The Centers for Disease Control and Prevention (CDC) estimates that about one in every 54 children in the U.S. has been identified as having autism spectrum disorder (ASD). Issues with sensory processing, eating, digestion, and incontinence are not uncommon symptoms for children with ASD to experience. Individually or combined, these symptoms can create difficulties for these children relating to potty training and present challenges to their caregivers. The following article outlines the role these common ASD symptoms play in potty training delays for children with ASD, as well as simple, medically approved ways to address or overcome them.
Common ASD Comorbidities That Negatively Impact Potty Training
One of the most common and difficult to overcome symptoms several patients with ASD experience in relation to potty training is sensory processing delays or disorders. The sounds, sights, and sensations associated with using the bathroom, such as the toilet flushing, running water, and use of toilet paper, can trigger those coping with sensory processing issues. Developmental delays can also play a role for some children with ASD. While some children with ASD are exceptionally fast learners, those with intellectual delays may take longer to learn a new skill, such as using the bathroom independently.
Food intake and aversions can lead to a series of their own challenges alongside ASD. If your child is known to be a picky eater, has food aversions, or only consumes a limited diet, they may not consume enough fiber and liquid naturally to allow for healthy, daily bowel movements. Incomplete stool emptying can negatively affect potty training success. Additional ASD symptoms that can contribute to potty training difficulties include but are not limited to, anxiety, ADHD, and delays in or issues with motor skills.
Overcoming These Challenges
When it comes to sensory processing issues, try practicing with your child and exposing them to these triggers in trials not associated with voiding or defecation. You can practice flushing the toilet and getting them used to the sound, as well as washing your hands or rubbing toilet paper against their skin (or yours!) to expose them to these stimuli. If your child has developmental delays associated with their ASD, set aside intentional time in your schedule to allow for more time for bathroom training and set realistic expectations. Ensure instructions are clear, consistent, and succinct.
If your child struggles with their relationship with food and you are concerned about the lack of fiber and liquid in their diet, try incorporating fiber supplements into their diet and utilizing water bottles with timed reminders. Ensuring your child is hydrated and preventing constipation is always beneficial for potty training. If your child has known or diagnosed anxiety and/or ADHD, it may take additional time and support to expose them to the bathroom and successfully toilet train. Structure and repetition both play a huge role here.
Not all children with ASD have limitations with their motor skills; however, if they do, this may naturally disrupt potty training. If your child with ASD has difficulty undressing themselves in a timely fashion or sitting/standing independently, they may be more prone to accidents. Practice undressing and sitting/standing by the toilet and using adaptive devices. Consider using diapers to avoid leaks and accidents while you work through this impediment with your child.
Next Steps
The two main things to remember when potty training a child with ASD are to always use positive reinforcement and to not be afraid to put things on pause. Toilet training is not a linear process for any child, and if things aren’t working out, consider going back to diapers and revisiting in a few weeks or months. When actively potty training, plan to involve your child’s support system and utilize schedules, standardization and consistent instruction. Ensure your child’s caregivers are on the same page during potty training about schedules, routines, and expectations. Timers for water consumption and bathroom practice, as well as sticker charts or other rewards, can work positively to develop your child’s relationship with using the bathroom.
It is never too early or too late to involve your child’s primary care provider in the potty training process as a resource for obtaining supplemental input and help. If you’ve exhausted most options, consider meeting with a pediatric urologist or pelvic floor therapist for additional, specialized care. For some children with ASD, it is important to know that obtaining continence may not be possible without more invasive measures such as evaluation and testing by specialists, medication(s), clean intermittent catheterization, and/or continence surgical procedures.
You are not alone in this process, and communities of support, such as other parents of children with ASD, may provide words of advice and useful tips. At the end of the day, your patience, support, and persistence will help your child overcome these obstacles and successfully manage their bladder and bowel control to the best of their abilities.
Samantha Eaker, DNP, CPNP-PC, is a board-certified pediatric nurse practitioner specializing in pediatric urology and a medical advisor for Aeroflow Urology.
