Parents of children with developmental differences often struggle with teaching them how to be toilet trained. I just finished reading Dr. Wenger’s excellent article in Contemporary Pediatrics, Toilet training Kids with ASD: Part 2.
Here is a summary of some of the important points:
It takes a village. Community support, compassion, a prescription for Pull-ups (so Medicaid might cover them) and a daycare or preschool IEP is helpful so teachers can be involved with the plan. Make sure his or her stools are mushy and not painful. Miralax or lactulose can be used if needed.
Starting at home. Read board books, watch children’s toilet training videos and develop a toileting chart to document the times of day the child urinates or defecates. A few children are very regular and it can be helpful to take the child to the toilet before these times.
Take him out of pull-ups while at home to help him learn about wetness. A bedwetting alarm during the day can be used to alert him and the parent/care provider when the wetting occurs. A recordable alarm, such as the Malem Recordable, can be programmed to play the parent’s voice rather than a loud sound when the wetting occurs. The small alarm sensor can be clipped to the outside of his underwear, where you would expect the first drop of urine. A command such as, “You need to go potty now” can sound when the wetting is detected. Over time, the child can begin to make the association between a full bladder and the sound.
Sitting training. The goal is first to have the child sit on the toilet with his pants on, even for 10-15 seconds. A free visual timer on their phone or a short personal video can help with this. Do this 6 times a day. As he begins to understand this, begin pulling his pants down.
Weekend work. Give your child plenty of her favorite drink. Have a sitting time every 30 to 60 minutes for 1 to 5 minutes. Offer a book, toy or 3 minute video to reward sitting time. Each child is different so doing this for 2 or 3 hours may be all you can manage on the first day. The goal is to have her actually pee in the toilet. Do this for the weekend and enlist the teachers to continue a similar pattern while at school.
Habit training. Have the school and home use timed toileting sessions. Parents can use a phone timer or vibratory watch as their personal reminder. Gradually increase the times between the bathroom intervals from 30-60 minutes to 2-3 hours. Know that accidents will happen and have plenty of clean clothes available.
Self-initiation: the last step. Toileting independence comes when your child learns to communicate the need to go to the bathroom, verbally, with sign language or with augmentative communication. Continue to work on wiping and washing hands after each bathroom break.