What’s the best way to approach potty training a neurodivergent child (with developmental delay, learning disabilities or autistic spectrum disorders?) What about children who struggle to communicate or are non-verbal? Should you use a different process or follow mainstream potty training approaches? This blog explores the answers to these important questions.

If you are a parent reading this, chances are you may have already scoured the internet as well as your friends and families opinion on how to approach potty training with your child. To counteract the wealth of conflicting and anecdotal advice, here at Little Bunny Bear, we bring you the research evidence to inform your journey.

What does existing research tell us?

Neurodivergent Children or those with with developmental delays, learning disabilities or autistic spectrum disorders generally take longer to attain toilet training independence and are at a higher risk of developing constipation or soiling (Matson and LoVullo, 2008). As well as later attainment of bladder and bowel control, almost 20% of children with learning disabilities can have continence issues that persist into early adulthood (Von Wendt et al., 1990, Bennings 2004). Expectations for this group of children seem to be lower, perhaps perpetuating a delay in achieving toileting independence.

Despite any physiological and sociological challenges you may be facing, research also shows that  structured learning-based methods including positive reinforcement, behavioural conditioning and prompting can work well for children with developmental delay (Matson and LoVullo, 2008, Cocchiola et al, 2012, Cicero and Pfadt, 2001). My literature review revealed that the vast majority of children can be potty trained eventually and I found no evidence suggesting that the challenges you face cannot be avoided or overcome with the right approach. An important factor to consider is the timing of starting learning. We know that children with learning disabilities can take longer to master skills and that children with autistic spectrum disorders can struggle to adapt to change. We also know that where becoming independent from nappies is concerned,  earlier potty training avoids the risk of developing ongoing wetting and soiling problems (Mottram, 2018).  Based on the available evidence,  it is logical to conclude that starting potty training early is even more important for children who are at higher risk of developing toileting problems.

Child development and potty training

All children must go through the same 3 stages of learning, regardless of age or developmental stage. These stages are:

1.Awareness
2.Responding
3.Independence.

The first stage, Awareness, is all about realising what needs to happen and when it
happens. This is primarily body awareness, meaning that your child needs to learn to understand the signals their body is giving them at the time that they happen. The second stage, what we can call Responding,  involves understanding where the wee and poo needs to go: i.e. using a potty in response to body signals. It’s important to understand that for all children, this part of the learning has to be very practical, in order for them to join up the dots physically. The final stage is Independence and as it suggests, this is about your child learning how to do the first two stages on their own, according to their age, skills and understanding.

Based on this learning sequence, it is possible that a small minority of neurodivergent children will never develop complete independence in that they may always require assistance of some kind. This may include assistance with prompting, communication or physical aspects of toileting. However, this does not mean that your child is destined to always use nappies.

When to start

Research clearly shows that starting this process sooner is important for neurodivergent children with any sort of developmental delay, learning disability or autistic spectrum disorders (see references below). Children with delay or learning disability need to start learning the skills as soon as possible, as it will likely take them longer to learn them. For children with autistic spectrum disorders, especially where change of routine or sensory changes are difficult to process, it’s important to make using a potty part of the usual and normal process, so that your child can better adapt to the transition between using nappies and using the potty or toilet.

There is no lower age limit at which you can help your child start learning potty-related skills. Some parents even start this process at birth, helping their babies use a potty at least some of the time so that their children learn that process to be a normal part of life. The point is, it’s never “too early” to start and your children are always ready to start learning everything, whether it be how feels to wee or poo into a potty instead of a nappy, how it feels to sit (or be gently supported) on a potty, where wee and poo go (does the toilet). All these experiences help children to develop their awareness and understand how to respond to their body’s needs.

Independence develops gradually, in line with your child’s natural development. This is really the key if your child is likely to take longer to acquire skills: the sooner they start practising, the sooner they will gain mastery. Also, research shows that some neurodivergent children with developmental delay, learning difficulties or autistic spectrum disorders will never show the so-called “signs of readiness” therefore it’s not a good idea to wait around for this to show up.

Skill development

Skill acquisition can be tailored to each individual child’s needs. In my baby pottying book and my online potty training course I describe the average learning process for neurotypical children in terms of ages and stages. However, as above, skills are generally learned in the same order (Awareness, Responding, Independence). A child cannot learn how to respond to their body without the necessary body awareness, and they cannot learn how to do things independently if they have not mastered an understanding of where wee and poo needs to go. So regardless of your child’s age and stage, the sequence is the same. That said, there may be some helpful adaptations you can make to helping your child learn if they have a developmental delay, learning disability or autistic spectrum disorder.

Key tips:

1. Your child may take longer to learn each stage, so adjust your expectations and don’t rush the learning. Consider focussing on one still at a time.
2. Don’t wait for the so-called “signs of readiness” or leave it late before you start: research shows the earlier the better.
3. Consider using learning aids such as visual charts, images and adult role-modelling. You can make your own by taking photos of your bathroom, drawing pictures of the steps, or by
   searching on the Internet for visual routines. A standard routine could be: 1.
   Undress, 2. Underwear down, 3. Sit, 4. Do wee/poo, 5. Wipe, 6. Pull up underwear,
   7. Pull up trousers/dress, 8. Flush toilet, 9. Wash hands.
4. Be as consistent as possible. The more consistent you are, the quicker your child will learn the skills.
5. Consider your child’s natural temperament so you can adapt your approach to suit it (find out more in my eLearning).
6. Help your child learn the physical skills needed by breaking them down into smaller steps and allowing your child to do the last step independently. For example, help them push their trousers down most of the way, then have them push the last bit down themselves. Same when pulling them up again.
7. Make sure the space is accessible to your child, e.g. using a step stool, dressing chair or other practical adaptations.
8. Encourage independence as soon as you see it developing, phasing out support once your child shows competence.
9. Use stories, props and games to teach your child what to do and how to do it.
10. Offer your child plenty of positive encouragement and verbal praise when they make efforts in the right direction.

What skills are required for independence from nappies?

When it comes to the skills required to stop using nappies completely and do at least some of the process independently, most children are capable of success if they can:

• Understand basic commands such as ‘give this’, ‘take this’, ‘go there’, ‘come here’
  etc.
• Communicate verbally or nonverbally their needs to you, e.g. “I’m thirsty”, “I’m
  hungry”, “I want to cuddle” etc.
• They can remember at least some parts of the nursery rhyme or a tune that they’re familiar with
• They can sit up, stand up, and move about with or without your help.

As you can see, this list is not age-dependent and there is no lower age limit to begin learning the skills. Many cultures around the world start learning the process from birth and some children may be able to do all these things by the time they’re one year old. Also, there is no requirement for your child to have to verbalise their needs in order to start learning. You probably already know when your child is telling you something, even if they are doing it non-verbally. if your child is non-verbal, you may want to help them learn some basic sign language around potty needs, so they can communicate this to others as well.

Additional support

If you need one-to-one support with potty learning, you can book a private consultation with me, Rebecca Mottram.

References

https://www.eric.org.uk/guide-for-children-with-additional-needs

Foxx & Azrin (1973). Dry Pants: A Rapid Method of Toilet Training Children. Behav. Res. Therapy (11 435-442.

Mottram, R. (2018). The Dangers of Early Potty Training: Do they really exist? www.littlebunnybear.com

O. Burns, C. and Matson, J. (2017) Normal Developmental Milestones of Toileting in Clinical Guide to Toilet Training Children. Matson (Ed.) 2017. Springer.

Toilet training and the autism spectrum, Eve Fleming and Lorraine MacAlister, 2015