Potty Training Your Child on the Autism Spectrum - My Experience

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Aug 7, 2004


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The Bottom Line My 3.5 year old on the autism spectrum successfully trained - It can be done!

As a parent of a child diagnosed with Pervasive Development Delay (PDD-NOS), which is on the Autism Spectrum, one of many challenging areas for us has been potty training. In connecting with other parents of children on the spectrum as well as professionals - a common theme that kept coming up was that these children are often very late and very difficult to potty train. In fact, I even read in the book Toilet Training for Individuals with Autism & Related Disorders by Maria Wheeler that those with autism are reported by researchers as being the most difficult population to potty train. Still, I had heard about enough success stories to know that it can be done and I was convinced my son would be able to do it. I feel it is important to state that this essay simply relates my experience, trials and tribulations with my son and potty training. I'm not an expert and these methods surely will not work for everyone. But, it is my hope, that something I share here may be helpful or inciteful to a reader - and that perhaps other parents and kids on the spectrum (and perhaps even 'typically' developing children) may find success.

Our Potty Training Adventures
Began around the age of 2 years old when my son became very curious about using the potty. He was a child that didn't like to be in a wet or soiled diaper and would remove his diaper whenever he'd soiled it and would tell me "Yuck!". He'd even go so far as throwing out the diaper into the garbage or diaper pail, and then would run around naked. I would be able to get him to sit on and use the toilet and he'd even occasionally elminate in it. But, there was no rhyme or reason to when this happened. It was my observation that he knew how to use the potty but his problems had to do with awareness in his own body and also with communication to tell us that he needed to go to the bathroom.

The summertime when he was 2 1/2 I tried really hard and thought we might be pretty close to successful but he didn't make progress. I took a very laid back approach for the next year after talking with a lot of other mothers who assured me that it would happen "when he was ready". And, given all the other stress and priorities in my life and my child's life we didn't put potty training as a top priority. So, this summer I approached potty training with him yet again and I'm happy to report success in this area.

Our Approach

The Doll
One of the first things that I did was to purchase my son a very inexpensive baby doll that wets after you give it a bottle of water. I showed him how after the baby drank it would need to pee and we played a lot with this doll. There are dolls specifically made for this on the market, many anotomically correct, and many quite pricey. The doll I purchased cost me a whopping $5.99 at a local Big Lots store and was no where near anotomically correct (it simply had a little hole near its bottom) but it got the job done and the point across just the same. Much to my husbands dismay my son really enjoys playing with this doll and making it wet.

Books and Movies
My son, like many, loves to read and look and look at picture books and watch videos. So, I purchased him a bunch of different potty themed books and some movies to enjoy.

There are tons out there, but the ones my son has (and enjoys) are:

Once Upon a Potty book (for boys)
The Potty Book for boys
Potty Time (from Usborne Books)
Potty Time with Bear (in the big blue house) VHS and book
I Gotta Go! Music Video


The Open Door Policy
Many of my friends disagreed with this but for me it seemed natural. My son had been following me into the bathroom since about the time he began walking and for a long time I was all about shutting the door and trying to get a moments privacy (as if). But, I figured that it he was following me into the bathroom when I used it then I would make the best of it to make it a learning experience. So, anytime I went to the bathroom so did he. I talked to him about what I was doing and showed him how first I pulled down my pants, then I went pee or poop, flushed, pulled up my pants and washed my hands. I would ask him if he wanted to try - and sometimes he did. I asked my husband to do the same and to illustrate to him about peeing standing up and to let my son come in the bathroom with him to watch.

Communication
Since my 3 1/2 year old little boy has some speech delays, I recognized that one big hurdle for us with potty training was his inability to communicate with me effectively and in a timely manner that he had to go potty. Often he would tell me or indicate to me but it would just be too late (as in he was already wetting his pants). In addition to some sign language we have incorporated the PECS Picture Exchange Communication System to aid in communication. The PECS system relies on small laminated cards with bold images that work like spoken words for non verbal and speech impaired individuals. Like sign, we have found that using PECS has opened up communication, eased frustration and served as a bridge to spoken language for our son. I printed out and laminated several 2X2 PECS cards for Potty (with the Mayer-Johnson standard image that they also use at my son's school) and made them available in every room of our house. I taught my son that if he ever needed to go potty he could either tell me "potty" or "go potty" or simply hand me the PECS card. This added an additional means for him to be able to tell us that he had to go. In the beginning he relied more on the card, but now he tells me "potty" or "diaper" and runs into the bathroom to take care of business.

Visual Aids
Since children on the autism spectrum are often visual learners it is important to provide lots of visual cues and prompts for them. In addition to using the PECS system we also use visual schedules for my son both at home and in preschool. It only seemed natural to carry that over into potty training to help reinforce the routine of using the toilet into this day.

First, we added the potty into his schedule. I made sure at home and at preschool to add in additional "stops" along his schedule for using the potty. At school these routine potty visits have remained in place but at home the only routine visits are in the morning, evening and anytime before we leave the home. The rest of his trips to the bathroom are now spontaneous and my son's choosing. But, in the beginning I tried to take him to the bathroom at least once an hour.

