Tuesday 25 February 2020

Let's Talk About ...... Toilet Training

**** Please note that the advice in this post is based on our personal experience in toilet training children. I do not receive commissions of any kind for any products mentioned in this post.****

Over the last few years on our Autism journey, I've been asked for advice on many different topics. One topic that comes up in conversation on a fairly regular basis, is "do you have any tips for toilet training my child?"

Well, where do I start?!?!?! Working in the early learning industry and toilet training both of my own children, I have used a number of different strategies to toilet train both little superheroes as well as children in my care at work. But let's face it, toilet training any child, regardless of diagnosis or not, can be daunting but toilet training a child who struggles to understand their internal body signals, interoception, can make toilet training that little bit harder.

Before we get into toilet training, I'll recap on interoception for those of you who haven't heard if it before now. Interoception is one of our hidden senses and it consists of all of the internal sensations that we feel on a daily basis - including when we need to go to the bathroom. For children on the spectrum, interoception can play a big factor in struggles with toilet training.

Children who have been diagnosed with Autism Spectrum disorder may struggle with toilet training for a myriad of reasons. Their sense of interoception may still be developing and even though their body is sending all the signals that they need to go to the bathroom, they may not be able to correctly interpret these signals. Children whose communication skills are still developing may not have the skills to verbally tell you that they need to go to the bathroom. They may also lack the motor skills - both fine and gross motor - to physically use the toilet.

So what tips can I pass onto you, the reader, on teaching your child, or perhaps a child in your care, to use the toilet?

First things first, the key to toilet training of any child is patience. Depending on the child's skill and developmental level, toilet training can take some time. Be patient and calm - children pick up on this in us. If we are patient and calm, then we can assist the child to be calm. Toilet training is a big skill for any child to learn. For some children, physically sitting on a toilet can be nerve wrecking.

You also need to ensure that your child is showing signs of being ready to toilet train. These could include -
  • Indicating to you that their nappy is wet or soiled - they may try to take the nappy off or they may vocalize or sign to you that their nappy is dirty.
  • Your child may physically take you to where the clean nappies are stored or they may go and get a clean nappy themselves.
  • Your child may be staying dry most nights while they are sleeping - this indicates that their bladder and bowel control is developing.
  • They take more of an interest in the toilet.
We began toilet training both little superheroes when they started to show signs of being ready. O was relatively easy to toilet train, but in saying that she was toilet trained at day care long before she was at home.

With O we used a book called "Stress Free Potty Training." At the beginning of the book, the reader does a quick questionnaire about the personality type their child and then based on the child's personality, the book is broken down into tips for each personality. When I initially read the section based on O's personality type (she was a child who would master a skill and then not do the skill again,) I said to my husband that the book could have been written specifically about O! We were then able to toilet train O very successfully and quite quickly.

With L, however, toilet training didn't come naturally to him and for a long time we really struggled. At times, L showed an interest in that he would sign to us that he needed to be changed or he'd simply take his own nappy off but we really struggled to toilet train him, and at other times he showed no interest at all.

It was really only after he started early intervention therapy and his therapists gave us some tips and tricks of the trade, that we were able to properly begin toilet training with L.

So what did we do? Well....

We had to build L's confidence up in using the toilet. To begin with we'd simply get L to sit on the toilet (with the lid down) fully clothed, just to get him to feel comfortable. We read stories about going to the toilet - one of his favourite books was a book with the Sesame Street characters in it. We'd read this book to L while he was sitting on the toilet. One of the reasons that I think L loved this book is that the final page was interactive - he was able to flush the toilet on the last page by pulling a lever down! We'd read the book and then he'd play with the last page over and over again!

We were made aware of the fact that L's sense of interoception was probably still developing which could account for him lacking the ability to tell us when he needed to go. Whenever either myself or Daddy Superhero needed to use the bathroom, we'd encourage L to try too. We'd let him know that "my tummy feels a bit sore, maybe I need to go to the toilet," in the hope that he would begin to recognise his internal feelings. L watched us many times when either of us went to the toilet!!

L's therapists at the early intervention centre created social stories for Lachlan about using the toilet. These were personalised with photos of Lachlan in the bathroom - flushing the toilet, sitting on the toilet and so on. We also had social stories about washing hands.

We put up visuals in the bathroom on the steps involved in going to the toilet and washing hands after using the toilet. We still use these visuals just as a reminder of the steps involved as occasionally L still forgets the steps. It's not a case of L being lazy, his executive functioning skills are developing so he genuinely forgets and just needs a visual to prompt him.

Whenever we were encouraging L to use the toilet, we'd say the word "toilet" and sign the word as well. Initially L was non verbal, so by learning the key word sign for toilet, he had a means of communicating to us that he needed to use the toilet.

We incorporated L's intense interest of superheroes into toilet training. Every skill that L has learnt, his superhero figurines have been there every step of the way, including sitting on the toilet. This was a huge motivator for L - if his superheroes could sit on the toilet, then he was keen to do it too!

Initially we kept a record of when L was soiling and wetting his nappy and/or clothes. When we established the times that he would generally soil or wet himself, we'd encourage him to use the toilet at roughly around those times.

We would also use a specific phrase once L was sitting on the toilet, something along the lines of "L, wees and poos go in the toilet," so that he began to understand why he was sitting on the toilet.

L likes to be in control of what is happening around him so we'd give him choices based on an outcome that we wanted. We wanted him to use the toilet so we would ask questions like "Who would you like to take you to the toilet? Mummy or Daddy?" or "Which toilet would you like to use?" Questions along these lines made him feel like he was in control. If we ever asked him "Do you want to go to the toilet?" the answer was always no!

We'd also give L a visual countdown of when he'd need to go to the toilet - we'd also let him know that in five minutes it was time to go to the toilet. This certainly helped as without a countdown, he'd become quite distressed.

Other tips that could be useful ....

  • You could encourage your child to simply sit, fully clothed on the toilet and praise your child if and when they do. Start off with a small amount of time and work up to longer periods.
  • Some children find the noise of the toilet flushing overwhelming - so initially, simply get them to be in the vicinity of the toilet when you flush it and work up to your child flushing the toilet. Again praise them if this is successful along every step of the way.
  • Your child may have difficulty in dressing and undressing themselves so they may need your assistance in this.
  • Some children may respond to reward charts - a stamp or sticker each time that they use the toilet and a reward once they get a certain number of stickers. We did try sticker charts and other rewards with both little superheroes, but neither were interested. They loved getting the sticker but it didn't help in any way with toilet training.
  • Once you begin toilet training, you can encourage your child to go to the toilet every 45 minutes or so. Some children respond to this, others can be quite resistant.
And finally, if you begin toilet training your child and have no luck, stop and try again in a month or so. It could be that your child simply is not ready. Have a break from toilet training, for both of you, and try again at a later date.

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