Recently someone asked me how I managed to potty train my autistic child. I said something like, “I went through hell and back, that’s how.” Without blinking, they asked directions for the road map to hell. I finally found the notes I used back in 2010 on a back-up drive (whew), and in reviewing what I went through, I decided this might make a better post than my review of Men In Black: International. Though, with fewer references to poop. For all the autism parents out there, this one’s for you.
When my son was six, I began to despair that he would ever be potty trained. I took him to the potty throughout the day, chirped inane positive phrases whenever he obligingly went pee, and thought I was training him. Turns out, he was training me!
I attended a seminar sponsored by a local Down Syndrome Association who brought a professional in from out of state. I heard about it through the grapevine and I have never been as grateful for any grape in my life–including fermented moscato derivatives.
What I learned at the seminar were some basic facts which I will attempt to boil down here–after nine years and forgetfulness, please forgive any errors. Please also note I am not a professional in this field, but I did go through the trenches using these methods.
This was the most intense training I have ever done and that includes learning to use an M-16 rifle and tossing a hand grenade in basic training. In fact, I would say, those two things were, by far, much easier than potty training and possibly less hazardous.
- Despite intellectual impairments, if your child stays dry at night and can follow simple directions, he/she is likely capable of being potty trained.
- If your child is mobile, can sit down and stand up, and can pull up or down their pants, then they capable of being potty trained.
- If your child does not have a physical or neurological impediment (kidney/urinary tract disease or malformation) he or she is probably capable of learning to be potty trained.
- If your child is older than seven years old, it will be much, much harder to train him or her. But it is still possible!
Hearing the last fact struck absolute terror into my heart. My son was already in small adult diapers by age six. I was ready to be tutored in ABA methods. For those of you who don’t know–ABA stands for Applied Behavior Analysis–or what my grandmother might have called The Carrot and The Stick approach to training behavior. But first, a few more facts…
WHY KIDS NORMALLY POTTY TRAIN:
According to the presenter, there are three reasons neurotypical children become potty trained, and as she spoke, she ticked off how and why this may not apply to an autistic child:
- Neurotypical children want to please their parents. An autistic child is unlikely to be motivated to please anyone but himself/herself.
- Neurotypical children are embarrassed or feel peer pressure to achieve same-age level of competence. An autistic child is barely aware other people exist and rarely embarrassed to pee or have accidents at all.
- Neurotypical children feel discomfort or dislike the sensation of wetness or smells. Autistic children can be very oblivious or confused by sensory inputs. They may not cry after being left wet or dirty for hours. Or the child may simply take the clothes off and leave them somewhere.
I distinctly remembered the hollow pit in my stomach when the presenter said, “If you take your child to the potty every time they need to go, what you are teaching them is that YOU are responsible for their potty needs.”
The presenter showed us videos, which, sadly, I have no links for. But we watched several excerpts which demonstrated what I am going to TRY to relate here.
How to Potty Train an Autistic Child
This methodology has science to back it up. I cannot produce said science because I only retained hand-written notes and did not footnote resources. Google ‘ABA’ and potty training, I’m sure someone has nice, long articles somewhere for you to read.
This is what I remember. If you plan to use ABA, you need to commit to this like nothing else you have ever done in your life. This is not like the gym membership that languishes unused. You need to plan to give up a minimum of 10 days of your life, with a possible two week extension for travelling outside of the home and instituting the same behavior plan at schools or daycares. Training happens everywhere! There is no “let’s fall back on bad habits, use pull-ups, so you can go on a vacation.” Commit, or be prepared to use diapers for the rest of your child’s life.
