Friday, April 10, 2009

Three Cheers For Poop!

Never in my life did I think I would call my child over to look at my poop. Never. Disgusting, right? Now, we've all taken a look at our own BM's (bowel movements for those that haven't discussed poop extensively in a clinical setting), perhaps been impressed or grossed out, but that's between you and you, and is extremely personal. But how do you toilet train an Autistic child who isn't speaking yet, and rarely makes nonverbal requests (unless you include gesticulating wildly when he catches a glimpse of Rice Krispie squares on the kitchen counter)? Modeling the appropriate behaviour is one way (hence showing Max my poop). Another key part of toilet training for a child with Autism is getting him used to the routine of toileting, even before he is actually ready to toilet train.
Max will be 3 years old on April 23rd. We know he isn't anywhere near being ready to "poop in the potty". It may take him a year or even two before he can manage it. If you think about it, there is a lot required for going the bathroom. If you break the process down, it's no surprise that kids, let alone kids with Autism, find it challenging. We are breaking the process down into tiny steps for Max so that he will gradually be able to incorporate them into his routine. The hope is that when he is ready, toilet training will be less stressful on all of us because he understands what is expected of him.
This is the toileting process as I see it:
Recognize that you have to go to the bathroom
Let an adult know you have to go the bathroom (verbal or nonverbal communication)
Go to the actual physical bathroom
Lift toilet lid, get little toilet seat in place
Pull pants down, pull underwear down
Sit on toilet
Wipe bum
Pull underwear up, pull pants up
Get down from toilet
Admire poop (you know you do this, admit it)
Flush toilet
Get up on stool to wash hands
Turn water on
Soap up hands (the soap texture is hard for some Autistic kids)
Rub hands together
Rinse hands
Dry hands
Do a big cheer for completing the process
That's no less than 20 steps! Geez...and we parents expect our kids to get this down in a day? Seems a bit unreasonable, even for a neurotypical kid.
We have reduced the process down to 3 steps for Max:
Change diaper
Put poop in potty, flush
Wash hands
He seems to be fairly comfortable with these steps, and isn't objecting to having his diaper changed nearly as much as he used to. I think this is because he knows that when we go in the bathroom, it is to change his diaper. We are being very clear about what is going to happen by using an activity strip, and telling him what we are doing and what is going to come next. He now reaches for the handle to flush the toilet after we put his poop in the toilet, and then moves to the stool to get up to wash his hands. I need to add a "dry hands" image for him, and also put a picture of a diaper on the front of the bathroom door so that he can either point to it, or bring it to me when he needs a diaper change. This process will not be completed in one day, but it will eventually result in Max being toilet trained. We just have to remind ourselves that this is a marathon and not a race.
One more thing - if you live in Canada, and your child is over the age of 3 years old and has a disability, you are eligible to receive funding for diapers from Easter Seals. With the costs of Max's therapy mounting, I am looking forward to getting help paying for diapers (though hopefully we won't need it for very long!)
Katrina Carefoot is a working mom with two children, her son Max, almost 3, and her daughter Cameron, almost 1. She works as a Marketing Manager in Toronto and writes about Autism, pop culture, and all things mommy at Fickle Feline.


  1. Where do you get your activity strip pictures?

  2. Our neurotypical kid is four and still won't poo in the toilet! I asked her pediatrician about it and he said that toilet training can be VERY challenging for many, many kids and the whole concept of poop is scary and difficult for a lot of kids to process. You guys sound like you are doing all the right things. As gross as it all seems, it will be worth it in the end.

  3. @ Stranded - Our Resource Consultant through Halton Region gets them for us. We just tell her what we need and she provides it to us and to Max's daycare teachers

    @ Stephanie - yep, pooping ain't easy!

  4. Great post, Kat. And very timely. Mr. Busypants slept all night in his underware for the first time. And he woke up dry! I'll be sure to link back to you when I post a celebration.

  5. So great to find your blog!
    I have 2 1/2 year old twins, one was just diagnosed as autistic and I am trying to potty train them.... ugh!

  6. My nearly 4 year old autistic son isn't potty trained yet. His school is going to try again next week but hey want me to wait until he starts to get the idea before I try at home. Good luck!!

  7. wow, im moving to canada ... free diapers???? my daughter will be 14 next month and is still in diapers. we've been trying to train her since she was 3 years old. as you see, not goin' too well :). our goal is toilet timing rather than toilet training at this point.

    best of luck to you!!

  8. It took both my boys (ages 7 and 6 both ASD) about 2 years of potty training to go #2 in potty. I got a book "Everyone Poops" by Taro Gomi, at the suggestion of their preschool teacher, she told us that in her 15 yrs of teaching special ed preschoolers the ASD kids are the hardest. Some have issues with "getting rid" of their stuff (including poop). The book is a staple in the preschool classrooms, even the NT kids like it, my 3 yr old like to read it while trying to go in the potty. Hang in there! HTH

  9. My son would not respond to all the different things we tried, the pecs, the schedule, rewards, taking things away after accidents,etc. He just wasn't ready until around 6. I finally had to take him out of the pull-ups and let him go in his pants. He had become desensitized to the feeling of being wet and poopy. He was night trained before he would stay dry during the day. One day when he was around 6 and didn't have fear of the toilet anymore we put him on the potty every 15 minutes and when he peed in the toilet we made a big deal out of it. After that he had a few accidents here and there. Praise right after he peed really motivated him. He was finally potty trained for pee and poo at 7. I think you need to completely forget about what is the normal age for a child to be potty trained by when they have mental and/or behavior challenges and just watch for signs that they are ready and be patient. Very patient : ) My daughter is 7 and potty trained in the normal age range but needs pull ups at night because she is such a deep sleeper.

  10. i know all other comments are from some years ago but if anyone else is still out, there my so is a 5year a.s.d he wont poo on the toilet only in nappy in sleep he take mass amounts of lactulose and prone juice and still wont go for weeks on end sometimes upto 3 weeks he holds them in with great pain and determination then when he dose finaly go they are so big and hard they have blocked my toilet i haw never seen anything like it my son only echos so he cant explain why he dose this. the dirty pants where poo comes right out then he sucks it back up again are offten a problem as hes in main stream school your not alone guys


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