The Ultimate Guide to Toilet Training

Successful toilet training is one of the most useful and (likely) socially significant skills we can teach our students with autism. When a child is ready for toilet training, we often have to put other programming aside in order to accomplish this goal – and that’s okay! This is a life skill that is important to the student and to those caring for him/her. Parents often come to us with toilet training being their number one goal. Our response is usually, “Is the child ready for toilet training?”

Where to Start with Toilet Training

There are a few pre-requisite skills we look for before introducing a toilet training program. These will make the process smoother and success more likely. The prerequisites were outlined by Foxx and Azrin (1971) in A Rapid Method for Toilet Training.

Does the child have bladder control? Can the child stay dry for several hours and eliminate all at one time (and not in small amounts)? Do they seem to know when they are eliminating? Some children do not like to be wet or dirty and want to be changed – this is a good sign!

Is the child physically ready? Can the child get to the bathroom without assistance? Are they able to pull their underpants and clothing up and down when going to the bathroom?

Does the child understand first-then? This is also a pre-requisite skill that we call the “first/then contingency”. One of the very beginner skills we work on is pairing and trust.  For teaching to be successful, a learner must understand that when they do something we ask, we praise and good things happen.  This is an important part of learning a new skill – “First I do something, then I get something.”

Ready to start toilet training your students? Download our data sheet below to get started!

Teach the Child to Tolerate the Toilet

Some children with autism need desensitization to the toilet. If the child protests and doesn’t willingly sit on the toilet during training sessions, we can pre-empt toilet training by breaking down the skills required to tolerate the toilet.

Teach the child to:

• independently walk to the toilet
• independently stay in the bathroom
• tolerate sitting on the toilet

Then you can systematically increase the length of time the child sits on the toilet. Remember to reinforce each successful approximation of the skill!

To help them come around, make the bathroom fun: Start by sitting on the floor and playing their favorite music, color, or watch funny YouTube clips together. Once they tolerate the floor, incrementally move your play closer to the toilet until they hop on the porcelain throne to listen to her favorite tunes.

Get Parents on Board

Once you’ve determined that the child is ready, speak with the parents and get them on board. Some parents find it overwhelming because they feel pressured to continue toilet training at home as well. We usually recommend that they leave the training to us until the child has reached a certain level of success.

When the child can stay dry for 30-45 minutes, then the skill is ready to generalize to the parents and other environments.

How to Toilet Train a Child

Having trouble with or feeling timid about transitioning your student with autism from diapers to the toilet? Fret not! Follow the steps below – it’s the approach we’ve used for many years to successfully toilet-train our students. Remember: Be patient, consistent, and their biggest cheerleader as they learn to use the bathroom independently.

You’ll want to start and stick to a toilet training schedule. Also, ditch the diaper. The child should be in underwear all day. At night, they can sleep in a diaper or pull-up.

Step 1: Pick a powerful reinforcer

Talk to caregivers about what the child REALLY likes.  We don’t typically love the idea of using edible reinforcers for many ABA programs, but toileting is an exception.  When toilet training, you want something that is highly motivating for the student and very quick to deliver.  Edibles are great for this purpose because they are also quickly consumed and you don’t have to remove them from your student.  Also, talk to the parents about reserving the chosen item/activity for ONLY toileting.  When kids don’t get access to that highly preferred item at any other time, they are typically more motivated to eliminate on the toilet in order to access it.  Check out our blog on reinforcement for more information.

Step 2: Put the child on the toilet at regular intervals

At the beginning, take the child every 10 minutes. Set a timer so you both know when it’s time to go. When it chimes, show the child a small picture of a toilet and say: “Pee pee” or “I want the potty.” Encourage them to point to the picture and say the words, so they’ll know how to, eventually, ask for the toilet by themselves.

Then sit the child on the toilet for 1 minute. If they pee on the potty, give them over-the-top verbal praise and a favorite treat, such as a preferred cracker or cookie (the only time they should get these nibbles is when they go to the bathroom appropriately). If they don’t pee, simply pull up their pants and resume what you were previously doing, resetting the timer for 10 minutes.

Some kids refuse to sit on the toilet or go anywhere near it. If that happens, then hold off on Step 1 until they think the bathroom is a cool place. Work on teaching them to tolerate the toilet as mentioned above! *Keep the child in diapers until they are no longer scared of the bathroom.*

Step 3: Increase time intervals

Once the child is accident-free for two consecutive days, take them to the potty every 15 minutes. Then, after two more dry-pants days, systematically increase the interval by 5 minutes until they are on a 45-minute to 1-hour schedule, or until they are initiating regularly.

Step 4: Dry pants checks

A child will toilet train faster and more successfully when you praise them for having dry underwear. Halfway through intervals, ask them if their pants are dry; have them feel their pants with their hand. Give them lots of verbal praise – “Your pants dry, I’m so proud of you!” or “Yes, fantastic!”– and, if hoorays aren’t motivating enough, add a small edible treat. Then, to reinforce the toilet training procedure, say, “You go pee in the toilet.”

Step 5: Keep accidents neutral

If the child is progressing well with positive reinforcement, this step won’t apply.  If, however, they aren’t learning by positive rewards alone, it’s a good time to draw attention to accidents. When they have an oopsy, stay neutral and say, “You wet your pants.” Sit them on the toilet for a few seconds and say, “You pee on the toilet.”  Don’t praise them if they pee a little on the potty during the process.

Remember to keep your tone and reactions neutral. Thereafter, prompt them to get dry clothes, wipe themselves in the bathroom, and put the wet clothes in the laundry hamper (show them what to do the first few times, then encourage independence). Keep attention minimal.

Finally, have them clean up the accident with a paper towel (with your hands-on help the first few times). The goal of this natural consequence is that the child will learn that it’s far easier to urinate on the toilet than in their pants.

Step 6: Initiation

When the child is able to stay dry for up to 1 hour, stop bringing them to the potty. At this point, they should learn to use the words you taught them to ask for the toilet when their bladder is full. If they don’t initiate independently, stop reinforcing for peeing on the potty and, instead, give a small reward when they request the bathroom.

Here’s how the sequence should play out: Macy has to go and you can tell by her pee-pee dance. You bring her to a picture of the toilet – have several posted on door frames throughout your home so there is always at least one in reach – and then, after seeing the image, she says, “I need to pee.” You say, “Wow, Macy, great telling me that you need to pee!” Immediately provide her with something small that she likes, such as a sticker, Goldfish cracker, or gummy bear. Thereafter, quickly bring her to the bathroom to complete the process.

Bonus Tips for Toilet Training Success:

Be consistent! Stick to the potty schedule like glue to ensure quick success. Wax and wane and it’ll take longer to toilet train, because the child may be confused about where it’s okay to eliminate and, as such, have more accidents.

Make sure the child is drinking a lot of fluids. A full bladder will give them more opportunities to pee on the potty.

Track where and when the child urinates on a simple chart. It’s easiest to use a simple data sheet to keep track of what’s happening and how often.  If you’re creating your own, be sure to include the date, time, accidents, successful pees on the potty, and initiations. This visual will help you see/know when to increase the time between potty intervals.

We said it before and it’s worth saying again: KEEP YOUR KIDDO IN UNDIES during daytime hours! It’s vital to ensure that the child is not confused about when and where they can empty their bladder.

Need more help toilet training your students? Join The Bx Resource and you can watch our training video on Toilet Training! Plus, download our toilet training data sheet below.

 

Reference:  Azrin N., Foxx R. Toilet Training in Less Than a Day. New York: Simon and Schuster; 1974.