Toilet Training 101 – Tips for Autism

POTTY T(1)How do you potty train an autistic child?  Isn’t that one of those million-dollar questions?  It is one I am still trying to answer for myself.  This post won’t necessarily be an explanation on how to do it, more just an overview of what’s happening in our house and some things I’ve done to help get us a little closer to bathroom independence.  We are still on that journey…and Lord am I so ready for it to be over!

When my son was about 3 he began to have a fear of the bathtub, he was terrified of it…which bled into just the bathroom overall.  He wouldn’t set a toenail in it.  So right as we were getting to that point (for my boys in particular) where the potty training signal was turning green, J’s signal got stuck on red, malfunctioned and completely burned out.  It was hard enough just getting him in there for a bath.  I had to keep him from climbing out of the tub, trying to bathe him with the other arm, while he screamed bloody murder.  I tried using a potty seat in another room, but he wanted nothing to do with it.  On top of all that, I was struggling with having no real form of communication with him and not always knowing for sure if he was able to understand what I was asking of him.  If we didn’t have that, then how the heck was he going to be able to tell me if he needed to go?  Plus, I wasn’t totally certain of his level of bladder control yet.  He was still waking up with wet diapers in the mornings (he still does even at age 6).  Not to mention he could have a mess in his pants, running down his legs and be completely oblivious to it.  I didn’t want to push him too hard because I was afraid that it would make him resist and fear the concept more, you know how they are about change.  So I ended up putting actual potty training on hold, for nearly two years.  Maybe that makes me a bad Mom, but I’m a tired Mom, I know when something is going to be a waste of time/energy and I need every ounce of what I have.

screen568x568unnamedWhat I did do during that time period was put a few apps on his iPad that introduced him to the topic in a fun way.  Pepi Bath was one that he really liked and so was Dino Bath and Dress Up.  Both had cute games for other skills like taking a bath, washing hands, brushing teeth, getting dressed etc.  I also took our potty chair and put it in the hallway across from the bathroom with the lid up.  I figured, this gets him close to the bathroom, but not in it.  He can look inside the bathroom as he sits there…baby steps, we needed to take baby steps.

It started working.  He began walk-bys while checking out the potty chair in the hall.  Then he’d go in the playroom and play his bathroom apps.  Soon he started to walk out with his iPad and began checking out the toilet seat while pushing various parts on his game that seemed to coincide with what he felt he was looking at.  He was making connections!  Eventually that gave way to him sitting on that little potty seat while he played his bathroom games.  Shortly after that, I noticed him peeking into the actual bathroom.  I asked my other kids to start leaving the door open when they would go so that he could watch what they were doing.  It wasn’t long before he was standing at the door whenever someone would go in, curiously observing what was going on while pressing the coinciding buttons on his apps to mimic what he was seeing.

One day J decided for the first time to go in the bathroom, all on his own.  He turned on the sink water and ran out screaming and covering his ears.  As much of a pain in the butt as it was to deal with this continually for several days, I knew he was starting to face some of his fears.  We had also been working on the same things in the bathtub, taking baby steps…which is another post I will do soon.  He started coming into the bathroom whenever any of us were in there with his iPad, watching and again, when someone would get some toilet paper, he would press the button on the app to give Pepi some toilet paper.  When it was time to wash, he translated with the app.  Everything he or we did, the app characters were always made to do.  He finally started getting brave enough to flush the toilet and run out into the hall.  Then about a week or so later he was able to flush and watch the water go down while staying in the bathroom.  After a bit of time all of this wore off and he seemed to have no interest again.  One step forward…one step back.

Everything withIMG_4243 Jadon is cyclic it seems.  Often we advance and revert, advance, revert.  I decided I needed to come up with something new to get him interested again.  He adores the movie Cars, so I printed out a large, colorful picture of Lightning McQueen and placed it in different areas of the bathroom each day.  I asked his wraparound therapist if she would begin taking him in to see where Lightning was and then exploring that area of the bathroom.  So if Lightning was near the sink, we turned the faucet on and off and talked to him about washing, etc.  I then asked the BSC (behavioral specialist consultant) for a social story that was personalized with pictures of J (and us) that talked about him using the potty and being a big boy like his brother and sisters.  I had his TSS begin reading that to him daily and we would walk him into the bathroom right after that.

