. Habit Training

Ch 6 …. Teaching Continence

Ch 7 …. Communicating the Need to Use the Toilet

Ch 8 …. When Toilet Training is Successful

Ch 9 …. Toileting in Unfamiliar Environments

Ch 10 … Nighttime Training

Ch 11 … Support Strategies

CH 12 … Common Problems (and Solutions)


Data Collection Form

Sample Social Story



“… once a person is beyond four years old, toilet training usually becomes a priority.” (pg. 11)

From Chapter 1

Autistic people have been reported by researchers as being the most difficult population to toilet train. Many techniques used to toilet train children are not sufficient when used to teach toileting skills to autistic persons. There are, however, strategies which have been demonstrated to be effective when teaching toileting skills.

Every individual is unique. However, there are particular characteristics associated with autism that impact behavior. These factors have a significant impact on the success of challenges presented when toilet training. To be successful in one’s training efforts, it is essential that the characteristics and needs unique to the individual be considered when planning interventions.

on the line

Characteristics to be addressed when planning intervention include:

  • Communication needs

  • Literal communication

  • Sensory awareness

  • Sensitivity to stimulation

  • Preference for routine or ritual

  • Motor planning difficulties

  • Limited imitation

  • Sequential learning

  • Increased levels of anxiety

  • Difficulty adjusting behaviors to fit new situations

From Chapter 3

Rather than be viewed as a single event, toileting needs to be approached as a sequenced chain of behaviors that includes all of the behaviors preceding and following elimination. Use visual cues such as picture strips showing the sequence of behaviors to complete as part of the entire toileting process.

Approach using the toilet as an entire sequence of related behaviors for the learner to complete, including:

  • Follow a visual schedule for eating foods, drinking fluids and accessing the toilet.

  • Enter the bathroom and close the door when appropriate.

  • Undress only as necessary for using the toilet.

  • Sit on the toilet, relax, and remain on the toilet until finished.

  • Access toilet paper, wipe, and properly dispose of toilet paper.

  • Get off the toilet, flush one time, close the commode lid, and get dressed.

  • Wash and dry hands, properly dispose of towel, indicate being finished with toileting, and exit the bathroom.

  • Return to check what is next on the schedule and begin that activity.

From Chapter 5 – Habit Training

One type of toilet training available is called habit training. When providing habit training, the goal is to develop bladder and bowel control by regularly accessing toileting facilities. Eliminating in the toilet becomes a learned habit by repeating the behavior in the same way over and over. This is different from the other goal of other types of toilet training. Usually the goal is teaching persons to independently access facilities when they are aware of the need to eliminate. Habit training provides a socially acceptable way to have dignity and improved personal hygiene when someone is not a god candidate for usual toilet training techniques.

Habit training may be an appropriate option to consider if:

  • There is no awareness of the need to urinate or defecate.

  • The person is older than six years of age and other training techniques have not been effective.

  • The individual has a mental age lower than three years.

  • There is no awareness or change in behavior when diapers or clothing are wet or soiled.

The most critical part of a successful habit training program is the development and consistent use of a suitable schedule. With habit training, accurately identifying times when the learner usually urinates and has bowel movements greatly affects the program’s success.

Developing and following a routine is an important part of habit training. Anytime the person is taken to the toilet, be sure to follow the entire toileting routine including visual prompts, undressing and dressing.

  • Avoid asking if the person needs to use the bathroom when the schedule indicates a toileting time. Simply prompt the person that it is time to use the bathroom. Allowing the person to indicate that they do not need to eliminate should not be an option at this point. The cue for “potty” on the schedule is the signal that the toileting routine needs to begin.

  • If the individual wets or soils clothing between schedules toilet times, calmly help them clean up with minimal social interaction. Do not act emotional, hostile, or upset. Do not scold, lecture, or nag. Simply help the person clean up in a dignified manner and continue with the next scheduled activity. Continue to take the person to the bathroom in accordance with the schedule, following the usual routine and making no reference to the earlier “accident.”

