Green Magic

For little boys who are reluctant to use the toilet, try adding blue food coloring to the water in the bowl. When they pee it will turn green right before their eyes. Magic! For variety: red food coloring + pee = orange.

Muffle it

Keep a pair of earmuffs next to the toilet for the reluctant trainees who can’t tolerate the sounds of flushing.

Poop or get off the pot

Success! Your child is still dry during the day, and perhaps even at night. You’re ready to tackle problem #2. Here are some pitfalls to avoid:

1.    Be aware that for some children, the added pressure and weight of a diaper filled with waste can be calming and therefore, they will resist having a BM in the toilet.

2.    If your child has a BM in his pants within twenty minutes of exiting the bathroom, make the toilet training experience more relaxing. Longer time on the toilet will not help.

3.    Be careful with picture cues of waste in a toilet. Some individuals with autism may interpret this as meaning they can have a bowel movement anywhere, as long as they then dispose of the waste in the toilet. Use a picture cue that shows waste being expelled while sitting on the commode.

4.    If constipation is a problem, add more fruits, vegetables, whole grains and legumes to their diet, or try a natural bulk laxative, which is very gentle.

5.    Some children have real fears about BMs; they think their insides are coming out, or that they are losing parts of themselves. If this is the case, go slow. Try explaining the digestive system to the child, using visuals of the human body. A very popular book with lots of moms and kids is Everyone Poops by Taro Gomi.

6.    How much wiping is enough? As a rule of thumb, teach him to wipe three times. This may not be enough at first and the adult present can continue to clean up, if necessary. But as he becomes more adept, three times should be enough.

Stay dry at night

Teaching your child to stay dry at night involves some preplanning and a few minor routine changes as nighttime approaches. Keep in mind the following ideas as you put together a nighttime potty training schedule for your child.

1.    Restrict liquids, including water, after 6pm. If he’s thirsty, give him only a few small sips.

2.    Schedule a toilet time immediately before he climbs into bed. Make it part of his bedtime routine, not an option.

3.    Once he’s asleep, check him periodically to determine when he’s urinating during the night; you’ll probably see a pattern. Then wake him up consistently ten to fifteen minutes before that time and take him to the toilet to urinate. Do this without a lot of fuss.

4.    Incorporate a visual prompt into his nighttime toileting routine. Post it at eye level on the bathroom door and direct his attention to it every time he uses the toilet-day or night. Hand him a matching picture when you wake him during the night. This will build the foundation for eventually using visual cues to prompt independent toileting at night without adult intervention.

5.    Make sure the visual prompt is located where he can see it when he awakens during the night, reminding him to get up and use the toilet.

6.    Be sure to also teach him to respond to a picture that symbolizes “sleep” and post this so he can readily see it when he finishes his nighttime toilet visit. You want to make sure he returns to bed and goes back to sleep.

The Potty training Process

 

Before you start potty training, chart your child’s urination patterns over a ten to fourteen day time period. This will help determine how long your child is staying dry, and also when urination is most likely to occur. You must be able to arrange a fair amount of time with your child to do nothing else but potty training. It is helpful to have two or even three people available to help.

Give your child plenty of fluids. This will encourage urination and will increase the opportunities to reward successful attempts. Place him on the potty at the first waking moment of the day, for about three to five minutes. Make this a fun time. Read stories, blow bubbles or play games. Use your data chart to gauge how frequently to put him back on the potty. If he is staying dry between sittings on the potty, expand the time gradually by a set increment of minutes.

If there is an accident, lessen the time between potty sittings to the previous amount of free time where he remained successful. After a few hours, if successful, you may want to put training pants on your child. Remember that potty training is a big step for a child. They have been peeing in those diapers for a long time. Habits don’t die easily; be patient and consistent.

A long list of related toilet training ideas follow; some alert you to the sensory issues involved with potty training a child with ASD. Others speak to encouragement, praise, and reward.

1.     Try to get your child to sit on the toilet with the lid down while he is still wearing diapers; then move on to sitting with the lid up and undressed.

2.     Teach pre-toilet dressing skills first; many involve motor planning skills that need to be in place to manage the dressing/undressing sequence and fastening pants.

3.     Don’t potty train when there has been a major event; for example, Mom is back at work, you moved to a new house, or the child moved to a bigger bed. Likewise, if your child gets sick during training, all bets are off. Delay the routine and start again once he’s well or changes are back to a minimum.

4.     Choose a method and stick with it. Give any method at least several weeks to see if it works. However, if you don’t see positive gains in two weeks, take a good look at your program for inconsistencies or errors and adjust accordingly.

5.     Use underpants; they get wet and provide feedback to the child. To help protect the furniture, and maintain good hygiene, try plastic pants over the underwear, or plastic padding on the furniture while training takes place.

