Toilet Training Part I

I recently joined a new facebook group for Parents of Autistic Children in Australia who are trying ABA. The old chestnut: When to toilet train?  came up and it reminded me to repost this advice:

Don't be pushed into it!
You have to be ready to persevere with it so make sure there are no holidays, or house moves coming up, or any kind of disruption to normal life as it will set you back.

Prepare by making a visual social story laminate the pictures and put them in the toilet where you can point to each step as you prompt them to do it.

You can also make a little book of pictures to represent each step - to read together.

These days you might be tempted to do a story using an App but please be warned - if you want it to be accessible during the toilet routine, you are setting yourself up for a water (and worse) accident with your iDevice.

Make it out of paper using pictures from any of the free image sharing websites listed below*
Adapt it to your child's needs and cognitive level to be very clear about the expectations. You might need to get a brown or yellow marker and color in some of the pictures if you know what I mean.

I also used a picture of clean pants and dirty pants. Use a pictogram rather than a photograph or you might find that they go from wearing pull-ups to being fixated with one color or style of underwear that you have to drive all over town to stock up on. A drawing is easy to generalise. A photograph can become a fixation.

Next, do some frequency charting.  Take a piece of A4 paper and write the time in 30 minute increments along the margin. Put it on a clip board and store it where you do nappy changing. Write a W (for wee) and P (for Poop) and tick the one you find to give you an idea of when to expect things. Take data over a couple of weeks to get the weekends recorded too. Kids will often have a very different rhythm in school.

You should also start preparing your rewards. These have to be JUST for toilet training so they are going out of circulation for any other activity. Something small and edible is just great as you can hide it and hand it over very quickly as soon as they are finished "performing" and washing hands of course.

Again, there is a temptation to give them access to iPads, iPods or even a mini-dvd as a motivation or reward. I suggest you start with the tangible treats and leave that in reserve. Unless you are prepared to ONLY give them access to the device after a successful toilet visit - and be prepared to fish it out of the toilet or hand basin (and replace it) then don't even think about it.

I would also suggest purchasing a large training potty. There is a model in the big toy shops that has a removeable tray, a base that converts to a step and removable booster seat. They can practice sitting on it in their pants and nappy while you read the social story booklet, until they get comfortable enough
Sitting high on a toilet for the first time can seem like sitting with your butt over the Grand Canyon, and  want them to feel calm and secure. They may also develop a fascination for the water and flush before you even get started - so a nice big secure potty is a way to avoid that.

Start with it in a room they feel comfortable with, and then move it slowly towards the bathroom. When Gracie got comfortable with using the potty, we were able to take it apart and use the booster seat part on the toilet and the step so she could climb up herself.  This is called pairing.

If they are at all interested in you when you go to the loo, you can start with the potty in there and do a little duet sitting a couple of times a day. Don't hang around waiting for a movement or wee, if they do one Great! Give them an instant reward, if they don’t, just get up and put the pants back on, wash hands and get on with the day. Don't build stress into the exercise, for either of you.

I also recommend the Bear in the Big Blue house "Potty time" episode on DVD or YouTube.
There are a couple of songs on it to learn and you can teach yourself to sing them to keep the whole event fun. Gracie loved this show so much she used to go and get Ojo, the little girl-bear and bring her to the bathroom with her. When Ojo appeared, we knew it was time for Gracie to do a No 2. so we followed her and supervised proceedings using the social story and picture cards.

Often around the time you start teaching your child with ASD to remove their nappy to sit down, they learn to remove it at other times - sometimes when it is full and they do a little bit of painting with the contents. This is incredibly stressful but do not feel alone. It happens with typical kids too but our kids may do it again and again. Remember the post on Behaviour? It is often your reaction that will fuel a repeal so remove the child from the event while keeping a straight face and put them securely elsewhere. If they are messy, by all means clean them up but don't be "giving out" while you do it. Just wipe the hands or whatevers and then give them something to do while you go back and clean up the mess.
They can actually find the big clean up reinforcing as you may not have spent as much time with them up until that point, particularly if you are running around after another child or just busy running the home. So don't let "making a mess with poo" become a means of getting your exclusive attention!

You should also start securing the nappy so they cannot remove it when soiled. Dungarees with difficult buckles, a neck to knee swimming costume (easy to get in the Summer) or once of those sleep suits that do up in the back are a good idea. Give up the toilet training until you have time to watch them closely - perhaps for a few hours each day.

There is no shame in giving up and coming back to try it another day. Don't let anyone pressure you into "getting them out of nappies." - there are far more important goals to be going on with and you might be better getting the fundamentals in place before you start.
For more about Toilet Training and Communication; Go here.

And now a word from the Bear himself: (no he does NOT do it in the woods, he uses a potty chair)

*Free Picture resources, click on the links or copy and paste into your address bar.


sharon Morris said…
Thanks. I'm inspired. Harri will wee when ever we put him on but he won't self initiate. We had been trying to avoid verbally prompting but I think in his case we may need to and then fade it.
Lisamaree said…
Be careful. Physical = fadeable. So a picture or a sign is a good bet. Hand over hand prompt him to make the sign or pick up a card. Good luck xx
Anonymous said…
Radosnego 2012!