How preparation and praise supports toilet training in children with autism

Toilet training is an adjustment for most children. When starting, try to keep things clear and consistent so that you set your child up for success. This is especially important for children with autism.

There are four levels of toilet training:

  1. Trip trained (urine): Your child does not have urine accidents when taken to the bathroom on a schedule.
  2. Bowel trained: Your child will have independent bowel movements in the toilet.
  3. Self-initiation: Your child communicates when he or she needs to use the bathroom.
  4. Night trained: Your child can sleep through the night without having accidents.

This article focuses on trip training since it’s required for targeting the other types of toilet training.

General toilet training tips

For your child to learn to use the toilet, he or she needs to be able to:

  • Recognize the sensation of fullness in the bladder.
  • Override muscle reflexes to release urine.
  • Learn appropriate places to go to the bathroom.
  • Fully release urine or fecal matter.
  • Correctly feel and identify when the bladder and rectum are empty.

Luckily, you can teach your child these skills, so don’t worry if he or she doesn’t have all these skills before you begin toilet training.

Before you start:

  • Rule out any biological or medical issues. Check with your primary care provider or gastroenterologist.
  • Clear your schedule. You will need a few days to devote only to toilet training.
  • Prepare your home. Find a space with hard floors where it is OK for your child to have an accident, or put plastic down over the carpets to create a space.

Trip training

You will need three days to devote to trip training. Some families find it helpful to set aside a long weekend (Friday to Monday) that allows complete focus on toilet training.

Use the following steps:

  1. Wear underwear
    • Your child should wear underwear when toilet training starts. Underwear allows your child to feel the sensation of wetness following an accident. This can help speed up the learning process.
  2. Fluid loading
    • Fluid loading increases the likelihood your child will need to urinate. This gives the opportunity to teach your child what happens when he or she goes on the toilet and what happens when he or she has an accident.
    • Allow your child to have juice or other favorite drinks during this time; stay away from liquids that contain caffeine.
    • Remember, fluid loading is only temporary.
  3. Reinforcement
    • Offer a reward every time your child urinates on the toilet.
    • The reward should be something your child really likes and that you can restrict at other times. This helps keep him or her motivated.
  4. Sit schedule
    • Begin by taking your child to the bathroom often. As he or she has success, slowly increase the amount of time off the toilet.
    • Start by taking your child to the bathroom every five minutes for a five-minute sit. Increase the time off the toilet by five minutes every hour.
    • If your child starts to have accidents (typically three in row), go back to the previous sit time.

Good luck, and hang in there. Remember that setbacks are normal, and the important thing is to be consistent and stay positive. Children with autism respond positively to rewards and praise.

Learn more about our toilet training workshop for further tips and treatment options.


We recognize that every child is unique and that the content of this article may not work for everyone. This content is general information and is not specific medical advice. We hope these tips will serve as a jumping-off point for finding the best approach to helping a child with autism. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.