Toilet Training Tips for your
Child with Special Needs
Lori Warner, PhD, BCBA
Director, HOPE Center
Jamie McGillivary MS, LLP, BCBA
Clinical Manager, HOPE Center
Veronica J. McAtee, MS, LLP, BCBA
Limited License Psychologist
Board Certified Behavior Analyst
Center for Human Development
Beaumont Children’s Hospital
When do I start training?
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Average age = 18-24 months
Key signals:
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The child is aware that his/her diaper is soiled and may
request to be changed
The child shows an interest in using the toilet
The child’s bladder muscles are developed enough to
hold urine (remain dry for at least 1 ½ to 2 hours)
The child can communicate his/her needs (verbally or
nonverbally)
The child can follow simple instructions and assist in
dressing
The parent/caregiver has time to devote to training
Preparation
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Use the bathroom for all toileting activities
Watch videos and read books about toilet training
Allow the child to watch parents/siblings using the
toilet
Use a doll to model the toileting process
Use words that the child understands
Practice sitting on the toilet; provide praise
Beginning Training
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This is a learning experience that requires
practice and may take time
Consistency is important!
Dress the child in loose clothes; have the child
pull up/down pants
Goodbye diapers!
Select rewards for the child (may need to be
more than praise)
Materials Needed for Training
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Potty seat that fits over toilet
Foot stool
Timer
Data on urination (taken week before)
Multiple pairs of underwear
Favorite drinks and snacks
Rewards, Rewards, Rewards!
Rewards – why do we use them?
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Increase the likelihood that the behavior will occur
again
Rewards are fun!
Child should be rewarded for all appropriate toileting
behavior
 Pulling up/down pants
 Walking to toilet independently
 Recognizing the need to use the toilet
 Remaining dry in between sittings
How to select rewards
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Observe your child during free time
Limit access to preferred foods/toys to increase
motivation
Start with powerful rewards – not just stickers!
What is motivating one minute, may not be the
next
When starting training rewards will be delivered
frequently
Rewards are faded as the child is successful
Intensive Toilet Training
Toilet Learning Center (TLC)
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Increase fluids
Scheduled sits:
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Example: child sits on the toilet for 10 minutes
then given a 5 minute break for the first hour (or
until urination)
Child is prompted to do all steps; increase
independence
When the child urinates in the toilet s/he is
rewarded with access to toys and highly
preferred food items; takes a break from sitting
Intensive Toilet Training
Toilet Learning Clinic (TLC)
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Time spent on the toilet is decreased until the
child urinates quickly after sitting
Break time is increased
Child wears pants alarm, goes off as soon as
child urinates in pants
Consistent Procedure for accidents
Accidents – Uh Oh!
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Remain calm & neutral! Do not punish the child!
Try to get the child to the toilet to finish
Tell the child “Uh-oh! Wet pants. You go on the
potty.” (Use words he/she understands)
Practice going to the toilet, pulling down pants, and
sitting (“This is where you go potty”)
Include child in clean up and have him/her change
into clean pants
Have a schedule (after meals, before school) so that
the child learns to use the toilet frequently, may also
consider using pants alarm
How do I train my child to use the
toilet? (Less intensive approach)
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Take data to ensure that your child is ready to
begin training
Put your child on the toilet at times when he/she
typically urinates
Have the child do the steps on his/her own
In the beginning stages, the child may need to sit
for up to 5 minutes; provide praise for sitting on
the toilet, use timer if necessary
Sittings should take place every 30 minutes to
increase success
How do I train my child to use the
toilet? (Less intensive training)
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As training progresses, sittings should be
spaced further apart
Take data on each sitting so you know when
the next one takes place (increase amount of
time if child urinates in toilet)
Reward the child when he/she urinates in
toilet!!
Bowel Movements
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Determine times when the child is most likely to have
a bowel movement (look at data)
Watch for signals
Put the child on the toilet as soon as you detect these
signals
Provide a reward for eliminating on the toilet
Scheduled sits for a longer amount of time
Larger rewards
Positive practice for accidents
Social stories/de-sensitization
Initiation Training
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An important part of toilet training at all times
Child should be prompted to request to use the toilet
before being taken to the toilet
 ASL, PECS, vocal, typing
Requesting to use the toilet is often not motivating for
children; may need additional rewards
Some children continue to require prompts to request
and it may take awhile for the child to initiate
Some children may be trained on a schedule
Rewarding Dry Pants
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Once the child has learned to urinate in the toilet and
is doing so on a fairly regular basis, the training is not
over!
Check for dry pants in between toileting times (about
6-7 per day)
Reward the child for remaining dry – let the child
know why it’s important to stay dry
Rewards
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In the beginning of training, rewards should be
frequent and strong enough to maintain the behavior –
this will speed up the training
As the child is using the toilet regularly, rewards for
going on the potty should be faded and the child
should be rewarded for remaining dry
A daily chart may be used to track progress; child can
work towards bigger reward
Nighttime Training
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This may happen at the same time if the child is
already remaining dry at night
Cut liquids by 6:00 pm (or 2 hours before bed)
Have a bed time routine that includes going potty
As soon as the child wakes up, have him/her use the
toilet
Reward dry nights
This isn’t working!
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My child does not want to use the potty
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Is she/he ready?
Are you ready to work on training? Can you be
consistent?
First step is to practice sitting on the potty (don’t
require urination); reward all potty related
activities
Gradually work up to training
Are rewards strong enough? Are you delivering
them frequently?
This isn’t working!
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My child has too many accidents
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Are you putting him/her on the potty at the right
times?
Take data on sittings and if he/she urinated;
helps you start the sitting at the correct time
Put the child on the potty frequently (every 15
minutes) until he/she urinates
Is your child in diapers?
Are you checking for dry pants and rewarding?
Are rewards strong enough?
Bed-wetting
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Common during training time
Some causes
 The bladder is not developed enough to hold urine
 The child is not able to awake in response to a full
bladder
Could be due to stress or changes in life (especially if
the child used to remain dry)
Could be due to a medical problem or side effect of
medications
Bed-wetting
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Cut fluids at night
Have the child use the toilet before bed
Consider waking the child to have him/her use the
toilet (1 - 2 hours after going to sleep)
Use an alarm to condition the response of awakening
to a full bladder
 Alarm senses wetness and goes off to alert the child
to awake and use the bathroom
Overcorrection procedure
Rewards when the child wakes up dry
Summary
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Toilet training is not easy
It takes time, effort, consistency, and most of
all…patience!
Do not be afraid to get help
Remember that it is a learning process; it doesn’t just
happen
Parents need to make sure that they are prepared to
begin training
Resources
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Toilet Training in Less Than a Day by Nathan H.
Azrin, Ph.D. and Richard M. Foxx, Ph.D.
Self Help Skills for People with Autism: A Systematic
Teaching Approach by Stephen R. Anderson
Steps to Independence by Bruce Baker & Alan
Brightman
Materials:
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www.bedwetting.com
www.pottytrainingsolutions.com
Contact information
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HOPE Center
1695 W. 12 Mile Road Suite 110
Berkley, MI 48072
(248) 691-4772
https://www.beaumonthospitals.com/hope
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Dr. Lori Warner, Director HOPE Center
(248) 691-4774