Toileting: A Neuroaffirming Approach to Support your Autistic Child

I worked as an Early Years/Primary teacher in SEND settings for over 20 years, prior to that I worked in child day-care and nurseries. I feel I have spent half my life talking about toileting, changing nappies and supporting children and their families with toileting! This topic continues to come up on a frequent basis in so many workshops I facilitate for families with Autistic children, so I thought I would pull some information together that I hope others will find valuable. I have signposted to a few great neurodiversity-affirming guides to support you and your child further.

Being ready for “toilet training” is often framed as a developmental milestone with the expectation for children to be ‘school ready’. It can feel like an awful lot of pressure for parents/ carers to have their child toilet trained by a certain age and there is often still so much stigma and shame if your child hasn’t met the magical milestone.

Trying to toilet train a child before they’re ready can lead to stress and frustration for everyone. Approaches based on neurotypical developmental timelines often overlook the unique ways Autistic children experience their bodies and the impact of their sensory system. It is more important to follow your child’s cues than trying to follow a rigid toilet training programme.

Autistic children’s ability to understand the body signals that they need to use the toilet is shaped by neurological differences in body awareness, sensory experience, and their ability to communicate their needs. Learning to use the toilet is not just about learning a routine, it’s about understanding how an Autistic person’s body and brain may process signals differently. For some children this may mean it takes them longer than other children to be able to transition out of nappies/ pull-ups as they are developing strengths and interests in other areas. If your child has additional learning disabilities or other medical conditions this may also impact them and need to be considered.

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Why “Toilet Training” Can Be Different for Autistic Children

Autistic children may experience challenges in areas that are often taken for granted in traditional toilet training approaches, such as:

• Interoception – the internal sense that helps us feel things like hunger, thirst, or feeling when they are wet/ soiled, in pain or needing the toilet
• Sensory sensitivities – having a spiky profile and fluctuating responses to sights, sounds, smells, and textures in their own body and the bathroom
• Motor planning and body awareness – difficulty coordinating the steps needed to get to and use the toilet
• Executive functioning – processing and prioritising the order of tasks needed to use the toilet and undress/ redress/wash hands etc
• Communication – difficulties and differences understanding or expressing toileting needs
• Emotional regulation – stress, anxiety, or past negative experiences around toileting and bathroom experiences
• Learning disabilities – additional learning disabilities this may impact people in multiple ways
• Medical needs – if your child has co-occurring medical conditions this may impact them in multiple ways
• Reward charts and sanctions – these are unlikley to help Autistic children in any situation and may cause harm and affect longer term wellbeing

Pressure to start toileting training before a child is ready (not just cognitively but also physically and sensory wise), will only lead to anxiety, shame and could delay things further.

If your child needs to be in nappies or pull ups for longer than some of their friends this is ok. Most people (without any additional learning or medical needs that impact toileting) will want to and be able to use the toilet in their own time.

Understanding these differences can help you reframe toileting challenges as differences, not deficits. There is no ‘right’ time for your child to be able to use the toilet independently. If there is one thing you can’t force or rush, it is toileting!

Rethinking “Readiness”: Every Child Is Different

Lots of checklists often don’t reflect how Autistic children develop and learn. Autistic development is not linear. You may feel like you have cracked the toileting thing one week only to find yourself back to square one the next week. It may all take a longer time. Due to being monotropic, many Autistic children will likely only be able to focus on so many areas of development at anyone time. Autistic children’s development may be more spiky and fluctuating than others.

Readiness for using the toilet might not always look like being dry for hours or asking to use the potty.

If your child is Autistic we need to look for more individual cues like:

• Awareness of being wet or soiled (even after the event)
• Curiosity about toileting routines
• Willingness to sit on the toilet with or without clothes
• Responding to visual or sensory routines

It’s important to honour your child’s developmental timeline, readiness can be sensory, emotional, and bodily, not just behavioural. Children may not always communicate verbally that they are ready, there may be other signals to look out for.

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Practical And Affirming Tips

1. Make the Bathroom A Safe, Predictable, Fun Space

Think about how the toilet/ bathroom sensory environment feels to your child. Loud flushes, echoing tiles, or cold seats can be distressing for some young people (public bathrooms can be even more of a challenge!). This is worth bearing in mind way before toilet training enters the picture so they see the toilet/ bathroom as a safe and even fun place to be when they are babies and toddlers.

