Increasing Independence
With Toileting

In the end, the goal is that your child independently recognize the need to eliminate, to go to the bathroom by himself and complete the toileting routine without your assistance, including reminders. So where do you start? When your child has mastered bowel and bladder control (he has no accidents and eliminates or tries to eliminate immediately upon sitting on the toilet), he is ready to be more independent with toileting.

Start by assessing where your child is with respect to the various parts of the toileting routine. For example, if your child can remove his own clothing or wash and dry his hands, pull back your assistance, including verbal reminders, and let him do it himself. If he needs a reminder, quietly point to the picture for that activity on his schedule.

Initially the adult is part of the toilet training process to support the child’s performance of new learning tasks. However, some children have difficulty learning to toilet alone because an adult is always present. As the child masters the steps in the toileting routine, you will want to support more independence so the child can complete the routine on his own without your assistance and reminders.

Here are some ways to help your child become more independent with toileting:

• From the very beginning teach your child to respond to environmental cues and visual supports. Gradually fade your verbal cues and point to the picture of the next step in the process or to the time to be used in the next step (e.g., pointing to the towel after he has washed his hands). Other environmental cues might include having your child hold a toy that is only used when sitting on the toilet or colored tape on the faucet to assist with regulating the water temperature.
• Decide when you can leave your child on his own in the bathroom – either at the end of the routine or at the beginning. For example, if he can wash and dry his hands independently, leave the bathroom then. Gradually leave sooner so he can be independent with more of the routine (e.g., leave him to flush and then wash and dry his hands). You may find the use of rewards helpful to promote increased independence.

Some individuals may always require some level of assistance and/or supervision while completing the toileting routine. For some children, some of the parts of the toileting routine may be physically and/or cognitively too difficult. The child may be able to master some aspects of the toileting routine but continue to require some physical assistance or at least verbal reminders as well as supervision for safety reasons. To whatever extent a child can do something himself, he should. The adults continue to provide whatever support is needed while allowing the young person do what he can by himself.

There are some common behavioral issues or problems that might interfere with total independence, including:

• Refusing to enter the bathroom
• Refusing to sit on the toilet
• Fear of flushing the toilet
• Excessive toilet flushing
• Refusal to wash and/or dry hands
• Playing in the water in the toilet and/or the sink
• Anxiety about eliminating in the toilet
• Resistance to using toilet paper