Part 4: Developing a Toileting Plan

As you get started, remember:

• Give it time. Toilet training a child with autism or other developmental challenges can be a lengthy process. Think in terms of accomplishments instead of days, weeks, and months.
• Set achievable goals.
• Start when you both are ready.
• Get everyone on board. Check with your child’s school, daycare, and other providers as you develop your plan. Consistency will help your child be more successful. Inform family and friends of your plan. Ideally, everyone should use the same language and the same routine. A written plan can help with keeping everyone on board. But, don’t be discouraged if everyone can’t commit to following the plan all of the time, including yourself.
• Be prepared to manage your own negative feelings. Expressing anger and reprimanding your child will interfere with success.

A toilet training plan includes your goal(s), the routine/schedule, the language to use, the location(s), and any supplies and materials needed.This Autism Speaks tool kit can help you develop a toileting plan.
 
 

Goals
After getting a better understanding of your child’s needs and ability, you may decide to start small, with a skill he can easily manage. For example, in the toileting sequence, you may decide that you will focus on your child pulling his pants down and up while you complete all of the other steps. It’s recommended that all of the steps in the toileting sequence be followed for each toilet trip even if you are beginning by focusing on one or two steps. The goal is for your child to participate in and to learn the sequence as a whole.

Write the goal(s) on the plan so all caregivers are familiar. And, communicate the goal(s) to the child both verbally and visually in a way he understands. For example, if the goal is to “pull down pants” – write this on the plan and find a photo or other picture that will help your child understand the goal.
 
 

Schedule
Track how long it takes in between when your child drinks and/or eats and when he or she is wet and/or soiled. Checking your child’s diaper frequently (e.g., every fifteen minutes) will help you decide when to schedule toilet trips. A printable chart like this can help you record your child’s toileting patterns.

Based on your observations of your child’s patterns, build a daily schedule around the time your child typically has to eliminate. Develop a reasonable schedule for waking hours that you can support consistently. Make toilet trips part of everyday life and plan them around your usual routine. Typically, you’ll have six toilet trips each day. For example, you can use a toilet trip schedule for toileting:

• when waking up
• before and after nap time
• before and after a new play activity
• before leaving the house for an event
• before and after a meal
• before bedtime

Or, your child may need a schedule that includes other daily activities as well as toileting at the same time each day. While such a schedule may seem overwhelming or complicated, it also makes life predictable for both the child and the adults. By following the schedule, your child can see what comes before going to the bathroom as well as what comes next when he has finished the toileting routine.

Follow this link to a sample daily picture schedule.

A sample picture schedule can also be found in the Parent’s Guide to Toilet Training in Autism from the Autism Speaks website.

You can also refer to our Visual Supports Tool Kit for sample visual schedules.
 
 

Routine
For each trip to the bathroom, teach toileting as a whole routine of sequenced behaviors, not just sitting on the toilet. Include all of the steps of the entire process. Pictures showing each step of toileting may help your child learn the routine and predict what will happen.

For example, you may follow this routine:

1. Enter the bathroom and close the door
2. Undress as necessary
3. Sit on the toilet, relax, and remain on the toilet until finished
4. Get toilet tissue, wipe, and throw the tissue in the toilet
5. Get off of the toilet, flush one time, and close the toilet lid
6. Wash and dry hands and exit the bathroom

Follow this link to a sample picture toileting routine.

If you need to break the routine down into smaller steps, see Part 3: Toilet Training Steps.

Your ultimate goal is that your child will complete each step of the routine independently. But, in the beginning, you may have to provide more assistance so that your child can complete each step successfully.

 
 
Language
Use words your child will understand. For example “Now we go to the bathroom” or “pee” for urinate. Parents and other caregivers involved in implementing the plan should use the same language. Consult with your child’s daycare and school regarding the words they are using.

If your child typically communicates using pictures, use them in the toileting routine also. Such pictures may include photos, drawings, and/or clip art. Consult with your child’s teacher or speech-language pathologist about the visuals they are using at school. Using a simple picture schedule that includes potty times can help your child feel less anxious about this change to his routine.
 
 

Place(s)
If you have more than one bathroom at home, choose the one where your child is most likely to be successful and start there. Eventually, you will add other bathrooms in both familiar and unfamiliar environments.

Remember that the environment and sensory issues should be considered to ensure success. For more information, refer to Part 6: Creating a Calm and Welcoming Bathroom Environment.
 
 

Supplies and Materials
Be prepared for success by having clean clothing, wipes, toilet tissue, soap, and towels readily available in the bathroom. Keep books, music, and other calming and engaging activities on hand in the bathroom to help your child relax and to minimize any negative reactions to the bathroom and/or the routine. You may want to put together a ‘survival kit’ containing these items for trips away from home.

Once your toileting plan is complete, share it with all those who will be involved in teaching and supporting your child. Start the process as you planned and give it time. You can continue to use the daily intake and elimination record to monitor progress. Review the plan periodically and, if you see areas where your child is struggling, don’t give up! There will be bumps in the road and perhaps even some regression. Your plan hasn’t failed – it may just need a few changes. Try to assess what is going wrong so that you can make changes to the plan. Talk to the other caregivers, professionals, and family members involved to get their ideas and suggestions. You may have to break down a step into even smaller ones so that your child can be successful.

If this is not realistic for your child, habit training may be a better toilet training technique. Through habit training, accessing the toilet becomes a learned behavior. The child creates a new habit of eliminating in the toilet versus in the diaper. By repeating the toileting routine over and over as part of a structured schedule, the goal is for the child to develop bladder and bowel control and more independent access of the toilet. Habit Training is described in Part 5.

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