Potty Training, Autism Style

 

Training a child to “go” on the potty is kind of like giving birth. Once it is DONE, you forget what a rough stage it was to go through. I asked a group of parents of teenagers with autism to recall what their potty training experience was like, and they looked at me as if  I’d asked them a trick question.  “I’ve blocked it out,” one finally replied, “all I remember was that it was all consuming and discouraging and went on forever. Can we change the subject?”

No, we can’t! Children with autism have whacky sensory systems and can be hard, but not impossible to train. You have to be creative. This is one time that you must even be open to unsolicited advice, because you never know what will work for your child until you try it.

I asked my Facebook autism forum to share their potty training success stories:

What is the best way to potty train a child with autism?

I have a friend that loves Halloween more than any holiday. Her problem is that she lives one mile up a steep hill. Still, she gets more trick-or-treater’s than anyone in town. How? She gives out 1 pound Hershey Bars. This is the idea behind a very effective potty training strategy: Motivation. Some call it bribery, others call it positive reinforcement, but the bottom line (no pun intended) is that children need to feel motivated to succeed. When your child has autism spectrum disorder, the motivation game is predictably unpredictable.

 

 What motivates your child?
“My daughter was still having accidents at age five, so I bought her a Hello Kitty Tea Set that she really wanted and set in top of the fridge where she could see it. I told her that once she went a month with no accidents the teas set was hers. What a nightmare. She started out well, with three good days in a row, and when she had an accident on the fourth day, she was so stressed out and had a huge tantrum. I gave her the tea set, and then switched to small rewards, like bubbles, stickers, time on the Wii each day she was accident free. She had fewer and fewer accidents and within a few months, she was having none at all.”

Sheila, North Dakota

It’s a good idea to stockpile practical and inexpensive motivators based on your child’s interests. ABA types say it’s best to stay away from food as reinforcers, but many of the parents that I talked with admit to using candy and goldfish in the mix.

 

Parents list of motivating non-food reinforcers:

• Video time- wii time,  iPad, iTouch time, iTunes cards
• bubbles, stickers
•  lego characters
• coloring books
• small toys like you might find in the treasure chest at the pediatrician or dentist, matchbox cars,  Silly putty
• a visit to the dollar store
•  praise (more about that below)
• coins for the piggy bank ,
•  time with mom alone, time with dad alone,
• puzzle pieces
•  piano time, drum time
•  crafty activities.

Not all children are motivated by toys and treats. When we started to potty train Matthew at age three, he was obsessed with drains. He even asked Santa for a drain for Christmas. “A train?” asked Santa, “No,” I laughed nervously “He wants a drain.” We live in California, where the idea of letting a child pour water down a drain as a reward was frowned upon. What else could we try?  Here are some inventive motivators that are so common sense that It I can’t believe wish I had thought of them myself:

 

Target Practice

“My son has Asperger Syndrome and when I tried to potty train him when he was 3 years old, he showed no interest, and I wasn’t sure what I should do.  My daycare provider was a woman with 9 children and several grandchildren. She had him potty trained in 2 weeks by putting dish soap in the toilet and telling him to make bubbles. Sometimes she would put cheerios in the toilet and tell him to try and hit the cheerios.”

Sarah, British Columbia

I know. Target practice isn’t so easy for girls. It is not a perfect world! More solutions:

Potty Training Videos

“My son has classic autism and is completely non-verbal. Showing him potty training videos (over and over and over again) worked for us. He was 5, and watched Elmo, and Bear in the Big Blue House potty training videos and potty training videos on you tube. He went from having no potty training skills to being completely potty trained in a few months.”

Sam, New York

Fun with timers?

“Try using a timer, and make it seem like a fun thing when it goes off. Be excited about going to the bathroom. This worked for us. We got a fun little Thomas the Train timer that my son could set himself.”

Kristin, Oklahoma

“We had great luck potty training our son, who is non-verbal, with pictures. I would set the oven timer for 15 minutes. When the timer went off, I would show him a picture of our bathroom, then tell him ‘potty’. I would take him and he would go. We went every 15 minutes for about a week, and then upped it to every 30 minutes. I would show him the picture before we went every time. We cleaned up all accidents in the bathroom to let him know that all toileting belongs in that room.”

