The First Steps of Toilet Training

Parents of children with autism who are thinking about toilet training often wonder when and how to start. This blog contains advice that I have gathered over the years by supporting many families with toilet training. Most of you may find that my suggestions are enough to get you started but some children may have specific difficulties that are not covered in this blog and will require more advice from an occupational therapist.

It is often hard to spot signs that your child is ready for toilet training and some children may not show any signs. The guide bellow will help you teach your child the first step of toileting which is sitting on the toilet even if they are not yet ready to use the toilet.

Prepare yourself

• Ensure that you are ready for a long journey. It can take more than a year with small goals achieved along the way.

• Avoid starting before a big change: moving to a new house, changing job or having a baby.

• Discuss your plan with your child’s school/nursery/child minder and the NHS team that supports you and your child, to ensure everyone is following the same approach.

• Choose “my child will sit on the toilet for 1 minute” as your first goal.

• Remember that toilet training of children with autism is a difficult but very rewarding task.

Prepare your child

• When you need to change your child's nappies, do it in the bathroom, next to the toilet. This will allow your child to start associating the toilet with its use.

• Together with your child, empty the poo from the nappy into the toilet and flush.

• Show your child how you use the toilet by taking them with you when you go.

• Always show boys how to wee sitting (boys should not learn how to wee standing until they are confidently using the toilet for a poo).

Prepare the environment

• Make the toilet area a nice place to be:

• You could decorate with wall stickers and posters with characters that your child likes.

• Buy a toilet seat and a stool that fits your toilet well.

From my experience of supporting parents through this journey the best toilet seats are:

1. Toilet seat with steps please read carefully to ensure that the seat fits our toilet. The seat has to be placed directly on the toilet and not on the seat that adults in the family use.

2. A stool + family toilet seat

Other toilet seats may not fit your toilet well and therefore might wobble which may scare your child.

• Prepare a transparent box with a lid and put a toy/book that your child enjoys inside. Alternatively, if you have a high shelve in the toilet that your child cannot reach, place the toy/book there. Crucially, this toy will only be used when your child sits on the toilet.

• You may have to cover the seat with a towel as some children do not like the cold feeling of the seat. You can try without, but bear this in mind as an option if your child refuses to sit.

• Prepare a few coloured and if possible laminated photos of the toilet at home or a toilet symbol (and write the word toilet under the photo or symbol).

How to start?

• Start by bringing your child to the toilet 1-2 times a day. It is best to start with once in the morning as they wake up and once in the evening before bath time or choose one of these according to whatever is most convenient for you.

• Ensure that your child is attentive. If your child is very active you need to use sensory strategies to help them calm before they can go to the toilet (this is something you will need to discuss with your occupational therapist).

• First take your child to the photo/symbol of the toilet - you can have a few of them around the house. Say “toilet” while you pick up the photo/symbol.

• Then take the photo/symbol and your child to the toilet and when you arrive say, “toilet”.

• Help your child to sit and give them the toy to play. After 1-2 minutes say “toilet is finished”, flush together and wash hands even if your child did not do anything.

• Persevere with the routine (you may have to do this for a month or two before you feel that your child can sit).

• If your child resists sitting, try to encourage it, but do not force them. If resistance continues, your child probably needs further occupational therapy support.

• Praise your child for sitting on the toilet, be specific by saying:”good sitting”.

• Avoid asking your child to manage their clothes. At this stage it is important to focus on sitting on the toilet. Asking your child to pull down their trousers and nappies will add unnecessary challenges at this step.

• With your child, take the photo/symbol back to where it was hanging in your house.

What not to do?

• Do not teach boys how to stand to wee until they can consistently do a poo on the toilet.

• Do not ask your child if they want to go to the toilet at this stage, just say “toilet”, show the photo/symbol and take them.

• Do not use the ipad/phone on the toilet as you may want to use these devices at other times. The toy should be a motivator just for sitting on the toilet and cannot be used at any other times.

• Do not give up too quickly. This is a new task for your child and children with autism need time to learn routines.