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A 6-step Plan to Potty Training your Nonverbal Child with Autism

How to potty train nonverbal child with autism - Alliance ABA

Every child can be toilet trained!  Maybe you have a child with autism, a child who is non-verbal, a child who has lots of difficulty with communication, or with aggressive behaviors, or with self-regulation.  Applied Behavior Analysis Therapy can help you to overcome each of these barriers, and get your child going in the toilet in no time.

Is my child ready for potty training?  In the world of autism and other developmental delays, age is not an important factor.  Your child may be the typical toilet-training age or much older when you decide that he is ready and your family is ready to give it your all.  And there is no such thing as someone who is “too old” to work on toilet training.  It is such an important skill for life, and lack of toilet training has so many negatively impacts (i.e. dependence, lack of privacy and cleanliness, limits access to options, limits relationships) that I would recommend working on toilet training at any age.  

Some resources list pre-requisites needed before you should start working on intensive toilet training.  I would recommend reviewing this readiness list, but taking each item with a grain of salt.  Potty training is so important that you may want to start working on it even before each of these targets are reached.  For example, if my child with developmental delay does not and probably will not have the ability to sit independently on the toilet, I would simply get an adapted toilet seat with supports, and continue to work on toilet training.

Toileting readiness factors to consider:
- Does he have a communication system? Potty training will be helped greatly if your child has a method for communicating what they want and need, whether it be pictures, signs, gestures, a high tech device, or words.
- Does she have body awareness?  Does she know when she is wet?  
- Is he physically ready?  Can he walk to the toilet, help with undressing, sit on the toilet?  
- Does she understand cause and effect?  She will need to be able to understand the reward system, and make a connection between going in the toilet and getting a reward.
When you’re ready to take the dive and start the toilet training process, follow these 6 steps and you’ll be on your way to success!
6-Step Plan to Potty Training
1. Rewards!  (a.k.a. incentives, a.k.a. bribes)
The most important aspect of toilet training is having a powerful reward.  Use this reward only for potty training.  Give it every time and quickly after your child pees or poops in the toilet, along with lots of praise and cheering.  For kids with autism and other developmental delays, giving a reward is the clear way to communicate to your child what you would like them to do.

Some reward ideas:  candy, a new toy that they’ve picked out at the store (which they can play with for 15 minutes after each successful trip to the bathroom), screen time with a special video, an iPad game.
2. Underwear!
Buy some fun new underwear together, and get excited about wearing them.  In order for toilet training to be successful, your child needs to be able to feel when they are wet, and it needs to feel uncomfortable and yucky.  Diapers or pull-ups quickly whisk the wetness away, and are not recommended for potty training.  If you are concerned about soiled furniture, you can have them wear plastic pants on the outside of their underwear.  The plastic pants will hold the pee and will feel very uncomfortable when your child wets.

3. Trip training
Before you can expect your child to have any success, he or she needs to be able to stay dry for long periods of time.  This is where trip training comes in.  Trip training is training your child to stay dry in between trips to the bathroom.  You do this by taking them to the toilet many times, and before they have a chance to wet themselves.

First, take notes on how often your child pees in a day.  (Do this before you introduce underwear and begin the training process.)  Calculate the average length of time he or she can stay dry  - by adding up the number of hours you recorded data and dividing that by the number of times they were wet when checked. (e.g. 6 hrs / 4 wets = 1.5 hours.)

Then use this information to make a trip training schedule.  Since you know that your child should need to pee at this time (e.g. every 1.5 hours), bring your child to the bathroom and expect them to pee.  If they don’t, bring them again 5 or 10 minutes later.  If your trip training calculator was right, your child does need to pee and will do it eventually.  And when they do, be ready with the reward and the party!

If they are wet in between trips to the potty, ignore it if possible.  Just change into dry clothes neutrally and quickly.  Many kids with autism either enjoy the attention of a lecturing caregiver, or will be turned off to the process if we continue to get upset.

This is also a good time to use visuals.  Children with autism benefit from having things presenting visually.  You can make pictures of the process for using the bathroom (e.g. walk to bathroom, pull down pants, sit on toilet, pee in toilet, you get your toy!).  Or you can make a first-then board (e.g. first pee in toilet, then get your toy!).  These visuals should picture what is actually happening (peeing in the toilet) for children with autism who take things very literally.

Also, ABA is all about taking data and making changes when necessary.  Remember to record successes and accidents on a data sheet, and consult your ABA Therapist about ideas for changes when needed.

4. Teach Communication
Throughout this process, you are also teaching your child how to ask for toilet.  They should use the method of communication that works best for them.  Maybe they can say toilet or something that sounds like toilet?  Maybe they can point to a picture, or grab a picture and bring it to you? Maybe they need to use an object instead of a picture (i.e. toilet handle)?  Prompt them to ask for toilet at every interval before you bring them to the toilet.  This will become key in the next step.
5. Slowly remove yourself from the process
If you know about ABA, you know about prompt fading.  This means reducing the level of prompting while your child moves forward independently.  Once your child has stayed dry for about 1 week with the help of your reminders and lots of trips to the toilet, then you are ready to start removing your assistance.

First, you should delay reminding them that it’s time to go to the toilet at the designated time.  Be sure to watch your child to see whether they are communicating in some way that they need to go (i.e. grabbing their pants, doing the “pee-pee dance”).  In this case, prompt them to ask correctly using their communication method, and then get them to the toilet quickly.

Over time, you can wait longer and longer before prompting them to go to the bathroom, and then hope and wait for them to tell you instead.  A few more accidents in this stage are normal, but if accidents increase by a lot, you may want to go back to prompted trip training until they get it consistently.

6. Poop training
The next step in toilet is bowel training.  Do the same thing using a trip training schedule, but this time try to figure out when your child usually goes poo every day.  Many people go at a regular time every day (if constipation is a problem, work on this first!).

Bring your child to the toilet at this time (using their communication method to prompt them to ask for toilet), and have them sit for a while.  This may take longer than for going pee.  When they are successful, have a party and give them their very exciting reward!
What if?
Your ABA Therapist can help you solve problems related to trip training or potty training or poop training.  Here are some quick tips that might help your situation:

*Keep trying!  While working on toilet training, your child is also learning lots of other skills (holding it, communicating, dressing, sitting…)  It will take at least a few weeks, and probably a few months to master.

*What if he is afraid of the toilet?  Work with your ABA Therapist to begin a desensitization program before working on toilet training.  There is hope that he will learn to tolerate the toilet.

*What if she holds her poop and then it hurts when she has a bowel movement, which makes her hold her poop more?  This is a common and frustrating problem.  I would recommend working on taking care of the constipation first, so that it doesn’t hurt to poo.  You can try fiber, laxatives, mineral oil, or other doctor recommended remedies.

*Aluminum roasting pan trick!  If you can’t really tell if your child has peed in the toilet, or if you think he needs more feedback about what is happening, try floating an aluminum roasting pan on top of the toilet water.  It makes a really fun noise when your child is peeing, and you can see exactly how much.
Check out this in-depth toilet training guide from Autism Speaks for more information.

Many families benefit from having support from an ABA therapist as they take the potty-training plunge.  Alliance ABA Therapy is the leading ABA therapy provider in Fredericksburg and Fairfax, VA.  Click here to contact Alliance ABA Therapy today.


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