It took about two weeks for Jadon to become acclimated to the routine and comfortable with it.  Once that happened, it was time to get him to sit on the toilet.  I knew that his sensory issues were going to prevent him from just diving right into bare-bottom sitting, so we began with just having him sit in his clothing on the lid of the toilet while we counted to ten.  He screamed his head off, but I knelt next to him and placed my hands on his lap to keep him seated and comforted.  We did this for about two weeks…until he was willing to go in and sit down on his own, which he did!  From there we moved it to opening the lid (which he had to do) and sitting with his pants still on, on a potty training seat insert for the toilet.  Counting to ten was also part of it.  I would explain to him how high I was going to count and again, kneel next to him so he knew I was there for him.  This was done for another two weeks or so, again until he was running in and setting up the toilet insert and step stool all on his own.  Finally I moved him to bare-bottom sitting.  He was a bit resistant about it, cried a little but sat until I counted to ten.  This was the longest phase because this was basically the last, outside of him actually going.

Every week I increased the count by five more.  I would explain to him at the beginning of each new week that we were going to count to a new number.  He did really great with it.  I think I stopped around 30.  I’m now at a point with him that I can just sit him on the pot without having to count and tell him he needs to go pee or poo.  Now it’s just a matter of getting him to release, and after that to be able to stay dry through the night.

Another thing that I started doing while we were working on bathroom-desensitization was trying to help him cope with the feeling of underwear.  I knew that this was going to be an issue.  To go from wearing a padded diaper or pull-up and then putting on underwear are two VERY different feelings…and that’s even for a person without sensory issues.  But for someone with them?  Huge deal.  So we did the same with counting, I would put on his underwear for a count of 5 once or twice every day.  He HATED them, the feeling was so different for him I’m sure.  We worked on this daily until he began taking off his pull-up to put on the underwear himself.  He always takes them off again to put the pull-up back on though.  I’ve been looking into those underwear that have an absorbent liner similar to a thick pad in them (I believe they are called TruFit by GoodNites) and the sides are elasticized similar to a diaper to help prevent leaking.  It seems the best of both worlds for transitioning, but the reviews on them aren’t very terrific.  I need to dig around more and see what I can find.  I think something along these lines would work really great for kids with sensory issues that are learning to use the toilet.

Another little something I feel worthy of mentioning.  Jadon loves home-videos.  He watches them obsessively, over and over again.  Sometimes the entire video, other times just a certain part.  I decided to use this to my advantage.  Anytime he even attempted to do something out of his comfort zone, even if for a short moment, I videoed it.  I found that he loved watching these videos..of course over and over.  I believe it helped him feel better about what he could expect while rationalizing it in his mind.  As a result I began noticing that he would take extra little steps in the days that followed, working closer to the goal.  I also started taking short videos of him when he would put on his underwear and take them off to put on the pull-up again.  I would narrate the video and emphasize how much he was a big boy and then when the pull up went on that, pull ups were for babies, he is a big boy now, big boys wear underwear, etc.  I actually use this technique for many of my so-called “training” lessons for him because they are so effective with that obsessive part of his brain.  He responds so much better when technology is involved.  Some people would claim that encouraging the obsessive behavior is a no-no, and maybe in some cases it might be.  But when it’s being turned into a tool to teach, I believe it should absolutely be harnessed.  This means that when he’s off in his own world, in his room, doing what he does for a large percentage of the day, I’m always there with him, teaching him.  I’m doing it within his comfort zone, in the way that he likes to learn.  And it works.  Again, this is another post I really want to do soon because if your kid is similar to mine, it is a great way to reach them while still allowing them that space they need.

This pretty much brings you up to date as to where we are in my house.  It’s definitely a slow-go, but we are making progress, and progress is good enough in my book, regardless of the speed.  I’m anxious about the fact that J is going to be 7 in March and we aren’t potty trained yet, but what can I do?  We go at his pace.  So I just keep moving forward, trying to “reinvent” the wheel when it seems necessary to do so.

What has potty training been like in your home?  Please feel free to share in the comment section, I’d love to hear about it.  If you have any tips you’d like to share, even better!  Best of luck to all the tired Moms and Dads that are as sick of diaper changes as I am!  =)


*No books, products or brand names etc, ever suggested on any part of my blog am I being compensated for.  They’re just personal preferences that I like or have found helpful/worthy of passing on.  Thanks! 

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