6.     Consider, how you dress the child during potty training. Potty training is easier in the summer because children have less clothing to deal with. Elastic-waist pants are a better choice than those that may cause him to have accidents while fumbling with zippers. He needs to be successful when he does the right thing.

7.     Be a model. Children learn from example. If it is comfortable for you, provide your child with opportunities to see how the potty is effectively used. Or use siblings to model the correct behaviors for your child.

8.     Use a positive approach and stay upbeat and supportive at all times. When you see appropriate behaviors, comment on them and reinforce them with specific verbal praise.

9.     Use simple, concrete directives and be consistent with your language.

10.  Expect some accidents and when they happen, remain calm. Never punish accidents; they’re part of eventually getting it right. However, teach your child responsibility for his actions by having him help clean up a mess he created. Clean up with minimal social interaction. As strange as it may sound, the verbal attention can be reinforcing for some children.

11. Schedule a relaxing or low stimulation activity just before scheduled toilet times so your child is more relaxed before starting the toilet training routine.

12. Teach using the toilet as an entire routine involving preparation and activities needed for completion, rather than just sitting on the toilet. Break the toilet training program into parts your child can handle. For instance, going to the bathroom and closing the door, undressing, toileting, dressing, washing hands, exiting the bathroom. Using a visual schedule will help promote independence. Cover your strip of visual cues with plastic, so they don’t get wet.

13. Avoid asking if the child needs to use the bathroom when the schedule indicates a toileting time. Until the child is trained, handing him a visual cue means that potty routine starts.

14. Make sure the bathroom is seen as a relaxing place, and not loaded with tension. Check for any stressors that might influence your child (bathroom fan, glaring lights, texture of the toilet seat or carpeting, smells)

15. If your child reacts negatively to sitting on the toilet, it may be in response to the feel of the seat, feeling unstable while on the toilet, being afraid of the noise from flushing or being afraid of falling into or touching the water.

a)    Use a stool so their feet are flat on a surface, at right angles to the floor, which supports their back.

b)   Change out the seat for a vinyl, padded one; consider a slightly smaller sized seat that is commonly available.

16. If your child impulsively jumps off the toilet to late at other things in the bathroom, place a small, plastic table over his lap once he sits down. Then give him a few favored toys or activities to play with on the table.

17. Be careful using perfumed soaps, lotions and wet wipes when completing the toileting routine. Some children are cued by the smell to engage in the related behavior. Smelling the perfume on their hands may prompt them to eliminate once outside the bathroom.

18. Eliminating in the toilet is one of the few tasks that you do NOT want the anxious child to focus on. Give her something else to focus attention on, such as a book or a toy. The more she thinks about eliminating, the more difficult it will be.

19. Think twice about using food as a reinforcer, as it may not be the enticing after a meal.

20. For children who eliminate several times per hour, because of a constant intake or food of liquids, consider incorporating scheduled intake of food and drink during the potty training program.

21. If you decide to use books or toys or a particular music CD to induce relaxation during the toileting routine, make sure items are not available to the child at any other time of the day.

22. If your child is too fascinated by flushing the toilet, make sure your picture cue shows not only when to flush, but how many times.

23. Handwashing: Use precise directions such as “use one squirt of soap” or “wash for one minute” (use a timer) if you find your child become stuck during this part of the sequence or use it for play.

24. Is your child using too much toilet paper?  Teach her to count out a specific number of sheets, or place a mark along the wall, several inches below the roll, then teach her to unroll the paper until the end touches the mark, then tear it off.

25. Once your child has learned to use the toilet properly, don’t remove all the visual cues. Change the appearance to simpler visual prompts, or those that are more natural looking.

26. Avoid trying to toilet train a child at night when frequent or regular wetting in the daytime is still a problem. First things first.

27. Communicate any information to your child’s teacher that may impact his toilet training program: unusual foods ingested, or new medications.

28. All caregivers, including grandmas, should consistently use the same toilet training methods. Teach them what you are doing and enlist their help and cooperation to maintain a consistent program.

Potty training a child with Autism Spectrum Disorder can be another one of those really daunting tasks. For this blog entry I have taken bits and pieces of useful questions with their answers, and some advice on how to go about the training process. Every child is different, and each of those children will probably need to be taught in a slightly or even drastically different way.  This topic will be broken up into several different parts, as potty training is a very intense time for you and your child.

Toilet Training Tips for Children with Autism

What if the child doesn't want to give up diapers?

Answer: 

Some kids are really attached to their diapers and
don't want to switch to underwear under any circumstances.
You can ease them out of diapers gradually.

- Start by wearing underwear under the diaper.  Let them
get used to the idea of having underwear on,
but still offer them the option of wearing the diaper
over the underwear.

- Gradually cut away small parts of the diaper.  Keep
making the holes in the diaper bigger, and bigger.  Keep
in mind that the last parts to cut away are around the
legs or waist.

