Back in the summer I wrote a post about potty training an autistic child. We were a couple of weeks in and I was already pulling my hair out. It was hard, real hard! I was going to write an update a little while into it, but not much had changed. I was so stressed about it all I didn’t want to sit and write about it too. We had advice and support from an incontinence specialist and whilst her was advice invaluable, it also made me feel really awful for getting so cross with Hayden and his ‘accidents’. Well after just over 6 months later I can finally say we (mostly) have a potty trained little boy now. After talking to another blogger a couple of weeks back, I realised that I wasn’t the only person to find it all so hard, potty training a neuro-typical child is hard enough (which I have since found out after taking the plunge with Ellis) but potty training an autistic child, especially one that is non verbal or has minimal communication skills is the hardest and most stressful time in my parenting journey so far. I thought I may be able to help other people with my experience and share how we potty trained our autistic son.
I am completely aware no two autistic people are the same so you could have tried and failed using all these techniques, or it could have been a breeze. This is simply me drawing from my own experience and giving a couple of little nuggets of information we received from our incontinence specialist. (Disclaimer: this is my understanding of her advice and information and not word for word quotation)
How we potty trained our autistic son
The first couple of points are much like the advice you see for neuro-typical children.
Wait for them to be ready
As with all children, you really have to wait for them to be ready. As Hayden got closer and closer to finishing pre-school and only weeks away from starting school, I was getting increasingly worried about social perception. A school child in a nappy? Not really ideal is it? I have since come to the conclusion I really don’t care what other people think anymore but that was where I was in my acceptance process at the time. As if by magic two weeks before Hayden finished pre school and we went into the beginning of the summer holidays, he decided no more nappies! I embraced it nervously, and what better time than the summer. Unfortunately the summer holiday’s weren’t as dry and sunny as hoped, so many accidents happened inside.
Reward the successes
As with neuro-typical children, for many on the spectrum praise goes a long way. I found praising Hayden really difficult actually. Not with my words, but rewarding him with a lolly or a little packet of sweets then caused mayhem from Ellis, who at 2 really didn’t understand why Hayden could have something and he couldn’t. We then went down the route of a sticker chart, but as our toilet is upstairs and much of the time Hayden would continue playing in his room after a success, all would be forgotten by the time he got downstairs a little later (usually asking for biscuits anyway). The best praise we could give him was high fives and lots of silly dancing and singing. He likes music so seemed to respond well. Reward whatever way suits your family, but it is so important.
Be prepared with PLENTY of pants, cleaning materials, baby wipes and air freshener/febreeze
Accidents are going to happen. A lot! I spent the best part of 3 months with a house that didn’t smell too pleasant by the end of each day. I could have gone down the route of hiring or even buying a carpet cleaner, but I would have been cleaning the entire upstairs every single day. As a mother of three children with a full time working husband, it just wasn’t feasible. We stocked up on vanish carpet cleaner (which might I add is rubbish-find an alternative) febreeze, cloths, scourers, air fresheners. Just to keep the house in some sort of order. Hayden much preferred to have his accidents upstairs, he could do it without being seen or told off. The problems came when he got it on himself. He doesn’t like the feel of it against him so would do anything and everything to find a way of getting it off his skin. I have cleaned walls, beds, doors, carpets, hand rails, wardrobes, teddies, bedding, all in one sitting!
And you will need plenty of pants, I think I changed Hayden’s pants 12 times in one day. I would have allowed him to stay naked but he was playing in the garden and I don’t know our neighbours all that well. Something I wasn’t really comfortable with.
Don’t make a fuss of the accidents
This was something that we were advised after an initial chat with our incontinence specialist. She sad that he may get pleasure out of helping, and find it a positive part of the toileting process. She said to use positive language to remind him what he should be doing rather than discussing what he had just done. And clean it up calmly and quietly without making a fuss and without him getting involved.
