Potty Train With Compassion – Part 1

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One of the biggest skills parents of my students want to work on is potty training, and rightly so. This skill is huge when it comes to independence! But, many times, ditching those diapers and pull-ups takes a lot more time than with neurotypical children. Why is that?

This is the first of three blog posts about potty training autistic children. We will delve into the unique challenges faced by parents and caregivers while providing practical strategies to identify where you can get started. I want to help you make toilet training a positive and empowering journey for all.

Why Does Potty Training Take Longer For Autistic Children?

Part of it is because of something called “interoception”. Have you heard that word? If not, you aren’t alone. I’ve only been hearing about it for a few years now.

Interoception refers to the ability to perceive and understand internal bodily sensations, like  hunger, thirst, pain, and the need to use the bathroom. It plays a crucial role in potty training because children need to recognize the bodily cues that indicate they NEED to go to the toilet. However, autistic children may have difficulties with interoception, which can impact their ability to recognize and respond to these internal signals.

Interoceptive Challenges

Interoceptive challenges in autism can manifest in a variety of ways:

  1. One is a reduced awareness of bodily sensations: Some autistic children may have limited awareness of the sensations associated with needing to use the bathroom. They may have a reduced ability to recognize feelings of fullness or the urge to urinate or have a bowel movement, which can make it harder for them to identify the need to use the toilet.
  2. Another challenge is difficulty interpreting sensory information. Because interoception is closely linked to sensory processing, autistic kids may experience differences in sensory processing. They may struggle to interpret the sensory signals that indicate the need to use the bathroom, such as the feeling of pressure in the bladder or discomfort in the stomach. These difficulties can lead to delayed or inconsistent responses to bodily cues.
  3. There are also sensory sensitivities affecting toileting. Sensory challenges can make the act of using the toilet uncomfortable or overwhelming for some little ones. They may be sensitive to the texture of toilet paper, the sound of flushing, or the feeling of sitting on a toilet seat. These sensory sensitivities can create barriers to successful potty training and may require adaptations or accommodations to address the individual’s specific sensory needs.

The book “Interoception: Sensory My World From The Inside Out” was written by Cara Koscinski. She is an occupational therapist who explains interoception in her book that came out in 2018. In her book she says “Interoception affects toileting. Many children with sensory difficulties have trouble with bowel movements. For most of us, when our bladder is full, we know it’s time to use the toilet. If we have intestinal cramping, we find the nearest restroom. Many children do not feel these urges. They may feel them too late or not at all. Bedwetting, frequent accidents, and holding stool/constipation are common when children struggle with interoceptive awareness. As an OT, I’m often told that my pediatric clients prefer to poop into a diaper. This might be so that they can actually ‘FEEL’ the poop leaving their body.

Language delays can make potty training more challenging for autistic children due to several factors:  

  1. Language delays often result in limited verbal communication skills, making it harder for autistic children to express their needs or communicate their urge to use the toilet. This can hinder their ability to effectively participate in the potty training process in the beginning.
  2. Potty training involves following instructions, understanding concepts such as body cues, and communicating about toileting needs. Language delays can make it more difficult for autistic children to comprehend and process these instructions and concepts.
  3. Autistic children with language delays may struggle to effectively communicate their discomfort, pain, or readiness to use the toilet. This can make it challenging for parents and caregivers to identify cues or signs that the child is ready for potty training, leading to delays in initiating the process.
  4. Potty training also requires the ability to generalize skills across different settings, such as home, school, or public restrooms. Language delays may affect a child’s ability to understand and apply the learned skills in various environments. They also may have difficulty understanding and following verbal instructions or cues from different people.

Addressing language delays through appropriate interventions, augmentative and alternative communication (AAC) methods, visual supports, and individualized strategies can help mitigate these challenges and support successful potty training experiences for autistic children.

How Can We Support Our Children and Prepare For Potty Training?

  1. Write down when your child/student is wet, soiled and dry-Take a couple of days to write that information down so you can see if a pattern shows itself. Later, once the child is sitting on the toilet consistently, you can use the tracking sheets to keep track of when they pee in the potty and when they have accidents. This can help you make adjustments to the plan to support their progress.
  2. Identify Readiness Signs-Is the child interested in any aspect of the toileting routine? Are they trying to take their diaper off when it’s wet. Do they go to a certain area away from everyone to poop? These are readiness signs. But, don’t worry. Even if they aren’t showing signs, there are things you can do to move forward with potty training anyway. 
  3. Prepare the Bathroom Environment-We want to make it relaxing. If children are pressured and stressed, it’s going to be a lot harder, or impossible for them to “release”. Add some relaxing music that you can play, or some dimmer lighting. Bring in some books or favorite toys to hold while the child is in the bathroom. Here is a list of my favorite potty training books.

