Teaching a child with autism to use the toilet can take longer and be more complex than for other children, and it can be highly stressful and challenging for parents. Lorraine MacAlister, Autism Training Consultant at the National Autistic Society, provides some tips.
People with autism may experience over- or under-sensitivity to sounds, touch, tastes, smells or light. All of these aspects can have an effect on a child with autism’s ability to learn about using the toilet.
Communication difficulties
Without clear and concise communication, toilet training can be challenging for children with autism. One particular area of difficulty is the confusing language used to talk about toileting. The word toilet can mean many different things - the action of going to the toilet, the facility itself, and the bathroom - which can make it hard for a child to know exactly what they’re being asked to do.
Idioms like ‘spend a penny’ can be hugely confusing for a child who perceives everything literally.
A child’s communication problems may also make it hard for them to communicate when they want to use the toilet, or if they are having any difficulties with this.
Parents can help to support a child with these difficulties by using clear and consistent language when talking about toileting, and clearly explaining what the child is being asked to do.
Many children will benefit from having information presented visually, as this can make it easier to understand.
Difficulties with social interaction and imagination
Children with autism can struggle to understand social interaction and unwritten rules of behaviour, which inhibits their ability to interpret what is expected of them and to know how to behave around others. In the context of toilet training, this can mean they do not have the usual social motivation to be like their peers. This makes it harder for children to move from nappies to underwear or a potty to a toilet.
Difficulties in social imagination can make it hard for children to imagine what’s going to happen next, which creates feelings of anxiety around new or unexpected situations. They rely on routine to manage this anxiety, which raises problems when they’re faced with a toilet that is new or unfamiliar, or when they’re asked to change from using nappies to underwear.
Children may also find it hard to realise that another person doesn’t know when they need the toilet, and that they need to tell somebody.
They may also not understand that soiling themselves or weeing in the wrong place has an impact on those around them. To address these issues, it can be helpful to integrate trips to the toilet into a daily routine, without the expectation of needing to wee or poo, to allow the child to feel familiar in a toilet setting. If a child is weeing or pooing in what others see as the wrong place, then they will need clear information about where is the right place, delivered with a patient step-by-step approach.
Sensory differences
The sensory differences of children with autism can make it hard for them to recognise when their bladder or bowel is full, or they may find it difficult to balance on the toilet itself.
The bathroom itself can be overwhelming for some children, whilst being full of fantastic sensory input for others.
For instance, some may feel a splash of water or sound of the flush too intensely and experience sensory overload, while others may enjoy all of the sensory distractions in the bathroom and forget about the toilet.
Some children may enjoy the texture of poo and love to play with it. In this case it is possible to recreate this sensation in appropriate settings, for example with toys like playdough. Sensory sensitivities can be hard to address, but understanding the child’s sensory needs and adapting the toilet environment can make all the difference.
Schools and toileting
Learning to use the toilet is an important part of growing up. Achieving continence can help boost a child's self-esteem, give them access to a wider range of activities, and help reduce stress and anxiety for them and all involved in supporting them.
It is helpful to include targets on learning toileting skills in Education, Health and Care plans. In this way, toileting is given equal importance with other learning targets.
ERIC, the UK Childhood Continence Charity, launched the Right to Go campaign to highlight every child’s right to good care for a continence problem at school, and to access safe and hygienic toilet facilities. This campaign is calling on schools to ensure they have appropriate policies and procedures in place to support children with continence problems and promote good bladder and bowel health.
ERIC has a wealth of practical information to help address continence difficulties at school, along with an overview of legal responsibilities under the Equality Act.
Five simple tips:
- Make sure you understand autism, and the related difficulties in the individual child.
- Assess any specific continence problems with the child's bowel or bladder.
- Keep your language consistent. Plan what words you will use to speak about toileting, and how you will deliver clear instructions, and stick to them.
- Start teaching a child about the toilet as early as possible.
- Be positive, reward progress and use positive language to talk about the toilet. Do not scold or blame a child for incontinence problems that they may not be able to control.
More information and strategies can be found on the NAS website
Click on this link for more information about ERIC and to download its guide for schools.