You need to devote 100% of your attention to the project. Don’t think you can half-ass this. It’s all or nothing! This is war. If anyone in the family poo-poo’s the plan, they are the enemy. Do not allow them to interact or undermine the plan. EVERYONE must be on board. Got it? That includes schools, day cares, grandmothers, well-meaning-friends-without-a-clue. EVERYBODY. If they are not in, they are out.*
Your child is not motivated by any of the reasons a regular/neurotypical child is motivated. So, the way this program works is to be on guard for moments to reward the desired behavior and to really, really discourage the negative behavior. The plan is to have a handy basket of really exciting, fun, highly motivating activities to do. The basket might have balloons, balls, toys, books, silly string, fidget spinners, crayons, action figures, videos, kittens…whatever gets your kid as happy as a kid can get. Let’s call this the Fun Basket!
In a second location, facing a wall or a corner, is the ‘negative reinforcer space.’ I’m sorry, but I’ll call it what it was–the Punishment Spot. For my son, we used sorting small objects (tiny plastic jewels and alphabet beads) from rice. He hated touching rice. Loathes it to this day. We didn’t have a convenient corner, so we pushed a small table up against the kitchen island and put two chairs there. The bucket of rice with trinkets sat next to a timer. (Though, timers were a highly motivating item for him, so this was a challenge. I had to set the timer and then face it away from him as part of the ‘punishment’ phase.)
The presenter warned us not to pick a negative reinforcer that our child needs to do in life–like forcing them to write sentences as a punishment. You had to pick something they hated, but that wasn’t quintessential to a fulfilled life. So, don’t force them to read, write, tie shoes, or eat veggies as a consequence. You don’t want them to equate school or meal time as a punishment. For some kids, just being made to sit out from fun would be detrimental enough.
Before we began, I prepared by covering the entire carpeted first floor with painter’s carpet protection tape instead of using drop clothes. It worked, but boy was it hard to pull up afterward.
I bought a bunch of toys, playdough, new cutter shapes, crayons, etc. I wrote a Social Story with pictures of my son in the various stages of pottying–including one with his wee little winky shown. (I never showed it to anyone outside our family, obviously.) We even had the Potty Scotty Doll to demonstrate giving him a drink and then taking him to the actual bathroom in our house to pee. We used the doll and the book to model the expected behavior. I took two weeks off work. It was go time.
I stopped taking my son to the bathroom and switched to underpants and waited to see what would happen. Lo and behold, he peed all over the floor instead. I learned I hadn’t been doing anything to effectively train him for six long years. It was time to do something different.
Baby Steps to Potty Training
- IN THE WEEKS BEFORE YOU BEGIN TRAINING: Associate the potty with fun! Start by placing a desired treat in a small dixie cup. (Food is probably not a good idea, but you decide.) Stickers, small bouncy balls, rocks, rings, dental floss whatever your kid will be pleased to find. If the child doesn’t find it on his/her own, clue the child in. “What did I see on the toilet/potty?” or “I wonder what that is?” and point. Once your child starts to check out the bathroom regularly to find treats, move to step 2.
- Don’t direct your child to go to the bathroom, particularly if they are involved with a super fun activity. Never ask:”Do you need to pee?” Don’t send them to the bathroom after they have already peed. It’s too late. Do subtly prompt the child when their bladder is likely to be full. Say, “Wow. I had a lot to drink. I feel full. You had a lot to drink, you may be full too.” You can say, ‘IF you need to pee, you know where the bathroom is.”
- If your child can pick up on these prompts and takes self to the potty, you gradually stop prompting and cueing and any external clues or reminders. Again, you want the child/ren to take themselves to the bathroom. Otherwise, they are training you to let them know when they need to pee.
- NO MORE DIAPERS. Your child switches to regular underpants. You can buy the super hero or sparkle princess kind, but I went with tighty-whities and lots of them. Have a truck-load on hand. (My kid wore nothing but underwear for two weeks.) Make a big deal about the child being a ‘big girl’ or ‘big boy’ and now they are rewarded for staying dry!
