After my youngest child was potty-trained, my husband and I cheered and celebrated for weeks, ecstatic not to have a child in diapers anymore. We donated the last of our pull-ups and were so proud of our boys for learning and mastering a skill they would use for the rest of their lives. Soon after, we found ourselves frustrated and seeking out expert help. One of our children struggled with potty-training regressions on and off every few months.
Teaching a child to use the restroom, wipe properly, and wash their hands is never easy, but when you have a neurodiverse child or child with autism, there are other challenges that arise. For instance, children with autism tend to be more likely to experience gastrointestinal symptoms that can add another challenge to potty training, which is why it is important to first speak to your child’s doctor about toileting concerns.
Once you have cleared things with your doctor, it can be helpful to sit down with a specialist in childhood development who has experience working with neurodiverse children. In addition to working with my own child’s team, I sat down with registered psychologist Rachel Tomlinson, an expert in child development.
For fellow parents of neurodiverse children, here are some helpful takeaways when it comes to potty training.
1. It can be “normal” for children with autism/ADHD to have more problems with potty training than their neurotypical peers
“Each child is unique in how autism and ADHD present, so not all children will have issues, and it’s important to note that not all children will experience the same kinds of issues with potty training,” Tomlinson said. “However, there are some general symptoms experienced by children with autism and ADHD that can definitely make potty training more challenging than for their peers.”
She provided some examples of these general symptoms:
- Autism is often coupled with sensory difficulties, and the experience of cold air, taking off clothes, sitting on the toilet, and the sensation of wee and poo leaving their body can feel quite distressing or overwhelming.
- Wiping and the loud sound of flushing can also feel this way.
- Children may also experience difficulty noticing or paying attention to body signs and signals that it’s time to go to the toilet, or indeed these sensations can cause them distress.
Additionally, she said “some children with autism are not verbal, which can result in added complexities when communicating cues or readiness or encouraging toileting. In addition, some children with autism enjoy routine or structure, and having to stop certain activities can be unexpected and can cause distress—instead, they might prefer to soil than to stop the activity or break routine.”
“For children with ADHD, they may struggle with sustaining attention on the entire process of toileting and may skip steps or have trouble completing all required steps associated with going to the potty. They may also experience challenges stopping or transitioning between activities and, so, might miss or ignore body cues that they are ready for the potty because they do not wish to stop what they are doing. Children with ADHD can also find it hard to sit still long enough to relax and may not release urine or their bowels, as they haven’t had the chance to allow their body to relax and release the muscles required for toileting,” she said.
2. Regressions can be normal
In the case of my son, he had all the tools and skills to go, but every few months, he still would start having accidents again. Here’s what Tomlinson said about regressions.
“Regression is something normal that occurs in childhood; either a period of change, distress, or even illness can cause children (not just those with ADHD or autism) to regress or revert back to an earlier stage of development. Also, as children are learning all of the time, they can regress when trying to perfect a new skill or during a period of intense development. It can be very distressing and frustrating for parents and children when regression occurs, particularly if the skill was hard won or took a lot of effort to perfect in the first instance (like potty training).”
She added, “patience is absolutely the key—adding additional pressure or big emotions to the mix will not make potty re-training any easier. If illness is involved, including prolonged periods of constipation or diarrhea, then engaging a trusted health professional is essential. If the issue is not physical, then there are a few strategies to try and get potty training back on track.”
- Try to keep a record of accidents and see if there is a pattern or rhythm (i.e 30 minutes after having a big drink of water or immediately after waking up). This way, you can prompt before the event and you will be more likely to catch them before an accident occurs.
- Draw up a potty schedule if your child enjoys or finds security in routines. It may also help for you to see expectations or timers so they know how long they have to wait during each attempt (particularly if your child finds it hard to notice their cues or finds it hard to sit and relax for longer periods). This will also help with transitions between activities if they know that a toilet trip is coming. Instead of stopping activities to toilet, you build toileting into the routine.
