Toilet Training

Is your child:

• Refusing to use the toilet?
• Already toilet trained but still having accidents?
• Having accidents at preschool or kindergarten?
• Leaving toilet accidents around the house?
• Missing out on doing a sleepover due to bedwetting?

Toilet training is often a challenging process in families with and without developmental difficulties. Parents may hear that they have to wait for the child ‘to be ready.’ However, in clinical practice, we see more often that the parents need to be ready. Children with a developmental age over 20 months are generally old enough to learn.

It is not necessary that that the child knows when he has to go to the bathroom or communicates that need. Instead, as a parent, you have to be willing to commit to the process. Prepare to be patient, consistent, and positive. It is helpful to track your child’s natural schedule for urinating or having a bowel movement.

Think about your child’s diet. Consider reducing dairy products and increasing foods that are rich in fiber and liquid, such as fruits and fruit juices. It may be necessary to consult your child’s doctor to ensure that no medical issues are restricting the potential to toilet train and to supervise any dietary changes.

Toilet training falls under the adaptive skills or ‘activities of daily living.’ Although any child could struggle with toilet training, children with disabilities tend to have additional challenges.

This struggle could be because of delayed development of language, lack of motivation to toilet train, lower degree of social skills and reciprocity, sensory problems, and digestion issues.

This program is a best-practice approach to toilet training, which can be effective for children with or without developmental disabilities. The program prescribed below, is provided in consultation with and the permission of Susan Hepburn, Ph.D., Clinical Psychologist.

Step 1:  Pre-Training

• Introduce toileting words to the child (such as ‘potty,’ ‘pee,’ and ‘poop’ and use proper terms for anatomy as well). It can also be helpful to tell your child that ‘accidents happen.’
• Try to change the child’s diaper in the bathroom.
• Try to change the child’s diaper as soon as possible so he/she doesn’t get used to the feeling of being wet or soiled.
• Dispose of waste in the toilet (from diaper) in view of child.
• Provide opportunities for the child to see mom or dad or siblings use the toilet.
• Keep track of when child is most likely to go.

Step 2:  Prepare to go without diapers

The most success comes from experience without diapers. It is important to begin with daytime urination training. Later, you will teach bowel training and night training. So, for now, the child can wear pull-ups at night. Also, if special circumstances arise (such as a long car ride or school field trip) in which going without a diaper is just not practical, you can decide to put one on your child. However, more time spent in diapers will make the training go slower. You have choices, don’t make yourself crazy, but know a trade-off is involved. Also, you may find you want to put plastic sheets on car seats or on furniture.

Step 3:  Identify motivators

• Create a list of rewards that can be given for cooperating with a toileting routine (e.g., special food/drink, sensory experiences, toys, etc.).
• Rewards should not be available outside of toileting.
• Keep rewards on-hand in the bathroom but out of reach of the child.
• Check out websites for toilet training products that are supposed to make the process fun (such as toilet targets – items that change size or color when urinated upon – yes, these things do exist).

Step 4:  Decide how you will handle accidents

• Do not punish or scold – your child is learning a new, difficult skill.
• Option 1:  gently correct and change the diaper.
• Option 2:  immediately place your child on the toilet and reward if she gets the tiniest bit out.
• Option 3:  allow your child to feel the sensation of being wet and involve him in the clean-up

Step 5:  Make a schedule

For most kids just starting out, combine scheduled trips (where you initiate taking them to the toilet at a time when you think they might be successful) and taking them as soon as it looks like they might be voiding. To do this approach well, look at your child’s typical toileting patterns. For example, how long after your child eats or drinks does he/she usually go? For most kids, we don’t want to do too many trips – or else is becomes meaningless – so aim for no more than 1 trip per hour.

Step 6:  Choose your teaching methods

Any combination of methods may help, depending upon the child’s learning style. For example:

• For a highly visual child, it may help to use structured teaching techniques (e.g., visual cues of each step of the toileting routine, or a 2-picture sequence of toilet and reward).
• For an active child, use a music box or radio and develop a routine of sitting until the music stops. Then, you might reward them for sitting for very short periods and build the time up slowly. A timer works well for most kids too.
• For a really social child, use more modeling and praise during the routine.
• For a distractible child, try not to talk during the routine, but use physical prompts to focus the child on the activity.
• For children who like books, you might make a homemade book that shows pictures and narrates the toileting routine. Published books and videos may also be helpful.

Step 7:  Commit to 3 weeks

Whatever methods you choose, commit to following your plan for at least 3 weeks before you change it. If possible, have the child practice this skill in many different places.

