Toilet Training Children with Autism

Johnny’s Journey to Happy Toilet Training

Anyone working with children who have special educational needs knows—or should know—that the use of punishment and rewards in behaviour modification need to be used properly and carefully.

In my very early years as an instructor therapist, a family called me in distress looking for a therapist to work with their son. Let’s call him Johnny. He was 3 years old and was engaging in severe self-injurious behaviours. For example, he would punch or bang his head on the walls hard enough to make holes in the drywall.

His mom reported that he had major bowel issues and would not go near a washroom. He engaged in the self-injurious behaviours most often when he was near a washroom. As I dug deeper to try and understand his behaviour, I learned that Johnny would frequently have bowel movements in his underwear. 

His previous behaviour consultant was a school teacher who had very little behaviour analytic training. She made him wash his soiled underwear, and anything else that was ruined by the bowel movement, in cold water. I was surprised that someone would use this sort of punishment procedure on such a little guy. The effect of the punishment procedure was that his toileting issues were getting even worse: not only was he having bowel movements in his underwear but now he wouldn’t go near a washroom.

I knew I had a big problem on my hands. I needed to figure out the best approach to get Johnny back to the washroom and tolerate just the sight of it without engaging in self- injurious behaviours or aggression. 

So I started off slowly. We would stand several feet away from the washroom and he received a few ketchup chips for not engaging in any problem behaviours. Over time, we got closer to the washroom. It took a few weeks to get him into a washroom but that was a happy day indeed! 

Then came the day when he walked into the washroom successfully! Our next step was to get him to sit on the toilet. It was a big moment that didn’t go quite as planned: he headbutted me so hard that he knocked me to the ground.  

It was a setback, but slowly and gradually, with lots of reinforcers, we worked past that hump and he was sitting on the toilet, having bowel movements on the toilet and his mother was beyond happy at his success. 

The moral of the story? When therapists consider the use of punishment, we need to factor in many things before we jump right in. We need to consider the possible side effects of punishment and ensure that we are always being ethical in our practices.

I remember asking his mom why she ran the procedure when she felt deep down inside that it wasn’t right for her and her son. She said “well, the professional told me to and I thought she knew best”. It’s so important for parents to remember that when you are selecting a professional to work with your child, be sure of their credentials and training. A skilled professional can help your child overcome many obstacles, but one with limited training and understanding of behaviour analysis can do the opposite.

As a professional, it’s important to know your limits and work within your competency.  Seek help or get the training you need to support your work. After all, it’s all about the children and how we can best help them.