Adventures in Toilet Training an Autistic Child: Part II

Image credit: Photo by studio_juan on Flickr Licensed under Creative Commons

When Austen was about four and a half, he had finally overcome his fear of the toilet and could intermittently use it to pee. Now I needed to figure out how to get us from "intermittent" to um, mittent? Hm. That is, to a point where he could use the toilet for all his waste release needs.

I started by whisking him into the bathroom first thing every morning, when I knew he was likely to have to go. I'd sit him down on the toilet and stay with him for a few moments until he'd emptied that nice full morning bladder. Now, you'll note, I said "sit down." Yes, he's a boy, but I'm both personally in possession of girl parts and am the one who cleans the bathroom. So, while there are other innovative ways to handle the problem of little boy pee, I did what worked for me.

Now we had to expand upon our one successful toilet use of each day and demonstrate that using the toilet was something not just reserved for the first pee of the day. So I did that thing you're supposed to do when toilet training kids: I put him in some exciting big boy Thomas the Tank Engine underwear! That motivates kids, right? Their favorite licensed characters tucked snuggly in their pants? No. My son was horrified. It was as if I'd asked him to defecate on a statue of the Virgin Mary. Put the sacred image of Thomas the Tank Engine on what was (as far as he was concerned) a diaper? It was an outrage. He'd have none of it. So we moved to dull briefs, which he treated as a new form of diaper, bothered not at all by the supposed discomfort neurotypical children were said to encounter on being wet and dirty.

This was not good. Underwear was harder to clean than diapers and provided no incentive to use the toilet, swiftly defeating the entire purpose of toilet training. So, I ditched the underwear, went to a strict policy of total nudity and stuck to only non-carpeted areas of the house. The floor was much easier to clean up.

Now all we needed to do was create a link between the need to empty bladder or bowels and our new friend the toilet. I'd explained this all, of course, very logically, using that old standby: a sticker chart. "When you need to pee or poop, go in the toilet. Then Mama will give you a sticker and when you get five stickers you get a prize." Austen would nod dutifully, sit on the toilet, get up and go pee in a corner fifteen seconds later.

But I was so not giving up. Not! Do you hear me? I reasoned that if he spent more time on the toilet than off (or close to it), he would have to pee there eventually, if only by accident or boredom. Then we could get a sticker and have a parade and reinforce what an absolutely fantastic and wonderful thing the toilet was. So, I got out the timer and started having him sit on the toilet for at least two minutes every ten minutes. And he still peed on the floor. So we tried every five minutes. And he still peed on the floor. But, I repeat, I was not giving up. So we tried every minute. And he got mercifully tired of being interrupted every minute for an hour to be reminded to pee and eventually... He peed in the toilet! He really did.

So our days went by. During toilet training time (which was limited to a few hours a day for all our sakes) he was naked and had to sit on the toilet every few minutes. (During the rest of the day and night, he was still in a diaper.) As he proved to me that he had things figured out, I gradually lengthened the times: using the toilet every five minutes, every ten minutes, every thirty minutes. And, as promised, every five (or eventually ten) times he peed, he'd get a prize. We also added underwear in, boxers this time, as the snug feel of briefs seemed to remind him of diapers, which led to accidents, while the loose feel of boxers seemed to give him that necessary non-diaper sensory feedback.

While we were making progress with the bladder, we were stalled at the bowels. I could tell when he needed to poop (almost all kids have a tell), but afraid that he'd "fall in" while pushing, he'd hold onto those bowel movements for dear life until the second he was back in a diaper. Still, desperate times call for desperate throwing of money at problems. So, I promised him that if he would poop in the toilet, even a little bit, I would put him right in the car, drive him to the toy store and buy him a brand-spanking new $20 (why are those things so freaking expensive?) Thomas train.

Each time I saw that he needed to go, I'd scoop him onto the toilet, and say, "Come on, baby! Thomas train! Right now! Let's go!" I held onto him and promised he wouldn't fall in. I gave his feet a little stool to rest on. And somehow, after days of trying, in spite of the weird feeling of using the toilet for a bowel movement, he went a little bit. True to my word, I loaded us up into the car and made a grand production of driving to the toy store and buying a train. And I did it every time he had a bowel movement until he was so hooked on the toilet and disgusted with diapers that he gained his own internal motivation and (thankfully) stopped needing to be bribed with trains. Yep, I accrued a lot of trains (and debt) but Austen was out of diapers before he was five.

Now if I could just get him to wipe...