- After your kid is in underpants and has taken himself/herself to the potty, he/she HAS to stay dry. Check dryness periodically, reinforce staying dry: “Great, you are dry. You get tickles!” Or kisses, or high-fives, or swing them in circles…basically, some easy, positive reinforcement for taking self to the bathroom. “You are dry so you get to have the sparkling tiara for the day. You are the princess of the dry kingdom!” Find your own phrase. We used, “You are such a big boy. Staying dry means we can have fun!”
If you are laughing at the above description because you’ve tried all of the positive reinforcers under the sun, short of buying them a pony, that’s understood. We all tried to bribe our kid to pee and, if you are here, it probably didn’t work. On to the Stick portion of the training.
HINT: Give your kid lots of water/juice! You want them to have something that makes them go pee a lot. **
Dry or Consequences…
- If your child is wet/soiled that is when Stern Mom shows up. You turn from Glinda the Good Witch into The Wicked Witch of the West. Say loudly: “NO! You are wet! You are poopy!” (Whatever word you prefer, but sound angry. We want them to not like what is about to happen.) “FUN IS DONE!” “You can’t have your Mr. Bippy.” “No more Toy Story Movie.” (Whatever their fun item was, you put back into the basket, under a blanket, or in toy box–out of sight.) Now we transition to the hard part. Channel your inner drill sergeant and say, “You have work to do!” or “Time to practice potty time.”
- Leave the child in their dirty clothing. Speak in strong tones. “Big boys don’t pee their pants. We stop playing and go to the potty.” Walk child to bathroom. Stand them at the toilet, make them push their pants down, get on the toilet, but immediately lift them back off the toilet! Drop a square of toilet paper in. Recite what you are doing. “Big Boys stop playing. Big Boys go to the bathroom. Take pants down. Sit on toilet. Pee or poop in toilet. Wipe. Get off toilet. Pull pants up.” You repeat these phrases and march them back to the spot where they had the accident. Point to the mess. “Big Boys don’t pee on the floor. Big boys go to the bathroom,” (take them back to bathroom) “…take down pants, sit on toilet. Pee in toilet. Wipe. Pull up pants.” You go back and forth between the toilet and the scene of the crime at least three to four times. If they start crying, you know you are at least reaching them on some level. You repeat what they should have done. (Remember they are still wearing wet pants and are likely dragging the mess around.) DO NOT LET THEM PEE OR POOP IN THE TOILET WHILE DOING THIS PRACTICE. Sounds crazy, but they have to take themselves there.
- Hand-over-Hand Clean Up — Your child needs to clean up their own floor mess. (Obviously, if there is a BM – you can use rubber gloves to recover the mess, but make sure they are still responsible for ‘cleaning up’ in some way.) Grab the handy wipes or paper towels and make the child bend over in an awkward crouch–no kneeling–you want this to be a Twister game maneuver that will make cleaning the most uncomfortable act. If they drop to a knee, make them stand up and bend to reach in a tiring position. (If you do yoga, think downward dog. See image below.) No kneeling or squatting allowed. You can recite what they are doing. “You peed. You pooped. No more fun! You need to clean up.” (Use small words/phrases. Same words. Repetition until you hear these steps in your sleep is the key.)
- Have child take off underpants NOT in the bathroom. If their bedroom is close, that would be appropriate, but if you don’t want a mess trailing through the house, adjust. Have them ‘clean’ their own underwear in a bucket or laundry sink and deposit it in the laundry bag or chute.
- Punishment Spot – obviously, call it something else. “Time out” or “NO MORE FUN TIME!” Set child at the prescribed table with non-preferred activity. Set timer. For younger children 5 minutes is probably sufficient. But I set it for 10 minutes when my son was 6. At first, I had to hand-over-hand force my child to sort through rice. It was not fun for either of us. I remember that we were not supposed to speak or interact or even give eye contact. Cold-shoulder task master is what you are in the time out chair. Simply redirect the child to do the unpleasant task until the timer rings. Do not look at the child. Do not give any positive reinforcement. Keep them at the activity.
