So, you have determined it’s time to potty train your child with ASD. Now, what??? How is this done? Here is a guide to help you through the “Potty Training a child with ASD process.”
Check out our post on- Is my child ready to be potty trained to learn more about toileting readiness.
· Accessible toilet or potty chair
· Highly preferred reinforcement
· Preferred liquid
· Salty snacks
· Program instructions outline
· Extra clothing
· Exciting books, music, toys to keep in the bathroom.
· A pants alarm-it device is an effective tool but usually not all that necessary. Also, keep in mind children with sensory processing disorders may have a hard time with this.
· Items to prevent mess- use mattress covers, furniture protectors, roll up the beautiful rug that you don’t want to ruin. This way you will react in a relaxed manner when there is an accident.
· Visual cue if needed (non-verbal children)
Ok, I have what I need. What do I do next??
No more diapers
You want your child to feel the wet sensation when they urinate in their underwear. This is building their awareness.
Also, you don’t want them to sit in a soiled diaper since they get used to the feeling. You want them to notice right away and change them. They will learn the difference between wet and dry.
I don’t recommend pull-ups since it is essentially the same thing as a diaper. You can use training underwear (thicker underwear) or plastic pants (avoids the mess, but the child still feels the wet sensation).
If you don’t want to train at night, pull-ups or diapers can be used at bedtime. But only put them on right before bed and change them back to underwear the moment your child wakes up.
Easy access pants
When potty training your child try to dress him in pants that have easy access. Avoid dressing him/her in pants with buttons, belts, hard to open snaps etc.
Increase fluid intake
This way we can get about 20 learning trials in a day so we can practice. After all, ABA is all about data and as many trials as possible to promote generalization! This helps with the learning curve.
The extra drinks phase only lasts 2-3 days and it is generally effective.
It is important to use preferred liquids such as sodas or juices since your child will not want to drink so much water. (Just make sure to brush his teeth that night extra well!)
Another idea is to serve your child salty snacks so he is motivated to keep drinking. We want a high frequency of urination to speed up the teaching process.
Rewards for successful use of toilet
We are setting our child up for success- Giving enough fluid, taking him every fifteen minutes, and reinforcing when he potties.
This makes him want to go again and moves up the learning curve.
Buy the most motivating reinforcers!
Even if you don’t love using a candy or a specific toy as a reinforcer, use it! It’s a short process and will help your child stay motivated!
Taking Data is VERY important.
You will feel like this is not working but if you take data you will notice that the first half of day one was 3 accidents; the second half was only 2 etc. You will see the learning curve and feel successful.
Keep the datasheets in your bathroom or use an app on your phone.
It is very easy to lose motivation when you are not tracking progress.
Also, you may notice a pattern of how often you went to the toilet and your child did not need it. As this occurs, you will learn your child’s schedule and adjust. We may also notice if a specific time/place is prone to accidents.
As a parent, you can write up interventions on your datasheet to keep handy.
Record: date, time, place, success/non-success, type of voiding, scheduled/self-initiated.
Keep the environment helpful
It is important to keep the environment helpful. Remove any obstacles to the toilet. Another good idea is to keep a stool near the toilet so your child can easily climb up.
Create a routine
Every fifteen minutes say “it’s time to go potty. Say potty.”
Have your child repeat potty (bathroom or whatever you would like them to say) and then take them
Reward if anything goes in the toilet. It doesn’t matter how much but it has to be something. Just sitting on the toilet shouldn’t be rewarded.
Repeat this every fifteen minutes and in between use dry pants checks and reinforcements.
Store the rewards in the bathroom.
The contingency has to be quick, with no delays. “You make, you get!”
The reward should be heavily emphasized– “Yay! You made!” or by dry pants check, “Yay! Your dry!” However, use less reinforcing items for dry pants and more special for using the toilet.
Dry pants check
Praise when they are dry. This helps avoid accidents and teach kids continence. Explain your pants are dry, you did not make in your underwear. You don’t want them to think you are proud they didn’t spill water on their shirt. Children with ASD need us to be very specific.
Positive practice for accidents
This is key and is the most important.
It’s a behavioral procedure when there is an accident.
It is not meant to be a punishment, it’s a teaching procedure.
Immediately after discovering an accident, say in a clear, firm voice, “oops, you forgot. You wet your pants. We don’t potty in the living room. We potty in the bathroom.”
Take them to the bathroom, take off wet clothes, and have them sit on the toilet for 5 seconds.
Even if they resist don’t give up and do it anyways.
Don’t get upset, scream, etc. You will get them scared and they are making the connection that being potty trained is scary. You can say we are not upset but we have to practice.
When you are finished resume your toileting schedule and take them back in 15 minutes.
The procedures above last for about 2 days.
You then can begin to dial back the potty schedule to normal, waiting about 60-90 minutes between toilet episodes but keeping the same strategies.
Also, work on teaching communication strategies upfront since children with ASD can become prompt dependent and we want them to initiate.
Even if your child does not say “I need to potty,” but starts whining, crossing legs, etc. then take them. You should prompt them to verbally state that they need the bathroom or show visual.
If you are using a visual cue make sure it is small and easily accessible. Visual cues can be helpful for verbal children as well. Sometimes at the moment they can get anxious and using a visual can help.
It is key to setting yourself up for success.
Make sure you are fully prepared both in your plan and supplies.
Once you start, you can’t decide to stop. It will make it harder to reach mastery. Timing also has to be appropriate.
Don’t choose a time with stressors (moving, holiday break, new baby, etc).
Also, it is helpful to baseline how often your child urinates and has a bowel movement.
It is important that the caregivers, teachers, and all therapists, etc. are on board with the same intervention for accidents. Preparation and coordination are key.
Good Luck and feel free to comment or leave a question!
A lot of this post is based on the teachings of Toilet Training in Less than a Day by Azrin and Foxx. It’s an old book but it has endured and is still considered the most research-supported intervention.