Potty Training: A Journey for Autistic Children

One beautiful Spring morning, Becca and I crossed the schoolyard together and made our way up to the entrance of her classroom. It was a day like any other day, and when we made it to the classroom entrance, we were greeted by Becca's teachers and her buddies.

Becca pulled off her jacket and backpack, placed them in her cubby, and walked over to her visual schedule with was displayed prominently on the wall. It was clear which schedule was hers; it was hanging right under a sign with her name and picture. She independently walked over to the schedule, pulled down the potty card, then walked over to the restroom and matched her potty card to the large potty card at the restroom, indicating that she needed to use the restroom. Then she walked into the restroom and closed the door behind her.

Potty training. It has been a challenging journey, but one not unlike the journeys of other children on the more severe end of the spectrum. Research shows that the average age of potty training for Autistic children is about a year later than that of their neurotypical peers, and that the ages skew even older when you consider those children with severe, nonverbal Autism. According to the NIH, nearly 50% of children in this category exhibit resistance to potty training, with many who have not been potty trained by school age.

And while society may be quick to point fingers at parents, labeling them lazy or unfit for failing to potty train their child by a certain age, there are so many reasons why an Autistic child Becca's age may not yet be potty trained, potty resistance being only one of them. Autism can present unique challenges to potty training, including difficulties with routines, sensory sensitivities, and communication delays. Autistic children may not be able to discern when they have to go, or may not be able to effectively communicate it to their caregivers. They may not be aware of the sensation of being wet or soiled, and so they may not feel any discomfort. Furthermore, gastrointestinal conditions like constipation and diarrhea, which are more common in individuals with Autism, can hinder potty training progress.

Add to that potential developmental delays that often exist in the nonverbal population: delays in motor skills that make it difficult to manage pulling their clothing on and off, receptive language delays that make it difficult to understand and follow directions, expressive language delays that make it difficult to communicate the urge to go, resistance to change which can affect the transition from diapers to underwear, and sensory sensitivities which may provoke anxiety. The sound of the flush, the coldness of the seat, even the texture of the bathroom floor can all make the potty overwhelming for children on the spectrum.

Autistic children, especially those on the more severe end of the spectrum, benefit from more targeted strategies to help them learn to use the potty. It can be challenging, but it is also achievable. We just need to have patience and realistic expectations. Our neurotypical children don't potty train overnight, so we have to understand that our neurodivergent children will not either.

Some strategies include:

1. Break down the process into smaller, manageable pieces. This is where a visual schedule comes in handy. Include a card for each step of the process - one for pulling down the pants, one for sitting, one for potty, one for wiping, one for flushing, one for washing the hands. Explain the various steps before actually trying it. And focus on one part of the process at a time. Have the child enter the bathroom, point out the potty, and have the child practice pulling down his or her pants. Once that step is mastered, then move on to sitting. And once both steps are mastered, then move on to the actual potty. And be sure to celebrate every step achieved!

2. Create a potty routine, with consistent times for the potty. This will help reduce anxiety and make the process more predictable.

3. Never, and I mean never, make the child feel badly for sitting on the potty but not actually going, or for having accidents or for persisting to use the diaper. Potty training might be stressful for the parent, but is even more stressful for the child who is learning a new skill that is difficult to master. We never want to make the process more anxiety-provoking than it already is, because then the child will associate the potty with anxiety, which will lead to more potty-resistance.

4. Collaborate with the service providers who are working with your child. The speech therapists, the occupational therapists, the pediatricians, the teachers, other adults who may be supporting the care of your child. Create a potty plan where there is consistency across settings so that the child knows what to expect each time.

5. Observe the child's body language. There may be some cues, especially once the child has some awareness of his or her body, that he or she has to go. Once you notice those cues, take the child to the potty so that the child begins to make the connection.

6. Use positive reinforcement, such as praise or rewards, to encourage the child to use the potty. Finding the right reinforcement is helpful, and you might want to find one that is not only motivating, but one that can ONLY be obtained by using the potty.

We have used and are using many of these strategies with Becca and have seen great progress. It was a proud moment for me when I saw Becca grab the potty card from her schedule and go without prompting. We are not fully there yet, but we are on the journey. And we will arrive, soon and very soon.