- When the timer is up, return to casual activities. You can set the timer and say, “Okay, let’s stay dry for 15 minutes!” If they are dry, a fun activity can begin again. Be checking to make sure they stay dry. After the timer dings, you reward them. “Great! You are dry. More fun time!” Be overly enthusiastic about being dry. DRY RULES! High fives when dry. Fun movies. Tickle time. Squishes with pillows. Fun books. Balloons! You get the idea. Glinda the Good Witch is back. All hail Glinda. Gradually increase how long they have to stay dry each time. Provide various new, fun activities to keep them motivated to stay dry. ***
- Keep providing liquids to encourage peeing. If and when the next accident happens, usher back in The Wicked Witch of the West and repeat steps 1-5 of Dry or Consequences. That’s it. Mostly.
I remember those ten days like they were a horrible fog of yelling and repeating all of the above steps. Honestly, I was surprised it worked, by about Day 8 or 9. Before then, I was ready to give up and declare my son untrainable. I spent every minute together reinforcing the positive or reacting to the accidents like he’d committed the worst offense possible. My goal was to make my son cry. My son was and is mostly non-verbal. He still has a hard time letting me know how he feels physically or what his emotional state is even using an augmented speech device. Back then, I wasn’t sure how he felt about anything unless he was actively laughing or crying. According to my notes though, crying is not actually a goal. Make them feel bad, yes. Terrorize them? Well… My son is at the severe end of the autistic spectrum, limited in communication, isolated from the world and the usual behavior you can easily interpret. I got through to him by being a tyrant about potty time. I never took him to the bathroom. I would remind him where it was. “The potty is over there, if you need it.” But, if he peed on the floor, I was all over him like stink on a corpse. And I made his time walking back and forth to the bathroom miserable, repeating the steps to lowering pants, sitting on the toilet, getting off the toilet, dropping the toilet paper, and going back to where he’d had the accident as uncomfortable and undesirable a consequence as possible. Make staying dry easier and preferable to having an accident! Above all, be consistent!
Public Potty Training Protocol
When your child seems to have a grasp on where and when he or she is supposed to pee, and can communicate a need to potty in some way, you might be feeling brave enough to try this in public. Pick a place that has a bathroom! You’ll need to carry a complete kit with you, if an accident happens.
- A change of clothes, including underwear and socks.
- Wet wipes
- Baggie to hold dirty clothes and wet wipes afterward.
- Small box of ‘punishment tools’
- Reward stickers/toys for staying dry. Candy might be good here as it is usually a highly favored thing.
You go to the store, for example, your first act is to locate the bathroom. You are NOT taking your child to the bathroom. You open the door, show him or her where the potty is “That is the Potty” and then immediately take them away from the bathroom, saying “That’s where the potty is if you need to go.”
If your child is non-verbal, if he or she knows the sign for ‘Toilet’ from school or from home training, that might help the child to communicate they need to go. You can repeat the sign every single time you use the word “Potty” while you are training them. For my son, the school used a closed fist with the thumb tucked under the curled index finger–and shake the fist to signal its meaning. You shake the fist, saying “Potty” or “Toilet” and, hopefully, they will be able to repeat the gesture to you. You can remind them as you are going through the store, “Remember, if you need the potty, it is over there!” Shake fist on word ‘Potty’ and point to the bathroom. My son actually would lead us to the bathroom by taking my hand and pulling. Make this the quickest trip to the store ever. Reward child for staying dry.
If your child has an accident in public, you must be prepared to do a quick, but accurate version of what you did at home. “Fun is done!” But, I’d recommend having them clean up their mess first, and THEN heading to the bathroom, quickly reviewing pants on/off, and dragging them back to the scene of the crime to ‘wipe up’ the mess again. Try to do this at least twice. If it isn’t really possible to be as severe and repetitive as at home, you do your best and then find a place to give them a long time out with the punishment box. (It was very easy to bring a small tupperware container of rice and small items as his consequence.) We’d go to the car and I’d make him sort through for the items if we had to. If you had promised a trip to the park for staying dry, they lose the highly desired reward. But, we didn’t have very many accidents outside the home once he was trained. The hard part is making sure you are keeping an eye on any request or indicator that they make to need to go to the bathroom. My son would lead us. Make this trip out of the home specifically to test for potty training. Do not go with the intention to get all the week’s groceries. Focus on the goal. Reward dryness. Punish accidents. Withdraw happy fun-time and enact the silent misery treatment.
