One of the early pressures for many parents is toilet training. Some kids take to toileting easily and others don’t. The problem is society expects you to have your child toilet trained at an early age and there is a clear expectation this should be done before a child starts school. Neither of my kids were toilet trained before they started school and trust me this was not through lack of effort. I tried, pre-school tried, the health visitor tried and we all kept trying but they were not ready. One of my kids was toilet trained at 6 and the other is still working on it (7).
It is actually really common for autistic children to take a little longer than their peers to master toileting. This can be for a few reasons which are explored below. The one thing about your child not meeting milestones like this is you tend to blame yourself. Reality is some kids need a bit more time, they will get there so try not to get too stressed out about it in the meantime (easier said than done).
Why do some autistic children take longer to toilet train?
One of the main reasons an autistic child may take longer with toilet training is simply due to developmental delay. Our milestone expectations in society are based on the average child not a neurodivergent child. Our kids develop at a different rate and often in a different order they have different skills to their peers and will take a longer time than their peers in some areas like toileting.
Another reason autistic children can struggle with toilet training is related to the processing of the interoceptive sense. Interoception is our internal body signals such as hunger, pain and needing the toilet. Autistic children often have sensory processing differences. This can include difficulty processing information from the interoceptive sense. So they may struggle to identify when they need the toilet or only register when the feeling is overwhelming and they need to go straight away. For some they need more time to recognise these signals and for others they will learn a different way such as habit forming. Habit forming is learning a routine i.e. I must eat three times a day so I eat a 8am for breakfast, 12 noon for lunch and 6pm for tea rather than eating when hungry. You can do the same with toilet training by having consistent toilet breaks throughout the day.
A slightly more challenging reason for struggling with toilet training can be related to demand avoidance. Whilst it may not present in the way we expect many autistic children are highly anxious which can result in demand avoidance. More extreme demand avoidance will be around daily demands such as going to the toilet. This is not a conscious choice for the child. If this is the case consistency, flexibilty and patience will be needed from you.
It can be common for autistic children to have continence issues such as constipation do speak to your GP about any continence related issues.
Where can I get help with toilet training
Do ask for help around toilet training, whilst often you will get the same well meaning advice you have been trying for the past year it is still worth asking as you never know who may have that helpful piece of advice. Health visitors can support with toilet training and may help you come up with a toileting routine or plan.
If your child is in pre-school or school as the SENCO (Special Educational Needs Co-ordinator) for advice. Depending on your local service they should refer children of school age to the continence service this may be a bladder and bowel nurse. In some areas they will also be able to provide nappies for you for older children which can be helpful when you are trying to find larger size nappies. Although I do personally recommend Pampers size 8 which you can pick up in the larger supermarkets such as ASDA.
Eric the bowel and bladder charity has lots of helpful tips and advice on their website including some useful resources.
School won’t change nappies
It really upsets me every time I speak to a parent who is being called into school to change their child as school are refusing to do it. If your school is not supporting your child with continence then they may be failing to meet their duties under the Equality Act by providing reasonable adjustments. You will often need an intimate care plan in place but schools should be supporting your child with toileting. If you are not being supported by school then do contact the Education Rights service at the National Autistic Society.
Some tips for toilet training
- Be patient
- Be consistent
- Use visuals to support – routines, books, reward charts. Click here for some toileting visuals.
- Try not to focus on the opinions of people who don’t understand your child