What If My Child Is Afraid?

If your child or student is scared to sit on the toilet, you don’t even need to do that while you are in the bathroom. Just, get comfortable in the space together. Read a book. Watch a favorite YouTube video. Then leave.  

It may feel like you are never going to get to the final goal, but starting small and building trust is so important for children who are anxious. 

When you start having them explore sitting on the toilet, it can be very brief. Say “1,2,3 all done” and praise them. Then you can move to counting to 10, singing the ABC’s or reading a book as they are sitting there. You could also start a routine where they watch a toileting video on YouTube. Don’t skip this step, because if the child is not willingly sitting on the toilet, the chances of them peeing in the toilet drop significantly.

Take into account the sensory differences. If they hate the sound of flushing, don’t flush when they are in the bathroom. That can come later when they are ready for it. At my school we had an automatic flusher and it scared kids. So, we taped paper over the sensor so it wouldn’t flush on it’s own. If the child feels scared having their feet of the ground, a stool can help. If they feel unstable on the big seat, you can get a potty training seat that will help them feel more secure. One of my favorite seats is from El Potty Nurse. She created a travel potty seat that can be taken anywhere and used to provide support, stability and consistency. It can also be used with a bag in places where a toilet isn’t readily available. I can’t say enough good things about her creation!

Use Visuals

When it comes to language delays, there are a few things you can do to start making that connection. Creating a predictable routine will help with receptive understanding and using visuals can help with expressive communication.  

For children who are non-speaking or have limited verbal skills, it is nice to have single, loose bathroom pictures in each room you are in. When you bring the child to the bathroom, pick up the picture and put it next to your mouth, and say “bathroom” before walking to the bathroom. Then, when you get to the bathroom, match it, or help them match it to a larger bathroom picture with velcro. You could also have a cup or container in the bathroom with a picture taped to it. Each time the little one walks into the bathroom, they put the picture in the cup.  You’ve just created a predictable routine. Eventually, they may pick up the picture on their own and give it to you! 

You are also going to want to make sure you have some visual supports ready to go inside the bathroom. This could be a visual sequence showing the steps that you have identified that you want to work on. For example, pants, down, underwear down, sit on toilet, underwear up, pants up. Then, you can point to and reference these to once again create a predictable routine.

Another valuable visual support is a social story. It could be a story about sitting on the toilet, a story about peeing in the toilet or a story about pooping in the toilet. These are great to have in the bathroom to look at together. You will also want to gather some children’s books about toilet training. Kids love seeing Elmo or Daniel the Tiger on the toilet. You can grab a copy of our Free Visual Sequence For Toileting here!

Use What Motivates Them

One last thing to think about when preparing the bathroom is “what is my child or students interested in?”. We all pay better attention to and are motivated by the things we love. Many years ago, I had twin boys in my class who were in 2nd grade and hadn’t been successful with toilet training yet. Their mom and I tried many different techniques, but nothing seemed to “click”. 

Then, I got an idea. These boys LOVED country music and country singers. I made them a story that said “country singers pee in the potty”. Each page had a picture of a country singer from the waist up and a Boardmaker symbol of a boy peeing in the potty. The story was simple. “Willie Nelson pees in the potty”, “George Straight pees in the potty”, “Big and Rich pee in the potty”. It was magic. The boys peed in the potty THAT day. Think creatively and see what you can come up with!

I hope that this has given you a few ideas to get started while you gather information and set the stage for success with the toileting journey. 

Is potty training your autistic child or students stressing you out?

Solve your potty training challenges with an individualized toilet training plan that will leave you feeling confident that you can move your child or student forward in their toileting journey! Potty Train With Compassion is the answer to your potty training challenges. This mini-course helps educators and parents of young autistic children go from feeling overwhelmed with toilet training to being confident and less stressed. Get started today with immediate access!

To listen to the podcast episode on this topic: Potty Train With Compassion – Part 1

Autism And Toileting Made Easier: 3 Tips for Success

Toileting Training Using Social Stories for Young Learners with Autism

If you use visual supports in your classroom or home, you are going to want to sign up for this free Visual Supports Starter Set ASAP! Click here to have one sent to your inbox. Also, be sure to read more about visual supports and how they can help autistic children here.

Visual supports starter set

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