Autism and Potty Training: Setting Your Child Up for Success

I received a call last week from the parent of an autistic four-year-old: “I’m trying to toilet train Ashley, but she’s terrified. What can I do?” And last night: “My son is five and isn’t potty trained yet – help!”

Whether you call it toilet training, potty training, or the more recent child-centred terminology toilet learning, this life skill looms large for many families. Your child may fear the small, enclosed bathroom with cold, hard objects, loud sounds, and spray. Society pressures us to train early: Kids who are not potty trained often cannot attend preschool or go to a restaurant. Children who have previously failed can associate it negatively, leading to increased resistance and power struggles.

But don't worry, there are solutions.

What are common issues?

Most neurotypical children are potty trained by age 3 ½ or 4 when they have bowel and urine control. In 2013, Dr. Mary Barbera, a registered nurse, behaviour analyst, author, online course creator, and autism mom known as The Potty Queen, surveyed 208 caregivers of autistic children and found that only 50% were potty trained by age four and five. Almost half said it took over one year, and 30% reported some regression after training.

They additionally reported these behaviours:

• Only going at home or in familiar bathrooms
• Insisting on removing all their clothes first
• Holding in bowel movements
• Fear of sitting on the toilet
• Fecal smearing
• Bedwetting
• Not being able to wipe properly

How will I know when to start?

Evelyn Romero, Manager of Clinical Services and Quality Assurance at Toronto’s Geneva Centre for Autism, looks for the following signs of readiness:

• The child can follow simple instructions
• Their diaper remains dry for at least 30-minute intervals
• They are able and willing to sit on the toilet
• They can communicate in some way, whether through speech, assistive technology, pictures or sign language
• They are adept at some self-care: they can pull their pants up and down

She asks parents to watch for clues they may not have realized exist: is your child squirming, doing a “pee-pee dance,” squatting, crossing their legs?

She also points to the critical need for family readiness. A regular, consistent daily routine is key. If a new baby is on the way, the family is planning a trip, guests are visiting, or Mom is away, it’s better to wait.

Depending on your child’s chronological and developmental age, Dr. Barbera believes starting as early as 12-18 months is ideal, with your child sitting on a small potty paired with a positive reinforcer. “The child will begin to realize this is just a natural part of the routine, and good things result from being in the bathroom. If you wait until a child with autism is 3 ½ or four years old and you try to abruptly potty train, it might result in more resistance.”

But she stresses that it’s never too late to start.

So how do we start?

Take a positive, non-punishment, goal-oriented approach. Both Dr. Barbera and Ms. Romero recommend the following:

• Do a diaper check every 30 minutes and record when the diaper is wet, soiled, or dry. This helps identify patterns that can lead to customized strategies.
• Name a “potty training manager,” often a parent or grandparent, and take a team approach. Dr. Barbera reminds us that this includes the child’s school: potty training strategies can be written into their IEPs.
• Sing songs, read stories, use visual supports and watch videos about going to the bathroom in different environments (home, school, the community). Family members can also model desired behaviours.
• If your child has sensory sensitivities, consider noise-cancelling headphones in the bathroom or a soft, cushy toilet seat.
• Determine if they need a step stool for foot support.
• Decide upon bathroom terminology. Whether you use “pee,” “poop,” ”potty,” “toilet,” “bathroom,” or “loo,” what matters is consistency.

Experts don’t always agree. Geneva Centre, for example, prefers that children wear underwear all day, except at naptimes, while Dr. Barbera believes they can train at scheduled times but still wear diapers or pull-ups outside the home for a while, as needed.

Be patient!

Set aside time

Potty training can take weeks or a few months. There will be accidents, so extra underwear, paper towels and cleaning supplies should be kept on hand. Washable shoes are also recommended.

Establish routines

Dr. Barbera suggests scheduling toilet sits 30 to 60 minutes apart to start. To increase the number of trials, give your child extra fluids; she says that even 4 ounces of liquid each hour is fine. With success, you can systematically increase the intervals.

Identify a reinforcer that will motivate your child

Some kids don’t understand why they should use the toilet. Reinforcers help them understand expectations. You can use a First-Then approach: “First you pee, then you can watch Paw Patrol.” Rewards can be an edible treat, special book, portable DVD or iPad kept in the bathroom. They should be immediate and reserved only for potty training. Special drinks like ice pops or lemonade can play a dual role as extra liquid and reinforcer.

Outside the home, think about your child’s needs

For example, if they are scared of the sound of a flushing toilet, you can cover the flushing sensor with a post-it note.

Throughout this learning period, jot down successes and accidents, and note how often your child sits on the toilet, urinates, or defecates and the amount of fluids they drink. This will continue to help identify issues and solutions.

What about associated medical issues?

Talk to a health professional if your child suffers from setbacks or more accidents than usual. It’s important to rule out medical issues like constipation and UTIs that may make using the toilet uncomfortable.

Constipation, in particular, can be a problem exacerbated by our Western diets and the push to potty train early. In pediatric urologist Dr. Stephen Hodges’ book It’s No Accident, he found that 90% of autistic children who have accidents are constipated, even when their parents say they’re not. Dr. Barbera adds that kids should ideally go to the bathroom daily with bowel movements like “sweet mashed potatoes” rather than long, formed stools or hard balls.

Let’s put potty training in perspective: it’s a behaviour like every other behaviour. The key to success is to have a plan, be consistent and take a systematic, team approach. Experts like Dr. Barbera and Ms. Romero are here to help if needed. And won’t you and your child be proud when they move past Huggies but still sing, “I’m a big kid now!”

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**For more detailed information:

You can download Dr. Barbera’s free potty training guide and sign up for a free Turn Autism Around® or Positive Toddler Parenting™ webinar at marybarbera.com/resources. Her books, Turn Autism Around and The Verbal Behavior Approach, each have a chapter on potty training. You can also find her on YouTube, Facebook, Pinterest, Instagram and TikTok.

Geneva Centre for Autism has a series of free webinars on toilet training, and families can access a free consultation with a behaviour analyst after the webinar. They also have a number of toilet training programs.