Parenting

6 Readiness Indicators for Toilet Training Young Children with Special Needs

Summer is the season when time seems to slow a little, when families “hang out” more, and take stock of their accomplishments and responsibilities to each other.

Across the globe, many people are currently  involved in a time-honored summer ritual; toilet training young children for the coming school year. Society as a whole treats toilet trained children differently, and has different perceptions and expectations for them.

The Toilet Training Process

Toilet training is a process for any child, but especially for those with Autism/special needs. A comprehensive social skills resource for these children, therefore must involve working on toilet training. In reality, it is considered to be one of the early social communication milestones that is overtly demonstrated in neurotypical children.  In Western cultures, toilet training is usually done with children around age two. Of course, one needs to account for a child’s mental and psycho-social age,  instead of the chronological age, when addressing social skills development, even regarding toileting. As with any social skill, a child needs to be ready to learn. A child needs to have the groundwork done, and the “stage set”. Toilet training children with Autism can be challenging. It requires a level of motivation and cognition in the child, and a level of guidance and patience on the adult’s part as well.

Toilet Training Children With Autism

We want the special needs child to endear himself to others, yet we need to remember that these children, with their unique “inner landscape” and neuro-motor functioning, resulting in a different Theory of Mind (TOM), may be “blocked”,  or on a different time table. That is not to say that we shouldn’t make toilet training our preschoolers with ASD a priority! We just need to go about doing so in a sequential, organized, methodical, and consistent fashion. This will help the child understand and internalize what is expected of him/her. It will also help him generalize what he learns to all environments such as home, school, and Grandma and Grandpa’s house etc.

Is My Child With Autism Ready To Be Toilet Trained?

Upon deciding to work on this important daily living skill, the child’s entire team needs to get on board and make it a group effort. The child’s success and mastery of this skill will certainly affect his future hygiene, social development, and overall behavior. One therefore needs to look at readiness indicators before starting to work on toilet training. Below are some factors that may “block” a child with Autism from being ready to be toilet trained. These factors can include:

Sensory issues

Sensory Issues such as partial or total lack of sensation in certain body parts leading to unawareness of being wet, reduced Sensory Integration resulting in decreased body awareness and proprioception, and aversion to smells and/or hyper-sensitivity to smells

Behavioral issues

Behavioral issues such as transitioning difficulty, inability to cope with changes in routine, disorientation to person/place/time, and reduced ability to “tune in” and attend to the task at hand

Cognitive issues

Cognitive issues affecting understanding of the sequence of events (e.g. “Get undressed, sit on the toilet, stand up, wipe up, and flush.”) and/or target vocabulary involving body parts, articles of clothing, oral directions containing verbs (e.g. “Flush the toilet, turn on the sink, take soap, and wash hands.”) and part- whole relationships (e.g. “Pick up the toilet seat.....Push down the handle to flush.”) Parents and professionals thus need to play detective and figure out if the child in question is truly ready to learn to be toilet trained.

Checklist of Readiness Indicators-Prerequisites For Toilet Training:

1. Joint Attention and rapport, so that positive reinforcement is meaningful. 2. Communicative Intent, so that child can ask for toilet and/or indicate wetness. 3. Understanding Causality (cause& effect, contingencies),  so that child can make a connection between his action(s) and your reaction(s). 4. Body Awareness so that child feels when he/she is wet and knows from where. 5. Understanding Part-Whole Relationships, so that child can follow the steps and make sense of the toileting process and the vocabulary involved. 6. Physical Agility, so that child can walk to toilet, climb up, and sit upright to use it, without any medical condition barring physiological/anatomical ability such as low muscle tone (hypotonia), spastic muscles, or poor motor planning and coordination resulting in difficulty walking (reduced ambulation) and chest i.e. thoracic rotation (sitting upright using the abdominal “core” muscles). * This post has been adapted with permission from  Socially Speaking™ Toileting Protocol, with permission