- Talk to a doctor if your child has been avoiding toileting and ends up with constipation. Distress associated with the sensation of toileting could be further exacerbated by hard or firm poop, causing them to hold on for longer (fearing the sensation), which actually makes constipation worse. This is absolutely a situation where a doctor’s support is essential, as they may be able to prescribe something to reduce the pain or soften their stools to make it more comfortable to pass.
3. Avoid shame when addressing accidents or children lying about them
It can be frustrating for parents to navigate lying about going to the bathroom, especially when you feel lost as to how to address this important skill. When my husband and I first discovered our son was saying that he wiped, we were concerned about his health and upset that he wasn’t telling the truth. And while our feelings were valid, we needed to remind ourselves that it wasn’t personal.
Tomlinson reminded parents that “all kids, regardless of having autism or ADHD, can have periods of soiling or forgetting to wipe.” She went on to say that “there is so much going on around them that they would prefer to do than going to the toilet and wiping themselves. However, regardless of the reason, the outcome (soiling, smelling, or have uncomfortable genitals or anus from not wiping or effectively toileting) can cause distress and shame for some children.”
She offered some suggestions to avoid shame when children lie about accidents or wiping
“Stay calm and say something like, ‘I have noticed that you might not have wiped—I wonder if you feel uncomfortable. Let’s go and fix it up so you feel better and you can get back to what you were doing.’ We don’t want to shame them, but we do want to draw attention to fixing potential discomfort and then reminding them that they can get back to their activity once they are all cleaned up.”
Additionally, “instead of drawing attention to soiling, smell, etc., you can ask them if they followed the steps, check in if they need your support, and make spending time in the toilet more appealing. Maybe there is a particular book or toy that only stays in the toilet (and is cleaned regularly), there are eye-spy puzzle pictures stuck up on the wall, or there is music playing. Think about your child’s interests and sensory needs and devise a way to set up the toilet/bathroom to be more appealing so they are likely to spend longer in there. You could also set up a timer or other way of ensuring they spend long enough in the toilet each time,” she added. “Generally, kids lie because they feel ashamed or fear the response if they have an accident. If a child has previously been toileting, it can be really frustrating and demoralizing for parents and children.” Instead, Rachel recommended that parents:
- Do not make a big deal out of the situation.
- Focus on helping them feel better rather than the accident itself.
- If they come to you on their own, remind them how appreciative you are that they shared this with you and work together on cleaning up.
4. Discipline with potty training can create more difficulties
While my husband wanted to take away my son’s screen time for lying about accidents when we were really desperate, I was always against it. After talking to Tomlinson, she helped me feel reassured that we are not being “soft” on him like some family members have suggested and instead are teaching him in a healthier way.
“Punishment can result in feelings of guilt and shame, and this can actually exacerbate stress associated with toileting and further avoidance of toileting,” Tomlinson said. “It can also result in lying or trying to hide soiling, which creates other issues.”
Punishment can result in feelings of guilt and shame, and this can actually exacerbate stress associate with toileting and further avoidance of toileting.
For discipline to be helpful, Tomlinson said it’s usually about implementing a natural consequence arising from an unwanted behavior so that kids make the connection. “For example, if they are breaking toys (unwanted behavior), they might not be able to play with that particular toy any longer, and it’s removed (consequence),” she said. “But with toileting, it’s very tricky to deliver a consequence that is aligned enough for them to learn. For example, removing a tablet or game for soiling isn’t well-connected, and children will likely end up confused about the two actions. Soiling is generally distressing enough for children without any additional consequences. They usually feel uncomfortable, both physically and emotionally, so helping them clean up and get more comfortable is the best way forward without any additional need to give consequences.”
5. The time table for potty training is unique depending on the child’s needs and situation
Like many parents, I often worry about my child falling behind his peers and possibly being bullied, but after talking with Tomlinson, I was reminded how each child’s development is different.
“This is really unique and depends on the unique needs and challenges of each child. Some children, particularly those with sensory issues, may take much longer to fully toilet train if they have trouble noticing the physical cues in their body. For those children who have regressed, once they have worked through the challenge or enough time passes for them to return to some kind of equilibrium, toileting usually reverts back and things improve,” she said.
Additional Potty-Training Resources for Parents