Caring for a child, potty accidents come with the territory, especially for those with developmental disabilities such as autism. As common these issues are, the good news is that they are also highly manageable. Our step-by-step guide below aims to tackle even the trickiest of toilet troubles. Let’s dive right in!
The goals here are two-fold. First, we’ll aim for seven days in a row with no more than one accident. The long-term goal is for your child to use the toilet for every elimination with no assistance. This program requires that your child be able to walk, sit for approximately 2-3 minutes, and grasp with her hands. You will also need the following:
- Training pants (preferably regular underwear).
- Simple clothing: no pants/elastic waistband pants, or short shirts for girls.
- A child-size toilet seat, or child’s potty chair if your child is uncomfortable on the adult toilet. (If you use a potty chair, keep it in the bathroom at all times.)
- A variety of your child’s favorite drinks.
- A variety of small food treats that your child likes. (Note: be sure to only make these food treats available as a reward for dry pants! Do not use these treats for anything else.)
- A variety of your child’s favorite toys and activities.
- Two or three days of free time with minimal disruption for training.
Understanding the Two Basic Procedures
Procedure 1: Toileting
Using the toilet is a chain of many small steps. Your child must be taught each of the following steps to help her learn these habits effectively:
a. Come up with a signal for your child to use to tell you she needs to go to the toilet:
Ask, “where do you go potty?” and vocally prompt the answer “toilet” or “bathroom.” Have your child imitate “toilet” or “bathroom” aloud if necessary. Praise your child for answering “toilet” or “bathroom.” If your child cannot talk, have her use a gesture or a picture.
b. Have your child walk to the bathroom in front of you. Physically prompt your child to do so if necessary.
c. Have your child take down her pants and sit on the toilet.
d. Give your child 2-3 minutes to use the bathroom. Encourage her to do so by stating “go potty.”
If your child eliminates, praise her and provide food treats (or other reinforcers of their choice). If your child does not eliminate, ignore it. Do not scold or express disappointment. Go to the next step.
e. Flush the toilet (or empty the portable potty) only if your child eliminates.
f. Say “Get down” and have your child pull up her pants.
g. If this was performed during a wet version of the “dry pants check” (Procedure 2 below), have your child walk back to the place she wet herself and change to dry pants
h. Continue with the toileting schedule.
Procedure 2: Dry Pants Check
This is a way to teach your child that you want her pants to be dry all the time. The procedure is as follows:
a. Ask your child “Are you dry?” Help your child place her hand on the crotch area of her pants so that she can feel for wetness.
b. If your child is dry:
Praise her for being dry (e.g., “Nice dry pants”), and give her lots of social reinforcers (e.g., hugs, kisses). Then give your child a small piece of the food treat or a sip of a drink.
c. If your child is wet:
Tell her “No wet pants.” Take her immediately to the toilet (using Procedure 1 above). Have your child do as many of the steps as possible and use hand-over-hand prompting for those steps your child does not know.
d. For the steps your child can partially perform:
*Pair every step in this procedure with the actual instruction (e.g., “walk to the bathroom”).
*Do not talk to or praise your child during this procedure; only give those verbal instructions to complete the step(s) involved. Your voice should be calm but firm.
*Do not scold or reinforce behavior (such as with a drink or affection) during this procedure.
Step 1. Change & Drink:
After a small breakfast (no starches) change your child’s diaper to training pants. At breakfast have your child drink at least 1 ½ cups (6 oz.) of her favorite drink.
Step 2. Perform Procedures 1 & 2:
Five minutes after breakfast perform a dry pants check (Procedure 2).
If your child is dry, praise her and give her a small piece of her food treat. Then ask, “What do you need to do?” Verbally prompt your child to state, “Go potty.” Proceed to performing toileting (Procedure 1). If your child eliminates, give her lots of praise and a reinforcer of her choice. If your child does not eliminate, say “nice try” and continue with the toileting schedule below.
Step 3. Toileting Schedule One:
After performing the above procedures, repeat the following cycles:
a. Every 10 minutes: Dry pants check (Procedure 2).
b. Every 20 minutes: Toileting (Procedure 1). Do this approximately 10 minutes before your child has a bowel movement (BM). The BM schedule is based on what you recorded on the original toileting data sheet prior to training. Record whether your child was dry, wet, and/or had a BM.
c. Every 1 hour: Have your child drink a ½ to 1 cup of her favorite drink.
Step 4. Toileting Schedule Two:
When your child is eliminating in the toilet with no accidents for at least three hours:
a. Every 15 minutes: Dry pants check (Procedure 2).
b. Every 30 minutes: Toileting (Procedure 1).
c. Every 90 minutes: Have your child drink a glass of liquid.
If your child has four or more accidents in a row, have your child repeat the toileting procedure after each accident two times and decrease consumption of the drink to a ½ cup.
For every three-hour interval your child goes without any accidents:
- Increase the intervals between dry pants checks and toileting procedures by 5 to 10 minutes.
- Increase the intervals between liquid consumption by 30 minutes.
Diapers should only be worn when your child is asleep. Eating schedules should be kept the same, but prepare lighter meals with fewer starches.
Day Two and Beyond
Continue with the same toileting schedule you ended with on Day 1. When your child is eliminating every two to three hours, stop giving liquids on a scheduled basis and slowly thin out (decrease) reinforcers for eliminating in the toilet. By continuing to follow this procedure, you and your child will be on the way to success!
Adapted from Toilet Training in Less Than a Day by Nathan H. Azrin and Richard M. Foxx
Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.