Try:

• It may be worth changing their nappy /pull-up / using the potty in the bathroom/ near a toilet so they begin to associate the events
• Turning off fluorescent lights or using natural light if they are sensitive to light can make the room more comfortable for some
• Playing their favourite music or using noise-reducing headphones may help reduce anxiety
• Have a scent they like near by for comfort
• Bringing a comfort or sensory item with them they want to can help reduce anxiety
• Let your child get used to flushing when you go to the toilet so they become familiar with the routine see it as fun and not an unexpected loud noise
• Let them flush later (or not at all) when they are ready to start using the toilet themselves. Flushing can be a whole extra demand in itself, take it one step at a time
• A footstool/ smaller seat can help with comfort and feeling safe

2. Build a Visual and Sensory Routine

Visual supports, sensory cues, or objects of reference can be really helpful to guide your child through each step. Keep routines consistent and use language they understand (verbal, signed, AAC).

Try:

• Start using cues early on in life, show a picture of their changing area/ give them a nappy to hold so they begin to associate and predict what will happen next. This will be a great foundation for when they show more independence and may be able to show or tell you what they need without relying on verbal communication
• Visual cues and picture reminders for what to do
• Use familiar songs/ music as a cue and for predictability to help reduce anxiety
• Read toileting social stories together for fun (neuroaffirming). You could even create your own story together.

Read:

• Little Puddins – Toileting Supports

3. Support Sensory & Interoceptive Differences

Many Autistic children may not feel or recognise the sensation of needing to go to the toilet, they may not feel that their nappy or pull up is wet or soiled, or only notice a long time afterwards. This is not a behaviour issue; it’s likely a sensory interoception difference and could also be impacted by being monotropic, inertia and finding it hard to move on from something they are really engaged with and is of interest to them (see theory of monotropism for more information about this).

Your interoception sense is what helps you understand if you are tired, hungry, thirsty, in pain and also if you need the toilet. Autistic people are more likely to have interoception differences and this can affect eating, drinking and toileting.

Strategies that may help:

• Body check-ins: “What does your tummy feel like?” (rather than directly asking “Do you need the toilet?”
• Follow their natural pattern of when they usually need to go and add in some consistent toilet times such as after each meal so you have a predictable routine
• Games like “guess what your body needs” (tired? hungry? toilet?) may help some children
• Practicing feeling sensations safely and validating what your child is expressing to you
  
  Some children may like the sensory feeling of when they soil their nappy. If your child is sensory seeking or smearing, it is best not to tell them off and instead, help them clean up and offer sensory alternatives for them to explore. Wearing vests with poppers on can help manage this and cause less distress for everyone. Children often explore the contents of their nappy for sensory reasons, offering playdoh or similar textures throughout the day will help give them the sensory feedback that they are seeking. This is often a sensory developmental phase and your child is likely to grow out of doing this when they are ready.
  
  Read:
  Kelly Mahler – Interoception and Toileting

4. Consider Physical and Medical Factors

Some Autistic children may also experience:

• Hypermobility or Ehlers-Danlos Syndrome (making it hard to sit securely/ move or control muscles)
• Chronic constipation or gut differences (may be also due to anxiety or restricted diet / ARFID)
• Bladder issues or pain that goes undetected due to low interoceptive awareness

Read:
Laura Hellfeld – Hypermobility and Toileting

Autistic Girls Network
SEDS Connective

Always speak with a GP or paediatrician if you’re concerned.

5. Celebrate Autonomy

Autonomy, respect, and safety are far more effective than pressure or bribes, stickers and reward charts.

Try to avoid:

• Avoid forcing a child to sit for long periods
• Avoid punishments for accidents
• Avoid using rewards and sanctions

Instead:

• Reframe your use of language and be specific as Laura Hellfeld (ND Nurse) suggests eg.
  Swap “Good job!” for “You noticed your body needed the toilet, well done listening to yourself.” “You remembered to sit down when you felt the urge. That’s great awareness.”
• Ask open-ended questions: “What helped you remember to go just now?”
• Celebrate autonomy and progress in a way that feels good for you and to your child.

Read:
Laura Hellfeld – Rethinking Praise in Toileting

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Toileting Journey

If toileting is causing distress for your child or your family, pause and reassess and revisit another time. Consider:

• Are they showing interest in toileting (regardless of their age)?
• Are they showing an awareness or interest when wet/ soiled (regardless of their age)?
• Are there any physical barriers (e.g. constipation, low tone, joint instability, underlying medical conditions)?
• Could you build more interoceptive or sensory support into the process?

Toileting is not a race, it’s a bodymind journey. For many Autistic children, their journey may look different. For some children, they may take their nappy off one day and never look back and for others it may take more encouragement, support and be a longer journey.

Lowering demands, respecting a child’s pace, sensory needs, ways of communicating and body signals can make all the difference.

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Further Resources and Support

• Kelly Mahler – Interoception and Toileting
• Laura Hellfeld – Neurodivergent Toileting Support
• Little Puddins –Toileting
• ERIC – The Children’s Bowel & Bladder Charity
• NeuroClastic – On Autism, Getting Dressed and Toileting