Next, I put up mini schedules or "sequence strips" with the steps of using the potty. I mounted a larger horizontal strip right above the toilet paper roll and next to the potty that includes the steps:

Pants Down
Sit on Potty
Toilet Paper
Flush
Pants Up
Wash Hands


Then, over by the sink I put up a similar strip for washing hands.

If you are looking to make a similar system you can find the images/instructions for making them at the following websites.


http://www.do2learn.com/picturecards/printcards/2inch/imagegridswords/bathroomword.htm

http://www.do2learn.com/picturecards/howtouse/schedule.htm#



We use these schedule reminder strips for just about everything from morning & bedtime routine, to handwashing, teeth brushing, going potty and more. My son is very oriented to a routine and having these pictures help him get through the activity and move on to whatever is next.

Behavior & Reward System
Many children on the Autism Spectrum can benefit from ABA - applied behavioral analysis, in some form or another. My son is not on a full blown ABA plan but we have found some ABA techniques to be very helpful and reinforce positive behavior. Even if you are not a fan of ABA think your traditional 'star chart' or reward chart that is so popular for potty training. We used not one, but two of these.

The first chart was a simple one that my son was already quite familiar with that I use for rewarding good behavior. The chart looks like a choo-choo train and has an engine and 5 pieces that are made of laminated card stock with velcro pieces attached. The top of the chart says "I am working for" and has a small box with velcro in it. In this box we attached a PECS card with a reward in it (a toy, a trip to McDonalds, hugs and kisses, whatever). In the top corner of the chart we velcro'd a PECS card for the potty to remind him that this chart was for using the potty. Then, any time he used the potty he earned a piece of the train. When the train was completed he earned the reward.

The first chart worked well for us but I felt that we needed something a bit more focused on the actual steps of the potty. So, for this, I mounted a second chart on the bathroom door that laid out the steps of the potty across the chart in the top row of a grid. Each box of the grid had a small piece of velcro in it and each time he completed each step successfully he would earn a small card (a token) with a truck or train on it that he could velcro into the spot. Then, you decide how frequently to reward - whether they have to complete X number of rows or columns with the tokens or fill in the whole grid. Now, you could use stickers or stamps or whatever works for your child. Since my son is used to manipulating velcro for lots of educational activities and the fact that the velcro makes it all reusable and very versatile we opted for that.


Social Stories
Children on the Autism Spectrum can often benefit from what is called "social stories". The concept of social stories, initially developed by Carol Gray - is that through the use of simple stories persons with autism are able to learn the appropriate way to handle or interact in certain social situations. My son's autism specialist helped me to create some appropriate social stories which would assist him in toileting. At first I read him the stories (multiple times) and then I left him alone with the stories to explore on his own. The stories use simple language and picture symbols to get the message across.

A simple example of a potty training social story can be found here:

http://www.polyxo.com/socialstories/ss0004.html


Doing away with Diapers
Finally, my biggest step and probably the one that made the biggest difference in potty training my son was to do away with diapers and disposable training pants (as much as possible). I found that if he was wearing a diaper or a "pull-up" type of disposable training pants he would easily pee or poop in it. But, if he had on underpants or nothing at all then he would try to eliminate in the bathroom. Afterall, since he'd been in diapers for 3 years of his life this was a huge habit and routine for him and one that was hard to break. So we moved away from diapers which hold in the moisture and pull it away from his skin and to a cotton training pants which he did not like the way it felt to be wet or soiled in.

Through the process of elimination I also found that my son was more comfortable in the old fashioned type of training pants (padded cotton) from Gerber, or loose fitting boxer type shorts instead of the traditional kids briefs. This, I am sure, is due to the sensory issues of the briefs having tight elastic which bugged the heck out him. Your child may prefer the tighter briefs or panties that come in the fancy character patterns, but my son chose the looser fitting simple underwear - and I'm fine with that. So, try different kids and find what your child is most comfortable in and what type of underwear motivate them the most.

The Bottom Line
At 3 1/2 years old my son is 99.9999% potty trained and has had very few accidents both at home and wearing big boy underpants at school. I do still put him into a pull-up at night or if we are going to be out of the house for a long period of time, but even then he has been pretty much dry.

As you can see from the long list above - we tried quite a bit of different things to help aide the potty training process. I can't say that one thing worked more than the other but that for us it was a combination of all of the above combined with my own persistence and my son's good effort. Finally, I believe that large component of his potty training simply was that he'd reached a point where he was mature enough to physically handle taking control of his body functions. Once things "clicked" his success with it just took off and he continues to make me a very proud parent.

Best of luck with potty training your child on the Autism Spectrum. It sure has been challenging but we are proof that it can be done successfully. I welcome any communication from parents struggling with this, so feel free to drop me an email or leave me a comment on this review.


My other Potty Training reviews
I Gotta Go! Potty training video
Gerber Soft Care Training Pants
Pampers Feel 'N Learn Advanced Trainers
Kids II My Little Step Stool
Baby Bjorn Little Potty
Safety 1st One Step Trainer Seat 11304
Ginsey Blues Clues Soft Potty Seat


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