Toilet training kids with autism– what works for me

Toilet independence is a very important life skill to be mastered that needs much effort even for the neuro-typical children. With the child with autism the time and effort involved can increase considerably and so can the stress when even consistent efforts may not give expected results. I am in the process of toilet training Tuhina since last 3 years and she is still not completely trained, but one thing that I can say is that it takes its own time but things do get better.

Every child is different and different children in spectrum face different set of challenges and strengths with toilet training. What works for one child may not work for another but there are some ways around which personal innovations and customizations can be made to suit your child. Before starting with toilet training some points need to be kept in mind. Some of these I understood by experience, some I learnt the hard way (fighting it out and failing) and some just seems right.

1. Toilet training can take a lot of your time, throughout the day and through days, months or years depending on the child. When you decide to start with it, plan your work accordingly so that taking your child to toilet consistently is a part of your routines and is not left out with other chores. It may be more stressful to start with toilet training when you have guests for stayover during summer vacations or when you are due to take a trip in a week. Choose a time period when you can incorporate the toileting schedule in your daily schedule with less stress until it becomes a habit (when you can manage it with more distractions example frequent outdoor trips or festival times).
2. This is a huge milestone even for the child. If the child does not seem ready in-spite your efforts, be ready to take a step back and not stress too much. This is easier said than done and I learnt this the hard way. But sometimes going a little easy on a few aspects may help. Keep in mind that there may be good days and bad days and regressions may happen.
3. Take in consideration the sensory issues the child may face during the entire process of using the toilet. It could be auditory overload with the sound of flush, the wet feeling of splashing water, the instability of legs not touching the ground or the cramped feeling of bathroom. Try to work around these challenges. eg using a stool under the legs, making the bathroom distraction free, or closing to toilet cover and letting the child stand a step away while you press the flush. 
4.  Find out things that motivate your child and use them as a rewards for the smallest accomplishments. Give lots of praises. Tuhina likes to look into the whirlpool inside the pot after the flushing. So that is her motivation and she gets to flush and look at it till the end every time she goes in the pot.

My daughter was born and spent to first two years of her life in the US where diapers are quite a norm. so it was even more difficult for me to let go off them and start with training. But i was rightly advised and realized that there is no other way than to take the child off diaper at the earliest. I think it is much easier to prepare for this transition in India where cloth diapers are more prevalent. The first step was to put the her on a toilet schedule. I started when she was 2 years old and was able to remain dry for around 1 hour or more. 

Putting the child on a schedule:

1. Chalking out a toilet schedule for the child is the first step. To start with, monitor the toilet schedule of the child for a week and note it down to understand the pattern.. This gives an idea of the frequency at which the child goes to toilet and certain times of the day/events which have more probability e.g after waking up, after meals or drink.
2. Depending on the child's needs, set up a routine to take the child to toilet after fixed intervals. If the child goes every hour, make a schedule to take him to toilet a few minutes before e.g every 50 minutes.  In the start the time interval should be small e.g 30 or 45 mins and should be gradually increased. It helps to document the outcome of every toilet visit. I did it as in the picture below. In the beginning Tuhina  would not go in the toilet on scheduled visit but would go minutes after taking her off the toilet. What worked for me was taking her every hour as per schedule and let her sit for 3mins. If she would not go, then I would take her after every 5 min for 2-3 attempts.  Gradually the idea of using the toilet set in.
   
3.  Make a big deal every time the child is successful, however small the accomplishment is. It could be just being able to sit in the toilet, but the success needs to be acknowledged and appreciated. What motivation works for the child differs for everyone. For some the reward system may work, for other social praise may work.

Putting the child on a schedule does not solve all the issues when the child may not be able to independently communicate the toilet needs but it does considerably decrease the accidents and at the same time the stress faced by the mothers.

Communicating toilet needs:

Even when the child is not able to communicate on his own, make it a point to communicate from your side whenever taking them to the toilet. The way of communication depends on what your child is most comfortable with. It could just be  ‘ go to toilet’ verbal instruction or showing a picture of toilet (or an object associated with it like toilet paper roll). what ever the mode used, it should be consistent. E.g it should be the use of same word ‘toilet’ when saying ‘go to toilet’ and not interchange with ‘go to potty’  or any other thing randomly. Sometimes children do give subtle hints when they need to go. Catch those hints and give them words.

What works for me is putting the picture of toilet seat with velcro (i started out with the picture of the same toilet she uses) at a designated place and everytime when its time to go, I ask her to give the picture to me (sometimes I use hand over hand or physical prompt) and say – ‘tuhina will go to toilet’.  

She still does not communicate on her own but I think with this method she gets an understanding of what is expected and how she can tell if need be. Eventually, I hope she will tell on her own.

Social story:

Building up a social story for going to toilet may also help. I tried it out but it didn’t seem to make much of a difference. But it may work for some children. However Tuhina did like me reading the social story to her and would look at the picture. So she may have got some understanding specially of the steps involved in the process like pulling the pants, flushing, washing hands.

Tuhina is still not there yet but she is miles ahead from where we started out. I am looking forward to the day when she will independently communicate her toileting need but I have kept that goal for sometime in future and have made up my mind to keep revising that deadline. It is much easier this way that setting up deadlines too close  by and then fretting over it.