Maria, California

“My daughter has severe autism, and responds to slow and steady, so we respect her pace. We take her into the bathroom with a timer (5 minutes max) and do our best to remain patient and unemotional about the whole thing. If we push her too hard, she gets anxious and regresses. She is 8 years old now and still wears pull-ups, but she’s able to communicate to us when she needs to go.”

Nora, Washington

Praise

“Our son is 4 1/2 and with the exception of an occasional accident he is fully potty trained. We tried to make it as much of a fun and positive experience as possible. We find that constant praise really works. We also got him a fun book called ‘ The Pirate Potty’    that has reward stickers and a cute pull out pirate hat.”

Jim and Katie, Florida

Don’t you hate it when friends with perfect children notice you struggling with milestones such as potty training, and they say “Potty training is hard for ALL children. You just have to be patient.”

I’ll give you patience…

 

Potty Party

“My son’s therapy coordinator and I had a potty party. We sat in the bathroom all day and pumped him full of fluids. We had books and toys in the bathroom. When he went potty he got to do his most favorite thing for 5 minutes and then went straight to the bathroom where the drinks continued. We did break for lunch. We did it from 8am to 5pm. We went straight to underwear and diapers at night. My son was completely potty trained in 2 weeks.”

Madeline, Michigan

Miralax

“My son is almost five, and it took us a year, but we finally have it down. Bribing worked great for urinating in the potty, but bowel movements were a completely different story. He wouldn’t ever go in his underpants, but he would hold it for seven days at a time until it became unbearable. By the time it got that bad, it really scared him because he was so constipated and worried it would hurt. We heard that many of our friends with autistic children used Miralax to solve this problem, so we asked our pediatrician. He gave us the green light, and it has made all the difference. We give our son just 1/3 of the adult dose, and mix it in with strawberry/chocolate milk. It’s NOT a laxative, it just makes it easier to eliminate and harder to hold in. Since my son loves cars and trains, we buy him underwear with those on it, and then we say, “We don’t potty on our friends!” and that really rang true for him. Our doctor told us to keep our son on Miralax for at least six weeks for best results. After the six weeks, our son’s fears were dissipated and he learned that potty time just a natural part of growing up.”

Claire, Rhode Island

Potty Boot Camp

“We set up in-home potty boot camp for my son when he was 5. Telling him why he needed to use the toilet didn’t really register, so we would wait until we thought he needed to go (usually an hour since the last time he went), then walk him over to the toilet and help him situate his naked bottom atop it. While he sat on his throne, we would let him watch a favorite video on my laptop until he produced — that way he could see for himself why using the toilet was a good idea, and so much less icky than going in his pull ups. And every time he produced, we gave him huge positive reinforcers: M&Ms, goldfish crackers, hugs, cheers — sometimes all four. We followed up with the peripheral aspects of toileting which can be overwhelming for kids like my son who need extra time and support to process sequences. Like wiping (and checking for effective wiping); pulling up underwear first, then pants; and washing hands (multiple steps). We encouraged him via reinforcers with his post-toileting routine as well.”

Shannon, California (Editor of   THINKING PERSON’S GUIDE TO AUTISM)

Matthew’s potty training ordeal was stressful, because he was entering a mainstream preschool with a long waiting list where all of the children were supposed to be trained before being admitted, and he did not appear to have any interest.

“He’s not 100% there,” I confided to his teacher, in fear of losing his spot. “I would actually say he is not there at all.” She told me she understood, and would help him.

After one week of effort from this dream preschool teacher, the job was done! How did she do it?

“I took him to the bathroom ever 20 minutes,” said Gretchen, “and praised him whether he went or not. By day three, he started pointing to the bathroom when he had to go.”

Did he do as well at home? Did I cave in and incorporate his love for drains and the target practice drill into his potty training?  It’s entirely possible, but I don’t remember.

I blocked that part out.

_____

Read the first three chapters of Laura’s excellent book HERE.

Order it HERE.