- Allow them to switch to pull-ups.  Pull-ups
aren't as likely to be so absorbent as the diapers,
some parents even let them feel when wet.  Pull-ups
also let them work on the skill of pulling
up and down pants.

What do you do if your child refuses to flush the toilet?

Answer:

Flushing the toilet may seem like a mysterious process to
some kids - where does the water go, how does it come back,
why is it so noisy?  Most kids respond well to
predictability.  Establishing a pattern to flushing will
reduce some of the fear of the process.

- Use a visual schedule to indicate when it's appropriate
to flush.
- Use a verbal cue - "Ready, set, flush, all done, its time
to wash hands."
- Allow them to wait at a "safe" distance while
you do the flushing.  Gradually encourage her/him to get
closer to the toilet (think baby steps.)

What do you do if your child won't wash his/her hands?

Answer:

Some kids don't want to take the time to wash hands or just
don't like the process.  Try to overcome his/her discomfort
by experimenting with getting hands in water or playing with
soap.

- Try shaving cream.  Some kids love the feel of shaving
cream and have fun playing with it in their hands.  There
are a variety of foam soaps that are similar in texture to
shaving cream, once you have them interested in shaving
cream you can switch to soap.

- Have a soap box/basket and let them choose.  Load the box
up with shaped soaps, samples, and hotel give-away.  Some
kids might love the option of picking out their own soap
and will be encouraged to wash.

- Use an anti-bacterial hand cleaner.  Just squirt on hands,
rub and the kid is good to go.

What if the child loves to play in the water (and we don't
mean the sink)?

Answer:

Sometimes diversion is the best strategy.  Providing some
appropriate ways to keep hands busy can eliminate the need
for lots of cleanup later.

- Offer squishy toys for tactile input.

- Place a lap desk, bed tray or TV tray over the individuals
lap with toys coloring books, and storybooks on it.  Encourage
them to get busy with the toys while sitting on the toilet.

How can I overcome my child's fear of sitting on the toilet?

Answer:

Lots of autistic children develop a fear or discomfort of
sitting on the toilet.  This reaction can be worked through
by helping the child become familiar with the toilet without
requiring them to actually use it.

- Practice sitting them on the toilet fully clothed. 
Let the child play, read, or color while sitting on the toilet
fully clothed.  They will become gradually more comfortable.

- Allow your child to sit on your lap on the toilet.  As
you hold the child, they will be secure knowing you
are there to help them and will gradually relax.

- Practice the procedure using a doll or favorite toy.
If your child is able to observe the procedure with their
favorite item, and realize nothing bad will happen,
over time the unease will go away.

What do you do if your child refuses to urinate in the
toilet?

Answer:

Sometimes children don't fully understand what they are
being asked to do.  Communication problems can make the
discussion of urination challenging.  The best thing to
do may be to use the "show me" method.   

- Adding food coloring to the water helps illustrate
what urinating in the toilets is all about.  Just like
magic, a little urine combined with the previously
colored water will guarantee a color change.  This can
be very intriguing for the child trying to master the
skill.

- Having something to aim for is always fun as well -
try biodegradable packing peanuts, special made animal
shaped toilet floats, or cheerios cereal.

What do I do if my child refuses to use toilet paper?

Answer:

Some kids are extremely sensitive to the texture and feel of
toilet paper.  In addition, many kids have developed a
familiarity with wipes.  Offer them different options instead
of toilet paper.
- Use wipes instead.  Many of the toilet paper manufacturers
are offering flushable wipes.

- Some kids are frustrated with the wiping procedure.  Offer
to perform the wiping for them until he or she has developed
the skills to wipe.

- Use a teaching story to outline the procedure.

What do you do if your child plays with feces?

Answer:

Some kids love to dig in the diaper and play with the
feces.  Although this is disgusting to us, the child
thinks this is a fun, sensory toy.  Provide them with some
sensory options or make it so difficult to get into the
diapers that they don't have the option.

- Put the child in bicycle pants.  These pants are so tight
fitting, and usually come up over the diaper, that they
will have a difficult time getting to the diaper.

- Use a reinforced belt.  Many outdoor recreation stores
offer belts made from a webbing material with a sturdy belt
closure.  Not only will this belt be hard to work under,
but also the closure will be difficult to open.

- For small children, some parents like to use cloth dog
collars.  These collars are made of a sturdy web material
and have closures that are hard for the child to open.

- Offer a belt with a variety of toys to play with attached
to the belt.  Keep rotating the toys, so it's always
something new and intriguing.  Koosh balls, yo-yo's, silly
putty, and cartoon toys, stretchy toys - all are good options
to keep little hands busy.

Here are a few helpful social stories videos:

 

http://www.youtube.com/watch?v=a9bqMaj2rAs

 

http://www.youtube.com/watch?v=HE8hqvFHZv8