Male1: I have been told that an autistic kid is very difficult to toilet train and many people have told me that you are very successful in getting a lot of these kids toilet trained, what tips can you give a parent who has a kid that is difficult to toilet train. First of all, what age would you start with?
Male2: Age is a funny thing because a typical kid, you could use typical guidelines. A typical child will toilet train around the ages of two and two and a half, boys a little bit later than girls. Of course, when you have autism and if there are any other developmental disability, what is going to happen is that is going to be delayed. Rather than using age as the prerequisite, probably we would look at prerequisite skills, such as, is the child able to sit for at least a minute on a toilet, is the child able to withhold urination, not necessarily purposefully, but able to withhold urination for at least half an hour if not an hour, reduction of any challenging behaviors that might interfere such as extreme tantrums, non-compliance, self injury and the ability to understand contingencies so that if they do something that is correct that they will get some sort of reward. If you have those in place, you are probably ready to start toilet training regardless if that is two and a half , three and a half, four and a half or even later. There is no end limit to toilet training. You can toilet train someone up until they are a teenager or above.
Male1: Okay, if you need those requirements, what would be the first thing you would tell a mother to do?
Male2: Data collection is always the first thing. We have to figure out how often they urinate, how often they have bowel movements. So the first thing I probably would tell a parent to do is take a good two weeks and just write things down, let everything go as is and write it down. You can even keep the child in the diaper at this point in time. If you are keeping the child in the diaper, I normally would do every 15 minutes to check the child, see if he is wet and if he is wet, change and if he is not wet, leave him alone.
Male1: Okay, so now, we have met all of this, now we are going to start. What should we do?
Male2: Now we are going to start. The thing is that really, the techniques that I am going to use to toilet train a child with autism are exactly the same as any technique you would use for any other child. It is really nothing new. It is the intensity that is different, so I am going to have to toilet train a little bit more intensely with autism.
What we are going to use is positive reinforcement which means that they are going to get rewards for appropriately urinating on a toilet. We are going to bring them to the toilet on a schedule, so prompt them to go when they both need to go and also just on a regular time schedule. So let us say, every half hour or every hour.
Then, you have the accidents, what are we going to do with that. What you are going to do with that, what we found to be more successful is to turn the accident to a teaching trial. So very logical, what you do with typical children is when you feel that they have to go to the bathroom, when they start urinating in their pants, you do a quick rush to the toilet, get them to the toilet and get them to urinate on the toilet when they actually have to go and reinforce that trial. And so actually, turn that accident into an appropriate teaching trial.
Now, like I said, with autism, we are going to do it a little bit more intense. So normally, what we do with autism, is we keep the student in the bathroom or at least near the bathroom for at least six hours a day, and then we run toilet training as an exclusive program for those periods of time.
Male1: Okay, so what do you do now? You have got the kid, you started this whole idea and you know that the kid is ready, what are you going to do now?
Male2: Kid is ready, we are going to put the toilet training plan into place. So the first thing we are going to do is use—there are three components basically. There is reinforcement which is reward on success on the toilet. There is a schedule. We are going to bring them every half hour or every hour and then there is also accident corrections, so when they start urinating in their pants and having an accident, we are going to quickly rush them to the toilet, get them to go on the toilet and turn that accident into an appropriate teaching trail.
With children with autism, we usually keep them in the bathroom or near the bathroom for a good chunk of the day, so you are going to really want at least a four hour consecutive stretch of toilet training exclusively in the bathroom or near the bathroom, if not more than that. Six hours, eight hours.
Male1: So, they get a reward for good behavior and not bad behavior.
Male2: Right. We are going to reward successful urinations on the toilets so on every half hour or every hour, we are going to put them on to the toilet, help them on, tell them to go. If they go, they will get some sort of reward—an edible reward or an activity or something that they like. If they do not go, after let us say one to three minutes, we are just going to take them off to the toilet and say, in case you did not have to go. The key is to be very natural, not candid in the way you are speaking to the students, just very natural. It is very natural language, very natural procedures.
Male1: If the kid is not doing what you want, you should never lose your temper, you should never yell?
Male2: There is no reason to, especially at the beginning of toilet training. I do not advocate for it and the research does not necessarily show the need for any sort of punishment techniques or anything for the accidents or any sort of verbal reprimands. Definitely, you keep neutral. You could be firm, but yet, you are not angry. So there is no emotions between you and the student when it comes to accidents, however, there is an emotional reaction when it comes to success. So when it comes to a successful urination or bowel movement on a toilet that is when you are going to have verbal praise and show support and show happiness for what the student just did.
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