Toilet training can be a daunting prospect, but perhaps even more so when a child is on the autism spectrum. Lauren Lobbestael, Clinical Director at Gateway Pediatric Therapy‘s Dearborn location, notes that children with autism typically need more time to develop the skills necessary to achieve toilet training success.
“Some children present with sensory difficulties and are bothered by things like wearing underwear,” she says as an example. “Others engage in challenging behavior during transitions. Going from voiding in a diaper to moving into another room and actually voiding in a toilet is a very big change.” Even so, Lobbestael says that toilet training can be achievable for any child provided he or she is offered appropriate support and encouragement.
“Toilet training involves a level of problem solving,” she explains. “What works one day may not work the next. Accidents will happen, and that’s OK. We try to make toileting a positive experience, and moving too quickly has the potential to make it an aversive one.” Lobbestael shares her tips for parents who are beginning to toilet train their kids or are struggling with the endeavor.
1. Create a checklist of prerequisite skills
To achieve success with toilet training, Lobbestael says children on the spectrum really need to have certain prerequisite skills, such as a tolerance for sitting on the toilet and wearing underwear, as well as some level of communication with others.
Additionally, Lobbestael typically asks parents to provide preferred snacks or toys that her team can use to reinforce positive toilet training behaviors.
“The idea is that we pair voiding in the toilet with access to their favorite things,” she explains. “From there, we slowly fade out these items, while adding in verbal praise. Over time, the child feels an intrinsic sense of pride when using the toilet and eventually can do so without needing that tangible item as reinforcement.”
2. Look for signs your child is ready
Lobbestael notes that certain readiness signs, including the child staying dry at night or attempting to remove a diaper after voiding in it, are more appropriate indicators of when to begin toilet training than is the child’s age. “A lot of our kids learn by modeling,” she adds. “Often they’ll see mom or dad go into the bathroom and become curious. Showing interest in the bathroom is a big sign they may be ready.”
3. Buy underwear with fun patterns or characters
“I tell parents to go out and get the coolest underwear they can find, to look for something their child will get really pumped up about,” Lobbestael says. For some kids on the spectrum, the waistband of underwear or the texture of the fabric may be bothersome.
Lobbestael and team will start getting the child used to the underwear without actively wearing it. “First we get them used to touching it and seeing it,” she says. “Slowly, we will build up to having the child put the underwear on and keep it on.”
4. Collaborate with your care team
Once prerequisite skills are in place, the Gateway team will work with parents to develop a concrete plan that can be worked on both in therapy and at home.
At Gateway, therapists will collect and analyze various data – when the child is taken to the bathroom, the amount of fluid consumed, how long it takes to void, number of accidents and successes, etc. – to create and fine tune a toilet training plan. “Typically, we see a lot of accidents at first and not as many successes, but eventually it will flip to the other way around,” Lobbestael says.
5. Take a break when warranted – and celebrate!
Lobbestael wants all parents to know that it is absolutely OK to take a break if it just isn’t working. “We may try it and determine the child isn’t ready yet,” she says. “Perhaps we need to target some other skills first. When that’s the case, we’ll take a break and give it a few months. We ultimately want to set our kids up for success.”
More than once, Lobbestael has observed parents moved to tears when they see their child achieve success with toilet training. “It’s a major accomplishment for any child. We get a lot of feedback from parents that this hurdle has made a huge difference in almost every aspect of their lives.”
June is Potty Training Awareness Month. For more tips and advice, check out GatewayPediatricTherapy.com.
For more information on Gateway Pediatric Therapy, visit gatewaypediatrictherapy.com.