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Dear Melissa,
My 4-year-old daughter has Autism. She will sit in her potty chair several times a day when I take her, and she even occasionally uses the potty. I think we are ready to actually start potty training. Now what?
Congratulations on all of your hard work…now for the hard part! Again, potty training was my LEAST favorite part of being a mommy, so I have read many different books and sought lots of advice on this matter. I have listed three approaches below. The third, a modified version of the first two approaches, is a “Seven Day Challenge” and has been my go-to approach for my own children.
The Gradual Approach
The gradual approach involves having the child wear pull-ups or training pants while you take her to the bathroom frequently throughout the day for several weeks. This approach has its benefits in that you don’t have to worry about your child having “accidents” either in your home or in public. The downside of this approach is that it often takes much longer for a child to become ready for big-kid underpants. In addition, pull-ups are so absorbent that children often can’t feel the difference when they do have an accident.
The “All-In” Approach
For this method, you take the child to the store, ask her to pick out her favorite big-kid underpants (I suggest buying a lot!), and then she NEVER goes back into diapers/pull-ups. First, you start off by taking the child to the toilet every 20 minutes and gradually move to every hour over the next several days. If a child has an accident, you do NOT shame the child. You are matter-of-fact about it being her accident (just as if she had spilled milk), and you ask her to clean it up. This approach means changing clothes and cleaning the floor if necessary. You can certainly help, but ultimately it is her responsibility.
The 7-Day Challenge Using an Adapted Approach
Personally, I used the “all in” approach for my own children, largely because it was what their school required. However, I modified the approach a bit and allowed my kids to wear pull-ups at nap and bedtime, and they still turned out OK. I suggest using this technique for one week. Hang in there for the full 7 days! It is really awful the first few days. However, if you see NO improvement by day 7, the child may just not be ready yet. That’s OK. Go back to the readiness tips from last week’s blog and try again in a couple months
7 Tips to considers:
- Don’t switch back and forth between diapers and pull-ups.This confuses the child and they can’t remember if they need to use a diaper or run to the toilet.
- Provide lots of positive role models.If everyone feels comfortable, allow older siblings to take the younger child to the bathroom, read books about “big kids” using the toilet, etc.
- Bribery works! Keep lots of tiny treats on hand for success. Think M&M’s, stickers, hand stamps, etc. Young children need immediate positive reinforcement rather than more extended behavior charts. However, they can save up their immediate rewards of stickers for larger prizes.
- Use easy clothing.Avoid buttons and zippers on pants during this time. In addition, clothing that is slightly too big is even easier to manage.
- Do not reduce fluid intake.Rather encourage her to drink lots of water. This will create more opportunities for successful use of the toilet.
- Don’t hesitate to help. Although the goal is independence, don’t hesitate to help your child when it comes to learning proper hygiene and proper cleanliness techniques.
- Praise, praise, praise! I know it often doesn’t seem like it, but young children really DO want to please their parents! The more you praise small successes (even simply sitting on the potty), the more likely your child is to cooperate.
As always, talk to your child’s therapists, pediatrician, and teachers to determine the best approach for YOUR child. In addition, your child’s speech therapist has the “magic fairy dust” of social stories. These fantastic stories help a child know what to expect with toilet training and make the whole process less intimidating.
Learn More
Consider attending the March 26, 2015 talk:
Toilet Training Children with Autism at the University of Arkansas, Fayetteville.
Resources:
Establishing Toileting Routines for Children. (2014). American Occupational Therapy Association, developed by Jay Doll, Bonnie Riley. Retrieved February, 2015 from AOTA.org.
Toilet Training Children with Special Needs (2014). American Academy of Pediatrics, retrieved February, 2015 from HealthyChildren.org.
Toilet Training. (2010). University of Michigan Resources on Child Development and Behavior Resources, compiled by Kyla Boyse and Kate Fitzgerald. Retrieved February 2014 from Med.umich.edu.
What has worked with toilet training your child?
Did you use the gradual approach, or go cold turkey? I would love to hear your ideas.
Please share! share@childrenstherapyteam.com