Toilet Training for children with Autism at home.

For most parents, toilet training their child is a huge task. When it is accomplished successfully, it feels nothing else than a personal achievement! Similar is the case with children who come under Autism Spectrum disorder (ASD). Keeping in mind the severity of ASD, training the child to care for himself/herself in the toilet can be challenging. Giving time and perseverance to this process, most children diagnosed with ASD are able to learn to use the toilet independently.

For a child diagnosed with ASD, going to the toilet and using it appropriately is a complex task as it is made up of small but several steps. The first and foremost step in teaching your child is to break down the whole task into basic steps and then start teaching one small part at a time. Though each child is different, some strategies that can be used are:

1. Visual supports: Visual learning is often much more uncomplicated for kids diagnosed with ASD when compared to verbal instructions. Visual cues and prompts can be in form of cards with either picture of the task or 2-3 words written on them describing the task in clarity. For example “STEP 1 – PULL DOWN YOUR PANTS” “STEP 2 – SIT DOWN ON TOILET”, So on and so forth. The point to be remembered is that the visual cues either in the form of pictures or words should be very simple and direct. This helps the child to understand and remember what he/she is supposed to do. Considering the fact that it may be difficult to provide visual prompts outside the home, therefore, a lot of research suggests adding verbal support simultaneously with the visual cues. This would help the child to go to subsequent steps especially when he is out of his routine and comfort zone.

2. Social stories: Like most children, a child diagnosed with ASD also would have some favorite mythical or imaginary characters like superheroes or cartoon characters. It would help the child to cope with unfamiliar situations if stories connected with their favorite characters are read to them. These stories may depict daily life skills including when and how to use a toilet with the help of pictures. Some pointers to consider while choosing the stories could be –

· Storyline should be simple with clear pictures

· Must be written from a child’s perspective

· Describes a daily life situation like using the toilet

· Details out the task step by step

· Describes the appropriate response to the task

· Gives an explanation why is the response appropriate and what benefit it brings.

3. Getting rid of diapers: Diapers are definitely convenient and helpful especially when both parents are working or there is a single caregiver who is managing 10 other different responsibilities. Research suggests that children should be moved to wearing underpants as soon as possible, as wearing diapers as they are growing is counterproductive to toilet training. Dues to the material of modern-day diapers the child does realize when he/she has urinated. With underpants, the child might start associating the uncomfortable feeling of wetness on their skin and this might help in toilet training.

4. Accidents are ok: While the process of training is going on, the child could have a few toilet accidents. Sometimes you may feel that they have become fully independent and suddenly could have an unintended accident. This could happen due to multiple reasons. Therefore, there is no need to worry about it. Rather, you should make sure that there is a minimum discussion with or around the child about the accident. All the focus should be on reinforcing his/her need and the use of toilet behavior. It would also be helpful if you can make a note of the accidents that happen like the time of the day, the circumstance under which the child was, and the place. There are high chances that these accidents are triggered by some overwhelming stimulus around the child or a pattern that others have missed. Noting down can narrow down the stimulus or the pattern that could emerge.

Keep rewarding: One of the biggest motivating factors which reinforce appropriate behaviors in children is rewards. Rewards in terms of their favorite activity, toys, or small treats should be identified. Rather than using these rewards generally, they should be reserved only for successful usage of a toilet, till they learn them completely. It is important to remember that these rewards should be immediate and consistent which would increase the chances that the child would understand the connection between appropriate behavior and the reward.

Written By: -

Isha Singh - Clinical Psychologist

Director - Clinical Services, Ananya Child Development Centre.