Effective Toileting Techniques for the Autistic Child
By Craig Gibson

This is a paired down version of an article I wrote for educators about toileting techniques for their students but the information is also helpful for parents. I hope it will help you with your mission of toileting your child.

For the entire paper, you can download it here :
http://img.autismspot.com/Effecting_Toileting_Techniques_for_the_Autisti...

The average age for independent toileting for autistic children is between ages six and seven. Toilet training for typically developing children is a challenge within itself, and doing the same for autistic children presents a whole new set of challenges.

Differences to be aware of:
* Autistic children may lack intrinsic or extrinsic motivation
* Autistic children may not be aware of bodily signals (e.g. sensations) and they may not recognize discomfort when having an “accident”
* Sensory levels are different from one child to the next (e.g. fear of flushing), but autistic children may also not understand the
sequencing of toilet training which can further complicate the process
* Determine Your Child’s Readiness
* Regardless of delay or disability, you’ll need to determine if your child is socially and/or physically ready for toilet training.

Consider the following when making this determination:
* Does your child act differently, or notice when his pants are wet?
* Does your child show interest in going to the bathroom (e.g. hand washing, dressing, etc.)?
* Does your child show interest when he sees his peers using the toilet, or when going to use the bathroom?
* Physically, is your child able to sit on the toilet while maintaining his balance in an upright position (e.g. understanding his body in space?
* Does your child cooperate with dressing and undressing before and after using the toilet?
* Does your child remain unsoiled for two hours at a time during the school day (including nap or rest times)?

Understanding Your Child’s Behavior

What events are talking place before any negative behavior occurs (e.g. tantrums resulting from the sight of the toilet, sink, etc.)? In other words, what could be causing the anxiety? It may be difficult, however, to determine the root-cause, as children with autism may not be able to verbally express their fears and anxieties.

Positive V. Negative Reinforcement

Positive reinforcement means providing a child with a motivator, or a reward, for completing the task independently (or with minimal assistance). But what motivates your child? While you might want to reserve food items as a last resort, sometimes it’s the only way to motivate. Whatever the reward, it should be given to the child immediately following the desired action, so he has a clear understanding of why he received the reward.

Negative reinforcement means you are removing an undesired object for the purpose of increasing desired behaviors. For example, if your child fears the toilet flushing after going to the bathroom, have him stand outside the bathroom while you flush the toilet. After a while, gradually decrease the distance the child stands from the toilet from one day to the next.
Creating a successful process

Collect Data - Collect data for about two weeks prior to toilet training to determine when, and how often, accidents occur during the day. Keeping this data will help you determine the best time to take the child to the bathroom, and will increase the child's likelihood for toileting success in the process!

Establish a Routine - Children on the autistic spectrum thrive on routine and predictability. Daily, consistent routines helps children on the spectrum feel safe and secure, and disrupting that routine may increase resistance and anxiety from a given activity or situation.

Create a Picture Schedule – One of the ways to help establish a successful routine is to create a picture schedule. To create a picture schedule, all you need is a camera, construction paper and some Velcro! Take pictures of the different activities your child does and then laminate (if possible) the pictures then place Velcro on the backs of each picture. With construction paper, place small pieces of Velcro vertically down the middle and line up the pictures in sequential order. When introducing toileting, position a picture of a toilet (or whatever picture you are using that represents the bathroom) positioned on the schedule during those times of the day when he is most likely to go (based on the data that you collected).

When it's time to use the bathroom, have your child go to his schedule, take off the picture of the toilet from the schedule, and walk it to the bathroom. As the child becomes more independent with the overall process, you can fade the prompts and visuals to independence.

In the End

Toilet training autistic children takes time, patience, and perseverance. It takes understanding your child's basic needs, what causes the fears and anxieties, and what truly motivates your child. It takes being on the "same page" with your spouse/significant other and even your child’s teacher.

Prior to toilet training any child, remember not to focus on comparatives (e.g. typical development versus atypical development). All children need to be toilet trained, and the best thing we can do is to focus on the necessary steps for each individual child.