    Diaper Cake

From Chapter 12

Negative Reactions to Taking Away Diapers

Occasionally, someone being toilet trained becomes upset and resists attempts to replace diapers with training pants or underwear. For individuals sensitive to the texture and pressure provided by different types of fabrics or clothing styles, this can be a significant source of discomfort. The satisfying sensations provided by the diaper may come from the tight feel at the legs and waist, the overall pressure of the diaper’s snugness against the body, or the feeling of the particular fabric against the skin.

When someone reacts negatively to having diapers replaced with training pants or underpants:

  • Place diapers over the underpants and over time gradually cut away or otherwise remove small parts of the diaper, starting with the part that does not provide the greatest amount of satisfying feeling to the person.

  • Have him wear underpants instead of diapers for short periods of time daily, gradually increase the number of periods in underpants, then increase the time frames.

  • Use preteaching strategies and reward wearing underpants.


Lauren tantrummed when Mom put underpants on her. She enjoyed the snug, thick feeling of her diapers. Mom decided to put underpants on Lauren and put her diaper on top of the underpants. Lauren did not seem to mind this. Mom slowly began fastening the diapers slightly looser each day, until some days they would fall off. This gradual change did not seem to bother Lauren. She would remove the diaper when it was too loose and became accustomed to the feel of underpants. After two weeks of baggy diapers, she would fuss if Mom tried to put a diaper on her.

Book Cover

Tips for Toilet Training

  • Use simple, concrete language.

  • Be consistent with the teaching method and use the same one everyday. If it isn’t working after a few weeks, try another method but then be consistent with it.

  • Get the child’s team and family member’s on board with the toileting plan so everyone uses it consistently. Toileting occurs across many settings.

  • Use visual supports throughout the toileting process to reinforce the steps. ASD children need visual supports to help process information.

  • Take the “autism view” when toileting. Break steps down into a logical order so the child understands them.

  • Use rewards that are truly motivating for the child and then only use them for the toileting process. Make sure they are meaningful to the child and not what a parent thinks is meaningful.

  • Reward mini-steps along the way to keep motivation high.

  • If the child does not know how to physically release a bowel movement, try having him blow bubbles or use a blowing-type toy (pop bottle whistle with a string that moves when you blow into it) while on the toilet to mimic the feeling of releasing a bowel movement.

  • Never punish a child for accidents or slip-ups. These will occur along the way.

  • Toileting is a complex process – have patience. It may take many weeks to break years of using diapers.

petey in training


Smearing faeces generally begins by incidental action when a child, exploring his own body, finds faeces in his nappy and pulls out a sample. To the child, faeces has no real meaning, negative or positive, until he/she encounters it. If the child is on the autism spectrum and enjoys the sensation of it, then he/she might be reinforced by that sensation and over time, learn to find more faeces with which to play in the absence of other acceptable stimuli for which he/she can be reinforced and in which he/she can find enjoyment. Both children and adults on the spectrum may smear, throw and/or eat their own faeces.

At a second level, social problems arise when concerned adults make a fuss over the faeces(as well as the child’s behaviour) from a health-hygiene perspective. Depending on the response from adults, a child may be reinforced socially for faeces-play by the fact that everytime he/she plays in it, generally mother approaches. Over time, faeces play becomes a form of powerful communication meaning “Come here!” Therefore, when any child(or adult) smears faeces, parents/carers need to approach after a random period of time without any fuss and direct the child to an acceptable activity for which he can be reinforced after half a minute or so. (The same applies to deliberate urinating or vomiting and self-injurious behaviour.) As is the case with so many other behavioural issues, punishing the child in a neurotypical conventional sense, for smearing faeces, actually makes the problem worse as any attention is “good” attention to the child.

For further reading…

“The Potty Journey”Author: Judith A. Coucouvanis


“TEACCH – Applied Structured Teaching Principles to Toilet Training”Includes examples of visual systems:

“NAS – Toilet Training”:


“18 and Under – To Treat Bed-Wetting, Try Healthy Doses of Patience”:


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