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Ahhh, potty training. That daunting task that most new parents fear will never happen. It is a tricky life skill to teach any child, and it can be even trickier for parents who are trying to teach a child with autism.
Is it harder to potty train a child with autism?
What makes potty training more difficult for children with autism is primarily the sensory aspect of this transition. Because most children with autism have sensory issues, it immediately poses one of two problems:
Oversensitivity (Hypersensitivity)
Hypersensitivity to environmental or body stimuli can be a challenge for children with autism in many ways that include sight, sound, smell, and feel. For example, the color of the bathroom, the sound of the toilet when it flushes, the feel of the toilet paper, and even the scent of the bathroom can cause issues. Considering some of these details about the bathroom itself can help set things up in a positive direction by eliminating sensory distractions.
Under-Sensitive (Hyposensitivity)
Children who are under-sensitive to their own needs or the environment can also prove to be difficult to train because they are not as aware of the urge to void their bladder or their bowels. These children need help to create an awareness of their body signals and how to respond to those signals in their surrounding environment.
So, you can see that potty training does take some extra concerted effort and strategizing for a child on the spectrum in comparison to his/her typically developing peers. That doesn’t mean that ALL children with autism have difficulty. Some children with ASD are highly perceptive and might train earlier than their peers, but the more typical scenario is usually a delay in potty training.
Is bed wetting part of autism?
Children with autism do tend to have problems with bed wetting. In fact, after the age of 5 it is speculated that about 15% of children with autism still have the tendency to wet their beds.
Even if a child with autism is potty trained, bed wetting can continue to be a problem for years after the child has learned to use the toilet during the day.
What causes this?
Sensory issues are definitely one of the main causes of the continued problem with wetting the bed at night. A child that lacks sensitivity to environmental stimuli can easily sleep in a cold puddle of urine throughout the entire night.
But, there are a host of other conditions that can lead to bed wetting:
Sleep Apnea
Some children have trouble with bed wetting due to interrupted sleep. A child with sleep apnea can struggle with enlarged tonsils or adenoids which can cause snoring, gasping for air, ear infections, sore throat, or daytime drowsiness from poor sleep. Some typically developing children with enlarged tonsils and adenoids also struggle with bed wetting due to interrupted sleep patterns. It is important to rule this out before struggling with potty training.
Small Bladder
Some children cannot hold urine throughout the night because they have an under-devloped bladder.
Hormone Imbalance
Anti-diuretic hormones (ADH) help to slow the production of urine at night. Any interruption in that balance can cause overproduction of urine at night.
Stress
Any significant life changes such as new school, moving, new siblings, or loss of one parent in a divorce can cause bed wetting.
UTI (Urinary Tract Infection)
An infection can be miserable and cause night wetting as well as day wetting, high frequency of urination, blood in the urine and pain. Be sure to rule this out with your pediatrician as soon as possible.
These are just a few things that can cause bed wetting. As a parent of a child with autism, you are probably aware of your child’s sensitivities or their problems with recognizing the signals that tell them when to go to the potty. Attention deficits, family history, and the sex of your child can also determine the probability of a child with autism having struggles with bed wetting. Boys are twice as likely as girls to wet the bed at night.
At what age is an autistic child potty trained?
There is no particular age when a child with autism is guaranteed to be potty trained. Some may fall right into the typical development schedule while others may continue to refuse to go to the toilet or just simply struggle with voiding themselves in the toilet during the day and night.
This can lead to a significant amount of frustration for parents. The first step to eliminating any frustrations about timeframes and milestones is to understand that there isn’t a definitive time frame when it comes to children on the autism spectrum. Each child on the spectrum has unique sensitivities and their own individual approach to everything that they do. Potty training will only be successful when they have the awareness and the willingness to learn this new skill amidst these sensitivities and by using their own approach.
How do I potty train my child with autism?
Potty training a child with autism is no different than potty training a typically developing child. It simply takes more time and a lot more patience to potty train a child with autism. Implementing some of the behavior strategies below can help make the process easier.
A typical developing child can tell you when they have to go potty.
This may not be the case for a child with autism. You will need to look for clues or signs that your child has to go potty. Does he/she hold himself/herself? Dance around? Start to cry? Stand near the bathroom? Take notice of his/her patterns as he/she starts to learn.
Teach him/her to communicate when they have to go potty.
Sign language or visuals such as a PECS communication board can help your child to communicate when they need to use the toilet.
Reinforce and reward your child when they are successful at using the toilet.
Find out what motivates your child and use that as a positive incentive to use the toilet. It could be anything from stickers to watching a favorite show. Reserve that special incentive strictly for those times that your child uses the toilet.
Avoid confusion.
Pull ups for toddlers are simply bigger diapers. This can be confusing for a child with autism because he or she might feel like they have taken a step forward into big boy pants or big girl pants and then suddenly realize that they can still pee or poo in these pants just like a diaper. Instead, use underwear that will get wet and feel uncomfortable when they are soiled.
Straight to the toilet.
Save yourself a step and use a seat insert on your regular toilet instead of buying a potty chair. Children with autism get settled into routines and getting them accustomed to a small potty chair is one more step in the chain of tasks that you will have to untrain. By using the big toilet with an insert, it is much easier to remove the insert and have them sit where they normally sit when they go potty. This is another way to eliminate confusion.
Use technology.
There are countless apps that you can download onto a tablet or phone that will sing repetitive songs and instructions to your child. This works well with children on the spectrum because they are drawn to visual stimuli and repetition when they are learning something new.
Don’t make a big deal about accidents.
Getting angry or visibly upset can cause the opposite outcome rather than the desired outcome. You definitely want to avoid causing unnecessary stress that will provoke more accidents. If your child wets their pants, simply state the obvious- “Oh, you wet your pants. Let’s get you some dry clothes.”
Timing is everything
When you decide to potty train your child, be sure that you can commit to it. If there is a new baby, a death, a divorce, a move, a school change or any other significant life change- this is not the time to potty train a child on the spectrum who will need your devotion to the task.
Consider sensory issues
Take note of the environment. The sounds, the smells, the sights or the feel of the floor, the toilet or even the toilet paper. If you notice anything that is causing distraction or distress try to make some adjustments and see if that resolves any issues that your child may be experiencing.
Rule out any medical conditions
Constipation or diarrhea can be problematic. If there is anything that indicates there may be pain or tummy trouble, seek the help of your pediatrician.
ABA Therapy Can Help
If you have a child on the spectrum, you may or may not be receiving ABA therapy for your child. ABA therapy is extremely helpful for tasks like potty training. An experienced ABA therapist can break a task like potty training into small, manageable tasks and reinforce your child’s successes along the way.
Circle Care Services in New Jersey has a highly qualified staff. We are trained to help children with autism to learn socially relevant skills and tasks that bring quality of life and enable these children to join their typically developing peers in all walks of life. Give us a call for a consultation today!
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