Mistakes to Avoid:
- No Bathroom Schedule–don’t schedule a time clock potty break (every half hour, every hour.) This works against the desired behavior–for your child to recognize when their bladder is full and react appropriately. Some children recognize the bladder separately from the colon. They might train better on one than the other. You can prompt your child with hints: “Hey, before I sit down to watch tv, I’d better go pee.” Model your actions and tell your child what you are going to do. Follow through. But don’t take your child to the bathroom or that makes you responsible for always taking them.
- No Belated Potty Breaks–don’t put them on the potty after an accident to try and make them go pee or poo there. They’ve missed their opportunity to take themselves. You do show them what they were supposed to do, but you never leave them on the toilet for more than a second or two before pulling the pants back up and leading them through the drama of Not Dry Consequences above.
- Underpants Rule–don’t switch back to pull-ups. That is back sliding. It may be convenient for the moment, but you are training for a future free of diapers. Commit and move forward with that goal in mind.
- No Forgiveness–if your child has an accident, it is never okay. (Now, obviously, if they get sick, this is not their fault.) But, while potty training is underway, all accidents are unforgivable and require the punitive/discouraging measures. You have to make accidents so undesirable a consequence that even your child is going to want to avoid them.
- Fade Prompting–once your child establishes that they know how to take themselves to the bathroom, you fade your hints and reminders of where the potty is–unless you go to a new place and you need to show them where it is. They have to rely on the signals their body is sending. IF they have an accident, you fall back on the rote punitive/discouraging measures.
Final Words of Advice
This is not a fun time. You won’t enjoy it. It will actually be harder on you than it is on your child, I can promise you that. I gave myself a goal that if we accomplished this I would get to order a Godiva Chocolate Cake that cost an insane amount of money. And it was extra delicious because of the pain and suffering we went through. If you make it through hell, you will never feel greater satisfaction in your life. You will have conquered a mountain and given your child the independence and responsibility all children deserve to learn.
Also, be prepared for failure. I remember they warned us that when children get hurt, sick or are teething, they are likely to fall back into accident behavior. You must be prepared to pull the emergency potty training backpack out of the closet and retrain using all the steps at your command. My son did relapse while teeth were coming in and going out. We only had to go through a few crash course reminders of hell week before he was back in the saddle again, so to speak.
Lastly, this training did not work for a friend’s child. Some children are so impaired, it may not work. You may need to seek medical advice to determine a cause.
And, in case it wasn’t very clear, you are never to spank, pinch, or physically hurt your child in any way to achieve the goal of potty training. Traumatizing your child can backfire and make them withhold peeing or pooping and create a bigger, more serious problem.
Remember, you love your child and are doing this for their sake as well as yours. This may be tough love…but it is done with love. Keep that in mind and good luck. And to all the moms and dads going through potty training right now, I salute you. Remember, you are heroes, everyone!
Asterisk Bedazzled Footnotes:
*If someone so much as starts the phrase, “Well I potty trained my daughter in a day, you must be doing it wrong…” you have my permission to slap the sh*t out of them. That child was a savant and potty trained herself; the mother had nothing to do with it.
**Making your kid shotgun juice boxes may not be the healthiest choice, but this is potty training. IF there were Potty Police, this would be called Juice Entrapment. But there’s not, so keep the sugar water coming.
*** Reward sustained dryness like they have earned an Olympic medal or Nobel Prize in Peeing on the Potty. Hell, hold a ceremony after a week of staying dry. Buy them that pony! It’s totally worth it.