Explore reasons why the accidents are happening
Another piece of advice from the specialist. Hayden’s accidents no longer seemed to be accidents as such. It was rooms with carpet that seemed to get the most soiled (not my wooden flooring downstairs which would have been a whole lot easier to clean). She explained that this could be a sensory thing for him. Maybe he liked the sound of it hitting the floor, the smell of wee or poo in his room, or maybe he liked seeing it hit the floor. Something that sounded so ridiculous to me, but for someone with heightened sensory needs, is totally understandable. She also asked if there was a particular spot in any room that he did it. Unfortunately there wasn’t, but she said she would usually advise people to put a bucket in that spot with a piece of carpet at the bottom of it. And then you could slowly move the bucket closer and closer to the toilet with time. She also asked how he responded when we did sit him on the toilet. We didn’t generally have any problems at that time but she suggested there could be a smell, sound or feeling in there that bothered him, for example one client had a lavender air freshener in her bathroom, once she took that away her child started using the toilet more consistently
Safety in numbers
One of our biggest turning points in the whole process was when we went away in October with family. We had 6 to 8 adults around, everyone could remind him, everyone could praise him and give him high fives, and because the other kids were constantly playing together, we were able to reward Hayden with lollies without the other boys asking why they couldn’t have one. Having that extra support was brilliant. When we got home we had a few accidents in the first few days, then all of a sudden 90% of Hayden’s wee’s happened in the toilet. I know not everyone can just go on holiday with everyone but when you have visitors or visit other people, use them to help!
Use prompt cards and visual timetables
This didn’t work as well as I had hoped, but did have a positive effect in the early days. My consistency was probably to blame here over the idea. I made Hayden some laminated toilet cards and a laminated visual timetable. I gave pre-school some, and he had the same at home. He would use the prompt cards at school but never at home. He likes counting so the timetable had the steps numbered. Every time we took him to the toilet he would count the steps but then Hayden soon lost interest. I think in all honesty, it helped him understand the process of what he should be doing at first, but once he knew what he was supposed to do he lost interest.
Change your tactics and find a method that works
Don’t give up if your first method doesn’t work. We started off with the potty which he hated, then bought a child seat for the toilet, which worked for a while but then he would start screaming every time we took him into the toilet. We had a go without the child seat and he calmed down again. WE had the same screaming issue a little while after, and realised he no longer wanted to be watched. We allowed him to close the door and we would sit outside. He then started taking himself. Just let them lead and try new things if something takes a negative turn.
Explore diet options
I would not advise you to do this without speaking to someone that knows what they are talking about first. But whilst we were at Hayden’s diagnosis appointment, we were asked about Hayden’s eating habits. Whilst they aren’t the best, we felt he was getting enough nutrition out of his diet, but I did want to explore exclusion diets as I have read about this helping autistic children in quite a few different ways. She, personally didn’t advise it for children as young as Hayden but would refer us to a dietician anyway to discuss it with someone more specialised. This conversation continued as we met with the incontinence specialist whilst awaiting a decision. At this stage we had turned a corner with weeing in the toilet but were still having lots of issues with poos. She asked lots of questions including about the consistency (sorry for the overshare). Whilst I hadn’t worried about the consistency before it was incredibly runny (nightmare to clean) and very yellow. James and I had a debate about the whole thing in front of this poor lady and the conclusion came to how much fruit he eats. She suggested we monitor his fruit intake over the next few weeks and she would give us a follow up call and she would advise further. We reduced the amount of fruit, but there was no change. I decided to buy gluten free bread one day after hearing that some intolerances can cause changes to a stools consistency. I didn’t want to make any massive changes to his diet without professional advice, so thought I would change his morning toast to gluten free and see what happened. Within three days his stools were firmer and a colour you would expect. And a few weeks after that we had reduced poo accidents by half.
So there we are. Some tips and tricks that have worked for us. We aren’t quite there all day, every day and we still have accidents. Some I just think catch him by surprise, other times I think he forgets until it is too late. But the house is much calmer on the toilet front. And smells so much better. I hope you can get something out of these tips, and good luck. You will need it! Have you potty trained a child on the spectrum? Did you use any of these tips or have any to add?
Now it is Ellis’ turn! Hopefully that will be a much quicker and calmer process!