Step 8:  Design a way to keep data on progress

You need to know the times the child voids and where it happened (accident or in toilet).

Step 9:  Just do it

• Lose the diapers during the day
• Take the child on scheduled trips to the bathroom
• Prompt the child through a toileting routine (sitting for 1-2 minutes, always flushing and washing hands after the time is up)
• Provide a small reward for cooperating with the routine
• Provide a huge reward for getting anything into the toilet
• If possible, interrupt accidents by startling the child “Toilet!!” and getting him/her there. This moment is your best teaching opportunity.
• Practice, practice, practice.

Step 10:  Review your progress after 3 weeks

Talk to your team (school, family members, or other parent) about when the successes are happening. What can be done to make them happen more often? Implement any additional rewards or structure of teaching that you think will help to learn this skill.

Step 11:  Make modifications as needed and try to stay consistent

Remember, most behavior plans do not work immediately. Your child may not be motivated by the rewards you chose. Your child may get frustrated and lose interest suddenly. You may find that the plan does not work as well when you are on the go. Regardless of these issues, don’t give up.

Step 12:  Celebrate all successes!

If you do not get sufficient progress within 3 months, seek some more guidance from a professional such as an Occupational Therapist or Psychologist who does a lot of toilet training. New methods are always available to try!

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Domestic Skills: doing chores and managing a daily routine may be difficult for those with challenges with toilet training
• Hygiene: toilet training troubles may relate to self-care, such as with showering and brushing teeth
• Learning problems / learning disabilities: toileting accidents at school might signal learning problems
• Emotional symptoms (Feeling): traumatic experiences may be a cause of accidents
• Anal Retentive: refusal to void urine or feces in order to maintain control

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Autism Spectrum Disorder: many children with autism struggle with toilet training, frequent accidents, or constipation
• Intellectual Disability: children with low IQ and adaptive skills may struggle with toilet training
• ADHD: children with poor attention and regulation may have difficulty with toilet training
• Developmental Disabilities: many children with developmental disabilities have difficulties with toilet training

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Speech Language Pathologists: to help with functional language skills
• Occupational Therapist: to help with toileting skills, self-dressing, sensory needs
• Psychologist: to consider in developmental and mental health context
• Pediatrician: If your child has a sudden change in toileting behavior or experiences diarrhea, pain with elimination, digestive problems, or dietary issues, consult your child’s doctor

These professionals may recommend or administer the following tests if toilet training is an issue:

• Vineland-III: a test of adaptive behaviors, including hygiene and self-care
• DAS-II: a test of cognitive ability for preschool and older children
• Mullen: a test of cognitive ability for toddlers

Toilet training products: http://www.galaxy.com/rvw93474-41438/Toilet-Training-Made-Easy-Sinkems.htm

Toilet training products: www.webehave.com

Bed wetting solutions. THERApee: www.bedwettingtherapy.com

Books on toilet training: http://www.parents.com/fun/entertainment/books/potty-training-books/

Toilet training tips for children with disabilities: http://www.specialchild.com/tips06.html

Toilet training for children with down syndrome: http://www.ds-health.com/train.htm

Tips for children with autism: http://www.bbbautism.com/pdf/article_25_toilet_training.pdf

Alarms and adaptive equipment for older children www.bedwettinghelp.com

Toileting Tool Kit: www.autismspeaks.org

Recent article from autism treatment network on toilet training: https://www.autismspeaks.org/blog/2016/07/22/toilet-training-dilemma-our-6-year-old-fights-going-near-bathroom

Article on dealing with constipation in children with autism: Autism Speaks ATN/AIR-P Guide for Managing Constipation in Children –

Author Credit:

Dr. Susan Hepburn, PhD, Clinical Psychologist consulted on this article. She is a leading clinical researcher and published author, teaching courses, training clinicians, and supporting community agencies in rural areas in best-practice assessment procedures and interventions. Dr. Hepburn is an expert in toilet training and consults with families and school districts to promote effective evaluations and treatment for children with autism and other developmental disabilities.

Dr. Marcy Willard, PhD, Psychologist, co-authored this article with Dr. Hepburn to disseminate this important information to families around the globe. Dr. Willard is a Nationally Certified School Psychologist and a Licensed Psychologist. She works with children from kindergarten-middle school on social, daily living, and academic skills.

Image Credit:
Description the idea of training the child to the potty with a toy bear, which also sits on a toy potty
Stock Photo ID: # 115482563 (Big Stock)
By: EvgeniiAnd
How-to-potty-train-your-child
Previously Licensed on: October 21, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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