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Toilet training and developmental disability

There are a lot of different skills involved in managing our elimination of waste.  This is so even for many animals.  I and my children were amazed when watching our cat toilet train her kittens.  She was very systematic and constantly intervening until they always used the kitty litter box without help.

When we think of all the skills needed it seems amazing that we all learn what to do so easily.  Most children with developmental disabilitiesalsolearn these skills in just the same way as typically developing children.  Those who have trouble do so because their disabilities interfere with their ability to learn all or some of these particular skills.

“Children with developmental disabilities are not all the same and neither are their toileting difficulties.  Toileting problems can have a number of different causes and as a result require a range of approaches to manage and resolve issues.  Children with developmental disabilities can sometimes find learning to use the toilet more difficult than typically developing children as the result of physical, behavioural or sensory differences, as well as the learning difficulties which are part of their developmental disability.  It is important to note that the majority of individuals with intellectual difficulties will (nevertheless) become self-toileting by adulthood” (Cerebra briefing, 4, 2012).

The way to compensate for a learning problem is to make the learning task easier.  We can do this by breaking the total business of managing and controlling the elimination of waste into its component parts and teaching each part separately.

Children who have difficulty with sequencing tasks will benefit from learning the last task first, then the last and the second last together, then the same combination of tasks with the third last task added, and so on.  This is called ‘backward chaining’, a standard teaching technique to assist in the learning of motor skills.  Managing one’s own toileting is, after all, a sequence of motor skills; that is, controlling and directing muscle movements.  In the case of self -toileting, though, the muscles to be managed include some which are inside the body.

Frequent practice helps cement the new skills.  Frequent drinks increase the number of times in a day that the bladder needs emptying.  This ensures frequent practice and thus helps children with learning difficulties to learn and remember the new skills.

Sometimes children with developmental disabilities do not notice bladder sensations. A pants alarm which sounds when the first two or three drops of urine escape brings the sensation of a full bladder into the child’s awareness so that the new skills can be attached to a full bladder.  This is when children need to go to the toilet.

You will find more pointers to help your child with toileting in the recently published book, “Toilet Training for Children with Autism or Intellectual Disabilities”, available on the web site,  The web site also contains other useful information about toilet training and a range of developmental disabilities and there are some free downloads.