Toilet Training Tips for your Child with Special Needs

Lori Warner, PhD, BCBADirector, HOPE Center

Jamie McGillivary MS, LLP, BCBAClinical Manager, HOPE Center

Veronica J. McAtee, MS, LLP, BCBALimited License PsychologistBoard Certified Behavior AnalystCenter for Human DevelopmentBeaumont Children’s Hospital

When do I start training? Average age = 18-24 months Key signals:

The child is aware that his/her diaper is soiled and may request to be changed

The child shows an interest in using the toilet The child’s bladder muscles are developed enough

to hold urine (remain dry for at least 1 ½ to 2 hours) The child can communicate his/her needs (verbally

or nonverbally) The child can follow simple instructions and assist

in dressing The parent/caregiver has time to devote to training

Preparation

Use the bathroom for all toileting activities Watch videos and read books about toilet

training Allow the child to watch parents/siblings

using the toilet Use a doll to model the toileting process Use words that the child understands Practice sitting on the toilet; provide

praise

Beginning Training

This is a learning experience that requires practice and may take time

Consistency is important! Dress the child in loose clothes;

have the child pull up/down pants Goodbye diapers! Select rewards for the child (may

need to be more than praise)

Materials Needed for Training

Potty seat that fits over toilet Foot stool Timer Data on urination (taken week before) Multiple pairs of underwear Favorite drinks and snacks Rewards, Rewards, Rewards!

Rewards – why do we use them? Increase the likelihood that the behavior

will occur again Rewards are fun! Child should be rewarded for all

appropriate toileting behavior Pulling up/down pants Walking to toilet independently Recognizing the need to use the toilet Remaining dry in between sittings

How to select rewards Observe your child during free time Limit access to preferred foods/toys to

increase motivation Start with powerful rewards – not just

stickers! What is motivating one minute, may not be

the next When starting training rewards will be

delivered frequently Rewards are faded as the child is successful

Intensive Toilet TrainingToilet Learning Center (TLC) Increase fluids Scheduled sits:

Example: child sits on the toilet for 10 minutes then given a 5 minute break for the first hour (or until urination)

Child is prompted to do all steps; increase independence

When the child urinates in the toilet s/he is rewarded with access to toys and highly preferred food items; takes a break from sitting

Intensive Toilet TrainingToilet Learning Clinic (TLC)

Time spent on the toilet is decreased until the child urinates quickly after sitting

Break time is increased Child wears pants alarm, goes off

as soon as child urinates in pants Consistent Procedure for accidents

Accidents – Uh Oh! Remain calm & neutral! Do not punish the child! Try to get the child to the toilet to finish Tell the child “Uh-oh! Wet pants. You go on the

potty.” (Use words he/she understands) Practice going to the toilet, pulling down pants,

and sitting (“This is where you go potty”) Include child in clean up and have him/her

change into clean pants Have a schedule (after meals, before school) so

that the child learns to use the toilet frequently, may also consider using pants alarm

How do I train my child to use the toilet? (Less intensive approach) Take data to ensure that your child is ready

to begin training Put your child on the toilet at times when

he/she typically urinates Have the child do the steps on his/her own In the beginning stages, the child may need

to sit for up to 5 minutes; provide praise for sitting on the toilet, use timer if necessary

Sittings should take place every 30 minutes to increase success

How do I train my child to use the toilet? (Less intensive training)

As training progresses, sittings should be spaced further apart

Take data on each sitting so you know when the next one takes place (increase amount of time if child urinates in toilet)

Reward the child when he/she urinates in toilet!!

Bowel Movements Determine times when the child is most likely

to have a bowel movement (look at data) Watch for signals Put the child on the toilet as soon as you

detect these signals Provide a reward for eliminating on the toilet Scheduled sits for a longer amount of time Larger rewards Positive practice for accidents Social stories/de-sensitization

Initiation Training An important part of toilet training at all times Child should be prompted to request to use the

toilet before being taken to the toilet ASL, PECS, vocal, typing

Requesting to use the toilet is often not motivating for children; may need additional rewards

Some children continue to require prompts to request and it may take awhile for the child to initiate

Some children may be trained on a schedule

Rewarding Dry Pants Once the child has learned to urinate in

the toilet and is doing so on a fairly regular basis, the training is not over!

Check for dry pants in between toileting times (about 6-7 per day)

Reward the child for remaining dry – let the child know why it’s important to stay dry

Rewards In the beginning of training, rewards should

be frequent and strong enough to maintain the behavior – this will speed up the training

As the child is using the toilet regularly, rewards for going on the potty should be faded and the child should be rewarded for remaining dry

A daily chart may be used to track progress; child can work towards bigger reward

Nighttime Training

This may happen at the same time if the child is already remaining dry at night

Cut liquids by 6:00 pm (or 2 hours before bed)

Have a bed time routine that includes going potty

As soon as the child wakes up, have him/her use the toilet

Reward dry nights

This isn’t working! My child does not want to use the potty

Is she/he ready? Are you ready to work on training? Can

you be consistent? First step is to practice sitting on the

potty (don’t require urination); reward all potty related activities

Gradually work up to training Are rewards strong enough? Are you

delivering them frequently?

This isn’t working! My child has too many accidents

Are you putting him/her on the potty at the right times?

Take data on sittings and if he/she urinated; helps you start the sitting at the correct time

Put the child on the potty frequently (every 15 minutes) until he/she urinates

Is your child in diapers? Are you checking for dry pants and rewarding? Are rewards strong enough?

Bed-wetting Common during training time Some causes

The bladder is not developed enough to hold urine

The child is not able to awake in response to a full bladder

Could be due to stress or changes in life (especially if the child used to remain dry)

Could be due to a medical problem or side effect of medications

Bed-wetting Cut fluids at night Have the child use the toilet before bed Consider waking the child to have him/her

use the toilet (1 - 2 hours after going to sleep) Use an alarm to condition the response of

awakening to a full bladder Alarm senses wetness and goes off to alert

the child to awake and use the bathroom Overcorrection procedure Rewards when the child wakes up dry

Summary Toilet training is not easy It takes time, effort, consistency, and

most of all…patience! Do not be afraid to get help Remember that it is a learning process; it

doesn’t just happen Parents need to make sure that they are

prepared to begin training

Resources

Toilet Training in Less Than a Day by Nathan H. Azrin, Ph.D. and Richard M. Foxx, Ph.D.

Self Help Skills for People with Autism: A Systematic Teaching Approach by Stephen R. Anderson

Steps to Independence by Bruce Baker & Alan Brightman

Materials: www.bedwetting.com www.pottytrainingsolutions.com

Contact information

HOPE Center1695 W. 12 Mile Road Suite 110Berkley, MI 48072(248) 691-4772

https://www.beaumonthospitals.com/hope

Dr. Lori Warner, Director HOPE Center(248) 691-4774