Potty-training a Child with Autism (token systems and visual schedules)
Daniel at 4
Example of a Visual Schedule
Example of a Token System
When my son, Daniel, was four and a half, we were desperate. His twin sister had already been potty trained for two years. Daniel has autism, and while he was verbal and considered high-functioning, he really had no concept or desire to take this next step. After a good brainstorming session, we came up with this plan that worked for toilet-training Daniel.
1) The week before our official effort began, we would point out when anyone went to the restroom. Then everyone would cheer for the person after they went on the potty.
2) For Potty Week, we decorated the bathrooms with his favorite things, streamers, balloons, etc. Since he was fascinated by rainbows, we put rainbow posters in the bathroom. The point was to make it a place that he would prefer to be in.
3) In the bathroom, we had a visual schedule for using the bathroom consisting of the simple, picture instructions that could guide him. This is a website with information about visual schedules.
4) During the day, he had a daily visual schedule and a picture of a potty was in between each task. Before each activity transition we would look at the schedule so he knew when it was potty time. The first day, the transition times were only about 5-10 minutes and we increased the time in between attempts each day.
5) We had a token system (info about token systems or token economies). Basically, we had a sheet with three squares and we had three pictures of rainbows (since that was his favorite thing). We used velcro to attach the rainbow pictures to the sheet. After each successful "peepee", he would get a rainbow for his chart. This alone was a good reinforcer. If he liked Dora, Elmo, or Thomas, we could have used these images instead. After the three boxes contained pictures, he earned a reward. We used treats and hugs as his reward. In Applied Behavioral Analysis (ABA), they call these rewards, reinforcers. We gradually increased the number of boxes needed to earn the treat.
6) The silliest of all steps was the poopie party. We had a big clear bin on our kitchen counter with party hats, confetti, balloons, tiny muffins (with icing to look like cakes), and a birthday candle. Daniel saw me blowing up the balloons and making the muffins. Every time he'd pass the kitchen and saw the bin, he would want those things. We would tell him that he had to go poopie first to have a party. I also drew a picture of a potty with a poop in it and stuck it on the bin. We found that visuals work so well for Daniel especially before his speech was really developed. When he finally did have a BM on the toilet. We had the party which included singing "Happy poopie to you!" He got to blow out the candle and have his little mini muffin. We gathered everyone in the house, wore the hats, and threw the confetti and balloons. He loved that. (We didn't use party horns since we was sensitive to loud noises.) We continued to do this every time he pooped on the potty for the next two weeks. It took us a while to figure out how to "fade" this reinforcer. Basically after a few days, we stopped the confetti. The next day we stopped the balloons, then the song, etc. Fading was always a hard thing for us to do since Dan really likes routine.
7) If he had an accident, the key thing was to not give him attention. We didn't ignore him, but just said, "Oh no, we need to go on the potty." We made sure he stopped what he was doing, sat on the potty, and then changed his pants or pull-up. In the unsuccessful past attempts, I would get upset and make a big deal about his accidents. The key to success was to have bigger reinforcers for using the potty than not. We found that my big reaction had been a huge reinforcer. Dan loved the predictibility of my reaction and he didn't care if I was angry or not. Often he did not want to stop what he was doing to pee or poop - it's a transition and he tried to avoid transitions at all cost. So it was important that he was required to still have that transition even if he just had an accident. If he went on the potty, he had to make that transition but he got lots of positives too like the party, toys, candy or whatever. With poop accidents, we made sure to go to the potty and put the poop from the pullup or pants in the potty. He needed to still sit on the potty too.
8) We put his underpants under his pull-up. We stocked up on cheap underpants from garage sales and hand-me-downs, which made it much easier. The key was to avoid the mess for us, but to make sure my son could feel the sensation. I would just pitch the poopy underpants along with the diaper during this period. A 10 pack of underpants was $7 at Walmart and not having to spend time and energy washing them out was well worth the money.
9) We read a potty training book, potty training video or social story every day, starting the week before potty week. Homemade social stories helped Daniel with many things like vacations, wearing a seat belt, stopping hitting, and eating more foods. Here is a link to some social stories.
10) We did not plan any trips, outings, or anything during potty week, and we made sure to keep him busy with activities on his schedule in between potty times. Most importantly we were extremely consistent! This was the key. We asked for help from neighbors, therapists, teachers, siblings, and relatives so we could devote our undivided attention to potty training for the first week.
This is what we did, and it worked for my son. However, all children are different. And especially, all children with autism are extremely different. My hope is that some of the items I've mentioned may help you. Definitely, there are no guarantees, but I wish you the best of luck on your efforts.
A special thanks to Dr. Amanda and Miss Ari who helped tremendously.
Great Potty Training Helpers
More by this Author
When a child starts school for the first time, it can be scary for not only the child, but mom and dad too. Having good communication with the child's teacher is crucial. It not only helps ease everyone's anxiety, but...
For a 37 year old, I guess you could say, I've been around. I grew up in a primarily blue-collar steel town just East of St. Louis in Illinois, went to college in northern Indiana at Notre Dame with a great assortment...